Journal of Healthcare Quality Research最新文献

{"title":"The weekend effect in hip fracture: The critical role of resource management","authors":"J.C. Segura-Nuez ,&nbsp;M. Infantes-Morales ,&nbsp;A. García-Hernández ,&nbsp;J. Segura-Nuez ,&nbsp;C. Martín-Hernández ,&nbsp;A. Roche-Albero","doi":"10.1016/j.jhqr.2025.101131","DOIUrl":"10.1016/j.jhqr.2025.101131","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The “weekend effect” refers to patients admitted at the end of the week who cannot undergo surgery until the beginning of the following week. The objective is to study the relationship between admission on a specific day of the week and the time to surgery.</div></div><div><h3>Material and methods</h3><div>A retrospective analytical study was conducted, including consecutive patients over 65 years old with a diagnosis of hip fracture admitted to Miguel Servet University Hospital from March 1 to October 31, 2023. Data such as admission day, age, sex, type of fracture, anticoagulant or antiplatelet therapy, and time to surgery were collected. A multivariate analysis was performed to investigate the factors influencing the time to surgery.</div></div><div><h3>Results</h3><div>A total of 348 patients were included. The average time to surgery for patients admitted on Monday was 2.04 days; Tuesday, 2.06; Wednesday, 2.14; Thursday, 2.94; Friday, 3.24; Saturday, 2.91; and Sunday, 2.17. The multivariate analysis showed that admission on Thursday (<em>p</em> <!-->&lt;<!--> <!-->0.001), Friday (<em>p</em> <!-->&lt;<!--> <!-->0.001), or Saturday (<em>p</em> <!-->&lt;<!--> <!-->0.001) increased the time to surgery compared to admission on Monday. Treatment with vitamin K antagonists (<em>p</em> <!-->=<!--> <!-->0.006) and direct oral anticoagulants (<em>p</em> <!-->&lt;<!--> <!-->0.001) also delayed surgery. Subcapital fractures were treated later than basicervical (<em>p</em> <!-->=<!--> <!-->0.039), pertrochanteric (<em>p</em> <!-->=<!--> <!-->0.018), and subtrochanteric (<em>p</em> <!-->=<!--> <!-->0.028) fractures.</div></div><div><h3>Conclusion</h3><div>In our center, admission on Thursday, Friday, or Saturday significantly increased the time to surgery compared to Monday. This may increase hospital costs and the potential complications related to surgical delay.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"40 5","pages":"Article 101131"},"PeriodicalIF":1.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La experiencia de los cuidadores no profesionales de pacientes crónicos","authors":"A. Picón-Santamaría ,&nbsp;S. Ballesteros-Peña","doi":"10.1016/j.jhqr.2025.101130","DOIUrl":"10.1016/j.jhqr.2025.101130","url":null,"abstract":"<div><h3>Introduction</h3><div>Population aging and the increase in chronic diseases pose significant challenges to healthcare systems. Informal caregivers play a crucial role in caring for these patients, yet their experiences remain underexplored. This study evaluates the experience of informal caregivers of hospitalized chronic patients.</div></div><div><h3>Materials and methods</h3><div>A descriptive observational study was conducted at Hospital Santa Marina, Bilbao, between 2023 and 2024. The IEXPAC-Caregivers scale was used to assess the experience of 182 informal caregivers. Data were analyzed using descriptive and inferential statistics. SPSS v.25 software was used for statistical analysis.</div></div><div><h3>Results</h3><div>The overall average score was 7.1 (±<!--> <!-->2.7) out of 10 (Cronbach's α<!--> <!-->=<!--> <!-->0.914). The best-rated items were communication during emergencies and medication administration. However, deficiencies were noted in training, information about available resources, and coordination between services. Significant differences were found in aspects such as emotional support and treatment follow-up based on the gender of the caregiver and the patient.</div></div><div><h3>Conclusions</h3><div>Informal caregivers play an essential role in the care of chronic patients. There is a need to improve service coordination and provide ongoing training and emotional support to them. Gender differences highlight the importance of personalized approaches to enhance their experience and reduce caregiving burden.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"40 5","pages":"Article 101130"},"PeriodicalIF":1.1,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving efficiency in a total hip arthroplasty program","authors":"X. Buyse ,&nbsp;J.Á. Fernández-Valencia ,&nbsp;A. Alías ,&nbsp;M. Tió ,&nbsp;M. Pablo ,&nbsp;A. Serra","doi":"10.1016/j.jhqr.2025.101117","DOIUrl":"10.1016/j.jhqr.2025.101117","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the application of Lean Six Sigma methodology to increase efficiency in a morning total hip arthroplasty program and analyze the challenges in improving operating room efficiency.</div></div><div><h3>Methods</h3><div>A quasi-experimental study with pre-post intervention analysis was conducted in a public university hospital. Multidisciplinary meetings and a retrospective analysis of the previous year were carried out to define improvement points. Study period: June–December 2023, with 24 planned sessions in Monday and Thursday morning modules. Measures implemented included selection of low-complexity cases, early start of surgeries, optimization of changeover times, and use of efficiency-facilitating systems.</div></div><div><h3>Results</h3><div>The feasibility of performing three procedures in one morning was confirmed, with 72% of cases having surgery times under 90<!--> <!-->min. 67% of the proposed target was achieved, despite the loss of an operating room module for four months. The average start time of the first surgery improved from 9:23<!--> <!-->±<!--> <!-->54<!--> <!-->min to 8:32<!--> <!-->±<!--> <!-->22<!--> <!-->min. The average number of procedures per module increased from 1.76 to 2.79. The average changeover time reduced from 29<!--> <!-->±<!--> <!-->12<!--> <!-->min to 18<!--> <!-->±<!--> <!-->12<!--> <!-->min.</div></div><div><h3>Conclusions</h3><div>The Lean Six Sigma methodology has improved operating room efficiency for hip arthroplasty by 50%. Identifying easily modifiable stoppers is crucial for successful implementation of improvements in the clinical process. Additional studies are required to address the challenges identified in post-surgery clinical process and to ensure continuous process optimization.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"40 5","pages":"Article 101117"},"PeriodicalIF":1.1,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical decisions on the end of life during internal medicine on-call shifts","authors":"R. García Caballero ,&nbsp;D. Real de Asúa ,&nbsp;K. Olaciregui Dague ,&nbsp;G. de vega González ,&nbsp;B. Herreros","doi":"10.1016/j.jhqr.2025.101129","DOIUrl":"10.1016/j.jhqr.2025.101129","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the frequency of decisions of withholding and withdrawing life-sustaining treatment and palliative sedation in patients previously unknown to physicians during on-call.</div></div><div><h3>Methods</h3><div>Observational study (survey) of Spanish internists.</div></div><div><h3>Results</h3><div>Two hundred seventy-three surveys. In patients they did not know, 95.2% decided during an on-call whether they should enter the Intensive Care Unit and 89% whether to initiate sedation. Measures most identified as “aggressive”: admission to the Intensive Care Unit, use of invasive techniques, cardiopulmonary resuscitation and invasive treatments. 48.4% make the decision to start sedation as a team and 4 out of 10 do not consult the patient. Decisions are planned most commonly with cancer patients (73%), with heart failure (60.4%) and chronic obstructive pulmonary disease (58%).</div></div><div><h3>Conclusions</h3><div>During the on-call, almost all internists make decisions about admission to the Intensive Care Unit or about sedation in unknown patients. It is planned more the decisions with cancer patients. The decision to sedate is usually made as a team and the patient is often not consulted.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"40 4","pages":"Article 101129"},"PeriodicalIF":1.1,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data: Europe's own path in artificial intelligence","authors":"A. Bahamonde","doi":"10.1016/j.jhqr.2025.101126","DOIUrl":"10.1016/j.jhqr.2025.101126","url":null,"abstract":"","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"40 5","pages":"Article 101126"},"PeriodicalIF":1.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The organizational well-being of healthcare professionals","authors":"M. Macías ,&nbsp;J.J. Mira ,&nbsp;I. Mediavilla ,&nbsp;E. Foglia ,&nbsp;E. Garagiola ,&nbsp;L. Ferrario","doi":"10.1016/j.jhqr.2025.101125","DOIUrl":"10.1016/j.jhqr.2025.101125","url":null,"abstract":"","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"40 4","pages":"Article 101125"},"PeriodicalIF":1.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failure to rescue in colon surgery","authors":"J.J. Rubio-García ,&nbsp;F. Mauri Barberá ,&nbsp;C. Villodre Tudela ,&nbsp;J. Ferri Romero ,&nbsp;M. Marco Gómez ,&nbsp;T. Viñas Martínez ,&nbsp;C. Gómez Alcázar ,&nbsp;M. Romero Simo ,&nbsp;J.M. Ramia-Ángel","doi":"10.1016/j.jhqr.2025.101118","DOIUrl":"10.1016/j.jhqr.2025.101118","url":null,"abstract":"<div><h3>Background</h3><div>Major complications (MC) after colorectal surgery are not uncommon and can have serious consequences for patient survival. Failure to rescue (FTR) is an indicator used to measure the capacity for correct management of MC, calculated as the number of patients who die among all those who present MC.</div></div><div><h3>Methods</h3><div>Observational study with retrospective data analysis of all patients undergoing scheduled colon cancer surgery at a Spanish university hospital from September-2012 to August-2016. Preoperative, intraoperative and postoperative variables were recorded. Postoperative complications Clavien–Dindo scores<!--> <!-->&gt;<!--> <!-->II were considered MC. FTR was defined as death within 90 postoperative days in patients with at least one MC.</div></div><div><h3>Results</h3><div>A total of 564 patients were included, of whom 140 (24.8%) presented MC. Of these, 22 died, representing an FTR rate of 15.7%. Patients with MC had a mean age of 69.6 years, and 30.7% were women. An open approach was used in 81.4%. Compared with survivors, the group of non-survivors presented a higher proportion of ASA III and IV (<em>P</em> <!-->=<!--> <!-->0.008), a higher mean age (<em>P</em> <!-->=<!--> <!-->0.001) and a higher proportion of anastomotic leaks (<em>P</em> <!-->=<!--> <!-->0.009). Multivariate analysis confirmed that age (OR 1.161; <em>P</em> <!-->=<!--> <!-->000), anastomotic leak (OR 18; <em>P</em> <!-->=<!--> <!-->0.001) and sepsis of origin other than anastomotic leak or intra-abdominal collection (OR 26; <em>P</em> <!-->=<!--> <!-->0.001) were significantly associated with FTR as independent factors.</div></div><div><h3>Conclusion</h3><div>The FTR rate after colectomy in our series was similar or slightly lower than other series. Age, anastomotic leakage, and sepsis of non-abdominal origin were independent factors associated with FTR. We contend that FTR is an excellent indicator of a center's ability to resolve MC. It is particularly useful for implementing measures to ensure effective treatment of MC.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"40 4","pages":"Article 101118"},"PeriodicalIF":1.1,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Textbook outcome in thyroid surgery: A new approach to assess quality in an endocrine surgery unit","authors":"D. Costa Navarro ,&nbsp;J.J. Rubio-García ,&nbsp;A. Gomis-Martín ,&nbsp;T. Viñas Martínez ,&nbsp;J. López-Noguera ,&nbsp;M. Franco-Campello ,&nbsp;A. Carrion-Tomás ,&nbsp;J.M. Ramia","doi":"10.1016/j.jhqr.2025.101120","DOIUrl":"10.1016/j.jhqr.2025.101120","url":null,"abstract":"<div><h3>Background</h3><div>Thyroidectomy is a term encompassing various surgical procedures involving the thyroid gland. Assessing quality is imperative for patient safety and clinical auditing and textbook outcome (TO) offers more comprehensive information on overall quality than single indicators. This study aims to define the parameters constituting TO in thyroid surgery, evaluate the outcomes based on TO criteria within an endocrine surgery unit at a tertiary hospital, and identify factors associated with failure to achieve TO in these cases.</div></div><div><h3>Methods</h3><div>A retrospective observational study of consecutive patients undergoing thyroid surgery at the Endocrine Surgery Unit in Spain between January 2020 and December 2022. The analyzed variables included, among others, age and sex, comorbidities, diagnosis, intrathoracic goiter, type of thyroidectomy, and several postoperative complications. The first TO definition in thyroid surgery was made.</div></div><div><h3>Results</h3><div>A total of 244 patients were included in the study. TOTS was achieved in 153 patients (62.7%), and there were no reported mortalities. Diabetes (18% vs 8.61%) and endothoracic goiter (40% vs 22%) were statistically associated with textbook outcome non-achievement. Also, the endothoracic goiter parameter was identified as a statistically significant predictor of textbook outcome non-achievement.</div></div><div><h3>Conclusion</h3><div>The implementation of the TO concept in thyroid surgery offers a comprehensive method for assessing surgical quality, encapsulating a range of critical postoperative outcomes. The rate of TO in our serie was 62.7%, identifying that endothoracic goiter is the main parameter of textbook outcome non-achievement.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"40 4","pages":"Article 101120"},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143767514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Análisis de los indicadores de seguridad del paciente en las complicaciones por cuidados durante la hospitalización","authors":"F.M. Escandell Rico ,&nbsp;L. Pérez Fernández","doi":"10.1016/j.jhqr.2025.01.001","DOIUrl":"10.1016/j.jhqr.2025.01.001","url":null,"abstract":"<div><h3>Objective</h3><div>To Analyze AHRQ Patient Safety Indicators (PSI) obtained through the Minimum Basic Data Set (MBDS) in improving patient safety.</div></div><div><h3>Method</h3><div>Observational descriptive and retroprective study. The CMBD hospital discharge registry of 342 hospitals of the National Health System was included. The MBDS indicators and analysis axes were from 2021 and the hospitalization MBDS information included the following general data: total discharges, average stay, average age and % mortality. Four patient safety indicators were analyzed: Pressure ulcers (PSI 03), Iatrogenic pneumothorax (PSI 06), Accidental puncture or tear in adults (PSI 15) and CVC-related to bloodstream infection (PSI 07).</div></div><div><h3>Results</h3><div>The PSI 06 and PSI 07 categories not only have a higher number of discharges, but also a longer average stay and mortality. In comparison, PSI 03 and PSI 15 categories show a much lower number of discharges, and a lower mortality and average stay. Conditions associated with PSI 06 and PSI 07 categories could be more severe or complex, leading to a longer hospital stay and a higher risk of mortality. According to relative risk analyses, all indicators show a slightly higher mortality risk in men than in women.</div></div><div><h3>Conclusions</h3><div>Advanced age and serious diagnoses, such as circulatory diseases or neoplasia, are associated with higher mortality and hospital stay. In relation to hospital size, smaller ones show higher risks and worse mortality outcomes. Therefore, these results could guide strategies to optimize resources and focus interventions on the most vulnerable groups.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"40 3","pages":"Article 101116"},"PeriodicalIF":1.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimización del reprocesado de materiales sanitarios en centros de atención primaria","authors":"E.A. Sabuco Tébar ,&nbsp;Á.R. Sáez Soto ,&nbsp;M. Culiañez Alenda ,&nbsp;Y. López Benavente ,&nbsp;R. López Alegría ,&nbsp;F.J. Campayo Rojas","doi":"10.1016/j.jhqr.2025.101124","DOIUrl":"10.1016/j.jhqr.2025.101124","url":null,"abstract":"<div><h3>Introduction and objetive</h3><div>Reprocessing of medical devices in Primary Care Centers (PCC) can be a source of infections. The aim of this study was to improve the quality of reprocessing devices in the PCCs of Area VII-Murcia/Este through an improvement cycle.</div></div><div><h3>Methods</h3><div>This prospective intervention study. was carried out in 12 PCC, 14 Local Clinics (LC), 4 Oral Health Units (OHU) and the professionals involved in the reprocessing. Between 09/2022-03/2023, a working group was created, and a situation analysis was carried out: inventory of autoclaves, consumption of materials, and visits to the PCCs. Between 04/2023-03/2024, improvement actions were implemented: purchasing plan, use of Chemical Indicators (CHI) and Biological Indicators (BI), training with prior knowledge surveys, work procedure, and processes traceability.</div></div><div><h3>Results</h3><div>In total 11 autoclaves were acquired. The percentage of BI completion was ≥ 45%, and 80% of professionals were trained. The following improvements were obtained: detergent technical data sheet in the washing Area (45% to 73%), sterilization dates traceability (10% to 78%), sterilization cycles traceability (11% to 66%), use of instrument brush (55% to 74%), bag labeling (45% to 68%), correct storage (45% to 78%), and use of tap water to generate steam (2% to 0%).</div></div><div><h3>Conclusions</h3><div>The implementation of an improvement cycle, through the training of professionals, standardization of procedures, and traceability of processes, in addition to having an expert nurse as a reference, increases the quality in the reprocessing of medical devices.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"40 4","pages":"Article 101124"},"PeriodicalIF":1.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}