International Journal for Quality in Health Care最新文献

{"title":"Use of wireless geographic locating system to improve medical equipment utilization and medical quality.","authors":"Tien-Lin Huang, Yi-Fang Lei, Pa-Chun Wang","doi":"10.1093/intqhc/mzaf005","DOIUrl":"10.1093/intqhc/mzaf005","url":null,"abstract":"<p><p>Hospitals require continuous process optimization to ensure uninterrupted care. This study investigates the integration of Real-Time Locating Systems (RTLS) with logistics and dispatch management in a metropolitan hospital. The system, which tracks circulating beds and medical equipment, improves resource allocation, reduces inefficiencies, and enhances task distribution using wearable devices and big data analytics. Results showed a 20.9% reduction in delivery time, 86.8% faster equipment search, and 91.2% staff satisfaction with zero adverse event recurrence. The findings underscore RTLS's potential to enhance medical quality, efficiency, and patient safety through digital technology adoption.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient safety in Low and Middle-Income Countries (LMICs): How can we do better?","authors":"Anuradha Pichumani, Andrew Likaka, Ezequiel García-Elorrio, Viviana E Rodriguez","doi":"10.1093/intqhc/mzaf006","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf006","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting equitable access to kidney transplant in remote Western Australia using continuous quality improvement.","authors":"Felicity Stewart, Nicholas Corsair, James Stacey, Sarah Cox, Joshua Bowring, Khalil Patankar, Iann Lee, Kristan Teasdale, Emma Griffiths","doi":"10.1093/intqhc/mzae120","DOIUrl":"10.1093/intqhc/mzae120","url":null,"abstract":"<p><strong>Background: </strong>Despite an epidemic of end-stage kidney disease in the Australian Aboriginal and Torres Strait Islander population, disparities in access to kidney transplantation persist. The journey to a successful kidney transplant is long, with an initial suitability assessment required before waitlist-specific activities begin. In an Aboriginal Community Controlled renal service, we aimed to: (i) design and implement a continuous quality improvement (CQI) approach to transplant suitability assessment, (ii) provide transplant suitability assessments for all patients of the service, (iii) describe what temporary contraindications to kidney transplantation should be the focus of health service improvements, (iv) explore participant experiences with the suitability assessment process, and (v) use our findings to inform pre- and post-transplant model of care development within Kimberley Renal Services.</p><p><strong>Methods: </strong>Mixed methods design with file review. Transplant suitability assessment results with descriptive analysis and semi-structured interview with thematic analysis.</p><p><strong>Results: </strong>Of completed assessments, 20/66 (30%) had no contraindications and were cleared for workup with median time on dialysis prior to assessment of 2.9 years, 42/66 (64%) had temporary contraindications, and 4/66 (6%) had permanent contraindications. Eighty-five temporary contraindications were identified in 46 individuals: 17/46 had both medical and nonmedical contraindications, 5/46 had medical contraindications only, and 24/46 had nonmedical contraindications only. The most common temporary contraindications were smoking (23/46), treatment adherence (17/46), and high body mass index (11/46). Patients wanted more information on the transplant process, and interviewers noted the importance of providing information in an appropriate way. Patients wanted more support to address modifiable health risk factors to improve their chances of future transplantation.</p><p><strong>Conclusions: </strong>In the first stages of our CQI approach to improving access to kidney transplants for Kimberley Aboriginal people, we achieved substantial catch-up in suitability assessments and a comprehensive summary of factors impacting successful waitlisting. Our results are consistent with, and build upon other work in this space, highlighting the importance of involving Aboriginal staff and patients in education and support for prospective recipients.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":"37 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case management in emergency care: impact evaluation of the CARED Program.","authors":"Colin Eng Choon Ong, Joanne Yan Ting Yap, Kamala Velu, Christine Xia Wu, Adrian Ujin Yap, Kai Xin Ng, Michael Yat Sen Chu, Yock Young Dan, Peng Hui Choa, Phillip Hin Choi Phan","doi":"10.1093/intqhc/mzaf003","DOIUrl":"10.1093/intqhc/mzaf003","url":null,"abstract":"<p><strong>Background: </strong>Hospitals face mounting pressure to reduce unplanned utilization amid rising healthcare demands from an aging population. The Case management for At-Risk patients in the Emergency Department (CARED) program is among the first ED transitional care strategies to focus on both frail older adults and emergency department (ED) re-attenders to reduce acute hospital utilization. This study aims to evaluate the effectiveness of the CARED program in reducing hospital (re)admissions and ED re-attendances within 30- and 60 days post-discharge.</p><p><strong>Methods: </strong>A retrospective, propensity-matched study was conducted from April 2022 to July 2023 in the ED of Ng Teng Fong General Hospital in Singapore. The CARED program identifies and enrols at-risk patients, i.e. frail older adults and patients who re-attend the ED within 30 days of hospital discharge, for a geriatric assessment. This is followed by multidisciplinary team care, discharge planning and right siting of care from the ED to community-based services by ED case managers. The primary outcomes were hospital (re)admissions and ED re-attendances within 30- and 60 days post-discharge. Secondary outcomes were cost avoidance and bed occupancy days from reduced acute hospital usage.</p><p><strong>Results: </strong>Nearest-neighbour 1:1 propensity score matching matched 1615 intervention group to 1615 control group. Baseline characteristics of the intervention and control groups did not differ significantly. Difference-in-differences (DID) analyses showed significantly lower 30-day (3.96%; 95% CI 2.71-5.23%) and 60-day (6.69%; 95% CI 5.47-7.91%) hospital admissions, as well as 30-day (4.89%; 95% CI 3.83-5.95%) and 60-day (6.50%; 95% CI 5.28-7.72%) ED re-attendances in the intervention group compared to the control group. Additionally, the reduced admission and ED re-attendance rates resulted in 30-day and 60-day inpatient admission costs avoidance [$1 553 548.96 (69.86%); 95% CI $1 525 827.76 to $1 581 270.15; P = .006; and $1 400 047.07 (32.56%); 95% CI $1 365 484.79 to $1434 609.37; P = .048, respectively], ED attendance costs avoidance [$25 849.92 (23.70%); 95% CI $25 091.93 to $26 607.89; P = .096; and $37 538.39 (18.09%); 95% CI $36 470.27 to $38 606.53; P = .086, respectively] and bed occupancy days saved (1212 days; 95% CI 1191.80 days to 1232.20 days; P = .003; and 1267 days; 95% CI 1242.58 days to 1291.42 days; P = .011, respectively).</p><p><strong>Conclusion: </strong>CARED program effectively reduced unplanned hospital use within 30- and 60 days post-ED discharge for at-risk patients. It also significantly lowered inpatient admission and ED attendance costs and hospital bed occupancy days, highlighting its potential to improve patient outcomes and reduce healthcare expenses.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case management in emergency care: impact evaluation of the CARED Program.","authors":"Colin Eng Choon Ong, Joanne Yan Ting Yap, Kamala Velu, Christine Xia Wu, Adrian Ujin Yap, Kai Xin Ng, Michael Yat Sen Chu, Yock Young Dan, Peng Hui Choa, Phillip Hin Choi Phan","doi":"10.1093/intqhc/mzaf003","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf003","url":null,"abstract":"<p><strong>Background: </strong>Hospitals face mounting pressure to reduce unplanned utilization amid rising healthcare demands from an aging population. The Case management for At-Risk patients in the Emergency Department (CARED) program is among the first ED transitional care strategies to focus on both frail older adults and emergency department (ED) re-attenders to reduce acute hospital utilization. This study aims to evaluate the effectiveness of the CARED program in reducing hospital (re)admissions and ED re-attendances within 30- and 60 days post-discharge.</p><p><strong>Methods: </strong>A retrospective, propensity-matched study was conducted from April 2022 to July 2023 in the ED of Ng Teng Fong General Hospital in Singapore. The CARED program identifies and enrols at-risk patients, i.e. frail older adults and patients who re-attend the ED within 30 days of hospital discharge, for a geriatric assessment. This is followed by multidisciplinary team care, discharge planning and right siting of care from the ED to community-based services by ED case managers. The primary outcomes were hospital (re)admissions and ED re-attendances within 30- and 60 days post-discharge. Secondary outcomes were cost avoidance and bed occupancy days from reduced acute hospital usage.</p><p><strong>Results: </strong>Nearest-neighbour 1:1 propensity score matching matched 1615 intervention group to 1615 control group. Baseline characteristics of the intervention and control groups did not differ significantly. Difference-in-differences (DID) analyses showed significantly lower 30-day (3.96%; 95% CI 2.71-5.23%) and 60-day (6.69%; 95% CI 5.47-7.91%) hospital admissions, as well as 30-day (4.89%; 95% CI 3.83-5.95%) and 60-day (6.50%; 95% CI 5.28-7.72%) ED re-attendances in the intervention group compared to the control group. Additionally, the reduced admission and ED re-attendance rates resulted in 30-day and 60-day inpatient admission costs avoidance [$1 553 548.96 (69.86%); 95% CI $1 525 827.76 to $1 581 270.15; P = .006; and $1 400 047.07 (32.56%); 95% CI $1 365 484.79 to $1434 609.37; P = .048, respectively], ED attendance costs avoidance [$25 849.92 (23.70%); 95% CI $25 091.93 to $26 607.89; P = .096; and $37 538.39 (18.09%); 95% CI $36 470.27 to $38 606.53; P = .086, respectively] and bed occupancy days saved (1212 days; 95% CI 1191.80 days to 1232.20 days; P = .003; and 1267 days; 95% CI 1242.58 days to 1291.42 days; P = .011, respectively).</p><p><strong>Conclusion: </strong>CARED program effectively reduced unplanned hospital use within 30- and 60 days post-ED discharge for at-risk patients. It also significantly lowered inpatient admission and ED attendance costs and hospital bed occupancy days, highlighting its potential to improve patient outcomes and reduce healthcare expenses.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":"37 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting equitable access to kidney transplant in remote Western Australia using continuous quality improvement.","authors":"Felicity Stewart, Nicholas Corsair, James Stacey, Sarah Cox, Joshua Bowring, Khalil Patankar, Iann Lee, Kristan Teasdale, Emma Griffiths","doi":"10.1093/intqhc/mzae120","DOIUrl":"10.1093/intqhc/mzae120","url":null,"abstract":"<p><strong>Background: </strong>Despite an epidemic of End-Stage Kidney Disease in the Australian Aboriginal and Torres Strait Islander population, disparities in access to kidney transplantation persist. The journey to successful kidney transplant is long, with an initial suitability assessment required before waitlist-specific activities begin. In an Aboriginal Community Controlled renal service, we aimed to: 1.) Design and implement a continuous quality improvement (CQI) approach to transplant suitability assessment2.) Provide transplant suitability assessments for all patients of the service3.) Describe what temporary contraindications to kidney transplantation should be the focus of health service improvements4.) Explore participant experiences with the suitability assessment process and:5.) Use our findings to inform pre-and post-transplant model of care development within Kimberley Renal Services.</p><p><strong>Methods: </strong>Mixed methods design with file review. Transplant suitability assessment results with descriptive analysis, semi-structured interview with thematic analysis.</p><p><strong>Results: </strong>Of completed assessments, 20/66 (30%) had no contraindications and were cleared for workup with median time on dialysis prior to assessment of 2.9 years, 42/66 (64%) had temporary contraindications, and 4/66 (6%) had permanent contraindications. Eighty-five temporary contraindications were identified in 46 individuals: 17/46 had both medical and non-medical contraindications, 5/46 had medical contraindications only, and 24/46 had non-medical contraindications only. The most common temporary contraindications were smoking (23/46), treatment adherence (17/46) and high body mass index (BMI) (11/46). Patients wanted more information on the transplant process, and interviewers noted the importance of providing information in an appropriate way. Patients wanted more support to address modifiable health risk factors to improve their chances of future transplantation.</p><p><strong>Conclusions: </strong>In the first stages of our CQI approach to improving access to kidney transplants for Kimberley Aboriginal people we achieved substantial catch-up in suitability assessments, and a comprehensive summary of factors impacting successful waitlisting. Our results are consistent with, and build upon other work in this space, highlighting the importance of involving Aboriginal staff and patients in education and support for prospective recipients.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using space technology approach to improve quality in emergency departments in India: a quality improvement program.","authors":"Saravana Kumar, G Vikneswaran, Jitendra Suryavamshi, Srinath Kumar, Manzoor Shaik, G K Reshma, M R Suresh, Alben Sigamani, V C Shanmuganandan, Alexander Thomas, A N Venkatesh, Imron Subhan, M Rajadurai, Sateesh Kumar Kailasam, B Nivetha, K U Shameem, TSarangpi Sangtam","doi":"10.1093/intqhc/mzae116","DOIUrl":"https://doi.org/10.1093/intqhc/mzae116","url":null,"abstract":"<p><p>Introduction Human errors are a leading cause of disability and death among hospitalized patients. Globally, various strategies have been employed to reduce errors and to improve the quality of patient care. One such novel effort never attempted before is the Health-QUEST (Quality Upgradation Enabled by Space Technology) initiative which aims at translating the best quality and safety practices of the Indian Space Research Organization (ISRO) into the realm of emergency care. The objective of this quality improvement initiative was to understand the performance of ED across India using key performance indicators (KPI) specified in HQ (Health Quest) document, adoptability of HQ based practices in hospitals and their effect on KPI. Methods A pre- and post-intervention study design was used where each hospital served as its own control. Preintervention phase captured the time-based key performance indicators based on their existing practice, followed by implementation and training on QUEST recommendations and the post intervention phase assessed any improvement in the KPIs. Data was collected in real-time using REDCap mobile application by scanning the patient wrist bands. The time based KPIs include Door to triage time, Door to doctor time, Door to needle time, Door to pain assessment time, Door to ordering of investigation time, Time from ordering to first review of investigation, Door to discharge/disposition time. Results Seventeen hospitals were invited to participate in this quality improvement initiative, with 14 hospitals completing pilot training for real time data collection. Among them, 10 hospitals participated in the pre and post intervention data collection contributing to 10,332 patients (5296 patients during the pre-intervention and 5036 during the post intervention phase). All the hospitals had a median triage time of less than 5 minutes. Nine out of the ten hospitals recorded a baseline median discharge time of around 2 hours. The most significant reductions in time (mean difference between pre- and post-intervention) were observed in triage time (11 minutes, p < 0.05), door-to-pain assessment time (23 minutes, p < 0.05), time from ordering to first review of investigation (26 hours, p < 0.05), and disposition time (1 hour and 30 minutes, p < 0.05) Conclusion This study evaluated real-time, time-based KPIs in patient management across emergency departments in India. The Health-QUEST program proved to be a straightforward and effective model, achieving significant improvements in multiple time-based KPIs across participating EDs.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming Emergency Care: Lessons from Innovations Beyond Healthcare.","authors":"Poonam Gupta, Anuradha Pichumani, Azhar Ali, David Greenfield","doi":"10.1093/intqhc/mzaf008","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf008","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Holding up the crystal ball: using regulatory intelligence insights to support quality in healthcare.","authors":"Martin Fletcher, Samantha Stark, Nikola Balvin, David Greenfield","doi":"10.1093/intqhc/mzaf001","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf001","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":"37 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Holding up the crystal ball: using regulatory intelligence insights to support quality in healthcare.","authors":"Martin Fletcher, Samantha Stark, Nikola Balvin, David Greenfield","doi":"10.1093/intqhc/mzaf001","DOIUrl":"10.1093/intqhc/mzaf001","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}