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

{"title":"Working hours, physician health, and quality of care: lessons from young doctors' deaths in Indonesia.","authors":"Muhammad Ali Adriansyah, Diana, Winastanto Wibowo, Aryanti Situmorang, Raup Padillah","doi":"10.1093/intqhc/mzag127","DOIUrl":"10.1093/intqhc/mzag127","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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868850","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":"Access and timeliness of acute stroke reperfusion after cluster-wide protocol standardization: an interrupted time-series study in Hong Kong.","authors":"Hoi-Lun Koo, Bun Sheng, Lilly D Engineer","doi":"10.1093/intqhc/mzag106","DOIUrl":"10.1093/intqhc/mzag106","url":null,"abstract":"<p><strong>Background: </strong>Protocol standardization is widely used to improve the quality and consistency of acute stroke reperfusion, but evidence from routine public hospital practice remains limited, particularly on whether gains are sustained during later periods of service stress. We evaluated changes in access to and timeliness of intravenous thrombolysis after cluster-wide protocol standardization in a Hong Kong public hospital cluster and examined whether these performance domains changed during a later Omicron-related service shock.</p><p><strong>Methods: </strong>In this interrupted time-series study, we analysed acute ischaemic stroke care in the Kowloon West Cluster, Hong Kong, from 1 January 2017 to 31 December 2024. Prespecified breakpoints were implementation of a unified reperfusion protocol in July 2019 and the Omicron-related service shock in February 2022. Primary monthly outcomes were intravenous thrombolysis rate, median door-to-needle time, and the proportion treated within 60 min. Secondary process outcomes were door-to-computed tomography time and imaging-to-needle interval. Secondary quarterly patient-centred outcomes were early neurological improvement at 24 h and 3-month functional outcome measured using the modified Rankin Scale.</p><p><strong>Results: </strong>Protocol implementation was associated with an immediate increase in intravenous thrombolysis access. Median door-to-needle time showed a more complex pattern, with an immediate worsening after protocol implementation followed by a favourable post-implementation trend. The proportion treated within 60 min improved after protocol implementation. During the Omicron period, thrombolysis access remained stable, but treatment timeliness deteriorated progressively. Decomposition of the reperfusion pathway suggested that this later erosion was driven mainly by prolongation of the downstream imaging-to-needle interval rather than by deterioration in initial imaging access. Early neurological improvement showed post-protocol improvement but attenuated during sustained service stress. Favourable 3-month functional outcome remained broadly stable, with sensitivity analyses yielding similar estimates despite declining follow-up completeness in the post-shock period.</p><p><strong>Conclusion: </strong>Cluster-wide protocol standardization was associated with improved access to intravenous thrombolysis and a mixed pattern in treatment timeliness. Implementation effects on timeliness were not linear and included early disruption, subsequent improvement, and later deterioration during prolonged service stress. Preserved treatment access should not be assumed to indicate preserved treatment speed. Quality evaluation of acute stroke services should distinguish access from timeliness and use pathway-level measurement to identify workflow segments most vulnerable to disruption.</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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148672027","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 clinician-led sustainability interventions in a tertiary intensive care unit: a quality improvement evaluation.","authors":"Wei Jun Dan Ong, Faheem Ahmed Khan, Woon Hean Keenan Chong, Lawrence Ace Azul, Amit Kansal","doi":"10.1093/intqhc/mzag132","DOIUrl":"10.1093/intqhc/mzag132","url":null,"abstract":"<p><strong>Background: </strong>Intensive care units are resource-intensive clinical environments with substantial material and environmental impacts. This study evaluated whether clinician-led sustainability interventions implemented through established quality improvement methods could reduce resource use while maintaining explicit safety oversight.</p><p><strong>Methods: </strong>We conducted a single-centre pre-post quality improvement evaluation in a 34-bed tertiary intensive care unit in Singapore. Following baseline audits, multidisciplinary stakeholder engagement and pragmatic prioritization, three interventions were implemented: digitization of clinical competency documentation, stewardship of ventilator circuits during intrahospital transport, and replacement of conventional sharps containers with repurposed disinfectant canisters for arterial blood gas syringe disposal. Interventions were refined using Plan-Do-Study-Act cycles; a structured process-redesign framework guided digitization, and Failure Modes and Effects Analysis informed risk mitigation for ventilator-circuit stewardship. Primary outcomes were changes in material use. Secondary outcomes included estimated environmental and cost impacts, staff acceptability and safety events identified through routine surveillance and incident reporting.</p><p><strong>Results: </strong>Full digitization eliminated ∼27 000 paper sheets annually. Ventilator-circuit use decreased by approximately three circuits per intubated admission, equivalent to an annualized reduction of 558 circuits. Repurposed canisters completely replaced 403 conventional sharps containers annually. These changes corresponded to an estimated annual reduction of ∼866 kg carbon dioxide equivalent. All 21 eligible respiratory therapists completed the circuit-stewardship survey, with favourable ratings for usability, preference, and perceived safety. Repurposed canisters were preferred over conventional sharps containers without a significant difference in perceived safety. No adverse events attributable to the revised workflows were detected.</p><p><strong>Conclusion: </strong>Clinician-led sustainability interventions integrated into established intensive care unit quality and safety -processes were associated with measurable reductions in material use. Multidisciplinary prioritization, iterative testing, and intervention-specific risk assessment provide a transferable approach for implementing sustainability initiatives in -critical 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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957820","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":"From reactive compliance to systemic value: a paradigm shift in global patient safety.","authors":"Tong Liu, Ji Luo, Feng Xiao, Jinmei Jiang, Jun Wang, Qinghua Zhao, Mingzhao Xiao","doi":"10.1093/intqhc/mzag126","DOIUrl":"10.1093/intqhc/mzag126","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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851617","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":"From compliance to prediction: Clinical laboratories as digital infrastructure for health-system quality and safety.","authors":"Shruti Gupta, Prasenjit Mitra","doi":"10.1093/intqhc/mzag091","DOIUrl":"10.1093/intqhc/mzag091","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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280788","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":"What supports sustainable pace in the operating room? A sequential explanatory mixed-methods study using self-determination theory.","authors":"Johan Eriksson, Kristina Lämås, Lena Lindholm, Micael Appelblad, Malin Sund","doi":"10.1093/intqhc/mzag130","DOIUrl":"10.1093/intqhc/mzag130","url":null,"abstract":"<p><strong>Background: </strong>Operating-room productivity is commonly pursued through throughput metrics, yet frontline staff point to organizational and interpersonal conditions that make a working pace sustainable. How everyday practices relate to staff motivation, and thereby to dependable workflow, remains underexplored.</p><p><strong>Research question: </strong>(1) What organizational and interpersonal conditions support or thwart a sustainable work pace among perioperative nursing staff? (2) How can these conditions be understood through Self-Determination Theory (SDT)?</p><p><strong>Methods: </strong>We used a sequential explanatory mixed-methods design at two operating room units in a Swedish university hospital. In Phase 1 the Safety Attitudes Questionnaire-Operating Room version was administered (October 2022; n = 47) to profile contextual contrasts between units. In Phase 2, semi-structured interviews (December 2022-March 2025; n = 24) were analyzed with inductive qualitative content analysis, after which SDT was used to interpret the resulting categories. Qualitative reporting followed the COREQ.</p><p><strong>Results: </strong>Survey responses differed between units in safety climate (32% vs. 68%; P = .02), stress recognition (57% vs. 21%; P = .02) and perceptions of management (18% vs. 63%; P = .002). Interviews yielded four cross-cutting conditions: predictable workflow and usable tools; psychologically safe teamwork; participatory planning with visible follow-through; and learning structures for mastery, with workload as a boundary condition. The same families of practice appeared at both units but were described with differing emphasis. Interpreted through SDT, these conditions supported autonomy, competence and relatedness when present and thwarted them when absent; need-thwarting patterns (late list changes, parallel documentation, sharp communication, tokenistic consultation) co-occurred with workarounds and conditional intentions to stay.</p><p><strong>Conclusion: </strong>Among perioperative nursing staff, a sustainable pace was described less as working slowly than as predictable routines, professional judgement over timing, stable teamwork, and protected standards of care under pressure. Modest, auditable routines that jointly support autonomy, competence and relatedness offer transferable, hypothesis-generating design principles for dependable operating-room productivity, rather than a ranking of units.</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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922513","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":"Decarbonizing health systems while protecting quality and safety: everyone has a role.","authors":"Jeffrey Braithwaite, Samantha Spanos, Carolynn L Smith, Yvonne Zurynski, Georgia Fisher, Lisa Pagano, Louise A Ellis, Kate Churruca, Ellen Joan van Vliet, Ezequiel Garcia-Elorrio","doi":"10.1093/intqhc/mzag137","DOIUrl":"10.1093/intqhc/mzag137","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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979240","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":"Glucometer versus standard enzymatic method for gestational diabetes mellitus: a systematic review for diagnostic test accuracy.","authors":"Laarni Hannah Lacorte, Wilfredo Quijencio, Lucylynn Lizarondo","doi":"10.1093/intqhc/mzag109","DOIUrl":"10.1093/intqhc/mzag109","url":null,"abstract":"<p><strong>Background: </strong>Gestational diabetes mellitus (GDM) is a major obstetric complication associated with adverse maternal and neonatal outcomes. Although the oral glucose tolerance test (OGTT) remains the diagnostic gold standard, its implementation is often constrained by logistical, financial, and infrastructural limitations, particularly in low- and middle-income countries. Point-of-care (POC) glucometers offer a rapid and accessible alternative; however, their diagnostic accuracy in pregnant populations remains uncertain.</p><p><strong>Methods: </strong>This systematic review followed the Joanna Briggs Institute (JBI) methodology for diagnostic test accuracy reviews. Electronic databases including PubMed, EMBASE, and the Cochrane Library, as well as gray literature sources, were searched for studies published from 2013 to March 2025. Eligible studies included pregnant women screened for GDM using POC glucometers compared with OGTT as the reference standard. Data on diagnostic performance and methodological quality were extracted and assessed using JBI and QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tools. Due to substantial heterogeneity, findings were synthesized narratively.</p><p><strong>Results: </strong>Six studies comprising 2856 pregnant women were included. Reported sensitivity ranged from 27.0% to 100%, while specificity ranged from 31.5% to 98.8%. Diagnostic performance varied widely depending on device type, enzymatic method, calibration of diagnostic thresholds, and pre-analytical handling. Studies employing validated enzymatic methods and calibrated capillary thresholds demonstrated higher accuracy, whereas unadjusted cut-offs and inconsistent procedures were associated with poor performance.</p><p><strong>Conclusion: </strong>Point-of-care glucometers may serve as alternative tools for GDM diagnosis in resource-constrained settings; however, their reliability is highly dependent on procedural rigor and threshold validation. Further standardized, high-quality studies are required before routine clinical adoption can be recommended.</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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703323","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":"Factors influencing perceived risk of lonely death among older adults living alone: analysis of the 2024 Seoul Senior Citizen Survey.","authors":"Hye Jin Nam, Sujin Lee, Han Nah Park","doi":"10.1093/intqhc/mzag094","DOIUrl":"10.1093/intqhc/mzag094","url":null,"abstract":"<p><strong>Background: </strong>As the elderly population in Korea rapidly increases, issues related to lonely death have also emerged as a social concern. The purpose of this study is to identify factors influencing the subjectively perceived risk of lonely death among older adults living alone.</p><p><strong>Methods: </strong>This study employed a cross-sectional design using secondary data from the seventh wave (2024) of the Seoul Senior Citizen Survey. A total of 955 older adults aged ≥65 years living alone in Seoul were included in the analysis. Descriptive statistics, Rao-Scott χ2 tests, F-tests, and complex sample multinomial logistic regression were conducted using complex sample procedures.</p><p><strong>Results: </strong>Significant differences across the lonely death risk groups (low, moderate, and high) were observed in relation to gender, education, household income, economic satisfaction, housing satisfaction, frequency of in-person contact, eating alone, satisfaction with social relationships and social/cultural activities, depression, history of falls, instrumental activities of daily living, subjective health, and preparedness for dying alone. Factors significantly associated with the subjectively perceived risk of lonely death included low housing satisfaction, eating alone, dissatisfaction with social relationships, and preparedness for dying alone. The perceived risk of lonely death among older adults living alone varies according to a range of social, economic, and environmental factors.</p><p><strong>Conclusion: </strong>The results of this study may serve as foundational resources for future research and policy development aimed at preventing lonely death.</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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400491","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":"Medical waste management within the Green Hospital approach: a systematic review of direct, contextual, and transferable evidence.","authors":"İbrahim H Kayral, Yankuba B Manga, Şeyma Boz, Peter Lachman, Usman Iqbal","doi":"10.1093/intqhc/mzag103","DOIUrl":"10.1093/intqhc/mzag103","url":null,"abstract":"<p><strong>Background: </strong>Medical waste management is a central pillar of the Green Hospital approach, yet evidence on effective strategies and system-level barriers remains fragmented. This systematic review synthesizes direct medical-waste-management evidence together with healthcare-sustainability and transferable waste-system evidence relevant to the Green Hospital framework.</p><p><strong>Methods: </strong>We conducted a systematic review in accordance with PRISMA 2020. The review protocol was registered in PROSPERO (CRD420251168204). Six bibliographic databases and one grey-literature source were searched for original empirical, intervention, case-study, modelling, and optimization studies published online between 1 January 2020 and 27 August 2025 that examined medical waste management or provided clearly relevant healthcare-sustainability or transferable waste-system evidence. Two reviewers independently screened records, extracted data, and appraised methodological quality using design-appropriate criteria: the Mixed Methods Appraisal Tool for empirical studies and an adapted model-appraisal framework for modelling, optimization, framework-development, and technology-evaluation studies.</p><p><strong>Results: </strong>Of the 21 included studies, 15 provided direct medical-waste-management evidence, five provided healthcare-sustainability or planetary-health contextual evidence, and one provided transferable waste-system evidence. Behavioural compliance, education, or segregation was addressed in 11 studies (52%); workflow or operational optimization in four studies (19%); digital or decision-support systems in five studies (24%); environmental or economic assessment, modelling, circularity, or resource recovery in 10 studies (48%); and systemic or organizational barriers in seven studies (33%). Studies could contribute to more than one synthesis theme; therefore, these categories were not mutually exclusive.</p><p><strong>Conclusion: </strong>Sustainable medical waste management within the Green Hospital framework requires an integrated socio-technical strategy combining behavioural reinforcement, operational improvement, decision-support technologies, environmental and economic assessment, and enabling governance. These findings can be interpreted through a Human Factors and Ergonomics (HFE) lens, although formal HFE interventions were not consistently evaluated in the included studies.</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":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13492086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671965","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}