International journal for quality in health care : journal of the International Society for Quality in Health Care最新文献

{"title":"Data, digital health, and AI: building the foundations of modern quality management in healthcare.","authors":"Amar Shah, Usman Iqbal","doi":"10.1093/intqhc/mzag142","DOIUrl":"10.1093/intqhc/mzag142","url":null,"abstract":"","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003292","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":"Targeting what matters: a quasi-experimental controlled before-and-after study on targeted double checks in parenteral medication administration.","authors":"Afke van de Plas, Fatma Karapinar-Çarkit, Janne Jacobs, Roger Rennenberg, Dorthe Klein","doi":"10.1093/intqhc/mzag147","DOIUrl":"10.1093/intqhc/mzag147","url":null,"abstract":"<p><strong>Background: </strong>Parenteral medication administration is associated with a substantial risk of medication errors. Independent double-checking by two nurses is widely mandated to reduce this risk; however, evidence is lacking, compliance is inconsistent, and the procedure is time-consuming. Medication safety organizations increasingly recommend targeted double-checking of high-risk medications, yet the impact of such a strategy in clinical practice remains unclear. This study evaluated the effect of implementing targeted double-checking, alongside barcode verification, on compliance with predefined safe administration procedures during parenteral medication administration.</p><p><strong>Methods: </strong>A quasi-experimental controlled before-and-after study was conducted on two comparable surgical wards in a Dutch university hospital between June 2022 and January 2024. On the intervention ward, parenteral administrations were categorized as high- or low-risk, with double-checking required only for high-risk administrations alongside mandatory barcode verification. The control ward continued universal double-checking combined with barcode verification for both high- and low-risk administrations. The primary outcome was the percentage of safe administrations, defined as compliance with predefined safety administration procedures according to administration risk level. Secondary outcomes included barcode verification rates, double-check application rates, medication errors, voluntarily reported incidents, and administration time as a measure of efficiency. Outcomes were assessed using disguised observations and retrospective data analysis. Data were analyzed using descriptive statistics and chi-square or Fisher's exact tests.</p><p><strong>Results: </strong>A total of 250 administrations were observed. Compliance with safe administrations increased on the intervention ward from 0% to 41% (P < .001) and on the control ward from 16% to 35% (P = .025). Double-check application decreased on the intervention ward (60%-11%, P < .001) but increased on the control ward (0%-16%, P = .002). Barcode verification during observations increased on the intervention ward (53%-76%, P = .007) and decreased on the control ward (71%-31%, P < .001). Retrospective analysis showed improved patient and medication barcode verification on the intervention ward (15% (1446/9567) to 51% (579/1133), P < .001) and a decline on the control ward (18% (1759/9857) to 12% (150/1229), P < .001). Implementation of targeted double-checking was associated with an estimated saving of 48 minutes of nursing time per day. No medication errors or incidents were reported.</p><p><strong>Conclusion: </strong>Targeted double-checking combined with barcode verification appears to improve compliance with safe administration procedures during parenteral medication administration; however, improvements on the control ward preclude definitive conclusions regarding effectiveness. This tar","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013483","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 intent is good but… exploring barriers and enablers to clinical pathway use in regional Australian Emergency Departments.","authors":"Innocent Tawanda Mudzingwa, Phoebe Griffin, Emma Tavender, Giles Barrington, Viet Tran, Sarah Jane Prior","doi":"10.1093/intqhc/mzag153","DOIUrl":"10.1093/intqhc/mzag153","url":null,"abstract":"<p><strong>Background: </strong>Clinical pathways can improve the quality, safety, and efficiency of care, but their integration into routine emergency department (ED) practice remains challenging. Factors influencing pathway use, particularly organizational and contextual determinants, are often overlooked, despite their importance for successful implementation and sustainability. These challenges may be amplified in regional EDs facing workforce and resource constraints. This study examined the barriers and enablers influencing the use of fractured neck of femur (NOF) and suspected stroke pathways in regional Australian EDs to inform service improvement and pathway redesign.</p><p><strong>Methods: </strong>A qualitative exploratory study was conducted across regional EDs in Tasmania. The study utilized big picture mapping workshops and semistructured interviews to examine pathway use in real‑world clinical settings. Twenty-five clinicians participated in three multidisciplinary mapping workshops, and 14 clinicians took part in in‑depth interviews. Mapping identified key steps and decision points within fractured NOF and stroke pathways, while interviews explored clinicians' experiences and perceptions. Data were deductively analysed using the updated Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Results: </strong>Mapping revealed common care processes but significant site-level differences, including inconsistent pathway initiation. Interviews revealed that pathway use was influenced by factors across CFIR domains: complexity and workflow misalignment were barriers, with digital integration a valued enabler (Innovation). Time pressures and resource limitations affected pathway use (Outer setting). Leadership buy‑in and champions enabled use (Inner setting). Clinicians expressed concern about diminishing clinical judgement (Individuals domain), while Implementation process domain barriers included limited collaboration.</p><p><strong>Conclusion: </strong>Pathway use in Tasmanian EDs is influenced by barriers and enablers across CFIR domains. Simplifying pathways and ensuring adaptability were perceived to improve usability, while misaligned workflows and paper-based processes hinder uptake. Addressing resource constraints, fostering leadership engagement, and strengthening education are essential. Embedding planning, collaboration, and feedback will ensure pathways remain practical, evidence-based, and deliver timely, standardized care.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with the presence of nonconformities in the certification of hospital clinical management units in Andalusian.","authors":"Patricia Bonachela-Solás, Luis López-Rodríguez, Antonio Cervera-Barajas, Elena Varela-Rubio, Rubén Morilla-Romero de la Osa","doi":"10.1093/intqhc/mzag145","DOIUrl":"10.1093/intqhc/mzag145","url":null,"abstract":"<p><strong>Background: </strong>Healthcare quality certification models are fundamental for ensuring patient safety and continuous improvement. The appearance of nonconformities (NC) during external audits reflects implementation difficulties. This study analyzes factors associated with the presence of NC in the certification of hospital clinical management units (CMU) in Andalusia over two decades.</p><p><strong>Methods: </strong>Retrospective observational study of 811 hospital CMU certification projects from the Andalusian Health Service registered between April 2003 and June 2023. Data were obtained from the Andalusian Agency for Healthcare Quality ME_jora C platform. Variables included certification level, project type, standard compliance percentages, temporal metrics, and territorial distribution. Descriptive statistics, bivariate analyses (Chi-square, Mann-Whitney U), and multivariate logistic regression were performed to identify factors associated with the presence of NC.</p><p><strong>Results: </strong>A total of 811 projects were certified, with 27.7% (225/811) achieving certification without any NC. The majority (86.4%) reached advanced level, 12.5% optimal level, and only 1.1% excellent level. Seville (25.1%) and Málaga (18.7%) concentrated the highest number of projects. Multivariate analysis identified five independent factors: each additional year between registration and certification increased the odds of NC (OR = 3.3; 95% CI: 2.4-4.9; P < .001); each additional year devoted to self-assessment reduced the odds of NC by ∼70% (OR = 0.3; 95% CI: 0.2-0.4; P < .001); higher final self-assessment percentage reduced risk (OR = 0.92; 95% CI: 0.87-0.97; P = .006); more recent certification years were associated with higher odds of NC (OR = 1.25; 95% CI: 1.10-1.43; P < .001); and higher number of self-assessors was associated with a slightly increased likelihood of NC. (OR = 1.06; 95% CI: 1.00-1.13; P = .049).</p><p><strong>Conclusion: </strong>Longer self-assessment periods were associated with lower odds of NC, whereas longer overall certification processes were associated with higher odds of NC. These findings provide quantitative evidence to optimize certification planning and support healthcare units in achieving successful certification outcomes.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013476","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":"In response to Baker et al.: Reconsidering the balance between access and continuity in primary care.","authors":"Andi Ratu Boelqiah Assaad, Wahyu Nisawati Mafrukha, Silmi Fadhila Ihsani, Raisa Zuhra Salsabila Awaluddin, Raup Padillah","doi":"10.1093/intqhc/mzag143","DOIUrl":"10.1093/intqhc/mzag143","url":null,"abstract":"","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003269","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":"Sustainable quality improvement interventions to ensure adequate physician documentation of chaperone presence in breast clinic: a multicycle clinical audit.","authors":"Cian M Hehir, Gavin G Calpin, Nadia Walsh, Gordon R Daly, Gavin P Dowling, Sandra Hembrecht, Katie Kearns, Michael Allen, Abeeda Butt, Colm Power, Arnold D K Hill","doi":"10.1093/intqhc/mzag141","DOIUrl":"10.1093/intqhc/mzag141","url":null,"abstract":"<p><strong>Introduction: </strong>Current best practice guidelines recommend chaperone presence during intimate clinical examination. Achieving guideline standards of documentation regarding chaperone presence has important implications from both clinical governance and medicolegal perspectives. This multicycle clinical audit provides insight into quality improvement interventions relevant to chaperone utilization and achieving guideline documentation standards.</p><p><strong>Materials and methods: </strong>This single-centre, multicycle quality improvement audit was performed in the setting of a tertiary breast referral clinic at Beaumont Hospital, Dublin, Ireland. The quality improvement audit consisted of three audit cycles with two distinct interventions employed. Firstly, a 'chaperone stamp' was entered into the clinical notes prior to consultation to serve as a memory aid for physicians. Secondly, following transfer of clinical notes from paper-based to electronic records, a mandatory check field was introduced ensuring adequate documentation.</p><p><strong>Results: </strong>A total of 388 female patients underwent breast examination at our centre. Despite levels of chaperone presence being directly observed at 100% in clinical consultations, chaperone documentation rates were poor (7.6%). Introduction of a chaperone stamp resulted in a 51.1% improvement in chaperone documentation. This intervention demonstrated poor sustainability as documentation standards declined by 13.6% at 6 months postintervention. Introduction of a mandatory check field using electronic patient records generated the most significant improvement in documentation standards, with 100% of clinical notes recording chaperone presence to reference standard.</p><p><strong>Conclusion: </strong>Accurate documentation of chaperone presence or decline thereof is of relevance from clinical governance and medicolegal perspectives. Simple, resource-efficient interventions such as the 'chaperone stamp' demonstrate significant quality improvement potential but with questionable long-term efficacy. Electronic records present a viable opportunity for units to achieve guideline standards in a time and resource-efficient manner.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient safety culture in low- and lower-middle-income countries: a systematic review of evidence involving hospital pharmacists.","authors":"Ezinwanne Jane Ugochukwu, Olanrewaju Faith Omotayo, Onyinye Blessing Ukoha-Kalu, Isaac Ibezim, Abdulmuminu Isah, Nneka Uchenna Igboeli, Chukwuemeka Michael Ubaka","doi":"10.1093/intqhc/mzag156","DOIUrl":"10.1093/intqhc/mzag156","url":null,"abstract":"<p><strong>Background: </strong>Patient safety culture (PSC) promotes shared values and practices to reduce harm. In low- and lower-middle-income countries (LLMICs), PSC is limited by resources and weak reporting. Hospital pharmacists are key to preventing medication errors and are underrepresented. This review summarizes evidence on their PSC involvement, domain findings, and influencing factors.</p><p><strong>Methods: </strong>We systematically searched PubMed, Web of Science, Scopus, and grey literature (January 2010-December 2025) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines (PROSPERO: CRD420251125507). Duplicates were removed in Rayyan. Two reviewers independently screened titles/abstracts and full texts against eligibility criteria (hospital pharmacists, PSC assessment, LMIC setting), resolving disagreements by discussion or a third reviewer. Data were extracted using a standardized form (study characteristics, PSC tool, domain scores, predictors, barriers, findings). Quality was appraised with the Joanna Briggs Institute checklist. Findings were narratively synthesized due to heterogeneity; no meta-analysis was performed.</p><p><strong>Results: </strong>From 1350 records identified, 29 studies met the inclusion criteria. All included articles were cross-sectional in design. Most studies were conducted in Africa (22; 75.9%). Only six studies (20.7%) focused exclusively on pharmacists. The Hospital Survey on Patient Safety Culture (HSOPSC) was the most frequently used tool (22; 75.9%). Across studies, teamwork within units was the most consistently high-scoring domain (18; 62.1%). The lowest-scoring domains were staffing and work pace (10; 34.5%) and patient safety incidents, reporting 12 (41.4%). Common barriers identified: blame culture (55.2%), severe staffing shortages (51.7%), and resource constraints (41.4%).</p><p><strong>Conclusion: </strong>Evidence involving hospital pharmacists in LLMICs is limited and largely derived from mixed-profession studies. Teamwork was a relative strength, while staffing and nonpunitive response were recurrent weaknesses, highlighting priorities for strengthening PSC.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070827","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":"Case-mix adjustment of HCAHPS scores based on national benchmarks in Japan: a multicenter cross-sectional study.","authors":"Takuya Aoki, Masato Matsushima","doi":"10.1093/intqhc/mzag160","DOIUrl":"10.1093/intqhc/mzag160","url":null,"abstract":"<p><strong>Background: </strong>Despite the increasing adoption of patient experience measurement in Asia, including Japan, limited progress has been made in identifying suitable patient-level adjusters and developing statistical methods for case-mix adjustment. This study aimed to develop and evaluate a case-mix adjustment model for the Japanese version of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) using nationwide benchmark survey data.</p><p><strong>Methods: </strong>We conducted a multicenter cross-sectional study using data from 83 hospitals across Japan that participated in the 2023 national patient experience survey. Self-administered questionnaires were distributed to adult inpatients (aged ≥20 years) discharged between September and November 2023. The Japanese version of HCAHPS, comprising six composite measures and two global ratings, was used to calculate top-box scores (percentage of most positive responses). Candidate case-mix adjusters included age, gender, self-rated general health, self-rated mental health, and admission through the emergency department. The explanatory power (EP) of each adjuster was calculated as the product of predictive power and the between- versus within-hospital variance ratio. The impact of adjustment was evaluated by comparing unadjusted and adjusted scores and by assessing hospital rank changes using Kendall's τ.</p><p><strong>Results: </strong>Data from 13 602 patients were analyzed. Self-rated mental and general health showed the highest EP, whereas gender and emergency admission contributed minimally. The mean absolute adjustment of top-box scores ranged from 0.77 to 1.96 points. Case-mix adjustment changed hospital rankings in 3.4%-10.2% of all possible pairwise comparisons (Kendall's τ = 0.80-0.93).</p><p><strong>Conclusion: </strong>This study provides the first evidence-based case-mix adjustment model for HCAHPS scores in Japan. Applying such an adjustment is crucial to ensure fair benchmarking of PX across hospitals and to support data-driven quality improvement and accountability initiatives within Japan's evolving healthcare quality framework.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070851","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":"Transitional care services are cost-effective for older patients with chronic obstructive pulmonary disease in Korea.","authors":"Yu Seong Hwang, Deog Kyeom Kim, Jung-Kyu Lee, Eun Young Heo, Hyun Woo Lee, Su Kyoung Kim, Yukyung Park, Woo Jin Kim, Seon Sook Han, Yeon Jeong Heo, Da Hye Moon, Oh Beom Kwon, Myung Goo Lee, Ji Young Hong, Chang Youl Lee, Heui Sug Jo","doi":"10.1093/intqhc/mzag136","DOIUrl":"10.1093/intqhc/mzag136","url":null,"abstract":"<p><strong>Background: </strong>Transitional care services (TCS) may reduce post-discharge readmissions and improve disease management in patients with chronic obstructive pulmonary disease (COPD). This study evaluated the cost-effectiveness of TCS using state-specific relative risks (RRs) derived from a randomized controlled trial (RCT).</p><p><strong>Methods: </strong>Between September 2022 and September 2024, 417 patients with COPD discharged from three university hospitals in South Korea were assigned to TCS (n = 210) or usual care (n = 207). State-specific RRs were derived from 3-month RCT outcomes and incorporated into a Markov model with 3-month cycles and a 10-year time horizon. Costs and quality-adjusted life-years (QALYs) were estimated for patients in their 60 s, 70 s, and 80 s. Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were performed to assess parameter uncertainty.</p><p><strong>Results: </strong>In the base-case analysis, TCS increased costs by USD 2,128.91 and USD 1,133.41 per patient in the 60 s and 70 s cohorts, respectively, but reduced costs by USD 58.01 in the 80 s cohort. Incremental QALYs were 0.155, 0.195, and 0.271, respectively. The corresponding incremental cost-utility ratios were USD 13,709.60/QALY and USD 5,816.85/QALY in the 60 s and 70 s cohorts, while TCS was dominant in the 80 s cohort. DSA identified the RR of respiratory-disease readmission as the largest driver of uncertainty, followed by the RR of COPD readmission; the RR of other-disease readmission and TCS intervention cost were also influential. At a willingness-to-pay threshold of USD 23,050/QALY, the probabilities that TCS was cost-effective were 55.7%, 67.9%, and 82.7% for the 60 s, 70 s, and 80 s cohorts, respectively.</p><p><strong>Conclusions: </strong>This study evaluated the cost-effectiveness of TCS for patients with COPD using state-specific RRs derived from an RCT. TCS was cost-effective across all age cohorts, with more favourable economic outcomes observed in older patients and dominance in the 80 s cohort. These findings support the implementation of TCS for patients with COPD, while further research is needed to confirm its long-term clinical and economic benefits.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148973000","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":"Implementing system improvement actions after peer review of emergency department incident reports: a before-and-after quality improvement evaluation.","authors":"Natsumi Hata, Tatsuya Nishiuchi","doi":"10.1093/intqhc/mzag139","DOIUrl":"10.1093/intqhc/mzag139","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Emergency departments are high-risk, high-workload settings where safety incidents and near misses may occur. However, incident reporting systems do not consistently translate reported events into timely learning and actionable system change. We evaluated a quality improvement initiative that integrated frontline peer review and recurring joint incident meetings into a centrally managed hospital incident reporting system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a single-center retrospective before-and-after evaluation in an urban tertiary-care emergency department. The intervention comprised an introductory session emphasizing a learning-oriented, non-punitive approach to incident reporting; end-of-shift mini-discussions; monthly peer review of incident reports by an emergency department peer-review team; and monthly joint incident meetings with the hospital patient safety management department. We compared 12-month pre-intervention and post-intervention periods separated by a 1-month wash-in period. The primary outcome was the number of system improvement actions reaching each of three prespecified cumulative milestones: proposal, approval for implementation, and initiation of implementation as documented in meeting minutes. Actions were also classified as emergency department-only or hospital-wide in scope. Secondary outcomes were incident-reporting volume and degree of harm. Event type categories were described as report characteristics. Monthly reporting rates were analyzed using interrupted time-series regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Incident analysis generated 24 proposed system improvement actions; 20 were approved for implementation, and implementation was initiated for 16 during the study period. Of these 16 actions, 4 required hospital-wide coordination through cross-departmental operational changes or organizational policy revision. The ED recorded 29 023 visits and 184 incident reports during the pre-intervention period and 28 313 visits and 430 incident reports during the post-intervention period. The reporting rate increased from 6.34 to 15.19 per 1000 visits. In interrupted time series analysis, the post-intervention period was associated with an immediate increase in the reporting rate (incidence rate ratio 2.07, 95% confidence interval 1.37-3.13). There was no statistically significant change in slope. The overall distribution of the degree-of-harm categories did not differ between periods, and no incident reports were classified in the death category.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Integrating ED peer review and recurring joint incident meetings into a centrally managed incident reporting system provided a structured pathway through which system improvement actions progressed from proposal to approval and initiation of implementation, including actions requiring coordination beyond the ED. Longer follow-up and multicenter studies are needed to assess the sustainability of thi","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979248","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}