BMJ Open Quality最新文献

Introduction: Onboarding inefficiencies in student-run healthcare organisations can lead to unclear role expectations, inconsistent knowledge transfer and disruptions in leadership transitions. This quality improvement (QI) initiative evaluates the implementation of a standardised operating procedure (SOP) within Street Medicine Detroit (SMD), a medical student-run clinic, to improve onboarding and leadership continuity.

Methods: A QI initiative was developed to create an SOP based on retrospective surveys from past leaders, identifying key organisational challenges. Post implementation surveys assessed the SOP's impact on onboarding effectiveness, role clarity and preparedness. The project followed a Plan-Do-Study-Act cycle to guide the intervention and evaluate outcomes.

Results: The SOP improved new leader onboarding by reducing reliance on board members, increasing clarity of training materials and enhancing preparedness to lead from day 1. Leaders trained with the SOP reported fewer unanswered questions and greater self-reliance. Survey results indicated significant improvements in clarity and role understanding, with new leaders preferring to reference the SOP over informal knowledge transfer.

Discussion: The findings suggest that SOPs are an effective tool for improving operational efficiency and leadership transitions in student-led healthcare organisations. This intervention also integrated QI education, fostering leadership skills and systems-based thinking. The study highlights the applicability of this model to other healthcare settings. The implementation of an SOP at SMD successfully addressed long-standing onboarding inefficiencies, providing a scalable solution to improve leadership transitions. This model can be applied to other student-run clinics and healthcare organisations, enhancing both organisational efficiency and medical education.

Introduction: Pending test results not communicated during the post-acute care transition may pose harm and lead to diagnostic errors in patients. This quality improvement initiative aimed to assess the effectiveness of pending labs communication by automating a list of pending labs into discharge summaries.

Methods: A SmartLink was developed in the EpicCare electronic health record that populates a list of pending labs and pathology studies and was added to the standard discharge summary template for hospitalists and resident physicians. A 2-month pre-post review of randomly selected discharge encounters was conducted to assess the frequencies of discharge summaries reporting pending labs, discharges with pending labs, discharges with eventually abnormal pending labs and discharges with results reported in follow-up notes.

Results: Of the 291 pre-intervention encounters reviewed, 130 (44.7%) had one or more labs pending, compared with 115 (40.6%) of 283 post-intervention encounters. 35 (26.9%) of the pre-intervention discharge summaries mentioned all pending labs, compared with 104 (90.4%) post-intervention, p value <0.01. There was no difference in the frequency of discharge encounters with results reported in follow-up notes; however, a trend towards significance was observed for those with abnormal results.

Discussion: Implementing an automated link that pulls pending studies into discharge summary templates drastically improved documentation of pending labs. However, given the complexity of post-acute care transitions, more work is needed to ensure receipt and follow-up of this crucial communication.

Objectives: This research aimed to identify and co-design recommendations to optimise adolescent and young adult (AYA) healthcare through the development of a statewide strategy.

Methods: An exploratory mixed methods co-design constructionist epistemological framework was used to identify recommendations. Participants comprised young people (15-25 years of age) with experience accessing healthcare for acute or chronic concerns, carers and professionals. Focus groups and a statewide survey were conducted concurrently.

Results: Eighty-one individuals varying in location and fields across Queensland participated in nine focus groups. Themes and subthemes were successfully identified through the thematic analysis of the focus groups. Within the context of barriers and enablers, participants identified gaps and proposed recommendations to optimise care. Across the nine focus groups, consistent themes emerged, demonstrating sufficient data collection and saturation of responses. Additionally, 107 responses were collected, scored and ranked through the statewide survey prioritising predetermined recommendations to optimise AYA care, based on scoping work completed in 2020. Of the 57 recommendations presented to survey participants, 41 (71.9%) of these were classified as 'needed' and 'very important' to optimise AYA healthcare. Collective thematic analysis resulted in a list of prioritised recommendations to improve healthcare services for AYAs.

Conclusion: The research highlighted two central priorities: overcoming systemic challenges within AYA healthcare and establishing a clear, consistent definition and model of quality care in Queensland. The combined findings strongly support the urgent need to embed standardised principles, approaches and practices across the health system to ensure equitable and effective care for all young people.

Background: The overall rates of colorectal cancer (CRC) in the US population have been declining steadily over the past 30 years, in large part due to timely cancer screenings. Despite the emergence of new screening modalities, a large portion of the population has not completed CRC screening in accordance with guidelines. Adequate and timely screening can prevent or detect CRC in earlier stages. Various factors have been identified that influence screening completion. Lower screening rates have been associated with the underserved population, especially in the immigrant community and patients with inadequate access to healthcare. In the USA, primary care clinics associated with internal and family medicine residency programmes often serve as catch-net clinics for the community, serving to provide care to those with a higher burden of social determinants of health.

Objective: We aimed to increase the rates of CRC screening in a primary care clinic associated with the internal medicine residency programme of a large healthcare system. In October 2021, the clinic had a CRC screening rate of 55.40%.

Methods: This prospective quality improvement study was implemented from July 2022 to January 2025 at the resident-run clinic. Data on CRC screening completion were analysed monthly.

Interventions: Six Plan-Do-Study-Act cycles were implemented over the course of the project. These interventions were developed from results of root-cause analyses as well as feedback from patients and providers.

Results: CRC screening rates rose from 55.40% to 65.79% over the period of interest with the implementation of sequential targeted interventions.

Conclusions: Underserved patients are at higher risk of CRC screening incompletion. Multifaceted interventions and multidisciplinary collaboration are essential for increasing CRC screening in this vulnerable population.

Background: Sodium-Glucose Transporter-2 (SGLT2) inhibitors provide both cardiorenal and metabolic benefits but have several adverse side effects. Effective patient education is critical to ensure safe use and patient compliance. This project aimed to assess and address gaps in patient knowledge about SGLT2-inhibitors.

Methods and results: This quality improvement project was conducted in two tertiary and one district general hospitals in the UK in patients who had been prescribed SGLT2-inhibitors for either diabetes or heart failure. Initially, 100 patients were surveyed on their understanding of SGLT2-inhibitor use, including awareness of indications and side-effects. A patient information leaflet was developed in collaboration with the community pharmacy team and distributed to patients. Six months later, a follow-up survey of 54 patients evaluated their confidence in medication use and knowledge of adverse effects.The initial survey revealed: 70% were unaware of their medication, 12% had read the manufacturer's information, 5% were aware of sick-day rules and 12% recognised the risk of UTIs. Diabetic patients demonstrated low awareness of the risk of euglycaemic ketoacidosis (11%) and foot complications (5.6%). Diabetic patients also had higher hospitalisation rates due to drug-related adverse effects. 98% of patients agreed that receiving information about side effects was important. Postintervention, 100% of surveyed patients reported confidence in using SGLT2-inhibitors and knowing when to seek medical advice.

Conclusion: This initiative demonstrates that patients generally lack knowledge regarding the use of SGLT2-inhibitors. Patient education is crucial in improving understanding and medication compliance. Implementing accessible supplemental resources can enhance continued compliance and safety.

Introduction: Eliminating vertical HIV transmission requires high-quality Option B+ services, which provide lifelong antiretroviral therapy to pregnant and breastfeeding women living with HIV. In Malawi, coverage has expanded, but quality remains suboptimal, contributing to challenges in sustaining engagement in care. Quality improvement (QI) approaches can strengthen service delivery and evidence-based practices, with healthcare workers (HCWs) central to implementation. This study explores barriers and opportunities HCWs face in implementing QI in Option B+ within high-volume urban facilities in Lilongwe, Malawi.

Methods: A descriptive phenomenological qualitative study was conducted between March and June 2021 in five health facilities in Lilongwe, Malawi. Semistructured in-depth interviews were conducted with 30 purposively selected HCWs (4-8 per facility) involved in delivering Option B+ services. Thematic analysis was used, with data coded deductively and inductively. The Consolidated Framework for Implementation Research was applied to map the identified themes into relevant domains and constructs.

Results: QI practices among HCWs were hindered by resource constraints, lack of incentives/reimbursement for QI activities conducted beyond working hours, poor communication between QI teams and implementers and resistance or negative attitudes towards QI. Opportunities to enhance QI included increasing meeting frequency, providing mentorship, peer-to-peer learning through exchange visits and securing funding from development partners.

Conclusion: Improving QI utilisation in Option B+ requires mobilising resources and having a structured feedback and mentorship mechanisms. Targeted incentives/reimbursements for HCWs and peer-to-peer learning through exchange visits between facilities can further enhance QI. Therefore, a blended QI approach incorporating these recommendations is needed to better support HCWs in delivering evidence-based interventions, strengthen the health system and may improve engagement outcomes.

Objective: This rapid review aims to understand whether a standardised approach to developing quality standards and indicators for mental health has been used across the WHO European Region and beyond to inform methods to develop quality standards for child and adolescent mental health services.

Introduction: Improving the quality of child and adolescent mental healthcare across the WHO European Region is a priority. Despite advances in quality of care for mental health, many challenges remain, including the lack of a standardised approach to quality improvement.

Inclusion criteria: Papers that outline methods used to develop quality standards or indicators for mental healthcare, published since the year 2000 in English and for use in the WHO European Region, Australia, Canada or the USA, were included.

Methods: Methods were based on guidance from the Joanna Briggs Institute and WHO. Searches were conducted across PubMed, Scopus, PsycInfo and Google Scholar from 16 January to 30 January 2024. The titles/abstracts and full-text articles were screened by two reviewers independently, and the inclusion/exclusion criteria were applied. A template based on five steps proposed to develop health indicators was used to extract relevant data by one reviewer and verified by another.

Results: 21 studies were included in the review. All papers originated from high-income countries, with dominance from the USA, Canada and the UK. Most papers described four or five of the five proposed steps; however, there was variation in the extent to which these steps were described and how they were implemented.

Discussion: The results suggest that no consistent approach has been used to develop quality standards/indicators for mental healthcare. There is a need for more participation from people with lived experience and for more research across a wider geographic area.

Prsopero registration number: CRD42024496509.

Background: Foreign body ingestion is a common reason for paediatric emergency department (ED) attendance. At baseline in our institution, only 55% of children were managed in accordance with international best practice. No local guideline was in place.

Aim: To implement a locally developed guideline and educational intervention to improve adherence to best practice in the management of paediatric foreign body ingestion.

Methods: We conducted a quality improvement project in a single tertiary ED over 5 months, using three plan-do-study-act (PDSA) cycles. Interventions included guideline development, dissemination at NCHD induction and departmental teaching and case-based discussions. The SMART aim was to improve correct management from 55% to >80% within 5 months. The primary outcome measure was the proportion of cases managed correctly according to the guideline. Process measures were unnecessary imaging and inappropriate specialist referrals; return visits were tracked as a balancing measure. Data were analysed descriptively and displayed using a p-chart. Educational impact was explored with case vignettes.

Results: 27 consecutive patients were included in the intervention period. Correct management increased from 55% at baseline to 87%-100% across PDSA cycles, exceeding the SMART aim. Process measures improved: unnecessary imaging decreased from 16% to 12% and inappropriate referrals from 3% to 0%. Avoidable return visits fell from 4% to 0%, without evidence of harm. Case vignette scores improved modestly (54%-63%), with variation across individual cases.

Conclusion: Introduction of a locally developed guideline significantly improved adherence to best practice in paediatric foreign body ingestion. Improvements extended to process and balancing measures, demonstrating a true test of change. Embedding the guideline in induction, teaching and the hospital intranet is expected to support sustainability.