Quality Management in Health Care最新文献

{"title":"Missed Nursing Care in Pandemic Crisis of COVID-19: A Systematic Review.","authors":"Mahsa Pourshaban, Hadi Hasankhani, Atefeh Allahbakhshian, Sarieh Poortaghi","doi":"10.1097/QMH.0000000000000508","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000508","url":null,"abstract":"<p><strong>Background and objective: </strong>High-quality nursing care ensures patient safety. However, missed nursing care (MNC) poses a significant risk. During the COVID-19 pandemic, the dynamic clinical environment negatively impacted nurses and patient care quality. This review examined the most frequently reported elements and contributing factors of MNCs in studies conducted during the pandemic.</p><p><strong>Methods: </strong>This was a systematic review (PROSPERO CRD42023460938). A systematic search was conducted across databases including ProQuest, CINAHL, Web of Science, Google Scholar, Scopus, PubMed, PROSPERO, and Cochrane CENTRAL, using Boolean operators based on PICOT-SD criteria from December 2019 to July 2024. Keywords were selected based on Medical Subject Headings (MeSH) and previous studies. After reviewing the inclusion and exclusion criteria, 31 quantitative studies from 17 countries were included in the final evaluation. Findings were reported following PRISMA guidelines.</p><p><strong>Results: </strong>During the pandemic, MNC elements were categorized into 5 domains based on the Nursing Intervention Classification (NIC). At the same time, contributing factors were organized into 6 levels based on the MNC model. The most frequently observed MNC elements were identified in the basic physiological domain. The primary contributing factor for MNCs was the demand for patient care, with inadequate staffing being the most reported issue during the pandemic.</p><p><strong>Conclusion: </strong>The SARS-CoV-2 pandemic revealed that nurses' reluctance to engage in close contact with patients for various reasons led to significant losses in care. High care demands and staffing shortages remain prevalent factors contributing to MNCs, highlighting the need for effective management strategies in future health crises.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797576","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":"Implementing a Social Needs Screening and Intervention Program at a Pediatric Diabetes Center.","authors":"Shilpi Relan, Emily DeWit, Katelyn Evans, Michelle Manaskie, Jasmine Roghair, Heather Feingold, Samantha N Jacob, Courtney Winterer, Jeffrey D Colvin, Mark A Clements, Kelsee Halpin","doi":"10.1097/QMH.0000000000000577","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000577","url":null,"abstract":"<p><p>Social risk strongly influence diabetes control and contribute to inequity in diabetes care. We aimed to improve and sustain health-related social needs (HRSNs) screening of patients with diabetes from 0 to >50% over a 2-year period at multiple clinic sites within a pediatric hospital center. Using a multidisciplinary team and quality improvement techniques, we implemented and maintained an intervention over a 2-year period to screen for HRSNs and connect those with positive screens to local resources. We used statistical process control to assess change over time. Screening for HRSNs increased from 0% to 68% within 3 months and was maintained at a mean of 62% for the subsequent 20 months. Overall, 9026 screens were completed, with 956 (11%) positive for HRSNs. Of those, 146 (15%) requested direct assistance with connecting to resources, 507 (47%) requested resources to self-navigate, and 305 (32%) declined wanting assistance. Less than 1% of screens (n = 48) required urgent intervention from clinical social workers. Implementation of universal HRSN screening within a pediatric diabetes clinic is feasible across multiple clinic locations.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797599","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":"Improving Success Rates in Infant Lumbar Punctures: A Quality Improvement Initiative Using Ultrasound Guidance.","authors":"Alyssa Goodman, Danielle Paulin, Esther Son, Michael Oravec","doi":"10.1097/QMH.0000000000000564","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000564","url":null,"abstract":"<p><p>Infant lumbar punctures (LPs) are common procedures in the pediatric emergency department, yet first-attempt success remains challenging. Point-of-care ultrasound improves landmark identification and has been associated with higher LP success rates. We implemented a quality improvement project aiming to reduce multiple LP attempts in children younger than 24 months from 55% to 30% over 1 year through an ultrasound-guided LP education program. The intervention included an online module, hands-on simulation, competency assessment, and Plan-Do-Study-Act cycles. Chart review of 167 patient encounters compared baseline and postintervention outcomes. Multiple-attempt LPs decreased from 55.1% to 43.5%, traumatic LPs declined from 47.0% to 35.6%, overall LP success increased from 84.7% to 85.5%, and ultrasound-guided LP use rose from 5.1% to 14.5%. Although limited sample size prevented statistical significance, integrating phantom simulation and static ultrasound guidance into infant-specific training shows promise for reducing procedural attempts and traumatic LPs while improving patient, family, and clinician experiences.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851018","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":"Quality of Life in High-Risk Pregnancies: A Scale Development Study.","authors":"Güleser Ada, Nazli Ünlü Bidik, Kevser İlçioğlu","doi":"10.1097/QMH.0000000000000533","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000533","url":null,"abstract":"<p><strong>Background and objectives: </strong>The care process is crucial in improving quality of life and providing comfort during a high-risk pregnancy. This study aims to develop a \"Quality of Life Scale in High-Risk Pregnancies\" in order to identify the areas most affecting the quality of life of these women and to guide steps for improving their quality of life.</p><p><strong>Methods: </strong>This methodological study, a scale development study, was conducted in 3 stages. First, a draft scale was created with a 5-point Likert-type item pool consisting of 22 items, prepared in line with the literature. The items were then sent to 11 experts in the field for evaluation of their semantics and content. Following their feedback, 1 item was removed, and the scale items were finalized. After conducting factor and reliability analyses, with data from 210 pregnant women diagnosed with high-risk pregnancies, the scale was refined to 16 items. Data were collected face-to-face through a questionnaire developed by the researchers.</p><p><strong>Results: </strong>A total of 210 women with high-risk pregnancies, with a mean age of 29.41 ± 5.18 years, participated in the study. One item was excluded from the analysis based on expert opinion, and 5 items were removed during factor analysis because they overlapped, fell outside the theoretical dimensions, and had factor loadings below 0.30. The developed scale was determined to consist of 16 items and 3 sub-dimensions. The Cronbach's alpha internal reliability coefficient for the scale was 0.860, and the reliability coefficients for the sub-dimensions ranged from 0.817 to 0.844, indicating relatively high reliability.</p><p><strong>Conclusion: </strong>This study demonstrates that the Quality of Life Scale in High-Risk Pregnancies is a valid and reliable measurement tool. This scale, which can assist healthcare professionals in assessing the quality of life in high-risk pregnancies, can also be adapted to different cultures.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621329","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":"Exploring Second Victim Syndrome and Support Resource Perceptions Among Nurses in a Teaching Tertiary Care Hospital.","authors":"Brayal D'Souza, Suba Sooria, Samith Mk, Suneel Mundkur, Paulo Moreira, Varalakshmi Chandra Sekaran","doi":"10.1097/QMH.0000000000000556","DOIUrl":"10.1097/QMH.0000000000000556","url":null,"abstract":"<p><strong>Background and objectives: </strong>The assessment of second-victim phenomena within health care organizations and the evaluation of existing support systems are crucial for health care leaders. However, there is a paucity of evidence highlighting nurses' perceptions associated with the physical and psychological distress they experience following an adverse event in lower and middle-income countries (LMIC). Hence, this study aims to explore the magnitude of second-victim experiences among nurses and their perceptions of support resources available. Support systems focusing on training and resilience in coping, peer support programs, and mental health resources have been deployed by some hospitals to combat second victim syndrome. The objective of this research is to investigate the extent of second-victim experiences among nurses in a tertiary teaching hospital in south India and their perceptions regarding the availability of different support resources.</p><p><strong>Methods: </strong>A total of 1074 respondents participated in the study, which was conducted at a teaching tertiary care hospital in Coastal Karnataka in April 2023. The respondents consisted of nurses aged 20 years and older who were directly involved in patient care. Standardized and validated instruments were employed to collect the data. All survey responses were coded and summarized in a master Excel sheet, and subsequently, the data were exported to IBM SPSS Statistics 25 for analysis. Descriptive statistics were utilized to summarize the obtained data.</p><p><strong>Results: </strong>One of the primary findings of the study is the inadequacy of organizational support services addressing the second victim experience. A majority of the nursing professionals highlighted the role of non-work-related support, such as love from friends and families, to cope with the experiences related to being a second victim. While timely responses from nursing supervisors are acknowledged and appreciated in the present study, nurses also reported a tendency for attribution of blame by their supervisor. In addition, our study reveals the role of second victim syndrome in absenteeism and turnover. This can be attributed to the significant psychological and mental distress experienced by nurses in such situations.</p><p><strong>Conclusion: </strong>The present study attempted to examine the second victim experiences of nursing professionals. The originality and value of this research lie in addressing the lack of evidence regarding nurses' perceptions and the physical and psychological distress they encounter following adverse events. This study sheds light on an understudied area, highlighting the need for further attention and support for nurses in the aftermath of adverse events.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579844","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":"The Influence of Hospital Reputation on Patient Satisfaction and Perceived Trust: A Cross-Sectional Survey Study.","authors":"Yuanyun Gao, Tat Huei Cham","doi":"10.1097/QMH.0000000000000559","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000559","url":null,"abstract":"<p><strong>Background and objectives: </strong>The aim of this study was to examine the influence of hospital reputation on levels of patient satisfaction and trust, particularly comparing hospitals with high and low reputations.</p><p><strong>Methods: </strong>The research was conducted in Sichuan, China, in 2023, involving 5 clinics with high reputations (scored 4.5-5.0) and 5 clinics with low reputations (scored 2.0-3.5). The total sample comprised 2154 patients, with 1238 in the high-reputation group and 916 in the low-reputation group. Patient Satisfaction Questionnaire (PSQ) and Patient Trust Questionnaire (PTQ) results were analyzed.</p><p><strong>Results: </strong>In high-reputation clinics, females (AOR = 1.18) and urban residents (AOR = 1.32) exhibited higher levels of satisfaction and trust. In low-reputation clinics, higher average income (AOR = 1.12) and frequent visits (AOR = 1.22) were associated with improved patient-hospital relationships.</p><p><strong>Conclusions: </strong>Overall, hospitals with higher reputations demonstrated significantly greater levels of patient satisfaction and trust, highlighting the substantial impact of reputation on patient experiences. Maintaining or enhancing hospital reputation is therefore crucial for improving health care quality and patient satisfaction.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449059","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":"The Case for Building Physician Engagement and Competencies in Quality & Safety… and How to Do It.","authors":"Sarah Tosoni, Tariq Esmail, Jon Mong, Kathleen A Sheehan, Peter E Wu, Lucas B Chartier","doi":"10.1097/QMH.0000000000000572","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000572","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite widespread benefits of physicians engaging in organizational quality & safety (Q&S) activities, such engagement often remains infrequent, informal, and inconsistent. This work aimed to design and implement uniquely-tailored and concurrent interventions to increase the size and Q&S competency levels of UHN's Physician Council on Q&S over a 2-year period.</p><p><strong>Methods: </strong>Ten Q&S competency dimensions were tracked as outcome measures: Q&S science & methods, engaging stakeholders for success, aligning local projects with organizational priorities, building local Q&S infrastructure, navigating organizational Q&S processes, obtaining funding for Q&S, scholarly approach to Q&S, academic promotion through Q&S, career development through Q&S, and teaching Q&S. Competency levels were reported on a 4-point scale (ie, novice, competent, proficient, and expert). Process measures centered around change concepts and included the number of attendees at Q&S events, the number of mentorship pairings, the number of QI projects awarded grant funding, and the number of visits to our Q&S intranet site.</p><p><strong>Results: </strong>Baseline results (n = 32) revealed participants were predominantly in the novice/competent categories for all dimensions. Competency levels were retested in 2023 (n = 41) and chi-square analyses revealed improvements in the expected direction on all dimensions. Statistically significant increases were observed for navigating UHN processes (P < .01) and building organizational Q&S infrastructure (P < .05). The Council grew over 5-fold in size from its 13 original members to 75 members with representation from all of our organization's programs, departments, and divisions.</p><p><strong>Conclusions: </strong>Results indicate that this approach to Educate and Connect (eg, rounds and summit), Promote and Support (eg, grants and awards), and provide Customized Resources (eg, playbook and intranet) was effective in growing a robust and competent physician Q&S community of practice.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449032","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":"Interdisciplinary Collaborative Strategies to Improve Delirium Screening Documentation in the Pediatric CICU.","authors":"Samantha Palmere, Jessica Thielen, Ashley Roesel, Brendan Homanick, Ilias Iliopoulos, Wonshill Koh","doi":"10.1097/QMH.0000000000000568","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000568","url":null,"abstract":"<p><strong>Background and objectives: </strong>A lack of consistent delirium screening and documentation has been a recurring problem across intensive care units. We aim to improve the rate of delirium screening and documentation among patients admitted to cardiac intensive care units (CICU) in a 34-bed tertiary pediatric cardiac intensive care unit from 10% to 85% over 12 months.</p><p><strong>Methods: </strong>We first reviewed our existing practice of delirium screening and documentation in the electronic Epic patient database system. Once key barriers in our unit practice were identified, the intervention included Epic admission order-sets and Flowsheet updates for standardized delirium screening ordering and documentation. We also provided unit-wide nursing education on delirium screening and documentation using the Cornell Assessment of Pediatric Delirium tool. Delirium documentation compliance was assessed before and after the implementation of the new strategy for those with age <18 years and CICU admission > 48 hours.</p><p><strong>Results: </strong>Our initial review showed inconsistent and sporadic screening and documentation of delirium where only 10% of eligible admitted patients had documented delirium scores in the chart. After implementing Epic changes and education, 97% of admitted patients had screening and documentation of delirium over a 1-year period following the change.</p><p><strong>Conclusions: </strong>Newly implemented multi-disciplinary strategy targeting a standardized delirium screening order and efficient Flowsheet organization along with nurse-focused education on delirium led to significant improvement in delirium screening and documentation in our pediatric cardiac intensive care unit.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449083","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":"Optimizing Referrals at a Free Community Specialty Care Clinic.","authors":"Claire Honl, Katie Gillespie, Tricia Levenhagen, Emmalie Anderson","doi":"10.1097/QMH.0000000000000574","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000574","url":null,"abstract":"<p><p>Referrals to specialty care are prolific, yet they are also associated with inefficiencies and clinician frustration. The literature suggests that structured referral templates improve the clarity and completeness of information exchange between multidisciplinary providers. This evidence-based practice project aimed to optimize multidisciplinary communication at a free specialty care clinic. Primary outcomes included specialty clinic provider and staff satisfaction, as well as primary care clinic intervention adherence. Specialty-specific referral templates were implemented for 5 specialties at the free clinic. The templates were piloted at 5 primary care referral sites and refined using the plan-do-study-act model. Templates improved satisfaction with overall referral processes, and 100% of survey respondents reported satisfaction with the finalized templates. Template adoption by referral sites was realistic and achievable, and referring primary care providers also expressed satisfaction with the templates. Specialty-specific referral templates are a no-to-low-cost intervention to improve information exchange between primary and specialty care providers.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431131","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":"Association of a Post-Discharge Phone Call With Post-Acute Care Utilization During the COVID-19 Pandemic.","authors":"Yiran Emily Peng, Sean Tackett, Erik H Hoyer, Daniel J Brotman, Diane Lepley, Shaker Eid, Melissa Richardson, Amy Yue Yu, Flora Kisuule, Amteshwar Singh","doi":"10.1097/QMH.0000000000000569","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000569","url":null,"abstract":"<p><strong>Background and objectives: </strong>A care-coordination telephone call made to a patient after home discharge has been associated with reduced 30-day readmissions. It is unclear whether this relationship persisted during the pandemic, when readmission rates were higher and fewer wrap-around services existed. Further, there is rising concern that readmission is an inadequate surrogate for post-acute care utilization. Our study aims to determine the association of a post-discharge phone call with three 30-day utilization outcomes during the pandemic: readmission rates, ED visits, and observation status.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 3555 patients discharged home from medicine services at 3 hospitals between December 2020 and July 2022. Patients discharged home without additional skilled services qualified for a phone call. We tracked readmissions, ED visits, and observation stays within 30 days of each initial hospital admission. Using logistic regression, we analyzed whether call receipt was associated with these outcomes.</p><p><strong>Results: </strong>When adjusted for patient and system covariates, the post-discharge phone call was associated with a significant reduction in 30-day observation stays (OR 0.60; CI 0.45-0.80, P < .001). It was not associated with a significant reduction in 30-day ED visits (OR 1.02; CI 0.85-1.23, P = .08) or 30-day readmission rates (OR 0.95; CI 0.72-1.26, P = .72).</p><p><strong>Conclusion: </strong>During the pandemic, the post-discharge phone call was not associated with a reduction in 30-day readmissions or ED visits. It was, however, associated with a significant reduction in observation stays, a finding that warrants further investigation.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382742","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}