BMJ Open Quality最新文献

Problem: Hospital readmissions following elective colorectal resections remain a persistent challenge, affecting recovery, hospital efficiency and overall quality of surgical care. Readmissions increase morbidity, healthcare costs and may delay ongoing cancer treatment. Within our institution, the colorectal surgical team noted a rise in unplanned readmissions after discharge, prompting structured evaluation.

Background: Colorectal resections form a major component of elective surgical activity at our centre. During early 2024, local Model Health System dashboards showed readmission rates above regional medians for both colonic and rectal resections. These findings, together with governance discussions about potentially preventable readmissions, led to a quality improvement project. National benchmarking data from the Getting It Right First Time programme were used to contextualise performance. These benchmarks are now integrated within the NHS Model Health System, enabling ongoing data-driven monitoring across surgical specialties.

Aim: To evaluate 30-day readmission rates following elective colorectal resections, identify contributory factors, and propose targeted quality improvement measures.

Methods: A retrospective observational review was conducted at Whiston Hospital for patients undergoing elective colorectal resections between July and September 2024. Data included demographics, procedure type, comorbidities, length of stay and 30-day readmissions. Causes of readmission were analysed and compared with national data.

Results: Among 28 patients (mean age 61±14 years; 61% male), the median length of stay was 6 days. The 30-day readmission rate was 14.2%, exceeding national benchmarks. Common causes included urinary retention, intra-abdominal collections, port-site hernia and gastrointestinal symptoms. Readmissions were associated with shorter stays and comorbidities. Model Health System data indicated early improvement in rectal resections but a modest rise in colonic cases.

Conclusion: Readmissions exceeded national averages, emphasising the need for enhanced recovery compliance, prehabilitation, improved discharge planning and early post-discharge follow-up. Continuous benchmarking supports sustainable improvement in outcomes.

Background: End-stage liver disease (ESLD) is a terminal diagnosis with a poor prognosis and an accelerating mortality rate in the UK. Limited research suggests that patients with ESLD have unmet palliative care (PC) needs, likely due to various factors, including difficulty predicting prognosis and lack of clear specialist palliative care (SPC) referral criteria.This quality improvement (QI) project aimed to assess and improve access to PC for inpatients with ESLD and unmet PC needs over a 6-month period using a novel intervention incorporating the Supportive and Palliative Care Indicators Tool for Liver Disease (SPICT).

Methods: The project was conducted at a tertiary centre between 2020 and 2022 with three data cycles: one baseline measurement and two Plan-Do-Study-Act (PDSA) cycles. PDSA cycle 1 involved regular screening of inpatients using the SPICT to trigger SPC referral. PDSA cycle 2 also involved screening using the SPICT, but instead to prompt multidisciplinary meeting (MDM) discussion between hepatology and SPC teams. Outcome measures reflecting holistic aspects of PC were assessed across all cycles.

Results: PDSA cycle 1 demonstrated a significant reduction in patients receiving no PC measures (67% to 26%, p: <0.001) and increased SPC input (32% to 52%, p: 0.04). Community PC referrals also rose significantly (13% to 39%, p: 0.01).PDSA cycle 2 failed to improve measures compared to baseline. Only 42% of eligible patients were discussed in the MDM. Most agreed plans were implemented, but only a minority included SPC review, community PC referral or advanced care planning.

Conclusion: Patients with ESLD continued to have unmet PC needs despite implementing an intervention based on expert guidance. PDSA cycle 1 demonstrated some significant, positive impacts, supporting the clinical utility of the SPICT, but within the context of a small, single-centre QI project with methodological limitations.

Introduction: Healthcare team performance directly impacts the quality and safety of medical care. However, measuring the performance of teams is challenging and requires methodologies to investigate different contributing elements. This study proposes an AI(artificial intelligence)-driven multimodal approach to visualising gaze (ie, joint visual attention) and speech in medical team performance and examines how these might differ across medical expertise, using eye-trackers and our own automatic gaze annotation programme.

Method: Four simulation sessions, two in Japan and another two in the UK, were filmed with eye-trackers worn by a clinician and a nurse. In each site, one session was conducted with an experienced pair (UK_Ex and JP_Ex) and the other with a less experienced pair (UK_LessEx and JP_LessEx). The scenarios were a difficult intubation in Japan and a urine infection, with a family member present, in the UK. The numbers of occurrences and the time lengths of joint attention and individuals' speeches in the four data sets were compared in total and in 15 s time ranges to see the correlations.

Result: The Ex pairs in both contexts paid joint visual attention more frequently and longer and spoke more than the LessEx pairs. In the JP_Ex, the positive correlation was found between the numbers of joint attention and the total speech durations (r=0.81). That indicates the team members verbally coordinated each other's attentional objects, which is termed coregulative attentional engagement. In contrast, in the UK_Ex, the correlation was negative (r=-0.70), where they visually monitored each other's actions while talking to the patient's family, which we call coinfluential attentional engagement. These tendencies were weak in the LessEx pairs.

Conclusion: Although the accuracy of automatic annotation (approximately. 40%-60%) should be improved before applying it to medical training, the research method could provide preliminary insight into elements of good team performance.

Workplace harassment among healthcare workers, particularly nursing students, has reached concerning levels, often resulting in serious consequences. At an acute tertiary teaching hospital in Singapore, reported cases of harassment among nursing students doubled from four in 2019 to eight in 2021. Delayed reporting, often due to a lack of awareness of a structured reporting system, exacerbates the issue. The Clinical Abuse Preventive Education for Students (CAPES) team was formed in January 2022 to empower nursing students to identify, manage and report abusive situations, with its impact evaluated using Kirkpatrick's four-level training evaluation framework.

Methods: Interventions included the development and dissemination of infographic booklets, the establishment of CAPES Buddy for incident reporting and faculty training in psychological support skills. A total of 811 nursing students commenced training under the CAPES initiative between January 2023 and April 2024. Of these, 542 completed both baseline and follow-up surveys, which measured understanding of workplace harassment and confidence in responding. Additionally, 54 faculty members underwent psychological support training to strengthen their ability to support students in crisis.

Results: Following the interventions, nursing students demonstrated a 13.7% increase in their ability to identify harassment and an 18.7% increase in confidence to respond appropriately. Overall, 98% of students demonstrated comprehension of harassment-related issues. These improvements were accompanied by increased reporting and more appropriate triage of harassment cases, with students using CAPES Buddy for complex incidents while clinical instructors managed less severe cases as first-line support. Faculty members also reported enhanced competence in supporting students, contributing to a safer learning environment.

Conclusion: CAPES strengthened students' awareness of workplace harassment and improved their confidence in responding and reporting incidents. While most students found the training relevant and beneficial, delayed reporting remains a challenge. Future work should explore factors contributing to reporting delay such as fear of retaliation or lack of trust in reporting systems and evaluate targeted strategies to address them.

Background: Artificial intelligence (AI)-generated text to video is emerging in medical education, but its effectiveness, accuracy and safety remain uncertain. We aimed to synthesise empirical studies evaluating these tools in learner or patient education.

Methods: A comprehensive search was conducted in MEDLINE/PubMed, Google Scholar, Scopus, Cochrane Review and Web of Science for studies published up to January 2025. Eligible studies evaluated AI-generated text to video for medical or patient education, reporting both quantitative and qualitative outcomes. Two reviewers screened and extracted data. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Out of 103 identified studies, five studies met the inclusion criteria: four evaluated patient education and one evaluated physician training. Clinical areas were ophthalmology (2/5), plastic surgery (1/5), dysphagia rehabilitation (1/5) and neurosurgical training (1/5). In ophthalmology, control materials outperformed AI-generated videos on image/script accuracy (p<0.005), with similar script-image alignment. In dysphagia rehabilitation, a randomised trial reported improvements in swallowing function and related outcomes with an AI-assisted video game intervention (p<0.001). A plastic surgery study reported greater user preference for a video avatar tool compared with a text chatbot (63.5% vs 28.1%). Across the reviewed studies, samples were small and CIs were rarely reported. Outcome measures were heterogeneous, and meta-analysis was not feasible.

Conclusion: AI-generated videos can enhance engagement or selected outcomes in certain contexts, yet concerns about accuracy and inconsistent measurement persist. Current evidence is sparse and mixed. Currently, these tools can complement, rather than replace, standard resources until non-inferiority is demonstrated for the prespecified primary outcomes.

Prospero registration number: CRD42025640042.

Introduction: This quality improvement project was designed to identify perceptions, knowledge and training needs of primary care providers (PCPs) in British Columbia regarding smoking cessation treatment with the intent to improve practices and identify feasible methods to mitigate barriers.

Methods: An integrated knowledge translation approach was used to design, implement and analyse a survey for primary care practitioners in the provincial context of British Columbia. The survey was divided into the four main sections: Demographic Information, Knowledge Assessment, Training Needs and Perception of Barriers. It was distributed through advertisement in e-newsletters for family physicians and nurse practitioners. It is aimed to evaluate and understand PCPs' perceptions of tobacco use disorder and smoking cessation treatment; confidence when providing tobacco use disorder and smoking cessation support and treatment; educational needs and desired supports and barriers to providing and accessing smoking cessation supports and resources.

Results: The survey garnered 198 complete responses from 154 family physicians and 44 nurse practitioners. Findings highlight a need for increased training and resources while exploring desired training content and methods of delivery. Time constraints were identified as the primary barrier to providing smoking cessation intervention, alongside lacking referral pathways, clinical services and support, and compensation. Respondents expressed a desire for 'cheat sheets' with information on smoking cessation resources and best practices, training and education on counselling techniques and vaping cessation guidance, and integrated clinical workflows.

Conclusion: This project emphasises the need for an interdisciplinary approach to smoking cessation centred around integration of resources, training and policies into current workflows (such as electronic medical records or a centralised platform for information). Important gaps have been illuminated in the processes that support smoking cessation in primary care in British Columbia.

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.