BMJ Open Quality最新文献

{"title":"Why EQ-5D and the Oxford Hip and Knee scores do not measure the same things.","authors":"Tim Benson","doi":"10.1136/bmjoq-2024-003214","DOIUrl":"10.1136/bmjoq-2024-003214","url":null,"abstract":"<p><strong>Introduction: </strong>The outcome of treatment is always paramount for patients and healthcare professionals. Patient-reported outcome measures have been developed to measure outcomes.Since 2009, all patients in England having hip and knee replacement surgery have been asked to complete the generic EuroQol EQ-5D-3L and EQ visual analogue scale (EQ-VAS) and the condition-specific Oxford Hip Score or Oxford Knee Score for hips and knees, respectively.</p><p><strong>Methods: </strong>EQ-5D-3L has five dimensions with three options each. Each combination has been scaled relative to the best conceivable health state (value 1.0) and the state of dead (value 0) to produce a relative severity score (EQ-Index) with a range from -0.594 to 1.0. This can be used to calculate quality-adjusted life-years. The EQ-VAS is a visual analogue scale from 0 (dead) to 100 (best conceivable health state).The Oxford Hip and Knee scores are similar to each other. They have 12 questions with five options each, scored 0-4. These scores are added, giving a scale with range 0 (no problems) to 48 (extreme problems on all questions).Using over 40 000 records for patients undergoing hip and knee replacements from the National Health Service patient-reported outcome measure database, we compare EQ-5D-3L with the Oxford Hip and Knee scores. To aid comparison, each score was transformed arithmetically to a common 0 (floor) to 100 (ceiling) scale.</p><p><strong>Results: </strong>EQ-Index, EQ-VAS and the Oxford scores give very different results in terms of change, effect size and correlation.</p><p><strong>Discussion: </strong>More research is needed, but some speculative ideas are put forward, which could explain these findings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246295","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 local authority financial support services for users with complex health needs: a mixed-method economic evaluation of Social Navigators in South Tyneside, UK.","authors":"Peter van der Graaf, Andrew McCarthy, Murali Krishnan Perumbakkam Subramanian, Bronia Arnott, Dilupa Samarakoon, Sarah Lee, Joanne Gray, Angela Bate","doi":"10.1136/bmjoq-2024-003290","DOIUrl":"10.1136/bmjoq-2024-003290","url":null,"abstract":"<p><p>Despite social prescribing being promoted by the UK government for the last decade, the evidence supporting social prescribing remains weak and has mainly been confined to clinical contexts. Our study aimed to evaluate the impact of a Social Navigator (SN) service in South Tyneside on the health and well-being of users who experience financial hardship with complex health needs and limited access to mental health services.Using a mixed-methods design combining secondary analysis of service data (n=330), qualitative interviews with service users (n=15) conducted by peer researchers, and a social return On investment analysis that matched service data with health economic indicators from the UK Social Value Bank.Our findings demonstrate clear value for money with a £3 return for every £1 invested in the service, with a positive return confirmed in sensitivity analysis. SNs were able to improve the confidence of service users, with statistically significant changes across all eight confidence-related outcomes, and helped them to access other advice and financial services. This resulted in one-off financial gains (average £1237) and annual financial gains (average £1703) for service users. The interviews identified that relieving financial burden and stress improved the quality of life and mental well-being of users as a result of their involvement with the service.SN can break the cycle of multiple visits to crisis teams by building trusting relationships and providing emotional and practical support, while being responsive to the service users' needs and available when they have needs. They play a key intermediary role in integrated care systems with a unique focus on the wider determinants of health and financial hardship, advocating for service users without time limits and navigating the complexities of the system across local government. Greater integration of local support services could be achieved by mapping all available pathways for support.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246358","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":"Career impact of the national interprofessional fellowship in patient safety: an alumni evaluation.","authors":"Bradley V Watts, Kathleen Carluzzo, Blake F Webb, Kelley Arredondo","doi":"10.1136/bmjoq-2024-003090","DOIUrl":"10.1136/bmjoq-2024-003090","url":null,"abstract":"<p><strong>Background: </strong>There has been a proliferation of health professions training programmes focused on quality and patient safety, but little information regarding the outcomes of these programmes. The purpose of this study was to examine the impact of an interprofessional quality and patient safety curriculum on career outcomes of interprofessional healthcare learners for the Veterans Affairs Patient Safety Fellowship.</p><p><strong>Method: </strong>We conducted a survey-based assessment of 117 alumni of the Interprofessional Fellowship in Patient Safety assessing their satisfaction with the training program and career impacts.</p><p><strong>Results: </strong>84 of 117 alumni were located and participated in the assessment. Fellows entered the training programme from a wide range of educational experiences, but most were in their early career at entry. Satisfaction with the training programme was high, with 42% (n=35) of alumni reporting being extremely satisfied with their fellowship experience. Programme alumni reported being either extremely or very knowledgeable about quality and patient safety (77%, n=65). Fellows reported considerable engagement with the academic field of patient safety and quality, with 63% (n=53) having published at least one manuscript about the topic and 75% (n=63) reporting a role teaching patient safety and quality improvement. Fellows' employments post training were quite varied, although positions focused on health profession education were most common.</p><p><strong>Conclusions: </strong>The Interprofessional Fellowship in Patient Safety is an early successful example of an interprofessional training programme that resulted in satisfied alumni who reported good knowledge and abilities in the topic of patient safety. Career pathways were varied, but a focus on health professions education post fellowship was prominent.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233094","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":"Developing an evaluation tool for the impact of consumer partnerships in healthcare governance: a coproduced mixed methods study.","authors":"Rae Parker, Jodie Nixon, Faiza El-Higzi, Melanie Lynch, Ruth Cox","doi":"10.1136/bmjoq-2024-003285","DOIUrl":"10.1136/bmjoq-2024-003285","url":null,"abstract":"<p><strong>Background: </strong>Consumer partnerships are a recent innovation in healthcare governance to diversify decision-making perspectives. These partnerships bring complexity necessitating comprehensive evaluation. This study proposes that evaluation tools should include the impact of healthcare governance partnerships. This study aimed to coproduce an impact evaluation tool for healthcare governance committee partnerships.</p><p><strong>Methods: </strong>This study used a coproduced mixed methods cross-sectional design conducted in two phases. The first study phase included an online focus group and online survey to identify stakeholder expectations and needs for an impact evaluation design. The second study phase used an adapted Jandhyala Method to determine participant awareness of governance committee partnership impacts and consensus agreement to establish an impact evaluation survey. The development of governance committee partnership impact items was guided by a capability development framework for successful staff and consumer partnerships for quality improvement and the Engage with Impact Toolkit.</p><p><strong>Results: </strong>In phase one, staff (n=4) and consumer partners (n=3) provided recommendations to improve the development and acceptance of a governance committee partnership impact evaluation. Phase two was completed by 34 participants (>90% completion). An initial online survey generated 338 statements detailing broad governance committee partnership impacts. No statistically significant difference in the count of impacts by Engage with Impact Toolkit domains was found between staff and consumer partners. A second online survey resulted in a consensus ranking of 24 impact statements for inclusion. The highest consensus impact domains are knowledge, confidence and trust, equity and inclusivity and patient outcomes and experience.</p><p><strong>Conclusion: </strong>This study pragmatically used the insights of expert staff and consumer partners to develop a prioritised list of survey items to evaluate the impact of healthcare governance committee partnering effectiveness. The resulting healthcare governance committee partnership impact evaluation item list has the potential to be used in other healthcare organisations.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214868","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":"It's raining bots: how easier access to internet surveys has created the perfect storm.","authors":"Isabelle Caven, Zhenxiao Yang, Karen Okrainec","doi":"10.1136/bmjoq-2024-003208","DOIUrl":"10.1136/bmjoq-2024-003208","url":null,"abstract":"<p><p>Online surveys are an increasingly common way to collect data from the public, with social media and financial incentives (e.g. gift cards) commonly used to increase participation rates. Anonymity, ease of response, and the potential to reach diverse demographics have also contributed to the popularity of online surveys. Health services research benefits from the increased accessibility that online survey-based data collection provides; however, fraudulent responses are of concern. The following article describes our team's experience with a national survey of Canadian healthcare providers being overrun with fraudulent responses and approach to ensure the validity of our survey data. We provide recommendations for research teams on how best to design their surveys, work with their institutions to implement safeguards within survey platforms, and screen completed responses. We also describe fraudulent open-text responses that we believe to have been produced with the help of artificial intelligence and are sounding the alarm for other researchers to be aware of this potential threat to data integrity. Informed by the learnings shared, researchers and research institutions can be better equipped to prevent and screen fraudulent responses to continue successfully engage the public in online research.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198164","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 temporary nursing staff on communication patterns: an observation study during daily nurse huddles.","authors":"Sarah Dana Schmelzer, Sina Berger, Julia Carolin Seelandt, Zeynep Erden, Florian Liberatore","doi":"10.1136/bmjoq-2024-003242","DOIUrl":"10.1136/bmjoq-2024-003242","url":null,"abstract":"<p><strong>Background: </strong>Effective communication within healthcare teams is essential for efficient work coordination and patient safety. Communication in teams can take two forms: implicit and explicit, both of which play important roles in enhancing teamwork and output. However, within an unstable team constellation, maintaining effective communication can be challenging. There is limited empirical research on how temporary nursing staff impact team communication. The aim of this study is to evaluate the differences in communication patterns of permanent and temporary nursing staff.</p><p><strong>Methods: </strong>In this observational study, we observed communication patterns among nurses during their daily afternoon huddles. During the live observations, we used INTERACT coding software for assessing communication patterns of permanent and temporary nursing staff. Whereby we distinguish between temporary and per diem nurses. We used lag sequential analysis to explore implicit and explicit communication patterns of temporary, per diem and permanent nursing staff. We hypothesised that temporary nursing staff primarily rely on explicit communication, whereas permanent nurses tend to rely more on implicit communication.</p><p><strong>Results: </strong>Across 50 huddles with a total of 309 participating nurses, the mean huddle duration was 8.50 min and included 3074 communication transitions. We found that for per diem nurses, implicit communication was followed by explicit communication. This pattern was not observed for permanent and temporary nurses. Furthermore, for permanent and temporary nurses, preceding implicit communication was followed by implicit communication.</p><p><strong>Conclusion: </strong>Our study reveals that per diem nurses, with their lower employment levels and less consistent presence, tend to shift from implicit to explicit communication. This contrasts with temporary and permanent nurses, who maintain implicit communication patterns, likely due to more developed team mental models and greater mutual trust. These findings suggest that experience and consistency in the work environment are important factors shaping communication styles among nursing staff.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198163","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 accurate documentation for reducing restraint use: a quality improvement project in a Dutch academic hospital.","authors":"Liesbeth de Boer, Jeroen Scheepers, Christianne Vertommen, Dorthe O Klein, Tessa Rietbergen, Roland A Bal","doi":"10.1136/bmjoq-2024-003046","DOIUrl":"10.1136/bmjoq-2024-003046","url":null,"abstract":"<p><p>During a patient's hospital stay, restraint use in the Netherlands-defined as 'interventions that have restrictive consequences for the individual freedom of patients'-may be necessary to protect the individual from harm, provided it is applied proportionally, effectively, safely and with subsidiarity. Restraint use can have physical and psychological effects on patients and should therefore only be used when necessary and in accordance with established guidelines and regulations. In the Netherlands, five categorisations of restraints are used. The least invasive restraints are classified in category 1, and the most restrictive are classed into category 5. Accurate documentation is crucial to gain insight into restraint use, but it is often lacking. The aim of the project was to improve the documentation of restraint use for adult patients on a general nursing ward in a Dutch academic hospital. Three Plan-Do-Study-ACT (PDSA) cycles with follow-up measurements were undertaken to assess whether documentation was carried out correctly and completely.Medical record review (describing indication, consultation with a second nurse and physician, consent of the patient's and/or legal representative and applied restriction) has been conducted to establish the baseline measurement.The first PDSA cycle started after implementing a new form of documentation. The second PDSA cycle was performed after implementing a multifaceted intervention to improve documentation and increase knowledge on restraint use among nursing and medical staff. The third and final PDSA cycle took place after the medical record reviews were conducted and communicated to the leaders of the nursing teams. The nursing teams were asked to focus on restraint use at the departmental level.Introducing a new form of documentation for restraint use improved documentation from 0% to 55.9% during the course of the study.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186515","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 initial vital signs assessment and documentation in the emergency department of regional hospital, Bhutan: quality improvement project.","authors":"Sherab Wangdi, Kashap Guragai, Pema Namgay, Jamyang Dorji, Kesang Wangchuk","doi":"10.1136/bmjoq-2024-003151","DOIUrl":"10.1136/bmjoq-2024-003151","url":null,"abstract":"<p><strong>Background: </strong>Vital signs are key indicators of a patient's physiological status. It includes blood pressure, temperature, pulse rate, respiration rate and oxygen saturation (SPO₂). Derangements in vital signs are associated with an increased risk of morbidity and mortality, and thus serve as important indicators for risk stratification and early detection of clinical deterioration. Despite this, several studies have indicated that vital signs are not consistently recorded, which can have a significant impact on the effectiveness of the rapid response system. A baseline study in our emergency room showed that the rate of complete assessment and documentation is only 40%.</p><p><strong>Method: </strong>A quality improvement initiative was undertaken to improve the initial vital signs assessment and documentation in the Emergency Department of a Regional Referral hospital for a duration of 10 weeks. Our team implemented four cycles of intervention which were based on a baseline survey, analysis of plan-do-study-act cycles, previous similar projects and discussion within the group.</p><p><strong>Intervention: </strong>The interventions included sensitisation about the vital signs, making monitoring equipment easily available and redesigning areas for assessment and documentation.</p><p><strong>Result: </strong>The rate of complete assessment and documentation of vital signs increased significantly from 40% to 97% at the end of the 10 week period.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186513","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":"Assessment of the quality of care provided to women with gestational diabetes mellitus by different hospitals in Karachi, Pakistan.","authors":"Javeria Mansoor, Shafaq Alvi, Romaina Iqbal, Narjis Rizvi, Sabahat Naz","doi":"10.1136/bmjoq-2025-003362","DOIUrl":"10.1136/bmjoq-2025-003362","url":null,"abstract":"<p><strong>Background: </strong>Since gestational diabetes mellitus (GDM) prevalence is increasing in Pakistan, the quality of care provided to women with GDM is crucial for improving maternal and neonatal outcomes. Therefore, our study aimed to assess the quality of existing healthcare services related to GDM management across different hospitals in Karachi, Pakistan.</p><p><strong>Methods: </strong>We used Donabedian's model to evaluate the input, process and output phases. The first two phases were assessed through a cross-sectional design, while the output was evaluated via in-depth interviews. The study included six hospitals, one public and five private. We interviewed department heads (n=6) to assess the workforce and facilities (input) and nurses (n=17) and doctors (n=8) to examine qualifications for GDM management protocols (process). The output phase involved interviewing postpartum women with GDM (n=6) about their understanding of GDM, its complications and lifestyle modifications. We report frequencies and percentages for quantitative and thematic analysis for qualitative data.</p><p><strong>Results: </strong>Monthly, 9000 women sought antenatal care (ANC) services, with 500 deliveries in public hospitals, while 2000-5500 sought ANC services, with 160-461 deliveries in private hospitals. All hospitals, except the public one, had standard GDM protocols. Three hospitals had neonatal intensive care units, six employed an endocrinologist, three had a dietician and only one appointed nursing staff as GDM counsellors. Two hospitals provided blood glucose monitoring charts, three offered diet charts and five gave breastfeeding instructions. While all doctors attended GDM education, no nurses participated. Thematic analysis highlighted postpartum women's lack of knowledge about GDM, its complications and the importance of lifestyle modification postdelivery.</p><p><strong>Conclusion: </strong>Our study identified gaps in GDM care and highlighted the need for policies to develop and implement standardised GDM screening and management protocols, ensure mandatory training for healthcare providers and integrate multilingual educational material in healthcare settings to improve health outcomes for mothers and children.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186514","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":"Protocol for implementation of intraoperative adverse event recording during WHO checklist sign-out.","authors":"Katrin Burri-Winkler, Anne C Auderset, Dieter Hahnloser, Christoph S Burkhart, Valentin Neuhaus, Jörn-Markus Gass, Andreas P Vogt, Giorgio Prouse, Judith Winkens, Guy Haller, Amanda Van Vegten, Zuzanna Kita, Monika Finsterwald, Christian Schindler, Nico Streit, Lisa M Willms, Luzius A Steiner, Lauren Clack, Salome Dell-Kuster","doi":"10.1136/bmjoq-2024-003286","DOIUrl":"10.1136/bmjoq-2024-003286","url":null,"abstract":"<p><strong>Introduction & aim: </strong>Intraoperative adverse events (iAEs) increase postoperative complications, which are devastating to patients and costly to healthcare systems. To optimise patient outcomes, the WHO Surgical Safety Checklist (WHO SSC) was introduced in 2008, but adherence, especially to its third part (sign-out), is low, and iAEs are currently not routinely assessed. This gap between evidence supporting the use of the WHO SSC, current inconsistent sign-out practice and the lack of standardised reporting of iAEs warrants applying an implementation science approach. Hence, this project aims to simultaneously evaluate the effectiveness and implementation of the sign-out, including systematic recording and discussion of iAEs during the sign-out.</p><p><strong>Methods & analysis: </strong>Using a hybrid effectiveness-implementation approach, this prospective before-and-after-cohort project includes five surgical disciplines within nine Swiss hospitals. Following an extensive context analysis, this project is set up in three phases: (1) recruitment of 40 patients per surgical discipline and site (approx. 900 in total) for baseline assessment; (2) implementation based on a multifaceted, tailored implementation strategy (including formation of implementation teams, comprehensive education of healthcare professionals, top-down leadership, regular feedback rounds and tailoring implementation to local needs); and (3) recruitment of 40 patients per discipline to assess the changes after implementation (approx. 900). Implementation (eg, checklist fidelity composed of completion and quality) and effectiveness outcomes (ie, clinical patient outcomes) will be analysed using a mixed regression model.</p><p><strong>Discussion & conclusion: </strong>By enhancing adherence to the WHO SSC sign-out, including standardised reporting of iAEs, we expect to further improve perioperative patient outcomes. Based on the context analysis, we will provide a widely applicable implementation plan to support and sustain the required behavioural change, which will support roll-out in further hospitals. Meanwhile, clinical and implementation science expertise is meeting the challenges of the complex environment of perioperative care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186516","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}