BMJ Open Quality最新文献

{"title":"What about physician wellness? Impact of a quality improvement intervention.","authors":"Pamela Mathura, Isabella Pascheto, Jennifer Ringrose, Gillian Ramsay","doi":"10.1136/bmjoq-2024-003078","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003078","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) consultations with general internal medicine (GIM) are required when patients need admission, assistance with safe disposition or evaluation and management of complex or acute medical needs. GIM physicians often balance responsibilities between hospital wards and the ED, which can lead to delayed ED consultations, difficulty balancing workload and potential burn-out. To address this issue, a quality improvement (QI) initiative was trialled, establishing a dedicated GIM ED consultation service to manage these duties independently. This study aimed to evaluate the impact of this intervention on physician wellness.</p><p><strong>Methods: </strong>A pre-post design was used, with two questionnaires adapted from the validated Mini Z version 2.0 (Zero Burnout Program) Worklife measure for clinicians. These were distributed via Google Forms to collect feedback from participating GIM physicians before and after the intervention. Data were analysed using descriptive statistics and the Mini Z outcome measurement scale.</p><p><strong>Results: </strong>13 physicians completed the surveys. Applying the Mini Z scale, the GIM ED consultation service had no impact on physician well-being or burn-out. There was a minor increase in satisfaction (1 point) and stress levels (2 points), and the working environment worsened slightly (1 point). Comparing preintervention and postintervention survey responses, job satisfaction improved (36%), while reports of 'burn-out' (23%) and 'beginning to burn out' (8%) decreased. Postintervention, physicians reported decreased time for documentation (23%), a perception of a more chaotic work environment (23%) and an increase in work encroaching on personal time (15%) when on the ED consultation service. Additionally, there was a 23% reduction in the likelihood of needing to reduce clinical teaching unit service weeks.</p><p><strong>Conclusion: </strong>When conducting QI initiatives, consider measuring the wellness of physicians and other healthcare providers. Proactively integrating wellness strategies into interventions requires further exploration which may enhance participant experience and initiative sustainability.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073803","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":"Impact of introducing transnasal endoscopy on expanding diagnostic endoscopy services.","authors":"Ben Thomas Crosby, Laura Munglani, Karen Wright, Kay Charles, Wendy Evans, Megan Mathias, Stevie Davies, Badr Abdalla, Jeff Turner, Tom Crosby, Nigel Trudgill, Hasan Haboubi","doi":"10.1136/bmjoq-2024-002992","DOIUrl":"10.1136/bmjoq-2024-002992","url":null,"abstract":"<p><strong>Introduction: </strong>Demand for endoscopic services is outstripping capacity in the UK. Transnasal endoscopy (TNE) utilises a narrow calibre endoscope to pass through the nasal passages, thereby reducing retching and discomfort. It is better tolerated compared with standard transoral endoscopy (TOE) but is still rarely used as a diagnostic modality. There is still uncertainty about how well it performs against TOE in diagnostic ability, cost and efficiency.</p><p><strong>Methods: </strong>We explored utilising TNE to deal with the growing demand for endoscopy. We compared findings to TOE procedures undertaken during the same time period. We evaluated cost differences, duration/time in the department for procedures as well as quality of procedures (both in terms of performance indicators as well as image quality using the validated POLPREP score).</p><p><strong>Results: </strong>A total of 241 upper gastrointestinal endoscopy procedures were evaluated (100 TNE and 141 matched TOE) between December 2021 and February 2022. TNE outperformed TOE in obtaining >95% success rate in nationally approved key performance indicators (retroflexion and duodenal intubation, both p=0.026). It also was associated with better image quality in the oesophagus with a POLPREP A3 Score (excellent image quality) in 36/98 available images compared with 26/136 TOE (p=0.028) and was equivalent to TOE in the stomach and duodenum. TNE was identified as having a key role in facilitating complex cases, previously failed via the TOE route with a success rate in 11/12 (91.7%) of such cases. TNE also shows promise in correcting misdiagnoses of short-segment Barrett's oesophagus (39%) compared with TOE (14.8%) (p=0.087).</p><p><strong>Conclusion: </strong>TNE is an emerging endoscopic modality, which shows great promise in replacing TOE in most diagnostic circumstances. In a modern healthcare service, TNE is cheaper, better tolerated and outperforms TOE in multiple domains.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063674","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":"Continuous individual feedback to nurses at emergency medical dispatch centres: a stepped-wedge, interrupted time series analysis.","authors":"Douglas Nils Spangler, Hans Blomberg","doi":"10.1136/bmjoq-2024-002993","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002993","url":null,"abstract":"<p><strong>Background: </strong>Clinical feedback is often lacking in prehospital care, and while performance data is increasingly available to clinical and operational leadership, it is seldom made available to care providers themselves. In this study, we investigate the impact of a simple intervention consisting of the provision of monthly feedback reports via email to emergency medical dispatch nurses in three Swedish regions.</p><p><strong>Method: </strong>Individualised reports consisting of 14 measures divided into descriptive (eg, priority-setting and call times), process (eg, dispatch times and documentation completeness) and outcome (eg, over/under triage rate) categories were developed with staff and management input. Report delivery was implemented using a stepped-wedge design, and effects were evaluated using a hierarchical regression-based interrupted time series analysis.</p><p><strong>Results: </strong>40 dispatchers were included in the study between March 2020 and October 2023, who handled a total of 246 353 incidents. Some impacts on documentation-related process measures were identified, with the odds of complete documentation increasing by 7.5% (95% CI 5.1 to 9.9) and the odds of having a documented contact reason increasing by 3.8% (1.5-5.9). These effects remained robust over the post-intervention period. Weaker impacts on outcome measures were identified which could be explained by a higher priority given to emergency medical dispatches overall.</p><p><strong>Conclusion: </strong>Providing performance data can influence care providers to adjust their behaviour to improve process-related quality metrics under their direct control. The intervention may also have induced nurses to more often upgrade the priority of their patients. Improving outcome metrics may however require more intensive, multifaceted interventions.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063670","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":"Enhancing patient safety and risk management through clinical pathways in oncology.","authors":"Marco Milanesi, Rita Fiorito, Lara Caloccia, Chiara Guglielmetti, Giulia Giganti, Sara Elisa Andreasi, Antonio Triarico","doi":"10.1136/bmjoq-2024-003012","DOIUrl":"10.1136/bmjoq-2024-003012","url":null,"abstract":"<p><p>The increasing emphasis on risk management and quality assessment in hospital management necessitates strict adherence to government and international standards. Those standards are particularly important, and certification requirements further underscore this need. The objective of this paper is to outline the application of the INTegrated Audit Model in a Comprehensive Cancer Center. This model represents a revised version of Tracer Methodology, for audit surveys, aimed at aligning audit activities with UNI EN ISO 9001:2015 and Joint Commission Standards for quality, patient safety and clinical risk management.Using the INTegrated Audit Model, a total of 7 tracers were conducted, and 31 units underwent auditing during the period spanning from 2022 to 2023. Each audit inquiry was documented, categorised and cross-referenced with International Organization for Standardization (ISO) and Joint Commission International (JCI) standards. Areas exhibiting the highest incidence of non-conformities and observations were systematically linked to relevant standards. Subsequently, a comprehensive analysis was conducted on the ensuing findings.The INTegrated Audit Model allowed for systematic data collection across clinical pathways, revealing prevalent issues and areas for improvement in patient care. By aligning identified topics with ISO and JCI standards, compliance with international guidelines was assessed, offering units insight into their current status and areas for enhancement.Overall, both auditees and auditors expressed satisfaction with the methodology and continuous training, highlighting its effectiveness in fostering collaboration, improving time management and promoting adherence to accreditation standards.The study highlights the effectiveness of the methodology in monitoring unit activities and adherence to clinical pathways and international standards applied to an oncological setting. Audits conducted with this approach provided a thorough assessment of critical areas impacting patient care and clinical governance, contributing to a comprehensive understanding of service delivery.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057901","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":"Avoiding never events in orthopaedics theatres: a quality improvement project.","authors":"Bhaskar Amarnath Bhavanasi, Shrikant Kulkarni","doi":"10.1136/bmjoq-2024-002971","DOIUrl":"10.1136/bmjoq-2024-002971","url":null,"abstract":"<p><p>Never events in the operating room are a surgeon's nightmare, with an incidence rate of 54%. These events are highly stressful for theatre staff and significantly compromise patient safety. The aim of this project is to avoid never events in trauma and orthopaedic theatres by ensuring that theatre staff adhere to the surgical pause and imaging pause protocols through regular audits.This prospective study was conducted in both trauma and elective orthopaedic theatres. It involved theatre staff members who were not part of the surgical team. The study was designed to take place on random days across different theatres, with the operating team unaware of the audit to ensure genuine behaviour and compliance.The audits focused on observing whether the surgical and imaging pause protocols were followed correctly. These protocols are critical for verifying patient identity, the surgical site, and the specific procedure and confirming the correct imaging is available and reviewed before proceeding. Data collected and corrective actions were implemented when non-compliance was observed, and data on compliance rates were systematically collected and analysed.Preliminary results indicate a substantial increase in compliance with both the surgical and imaging pause protocols, corresponding with a reduction in the occurrence of never events. Theatre staff reported improved understanding and confidence in performing these safety checks The use of external auditors who were not part of the surgical team provided an unbiased assessment of compliance, enhancing the reliability of the findings.In conclusion, the project demonstrates that regular audits, and data collected by non-surgical team staff, significantly improve adherence to surgical and imaging pause protocols, thereby reducing the incidence of never events in trauma and orthopaedic theatres. This approach highlights the importance of continuous monitoring and education in fostering a culture of safety and precision in surgical practice.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051530","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":"Reduction in bacterial culture positivity rates at a human milk bank facility of a tertiary care hospital: a quality improvement initiative.","authors":"Sailusha Vadapalli, Chhaya Valvi, Rahul M Dawre, Vaishnavi Bhagat, Sangeeta Chivale, Sameer Pawar, Aarti A Kinikar","doi":"10.1136/bmjoq-2024-002775","DOIUrl":"10.1136/bmjoq-2024-002775","url":null,"abstract":"<p><strong>Background: </strong>Human milk banks (HMBs) offer the best feed for neonates after mother's own milk (MOM), especially when MOM is insufficient. Although HMBs are founded on standard protocols, contamination and wastage of milk due to positive milk cultures remain a problem. Present study was planned as a quality improvement (QI) initiative to reduce culture rates at the HMB.</p><p><strong>Aims statement: </strong>The aim is to reduce the milk-culture positivity rates at the HMB by 50% or more, over a span of 3 months.</p><p><strong>Materials and methods: </strong>A QI initiative was undertaken at the milk bank of a tertiary-care hospital in Western Maharashtra in 2020. All human milk cultures sent since January 2018 were recorded from the data at HMB registry. The milk-culture rates had increased from 105/4376 to 125/3823 between 2018 and 2019. A fishbone analysis identified sources of contamination of donor milk during 2018-2019. PDSA (Plan Do Study Act) cycles begun from 2020, interventions aimed at reducing milk-culture positivity rates were tried, namely improved hand-hygiene, sanitisation of milk donors before collection, steam sterilisers for breast-pump accessories and recruitment of staff nurses at all stages of milk handling.</p><p><strong>Results: </strong>Milk-culture growths had increased from 105/4376 (2.37%) in 2018 to 125/3823 (3.27%) in 2019 and then declined to 23/2103 (1.09%) in 2020, 12/2345 (0.51%) in 2021, 9/2985 (0.30%) in 2022 and 1/1322 (0.08%) in June 2023. The unit achieved reduction of over 99% in milk wastage during this period. This improvement was sustained till 2023 with consistent increment in quality of consumable donor milk.</p><p><strong>Conclusions: </strong>The QI initiative was successful and led to significant decrease in milk-culture rates, which has been well sustained. The measures that led to the improvement in the quality of milk at the HMB were improvement in hand hygiene, use of steam sterilisers and presence of committed individuals at all stages of milk handling. These methods are simple, easily replicated and sustainable with a promise of ensuring a steady supply of high-quality human milk.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036785","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":"Introducing and establishing birth companionship in labour ward of a tertiary care centre in North India: a quality improvement journey through and beyond COVID-19 pandemic.","authors":"Meenakshi Singh, Manju Puri, Saji Bessy, Geeta Ranvir Singh, Susan George, Abha Singh, Reena Yadav","doi":"10.1136/bmjoq-2023-002294","DOIUrl":"10.1136/bmjoq-2023-002294","url":null,"abstract":"<p><strong>Background: </strong>Allowing a birth companion is the basic right of a mother and is identified as an important component of respectful maternity care. The implementation of this intervention has been a challenge in heavy-load public health facilities in India.</p><p><strong>Local problem: </strong>Despite the proven benefits of the presence of birth companions on maternal-fetal outcomes, there was no policy of allowing birth companions in our hospital.</p><p><strong>Methods and interventions: </strong>We aimed to introduce and establish the practice of allowing birth companions for all eligible mothers admitted to the labour ward from 0% to 70% in 8 weeks duration. The study was conducted in the Department of Obstetrics and Gynecology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi. A quality improvement (QI) team was formed. After collecting the baseline data and observing the process flow, fishbone analysis was done to identify the main problems. Various change ideas were listed and tested in the form of plan-do-study-act (PDSA) cycles and ideas were either adapted or adopted. Simple interventions such as antenatal sensitisation and counselling of the mother and the family, WhatsApp groups, and monthly labour room induction classes for residents helped achieve the target. During COVID-19 pandemic, the practice of allowing birth companions was suspended temporarily but was rolled out again after the second wave of COVID-19 in COVID-19-negative and COVID-19 suspect labour wards.</p><p><strong>Results: </strong>The median value of the percentage of mothers accompanied by birth companions marginally increased to 20% after the first PDSA cycle. Finally, after multiple PDSA cycles, we could achieve our goal in 8 weeks. During a pandemic, the project was suspended temporarily during the first two waves but was revived again and we succeeded in reaching the desired goal and sustaining the policy after fewer PDSA cycles compared with the first phase.</p><p><strong>Conclusion: </strong>The application of QI methodology and teamwork is pivotal in implementing any novel idea for patient care without additional infrastructure, manpower or financial resources.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036840","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 access to pulmonary rehabilitation for patients with COPD treated for substance misuse in the London Borough of Islington.","authors":"Divya Narasimhan, Jane Simpson, Duncan Stewart","doi":"10.1136/bmjoq-2024-003002","DOIUrl":"10.1136/bmjoq-2024-003002","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is a collection of conditions that cause permanent damage to the lungs. Among a range of treatment options, patients can benefit from pulmonary rehabilitation (PR) programmes involving physical exercises and education.The risk of developing COPD is higher for substance misusers than the general population. Substance misusers with COPD have more severe symptoms and poorer health outcomes than other COPD patients, and experience inequalities in accessing PR services.This project aimed to work with a local substance misuse service to increase the referrals of patients with COPD with a history of drug and/or alcohol problems to a PR programme in the London Borough of Islington. Quality improvement methods were used to explore barriers to accessing PR and to identify ways of making referral to PR easier. A series of change ideas were implemented and tested sequentially through plan-do-study-act, including updating referral systems, educating staff and improving access to diagnosis.The primary objective was to achieve 100 eligible referrals during the 14-month project period. In practice, a total of 57 patients were referred to the programme. Sustained engagement with patients was challenging, with significant attrition observed from referral to programme completion. However, there was indicative evidence of clinical improvements in dyspnoea and exercise capacity among PR completers and qualitative feedback of improved health and well-being.Although referrals numbers were less than expected, we have established an innovative respiratory care pathway for substance misusers, founded on a holistic approach to diagnosis and treatment. There are also clear pointers as to how this approach can be sustained and developed further to maximise the benefits for this cohort of patients.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021838","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":"Impact of primary care benefits on healthcare utilisation and estimated out-of-pocket expenses in urban, rural and remote settings in the Philippines.","authors":"Janelle Micaela S Panganiban, Romelei Camiling-Alfonso, Josephine T Sanchez, Regine Ynez H De Mesa, Gillian Sandigan, Arianna Maever L Amit, Mia P Rey, Johanna Faye E Lopez, Noleen Marie Fabian, Cara Lois T Galingana, Nannette Bernal-Sundiang, Maria Rhodora N Aquino, Chad Lester Lastrilla, Miguel Callo, Carol Stephanie Chua Tan-Lim, Leonila F Dans, Jose Rafael A Marfori, Ramon Pedro Paterno, Antonio L Dans","doi":"10.1136/bmjoq-2023-002676","DOIUrl":"10.1136/bmjoq-2023-002676","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to determine the effects of primary care interventions on healthcare utilisation and estimated out-of-pocket (OOP) expenses in selected urban, rural and remote settings in the Philippines.</p><p><strong>Methodology: </strong>Context-specific measures relating to expanding healthcare provider networks, augmenting the health human workforce and subsidising transportation costs were implemented to strengthen primary care systems. In this study, two key outcomes were monitored: (1) monthly healthcare utilisation measured by the total number of outpatient consultations per site and (2) change in OOP expenses from baseline to endline within a 1 year study period.</p><p><strong>Results: </strong>All sites had a positive trend in monthly outpatient consultations in healthcare utilisation over 1 year. The remote site had the steepest increase in outpatient consultations, with a 401% increase compared with the baseline during the peak of consultations at month 7. The urban site had a 62% increase in outpatient consultations from baseline to month 6, while the rural site had a 251% increase from baseline to month 11, which corresponded to the peak month in terms of the number of outpatient consultations. The rural site had the largest decrease in estimated OOP expenses (50.3% reduction, 95% CI -88 to -13), followed by the remote site (33.2% reduction, 95% CI -67,+1) and the urban site (16.0% reduction, 95% CI -65,+33).</p><p><strong>Conclusion: </strong>The rural site showed a significant reduction in estimated OOP expenses and an increase in healthcare utilisation. The remote site had the steepest increase in utilisation, but the reduction in estimated OOP expenses was not statistically significant. The urban site experienced the lowest increase in utilisation, and the smallest reduction in estimated OOP expenses, which was also not statistically significant. Implementing primary care benefits will necessitate contextualised approaches to avoid the inadvertent aggravation of inequities in healthcare.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021829","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 sonographic visualisation of the appendix in a regional referral hospital.","authors":"Shyr Chui, Carly Phinney, Karina Hansen, Deanna Danskin","doi":"10.1136/bmjoq-2024-002865","DOIUrl":"10.1136/bmjoq-2024-002865","url":null,"abstract":"<p><p>Ultrasound is a first-line and often preferred imaging modality in the diagnosis of acute appendicitis. When the appendix is not visualised during a dedicated appendix ultrasound study, patients may require a CT study, which uses ionising radiation, or undergo conservative clinical observation with the inherent risk of clinical deterioration, perforation and sepsis. Median baseline data, at our hospital imaging department, revealed a rate of combined normal and abnormal appendix visualisation of 34.5% which is below the reported visualisation rates in the North American literature and well below the rates reported in the global literature. We embarked on a formal quality improvement (QI) project to improve the rates of appendix visualisation in our hospital ultrasound department. Using the Model of Improvement framework and a team approach, we generated and trialled multiple plan-do-study-act interventions over a project term of 12 months. In the second half of the project term, we saw a sustained rise in appendix visualisation exceeding our original stretch goal of 75% visualisation which was sustained 6 months after the formal project end (p<0.001). This rise was accompanied by a commensurate increase in sonographer confidence in appendix visualisation. In our case, the Model of Improvement methodology proved successful in solving our complex problem of sonographic appendix under-visualisation. The learnings of this QI project have been widely shared and spread according to the ethos of QI.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021839","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}