BMJ Open Quality最新文献

{"title":"Improving the primary care clinical testing process in southwest Scotland: a systems-based approach.","authors":"Alex Howson, Richard Ishmael","doi":"10.1136/bmjoq-2024-002901","DOIUrl":"10.1136/bmjoq-2024-002901","url":null,"abstract":"<p><strong>Introduction: </strong>Across all healthcare environments, inadequately specified patient test requests are commonly encountered and can lead to wasted clinician time and healthcare resources, in addition to either missed or unnecessary testing taking place.Before this work, in a general practice in Southwest Scotland, a mean value of 42% of test requests were already uploaded to ordercomms (a widely used system in general practice for designating clinical testing instructions) at patient presentation, leaving an opportunity for error and wasted clinician time/resources.</p><p><strong>Methods: </strong>Patient appointment records were retrospectively reviewed in a general practice in Southwest Scotland to monitor the proportion of test requests already uploaded to ordercomms at the time of patient presentation.The use of quality improvement tools and plan-do-study-act cycling allowed the testing of four change ideas attributable to different 'pathways' of origin for test requests.Change ideas included increasing clinician and secondary care/docman origin test requests already on ordercomms prior to patient presentation, reducing patient origin test requests and improving the test requesting system.</p><p><strong>Results: </strong>The percentage of test requests already on ordercomms at patient presentation increased from a mean of 42% to 89% over a 30 week test period. The use of test pre-set templates was a welcome intervention that was agreed to be made accessible to 30+ regional general practices.</p><p><strong>Conclusion: </strong>The use of pre-set templates for clinical testing encouraged a 47% rise in test requests already uploaded to ordercomms prior to patient presentation. This saved up to 90 min of clinician time weekly and ensured patients received the correct tests at the appropriate time.Our findings supported the use of pre-set testing templates, in combination with effective information communication, and were recommended for use in any clinical environment requiring patient testing.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614258","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":"Simulation with Monte Carlo methods to focus quality improvement efforts on interventions with the greatest potential for reducing PACU length of stay: a cross-sectional observational study.","authors":"James Harvey Jones, Neal Fleming","doi":"10.1136/bmjoq-2024-002947","DOIUrl":"10.1136/bmjoq-2024-002947","url":null,"abstract":"<p><strong>Background: </strong>Time and money are limited resources to pursue quality improvement (QI) goals. Computer simulation using Monte Carlo methods may help focus resources towards the most efficacious interventions to pursue.</p><p><strong>Methods: </strong>This observational, cross-sectional study analysed the length of stay (LOS) for adult American Society of Anesthesiologists (ASA) 1-3 patients in the postanaesthesia care unit (PACU) at a major academic medical centre. Data were collected retrospectively from 1 April 2023 to 31 March 2024. Statistical analysis with Monte Carlo methods simulated the per cent reduction in PACU LOS following the elimination of postoperative nausea and vomiting (PONV), hypothermia (initial temperature<36°C), severe pain (pain score≥7) or moderate opioid use (≥ 50 mcg fentanyl or≥0.4 mg hydromorphone).</p><p><strong>Results: </strong>The PACU LOS of 7345 patients were included in this study. PONV was experienced by 10.29% of patients and was associated with a mean PACU LOS of 96.64 min (±33.98 min). Hypothermia was the least frequent complication, experienced by 8.93% of patients and was associated with a mean PACU LOS of 83.55 min (±35.99 min). Severe pain and moderate opioid use were seen in 34.05% and 40.83% of patients, respectively and were associated with PACU LOS that were shorter than those experienced by patients with PONV. Monte Carlo simulations demonstrated that the greatest impact on PACU LOS (12.5% (95% CI 12.0% to 13.0%)) would result from the elimination of moderate opioid use.</p><p><strong>Discussion: </strong>Although PONV was associated with the longest PACU LOS, statistical simulation with Monte Carlo methods demonstrated the greatest per cent reduction in PACU LOS would result from the elimination of moderate opioid use, thus indicating the most efficacious project to pursue.</p><p><strong>Conclusion: </strong>Statistical simulation with Monte Carlo methods can help guide QI teams to the most efficacious project or intervention to pursue.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614429","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":"Increasing resuscitation status-related goals of care discussions for older adults with severe mental illness in a Canadian mental health setting: a retrospective study.","authors":"Cristina de Lasa, Elnathan Mesfin, Tania Tajirian, Caroline Chessex, Brian Lo, Sanjeev Sockalingam","doi":"10.1136/bmjoq-2024-002798","DOIUrl":"10.1136/bmjoq-2024-002798","url":null,"abstract":"<p><strong>Background: </strong>Older adults with severe mental illness, including advanced dementia (AD), within geriatric admission units (GAU) often prioritise comfort care, avoiding life-prolonging procedures including cardiopulmonary resuscitation (CPR). Pre-2019, hospital policy lacked a resuscitation status order (RSO) incorporating distinct do-not-resuscitate levels. Providers entered 'NO CPR' orders in the electronic health record (EHR), necessitating transfers for non-CPR medical issues, contradicting patient preferences.</p><p><strong>Methods: </strong>The study aimed for a 75% increase in resuscitation status-related (RSR) goals of care discussion (GOCD) completion rates within 1 week of GAU admission or transfer by December 2022. We implemented an EHR RSO, updated hospital policy and provided staff education. A 4-year GAU retrospective chart review assessed RSR GOCD frequency, completion time, documentation quality and discrepancies. Additionally, an environmental scan identified contributing factors to RSR GOCD.</p><p><strong>Results: </strong>Among 431 reviewed charts, the mean RSR GOCD completion rate was 13.9%; taking 39.5 days, with extreme outliers removed, the mean of time to completion was 15 days. Subgroup analysis highlighted a significant difference in RSR GOCD completion rates for AD (41.6%) compared with non-AD patients (16.3%). Discrepancy rates in charts with RSR GOCD were substantial: documentation without a corresponding RSO (66.7%), RSO without documentation (26.1%) and discordant resuscitation status between documentation and RSO (7.2%). Documentation quality varied: 32.9% lacked context, 20.7% had limited context, while 46.3% provided comprehensive context. Barriers to RSR GOCD included the absence of an EHR documentation tool and clear triggers.</p><p><strong>Conclusion: </strong>RSR GOCD completion rates were lower and took longer than anticipated, highlighting improvement opportunities. AD subgroup analysis indicated provider awareness of RSR GOCD importance in this population. Discrepancies and documentation quality issues pose risks to patient-centred care. Collaborative stakeholder efforts are imperative for developing system-based informatics solutions, ensuring timely, comprehensive and patient-centred RSR GOCD.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614413","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":"Aligning implementation research and clinical operations: a partnership to promote implementation research in primary care.","authors":"Valerie Chepp, Steven Masiano, Mario Scarcipino, Audrey Hudak, Eva Steinel, Christopher Babiuch, Anita D Misra-Hebert","doi":"10.1136/bmjoq-2024-002879","DOIUrl":"10.1136/bmjoq-2024-002879","url":null,"abstract":"<p><p>The rigorous evaluation of the implementation of evidence into routine practice in a health system requires strong alignment between research and clinical operational teams. Implementation researchers benefit from understanding operational processes and contextual factors when designing data collection while operational teams gain an understanding of implementation frameworks and outcomes using both qualitative and quantitative data. However, interventions to build capacity for these evaluation partnerships-particularly those tailored for clinical operational practitioners-are limited. We developed a model for a research-clinical operational partnership to build capacity for rigorous implementation evaluation. The model incorporated didactic and interactive education alongside small group discussion. Using reflective qualitative analysis, we show how the year-long partnership resulted in an effective collaboration that built capacity for rigorous operational evaluation, informed plans for data collection to include provider and patient barriers to adoption and increased awareness of implementation cost barriers. Improved capacity for implementation evaluation was demonstrated by the knowledge acquisition that resulted for both teams as a result of the collaboration and the education that penetrated to other aspects of the operational team's work beyond the immediate project. Programme successes and improvement opportunities were also identified. The partnership model shows how a formal research-clinical operational collaboration can build capacity for rigorous implementation evaluation and close the gap between implementation researchers and practitioners in a large health system. While larger-scale process evaluation is common, creating space for project-specific capacity-building initiatives, with varying levels of research involvement, can also advance the field of implementation science, offering new perspectives and partnerships, as well as opportunities to advance learning even for smaller-scale evidence translation.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614331","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":"Combining quality improvement and critical care training: Evaluating an ICU CPR training programme quality improvement initiative at the National Hospital in Tanzania.","authors":"Samantha Strelzer, Joseph Julius, Niyo Anicet, Odillo Byabato, Faraja Chiwanga, Saria Hassan, Festo Kayandabila, Agness Laizer, Trustworthy Majuta, Brittany Murray, Tatu Said, Samson Ndile","doi":"10.1136/bmjoq-2024-002891","DOIUrl":"10.1136/bmjoq-2024-002891","url":null,"abstract":"<p><strong>Background: </strong>The United Republic of Tanzania has had a 41.4% mortality rate in the intensive care unit. In Tanzania, the Ministry of Health and Social Welfare has implemented quality improvement (QI), yet the Tanzanian health sector continues to face resource constraints, unsustainable projects and gaps in knowledge and skills, contributing to unacceptably high mortality rates for Tanzanian patients. This research aims to determine if a Critical Care Training Program incorporating QI concepts can improve technical competence and self-efficacy of providers in a critical care setting in Tanzania.</p><p><strong>Methods: </strong>A 2-day Critical Care Training Program was developed for providers. It included the following modules: vital signs directed therapy (VSDT), cardiopulmonary and brain resuscitation (CPBR), blood glucose monitoring, introduction to critical care concepts and the QI concept of change management. For analysis, data were collected from pretests and post-tests and reported in REDCap. Descriptive statistics and paired t-tests were performed (alpha=0.05).</p><p><strong>Results: </strong>A total of 77 nurses and three providers attended the training. The overall score changes among participants for CPBR and VSDT were significant (p<0.001). Six out of 10 questions in CPBR demonstrated significant improved change (p<0.001). All questions in the VSDT training showed significant improvement (p<0.001). Based on hospital guidelines, 63 (95.5%) passed the CPBR evaluation and 62 (95.2%) passed VSDT.</p><p><strong>Conclusion: </strong>A pre/post analysis demonstrated improvement in knowledge, skills and increased confidence towards emergencies. This study suggests a Critical Care Training Program significantly improves the knowledge among providers and that QI impacts culture of change. This research exemplifies a systematic approach to strengthening capacity of critical care delivery in limited resource settings, with implications for further innovation in other low- and middle-income countries.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":16.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603410","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":"Improving the non-ST-segment elevation acute coronary syndrome (NSTEACS) pathway using quality improvement methodology.","authors":"Susan Goodfellow, Jonathan Goodfellow","doi":"10.1136/bmjoq-2024-002864","DOIUrl":"10.1136/bmjoq-2024-002864","url":null,"abstract":"<p><strong>Background: </strong>The National Institute for Health and Care Excellence (NICE) guideline quality standard for non-ST-segment elevation acute coronary syndrome (NSTEACS) pathway states that adults who have an intermediate or higher risk of future adverse cardiovascular events should undergo coronary angiography within 72 hours of first admission to hospital.The aim was to improve compliance with the 72-hour NICE quality standard for the acute coronary syndrome pathway between one district general hospital (DGH) and its cardiac tertiary centre by reducing the time from admission to angiography by 50%.Participants were front-line staff in the DGH and staff in the cardiac catheter laboratory in the tertiary centre.</p><p><strong>Methods: </strong>Continuous data were collected prospectively on all patients entering the NSTEACS pathway with time of arrival to hospital; referral to angiography; and start of angiogram to measure the NSTEACS pathway duration against the NICE quality standard. We used process mapping, ease-benefit matrix, Pareto analyses and the Institute for Healthcare Improvement (IHI) Plan-Do-Study-Act (PDSA) method of quality improvement.</p><p><strong>Intervention: </strong>Staff in both hospitals performed process mapping of their respective parts of the NSTEACS pathway. Their data informed decisions on process changes using the ease-benefit matrix. PDSA cycles were commenced, and changes were assessed using continuous measurement of pathway duration. In the tertiary centre, Pareto analysis was performed to help identify the major service constraints.</p><p><strong>Results: </strong>Between January 2021 and March 2023, there were four separate PDSA cycles, two each in the DGH and tertiary centre. Across the four PDSA cycles, the time to complete the pathway reduced from an average of 172 to 94.72 hours, an improvement of 45%, along with an overall reduction in variability of data. In the DGH, the process changes were sustained, but in the tertiary centre they were not, as PDSA 4 required staff recruitment to enable a 6-day rather than a 5-day service per week.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":16.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603425","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":"Achieving and sustaining reduction in hospital-acquired complications in an Australian local health service.","authors":"Qun Catherine Li, Jim Codde, Jonathan Karnon, Dana Hince","doi":"10.1136/bmjoq-2024-002940","DOIUrl":"10.1136/bmjoq-2024-002940","url":null,"abstract":"<p><strong>Background: </strong>Reducing the prevalence of hospital-acquired complications (HACs) is paramount for both patient safety and hospital financial performance because of its impact on patient's recovery and health service delivery by diverting resources away from other core patient care activities. While numerous reports are available in the literature for projects that successfully reduce specific HAC, questions remain about the sustainability of this isolated approach and there may be benefits for more wholistic programmes that aim to align prevention strategies across a hospital. This study describes such a programme that uses evidence and theories in the literature to achieve and sustain a reduction in HACs in an Australian local health service between 2019 and 2022.</p><p><strong>Methods: </strong>An organisation-wide HACs Reduction Programme underpinned by a 3-pillar strategic framework (complete documentation, accurate coding, clinical effectiveness) and a 5-year roadmap to clinical excellence was developed. Priorities were identified through Pareto analysis and aligned at organisational, service and specialty levels. The Institute for Healthcare Improvement (IHI) 90-day cycle was modified to implement contextualised evidence-based interventions supported by the application of the Awareness, Desire, Knowledge, Ability and Reinforcement change management model. Under this wholistic umbrella, specific projects were data-driven, evidence-based and outcome-oriented to promote clinical engagement and a continuous improvement culture.</p><p><strong>Results: </strong>Overall mean HAC rate per 10 000 episodes of care decreased from a baseline of 459.5 across 2017 and 2018 to 363.1 in 2019 and remained lower through to the end of 2022 indicating sustained improvement in performance.</p><p><strong>Conclusion: </strong>A wholistic approach to reduce HACs increased the likelihood of multidisciplinary integration for contextualised strategies and interventions. Improvement work, particularly in relation to patient outcomes, is a dynamic process that needs to be intentionally cultivated, targeted and coordinated. The modified IHI 90-day cycle proved to be an effective tool for implementation that contributed to sustained change.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142574953","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":"Increasing the uptake of advance care directives through staff education and one-on-one support for people facing end-of-life.","authors":"Leigh David Kinsman, Graeme Mooney, Gail Whiteford, Tony Lower, Megan Hobbs, Bev Morris, Kerry Bartlett, Alycia Jacob, Dan Curley","doi":"10.1136/bmjoq-2023-002727","DOIUrl":"https://doi.org/10.1136/bmjoq-2023-002727","url":null,"abstract":"<p><strong>Background: </strong>An advance care plan outlines a patient's wishes regarding medical treatment or goals of care in the case that they become unable to communicate or to make decisions. An advance care directive (ACD) is an advance care plan that has been formally recorded and has legal status. Despite ACDs playing an important role in person-centred end-of-life care, an earlier retrospective medical records audit demonstrated that only 11% (58/531) of people who died due to a terminal illness had an ACD.The aim of this project was to increase the proportion of patients with a terminal illness completing an ACD. A secondary outcome was to measure the impact of ACDs on hospital and intensive care unit (ICU) admissions in the last 6 months of life.This multifaceted project comprised (1) education for health professionals and the public; (2) individual support for patients on request; (3) development of online resources for health professionals and the general public; and (4) monthly team meetings.</p><p><strong>Method: </strong>The proportion of ACDs completed and hospital and ICU admissions during the last 6 months of life, were extracted via medical record audits.Written consent was required for patients to participate, including being contacted by the project team and accessing their medical records.</p><p><strong>Results: </strong>112 patients consented to participate in the project and 109 (97%) completed an ACD. There was no reduction in the average number of hospital admissions, while ICU admissions reduced from 14% (n=74) to 0%.</p><p><strong>Conclusion: </strong>The targeted, multifaceted approach to education and support for completion of ACDs, resulted in a significant increase in ACD completion and a major reduction in ICU admissions.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563928","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":"Click and learn: a longitudinal interprofessional case-based sepsis education curriculum.","authors":"Samita M Heslin, Asem Qadeer, AnnMarie E Kotarba, Sahar Ahmad, Eric J Morley","doi":"10.1136/bmjoq-2024-002859","DOIUrl":"10.1136/bmjoq-2024-002859","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a global healthcare challenge and a leading cause of morbidity and mortality. In the USA, the Centers for Medicare & Medicaid Services has integrated the Severe Sepsis and Septic Shock Management Bundle (SEP-1) into their Core Quality Measures, which has been linked to lower mortality rates. However, SEP-1's multiple bundle elements present compliance challenges without comprehensive education and a collaborative approach involving nurses and providers (attending physicians, resident physicians, nurse practitioners and physician assistants).</p><p><strong>Methods: </strong>We developed a virtual longitudinal, case-based curriculum using Kern's six-step approach to curriculum development and evaluated its effectiveness using the Kirkpatrick model. The curriculum was distributed hospital-wide over a 32-month period.</p><p><strong>Results: </strong>A total of 3616 responses were received for the Sepsis Case-Based Curriculum modules, with 47% from nurses and 53% from providers. Responses were distributed similarly among medical and surgical specialties, as well as intensive care units. Nurses' responses were 56% correct, and providers' responses were 51% correct. Most respondents expressed a likelihood of applying the learning to their practice and reported increased knowledge of sepsis. Themes from participant feedback indicated that they found the activity informative and applicable to real-world cases. Additionally, the hospital's SEP-1 bundle compliance improved from 71% (Q1 2021) to 80% (Q3 2023) during the study period.</p><p><strong>Conclusion: </strong>Meeting SEP-1 bundle elements requires a team-based approach involving providers and nurses. Given the busy hospital environment and diverse care providers, a longitudinal, engaging and concise educational curriculum related to real-life scenarios can enhance sepsis and SEP-1 education.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563924","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":"Community breast pain clinics can provide safe, quality care for women presenting with breast pain.","authors":"Mark Sibbering, Veronica Rogers, Louise Merriman, Iman Azmy, Denise Stafford, Kevin Clifton, Jennifer Pickard, Thilan Bartholomeuz, John Robertson","doi":"10.1136/bmjoq-2024-002882","DOIUrl":"10.1136/bmjoq-2024-002882","url":null,"abstract":"<p><strong>Introduction: </strong>Breast pain is not typically a symptom of breast cancer, yet nationally 20% of 2-week wait (2WW) breast referrals are breast pain alone. The East Midlands Breast Pain Pathway improves patient experience and frees capacity in secondary care diagnostic breast clinics, managing women with breast pain only in a community setting. We report the results of implementation of community breast pain clinics (CBPCs) at sites in Derbyshire (catchment population ~1 million), with 12 months follow-up data.</p><p><strong>Results: </strong>1036 patients were seen at CBPCs between June 2021 and February 2023. The median patient age was 49 (range 16-88) years. 993 patients (95.8%) were discharged from the clinic with breast pain management advice. 43 (4.2%) patients were referred for further assessment at a 2WW breast diagnostic clinic. Objective family history risk assessment identified 124 patients (12.3%) above population risk of breast cancer, who were offered referral to familial cancer services for ongoing management.</p><p><strong>Discussion: </strong>Seven patients were diagnosed with breast cancer at or within 12 months of CBPC attendance. Five patients were diagnosed through attending the CBPC, one patient was subsequently referred to 2WW clinic with a new symptom and had a mammographically occult tumour and one was diagnosed following a subsequent routine breast screening invitation. Two of the five patients had a personal history of breast cancer which was a stated exclusion criterion for the CBPC. Breast cancer incidence in women with breast pain only and fulfilling CBPC referral criteria was 4.8/1000, confirming that this population is at low risk of developing breast cancer.Patient service satisfaction was high with 99% (n=1022) 'extremely likely or likely' to recommend the service.</p><p><strong>Conclusion: </strong>The results confirm the pathway is the first to demonstrate women can be safely managed with breast pain alone in a community setting with high levels of patient satisfaction.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543549","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}