BMJ Open Quality最新文献

{"title":"Anaesthesiologists' Non-Technical Skills in Denmark Form: cross-cultural adaptation, reliability and validity of Turkish version in paediatric surgery team.","authors":"Nazmiye Celik, Senay Sarmasoglu Kilikcier, Gulsen Tasdelen Teker, Gulsen Keskin, Mine Akın, Sengul Ozmert, Melih Elcin, Emrah Senel","doi":"10.1136/bmjoq-2024-003249","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003249","url":null,"abstract":"<p><strong>Background: </strong>The Anaesthesiologists' Non-Technical Skills in Denmark Form (ANTSdk) is a widely accepted, practical, and comprehensive measurement tool used by anaesthesiologists and other healthcare professionals. This study aims to adapt the ANTSdk into Turkish as a valid and reliable assessment instrument. By doing so, it will contribute to establishing a common language and standardised terminology for integrating non-technical skills into the Turkish healthcare system.</p><p><strong>Methods: </strong>We conducted a standardised cross-cultural adaptation process. The psychometric properties of the Turkish-adapted version of the ANTSdk were evaluated through observations of 81 real paediatric surgical operating room teams, assessed simultaneously by two independent observers. Validity was examined using content validity analysis and confirmatory factor analysis. Internal consistency and inter-rater reliability of the Turkish version of ANTSdk (ANTStr) were also assessed.</p><p><strong>Results: </strong>The specified factorial model retained the same grouping of elements into four domains as in the original version of ANTSdk. All standardised factor loadings were greater than 0.3. The inter-rater reliability, measured by the intraclass correlation coefficient of the global score, was 0.98. The Cronbach's alpha coefficient for the scores provided by the first rater ranged from 0.83 to 0.94, while for the second rater, it ranged from 0.84 to 0.94. The generalisability coefficient calculated for ANTStr was exceptionally high at 0.96.</p><p><strong>Conclusion: </strong>The Turkish version of ANTSdk demonstrates strong psychometric properties for evaluating paediatric surgical team performance in the operating room. This translated instrument can be used to assess non-technical skills in paediatric surgical teams within real clinical settings, facilitating benchmarking and international collaboration.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636137","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":"Delphi analysis of how the practice team should organise event analysis in primary care.","authors":"Karena Hanley, Duncan McNab, Paul Bowie, Alexia Pellowe, Veronica Rainey","doi":"10.1136/bmjoq-2024-003282","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003282","url":null,"abstract":"<p><strong>Introduction: </strong>Significant event analysis is a common quality improvement activity in UK general practice (GP). How well do general practice (GP) teams conduct their analyses? There is little guidance and no measuring tool. This is a Delphi analysis among Scottish multidisciplinary primary care team members to establish a set of quality indicators by which practices can self-assess their practice processes in conducting their event analyses.</p><p><strong>Methods: </strong>A Delphi method specifically for identifying quality indicators in healthcare was used. Purposeful selection was of primary care team members with known experience of significant event analysis; informed participants. After setting a consensus score, 29 items for the first round Delphi survey, drawn from the literature, were sent out with the ability to comment on each. The second Delphi round contained those items which had passed the consensus score, the aggregated comments on those items and any suggestions for new items.</p><p><strong>Results: </strong>Of 24 informed participants approached, 10 (37.5%) agreed to undertake the full cycle of the Delphi process. 17 items from the first Delphi survey passed the consensus score with one additional item suggested. With the amalgamation of items, 16 statements were presented in the second Delphi, of which 15 passed the consensus score.</p><p><strong>Conclusions: </strong>Learnings from our Delphi are that practitioners prefer the term 'learning event analysis' to 'significant event analysis', and that practice nurses may need specific encouragement to become more involved in event analysis. There is reluctance to involve patients or patient representatives in the event analysis itself. Engagement in well-conducted event analysis strengthens the whole practice team.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636138","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":"Implementation of a multicomponent intervention including clinical decision support (CDS), e-course and feedback to improve general practitioners' radiology referrals: a feasibility study and study protocol.","authors":"Aslak Bjarne Aslaksen, Mia Louise Halsvik Mowinckel-Nilsen, Stefán Hjörleifsson, Nicolas Melchior Frederic Øyane, Satya Pal Sharma, Erik Vang, Miriam Hartveit, Stig Harthug","doi":"10.1136/bmjoq-2024-003256","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003256","url":null,"abstract":"<p><strong>Introduction: </strong>Overuse of high-cost imaging like MRI and CT scans is a growing concern, with 4-100% of examinations deemed of low value. This contributes to unnecessary healthcare costs and patient risks such as overdiagnosis. Norwegian general practitioners (GPs) demonstrate variable referral practices, with many referrals being inconsistent with guidelines. The study aimed to evaluate the feasibility and usability of 'VeRaVest,' a multicomponent intervention targeting improved radiology referral practices among GPs in Western Norway.</p><p><strong>Methods: </strong>The intervention combined three elements: (1) referral guidelines integrated into electronic systems, (2) group-based courses on guideline compliance using quality improvement principles and (3) a web-based feedback system. The study was conducted with 139 GPs recruited in two cohorts in 2023, evaluated using a step-wedge design. Data sources included qualitative feedback from GPs and quantitative measures like referral completion rates. Participants' referral data were anonymised and analysed using a PACS/RIS (Pictures Archive and Communications System/Radiology Information System) system.</p><p><strong>Results: </strong>Preliminary results indicate high GP satisfaction with the intervention. About 76% of participants reported changes in referral practices, including improved indication assessments, better referral descriptions and enhanced patient communication. GPs emphasised the importance of accessible guidelines, peer-based learning and actionable feedback. Integration of decision support tools and guideline-based training was pivotal in aligning practices with national standards.</p><p><strong>Discussion: </strong>The multicomponent VeRaVest intervention demonstrated feasibility and potential to reduce low-value imaging practices. Success hinged on embedding guidelines into workflows, fostering peer engagement and ensuring practical relevance. Future evaluations will focus on quantitative outcomes, including referral rates and quality. Findings suggest scalability to other healthcare settings and regions.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583047","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":"Unveiling team needs: a qualitative study of simulation training for endovascular cerebral thrombectomy.","authors":"Caroline Guldberg Fugelli, Britt Sætre Hansen, Hege Ersdal, Martin Kurz","doi":"10.1136/bmjoq-2024-002981","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002981","url":null,"abstract":"<p><strong>Background: </strong>Effective multidisciplinary teamwork is crucial for successful endovascular thrombectomy (EVT) treatment, a critical stroke intervention classified as a non-operating room anaesthesia (NORA) procedure. Our hospital incorporated EVT training into regular stroke simulation training. This study aimed to investigate team members' experiences of simulation training in preparation for clinical EVT, including how the training and related clinical procedures could be improved to address their identified needs.</p><p><strong>Methods: </strong>Six focus group interviews (one anaesthesia-only professional, five mixed healthcare professionals) were conducted with a purposeful sample of EVT team members. The data were analysed using inductive qualitative content analysis.</p><p><strong>Results: </strong>EVT team members considered simulation training an essential introduction to the clinical procedure, particularly for familiarisation with the angio suite, equipment, team roles and communication. However, they reported that the simulation did not prepare them for challenges inherent to NORA procedures encountered during clinical EVT. These included managing multidisciplinary task interactions, maintaining haemodynamic and respiratory stability, and working within spatial and access constraints. Consequently, the experience of disorganised teamwork persisted in clinical EVT. The team members reported a lack of shared understanding of roles, responsibilities and communication expectations, particularly between anaesthesia professionals and other team members. This contributed to unfamiliarity with team dynamics and workflow. The clinical EVT team leader inconsistently facilitated collaboration, impacting team communication and effectiveness. The participants proposed modifications to the simulation training and clinical procedure to address these issues.</p><p><strong>Conclusions: </strong>Our study highlights the need to incorporate the multidisciplinary challenges of NORA procedures into EVT simulation training, emphasising active input from all professional groups involved in the EVT team, particularly anaesthesia. Practical recommendations for planning and implementing such simulation training are proposed.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582979","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 the rates of inpatient HbA_1c assessment and medication deintensification in people with diabetes and frailty.","authors":"Ali Kareem, Hnin Lwin, Mohamed Fazil, Anu Thomas, Kevin Thottungal, Garima Gupta, Kashish Gera, Jawad Malik, Htet Lynn, Vishnusankar Umasankar, HayMar Tun, Aung Myo Naing, Sadaf Saeed, Meri Davitadze, Eka Melson, Alison Gallagher, Kath Higgins","doi":"10.1136/bmjoq-2024-003223","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003223","url":null,"abstract":"<p><strong>Background: </strong>Intensive glucose management in people with diabetes and frailty presents significant risk which outweighs potential benefit. Hospital admission presents an opportunity for interventions that may reduce the impact of overtreatment in people with diabetes and frailty. Our previous study has shown low rates of glycated haemoglobin(HbA_1c) assessment and inpatient medication deintensification in people with diabetes and frailty.</p><p><strong>Methods: </strong>We conducted a three-intervention quality improvement programme and studied the effectiveness of the interventions aiming to improve the inpatient HbA_1c assessment and management of inpatients with diabetes and frailty. A baseline assessment was conducted prior to cycles 1 and 2, with another audit conducted post-cycles 1 and 2. A further audit was then carried out with another audit post-cycle 3.</p><p><strong>Interventions: </strong>Interventions 1 and 2 involved publishing an infographic to aid assessment and medication deintensification in patients with diabetes and frailty, followed by spreading awareness among resident doctors of the baseline audit results and the infographic via email and WhatsApp groups. Intervention 3 involved allocating 'Diafrailty Champion' the medical wards to help improve the assessment and management of patients with diabetes and frailty.</p><p><strong>Results: </strong>A total of 291 patients with diabetes and moderate-severe frailty were included in our audits (96 patients in baseline audit, 102 post-cycles 1 and 2 audit, 92 post-cycle 3 'Diafrailty Champion' audit). Improvements were observed for the rates of HbA_1c assessment and deintensification in the post-interventions 1 and 2 audit, and these persisted following the introduction of 'Diafrailty Champion'.</p><p><strong>Conclusions: </strong>Interventions that included raising awareness of the inpatient assessment and management of people with diabetes and frailty were successful in improving inpatient HbA_1c assessment and deintensification rates. The improved HbA_1c assessment and deintensification rates persist following the engagement of a resident doctor 'Diafrailty Champion'.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583048","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":"Supported implementation of tailored multicomponent fall prevention interventions in hospital: a feasibility study.","authors":"Charlotte McLennan, Catherine Sherrington, Vasi Naganathan, Wendy Tilden, Bethan Richards, Tamsin McVeigh, Andrew Hallahan, Veethika Nayak, Matthew Jennings, Leanne Hassett, Abby Haynes","doi":"10.1136/bmjoq-2025-003313","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003313","url":null,"abstract":"<p><strong>Background: </strong>Falls in hospital remain a complex patient safety issue for health systems. Multicomponent fall prevention interventions can reduce patient falls in hospitals; however, the implementation of these approaches in routine practice can be challenging and inconsistent. Quality improvement (QI) education and clinical facilitation may support the implementation of hospital fall prevention interventions. We conducted a mixed-method implementation feasibility study with a primary aim of evaluating the acceptability of QI education and clinical facilitation to support implementation of tailored, multicomponent fall prevention interventions. Secondary aims were to describe preliminary implementation impacts, and barriers and facilitators to the intervention and its implementation, to inform study feasibility.</p><p><strong>Methods: </strong>Acute hospital wards (n=4) established a local team (2-4 staff members) to lead the implementation of multicomponent fall prevention interventions, informed by local incident data, on their ward. Education about QI (online or face-to-face) and clinical facilitation (12 weeks of weekly onsite support from a nurse manager experienced in QI) was provided to support the teams. Ward staff were invited to complete preimplementation and postimplementation surveys and postimplementation interviews. Descriptive statistics were used to analyse quantitative data. Qualitative data were analysed using inductive and deductive content analysis.</p><p><strong>Results: </strong>Acceptability: staff satisfaction with the strategies used to support the implementation of local fall prevention interventions had a mean score of 7.4/10 (SD=1.9, n=38). Reach: 28/38 (74%) survey respondents were aware of the multicomponent fall prevention interventions on their ward, with 24 (86%) reporting a positive impact on clinical practice post implementation. Adoption: delivery of multicomponent hospital fall prevention interventions increased 1.1/10 points between preimplementation (n=61) postimplementation (n=38) surveys. Survey (n=99) and interview (n=12) data indicated barriers and facilitators relevant to the intervention, implementation strategies, recipients and context. Examples of barriers included lack of accountability, competing priorities and staffing challenges. Examples of facilitators included local integration, empowered decision-making and dependable leadership.</p><p><strong>Conclusion: </strong>QI education and clinical facilitation appeared to be acceptable and feasible strategies to support the implementation of tailored hospital fall prevention interventions. The impact of these implementation strategies when adapted to address local barriers and support enablers warrants further evaluation.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582978","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":"Perception of 'patient safety culture' among healthcare professionals in the field of haematopoietic stem cell transplantation and CAR-T therapy: a multicentre cross-sectional observational study by Italian Transplant Group for Bone Marrow Transplantation, Haematopoietic Stem Cells and Cell Therapy (GITMO).","authors":"Marco Cioce, Giuseppe Vetrugno, Angela Iula, Patrizia Cornacchione, Stefano Botti, Valentina Zoboli, Raffaella Cerretti, Sonia Soave, Barbara Guidi, Giorgia Gobbi, Silvia Finotto, Denise Bettini, Nicola Mordini, Enrico Dutto, Anna Mele, Gabriele Sperti, Renato Congedo, Valentina De Cecco, Alessandra Picardi, Domenico Buonanno, Angelo Michele Carella, Matteo Steduto, Maria Teresa Lupo-Stanghellini, Anna Carmagnola, Maura Faraci, Marco Deiana, Chiara Visintini, Michele Cimminiello, Emilia Lerose, Smona Sica, Fabio Lamberti, Vincenzo M Grassi, Michele Di Donato, Carmen Nuzzo, Massimo Martino","doi":"10.1136/bmjoq-2025-003318","DOIUrl":"10.1136/bmjoq-2025-003318","url":null,"abstract":"<p><p>Adverse events associated with healthcare services in hospitalised patients represent a growing burden, generating significant costs for individuals, healthcare facilities and society. Their clinical and economic impact is particularly critical in the context of haematopoietic stem cell transplantation (HSCT) and chimeric antigen receptor (CAR)-T therapy. A positive safety culture is widely recognised as a crucial factor in reducing hospital errors. This study aimed to evaluate the perception of 'Patient Safety Culture' (PSC) among professionals working in the HSCT and CAR-T therapy fields.A multicentre, cross-sectional observational study was conducted by GITMO. The sample included healthcare professionals (physicians, nurses and others) who had been part of the Transplant Programme for at least 2 years. To assess PSC perception, the validated Italian version of the Hospital Survey on Patient Safety (SOPS V.2.0) from the Agency for Healthcare Research and Quality was used.The survey was completed by 166 professionals from 47 centres (54% participation rate). Binary logistic regression showed that haematologists reported higher PSC perceptions compared with nurses with positive responses exceeding 75%, particularly in dimensions such as 'Teamwork' (nurse OR=0.306, p=0.009), 'Organizational Learning-Continuous Improvement' (nurse OR=0.332, p=0.011), 'Response to Error' (nurse OR=0.360, p=0.024), 'Supervisor Support' (nurse OR=0.160, p<0.001), 'Communication About Error' (nurse OR=0.152, p=0.001) and 'Global Instrument' (nurse OR=0.150, p<0.001).The findings highlight the need for targeted interventions to address discrepancies in PSC perceptions across professional roles, age groups and regions. Enhancing staffing levels and promoting the use of incident reporting systems are critical strategies to strengthen safety culture in HSCT and CAR-T therapy settings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583049","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":"Applications of human factors approaches and methods to the development of teleconsultations in primary care: a systematic scoping review.","authors":"Aimee Ferguson, Rosemary Newham, Emma Dunlop, Kate Preston, Marion Bennie","doi":"10.1136/bmjoq-2024-003023","DOIUrl":"10.1136/bmjoq-2024-003023","url":null,"abstract":"<p><strong>Introduction: </strong>Given the level of encouragement seen in recent policy, it is important to understand how teleconsultation technologies are designed, implemented and used in primary care settings to further encourage their use. Despite being an area of research warranting interest from the area of human factors, knowledge of the discipline's application is scarce. This systematic scoping review aimed to identify human factors approaches and methods previously applied to the development of teleconsultation technologies in primary care.</p><p><strong>Methods: </strong>Medline, Embase, PsycINFO, Ergonomics Abstracts and Engineering Village were searched for peer-reviewed articles. Included studies were published 2010 onwards, focused on the development of teleconsultation technologies in primary care and adopted an approach or method fitting within the domain of human factors. Key findings underwent a content analysis.</p><p><strong>Results: </strong>70 studies were identified, most published 2019 onwards. The review identified 20 human factors approaches, the majority of which were applied to evaluate the use of teleconsultations, with less focus on the design and implementation stages. A variety of data collection methods, theories, models and frameworks were found. Although the focus of all studies fits within the domain of human factors, none of the included studies referred to 'human factors' explicitly.</p><p><strong>Conclusions: </strong>The findings illustrate approaches that have been applied when designing, implementing and evaluating the use of teleconsultations. Although the studies may not have intended to adopt a human factors lens, the approaches used relate to the wider discipline. Further analysis of the studies evaluating use could provide insight into how these technologies are being used and the factors influencing use.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567048","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":"Trigger tools in healthcare settings: insights from an umbrella review.","authors":"Mohammed As'ad, Nawarh Faran, Awad Al Omari","doi":"10.1136/bmjoq-2024-003119","DOIUrl":"10.1136/bmjoq-2024-003119","url":null,"abstract":"<p><strong>Objective: </strong>This study synthesises the effectiveness and applicability of trigger tools for detecting adverse events (AEs) across various healthcare settings.</p><p><strong>Design: </strong>This study used an umbrella review to consolidate findings from existing systematic reviews, assess the quality of evidence and identify gaps in current knowledge.</p><p><strong>Methods: </strong>A comprehensive search was conducted across SCOPUS, Web of Science and PubMed, and included systematic reviews and meta-analyses from 2009 to 2024 focusing on trigger tools used in healthcare settings. Data extraction and quality appraisal followed Joanna Briggs Institute guidelines. Narrative synthesis was employed owing to the heterogeneity among studies. Nine systematic reviews were included.</p><p><strong>Results: </strong>Nine systematic reviews were analysed. Results showed substantial variation in trigger tool performance. Detection rates ranged from 0.8% to 66% across healthcare settings and populations. Preventability rates varied widely from 7% to 94.4%. Automated detection methods demonstrated inconsistent results with AE prevalence, ranging from 0.1% to 29.2%. The studies within the reviews exhibited significant variability in the types of trigger tools analysed and the methodologies used, affecting detection outcomes. The quality of the included studies varied, with inconsistent definitions of AEs and differences in study design limiting the generalisability of the findings.</p><p><strong>Conclusions: </strong>Trigger tools vary significantly in effectiveness, influenced by healthcare context and tool design. Automated methods need refinement. Standardised methodologies and context-specific tools are essential to improve patient safety. Future research should focus on these areas to enhance the accuracy and applicability of trigger tools in different healthcare settings.</p><p><strong>Prospero registration number: </strong>CRD42024581456.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567049","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":"Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative.","authors":"Facundo Jorro Barón, Andrea Falaschi, Lía Bosio, Luz Gibbons, Emilse Vitar, Marina Guglielmino, Erica Negri, María Belén Peralta-Roca, Ana Paula Rodriguez, Inés Suarez-Anzorena, Juan Pedro Alonso, Viviana Rodríguez, Javier Roberti, Ezequiel García Elorrio","doi":"10.1136/bmjoq-2025-003390","DOIUrl":"10.1136/bmjoq-2025-003390","url":null,"abstract":"<p><strong>Background: </strong>Primary care has been essential in ensuring the continuity of health services for patients with COVID-19 and other conditions. We aimed to increase the adoption of evidence-based interventions to identify clinical deterioration in adult patients with confirmed or suspected respiratory COVID-19 at the primary care level.</p><p><strong>Methods: </strong>We implemented specific interventions in nine Primary Healthcare Centres (PHCC) through a quality improvement collaborative (QIC) with an interrupted time-series design. Interventions included triage for acute respiratory symptoms, the National Early Warning Score 2 (NEWS2) scale, portable oximeters for selected patients and the provincial telehealth system. Additional components involved leadership commitment, teamwork tools, reminders, audits, feedback and direct observation. A mixed-method evaluation was conducted, with two learning sessions and three action periods to test and implement selected change ideas.</p><p><strong>Results: </strong>Six PHHCs completed the study. Over 48 weeks, data from 877 patients were gathered, 356 in the baseline period (BP) and 477 in the implementation period (IP). Eight hundred and sixty-two medical consultations were reported, 367 for BP and 495 for IP. More COVID-19-confirmed diagnoses were observed in the IP group (1.9% vs 15%, p<0.001).The bundle was implemented in 0% and 28.4% of patients in the BP and IP groups, respectively. On evaluating the individual components of the bundle, we discovered enhancements in the utilisation of triage, application of NEWS2 and utilisation of oximeters when appropriate. A decrease in the number of follow-up calls was observed at the end of the implementation.Patients rated the quality of care as positive in 66% of the cases in the BP and 76% in the IP group (p=0.023).</p><p><strong>Conclusion: </strong>We successfully implemented a triage algorithm based on the NEWS2 score to identify respiratory deterioration in adult patients in primary care through a QIC. This intervention was perceived as an improvement in the quality of care by the patients.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538368","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}