BMJ Open Quality最新文献

{"title":"Improving surgical antimicrobial prophylaxis in patients with a penicillin allergy label: a quality improvement study.","authors":"Byron M Rudman, Olga Horn, Olivia Lamont, Niall Conlon, Salma Alamin, Jonathan McGrath, Sadhbh O'Rourke, Maebh Kelleher, Niall Fanning, Aine Cafferkey, Rory Naughton, Sean Keane","doi":"10.1136/bmjoq-2026-004450","DOIUrl":"10.1136/bmjoq-2026-004450","url":null,"abstract":"","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164235","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":"Addressing administrative burden in family medicine: a local quality improvement initiative.","authors":"Madura Sundareswaran, Max Moloney","doi":"10.1136/bmjoq-2025-004072","DOIUrl":"10.1136/bmjoq-2025-004072","url":null,"abstract":"","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163534","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":"Sustaining accurate penicillin allergy labels through electronic health record interoperability: a cross-sectional observational follow-up study 3 years after initial penicillin allergy evaluation.","authors":"Marie Bjørbak Alnæs, Ann Kristine Hammerstad, Benedicte Garfors, Oddvar Oppegaard, Bård Reiakvam Kittang, Torgeir Storaas","doi":"10.1136/bmjoq-2026-004293","DOIUrl":"10.1136/bmjoq-2026-004293","url":null,"abstract":"","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164017","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":"Antibiotic prescribing that aligns with a host-protein test at US acute care settings is associated with fewer subsequent hospitalisations.","authors":"Peter S Antkowiak, W Frank Peacock, Adam J Singer, Richard E Rothman, Gabriel A Bien-Willner","doi":"10.1136/bmjoq-2026-004217","DOIUrl":"10.1136/bmjoq-2026-004217","url":null,"abstract":"<p><strong>Background: </strong>Differentiating bacterial from viral infections in acute care is challenging, often leading to inappropriate antibiotic use. MeMed BV (MMBV) is a host-protein test integrating TNF-related apoptosis-inducing ligand, induced protein-10 and C-reactive protein to distinguish infection aetiology. We evaluated whether alignment between MMBV results and antibiotic prescribing is associated with downstream clinical outcomes and costs.</p><p><strong>Methods: </strong>Data were pooled from two prospective US studies (APOLLO and JUNO). Alignment was defined as: antibiotics prescribed for bacterial MMBV results or no antibiotics for viral results. The primary outcome was unplanned revisits and hospitalisations within 28 days. Exploratory analysis estimated healthcare costs using 2024 Healthcare Cost and Utilisation Project data.</p><p><strong>Results: </strong>The cohort included 297 adults (median age 36.4 years). 20.5% had bacterial, 68.0% viral and 11.4% equivocal MMBV results. In patients with bacterial MMBV results, antibiotic prescription (alignment) was significantly associated with fewer revisits (5.0% vs 33.3%; p=0.003) and hospitalisations (2.5% vs 19.0%; p=0.026). For patients with viral results, outcomes were comparable regardless of antibiotic use. In the exploratory analysis, alignment with MMBV was associated with lower estimated costs (£101 vs £1175/patient; difference £1074), driven mainly by fewer hospital days in the aligned group.</p><p><strong>Conclusion: </strong>Misalignment between MMBV bacterial results and antibiotic prescribing in acute care settings was associated with higher revisit and hospitalisation rates. These findings identify a quality gap under diagnostic uncertainty and support a methodology which includes assessment of test versus clinical outcome alignment when evaluating new diagnostic tests.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103876","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 sleep duration in NICU graduates: a quality improvement initiative.","authors":"Ramesh Choudhary, Chetan Meena, Vivek Kumar Athwani, Sunil Gothwal","doi":"10.1136/bmjoq-2026-004166","DOIUrl":"10.1136/bmjoq-2026-004166","url":null,"abstract":"<p><strong>Background: </strong>Protected sleep is a core component of developmental supportive care in neonates. However, the overstimulating neonatal intensive care unit (NICU) environment and procedures often disrupt neonatal sleep periods. With improving neonatal survival rates in low- and middle-income countries like India, focus must shift towards ensuring neurologically intact outcomes. We implemented a point of care quality improvement initiative using environmental modification to improve sleep duration in neonates admitted to the low dependency unit (LDU) of our NICU.</p><p><strong>Methods: </strong>This prospective quality improvement study was conducted at a tertiary care teaching hospital in North India from May to August 2024. All stable neonates admitted to the LDU during the study period were enrolled. Four sequential plan-do-study-act (PDSA) cycles were implemented, targeting cyclic lighting, noise reduction through alarm management and equipment repair, staff sensitisation and caregiver involvement. The primary outcome was the proportion of neonates achieving adequate sleep duration of more than 16 hours/day.</p><p><strong>Results: </strong>A total of 625 neonates were enrolled across three phases (baseline: n=115; implementation: n=312; post implementation: n=198). The proportion of neonates achieving adequate sleep increased from 15.7% at baseline to 62.2% during implementation and sustained at 58.1% post implementation. Mean sleep duration increased significantly from 12.95±3.22 to 16.38±3.12 hours/day (p<0.001). Environmental parameters also improved, with daytime mean light intensity reducing from 486±124 to 285±98 lux and mean noise levels decreasing from 62.4±8.3 to 52.8±6.5 dB.</p><p><strong>Conclusion: </strong>Simple, low-cost environmental modifications implemented through sequential PDSA cycles can significantly improve sleep duration in NICU neonates.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103834","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":"Transforming musculoskeletal injury management using Virtual Bones: a novel digital solution.","authors":"Mohamed A Mansour, Ali Al-Kulabi, Minaam Abbas, Layth Qaraqe, Sade Uwaoma, Ahmad Al-Sukaini, Lora Young, Sue Deakin","doi":"10.1136/bmjoq-2025-004121","DOIUrl":"10.1136/bmjoq-2025-004121","url":null,"abstract":"<p><strong>Introduction: </strong>Managing musculoskeletal (MSK) injuries requires effective communication and collaboration between the emergency department (ED) and orthopaedic teams. A quality improvement project analysing virtual fracture clinic (VFC) referrals, staff challenges and the impact of the novel digital solution, Virtual Bones (VB), was undertaken at the West Suffolk Hospital. VB is a digital platform, available at the point of care, that guides clinicians in the assessment and management of MSK injury presentations in ED and referral to VFC.</p><p><strong>Methods: </strong>VFC outcome data were collected between 2017 and 2022, with a 2-week focused data collection gathering diagnosis, ED processing times, patient leaflet distribution, VFC decisions and referral quality. An ED survey was distributed to explore staff challenges in the management of MSK injuries. Virtual Bones, a novel digital solution, was developed and deployed to enable clinicians to comprehensively digitalise MSK injury management pathways from first patient encounter to referral/discharge. Subsequent data collection cycles compared baseline to post deployment results.</p><p><strong>Results: </strong>The Virtual Bones pilot (undertaken May-July 2023) involved 352 users, 2400 sessions and 56 700 page views. The initial 2-week cycle included 260 patients while the subsequent cycles included a total of 258. Mean ED processing times decreased from 166 to 122 min, with an up to 90 min reduction in the Foundation Doctors' group (p<0.0001). Inappropriately referred dischargeable injuries decreased from 23 to 10. Improper documentation decreased from 58% to 30% (p<0.0001). The VFC discharge rate increased from 39% to 48% (p=0.021). Patient information leaflet use increased from 27% to 41% (p=0.032). The ED staff survey demonstrated improved staff confidence in the revealed challenges, including navigating local guidelines, locating equipment, applying immobilisation devices and supplying information leaflets.</p><p><strong>Conclusion: </strong>Robust engagement with Virtual Bones, along with improved metrics, suggests that this digital solution effectively streamlined MSK injury pathways and helped staff manage challenges.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103862","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":"Quality improvement project to improve immediate postpartum family planning utilisation at Dilla University Teaching Hospital.","authors":"Bereket Tesfaye, Birhanemeskel Damtew, Tizalegn Tesfaye, S Melaku, Surafuel Shewatatek, Nigatu Tilahun, Aberham Abeje","doi":"10.1136/bmjoq-2025-004062","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-004062","url":null,"abstract":"<p><strong>Background: </strong>Immediate postpartum family planning (IPPFP) is a proven intervention to reduce unintended and closely spaced pregnancies, yet its utilisation remains low in Ethiopia. At Dilla University Teaching Hospital (DUTH), only 10.2% of postpartum mothers received contraception before discharge. This quality improvement (QI) project was implemented to address gaps in counselling, provider readiness and interdepartmental linkages affecting IPPFP uptake.</p><p><strong>Methods: </strong>A QI initiative guided by the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles was conducted from 8 July 2025 G.C. to 1 October 2025 G.C. Five sequential PDSA cycles were implemented, including staff orientation, assignment of a focal person, integration of IPPFP indicators into the hospital's daily system bottleneck focused reform (SBFR) monitoring dashboard, strengthening maternal, newborn and child health unit linkages and continuous monitoring with weekly feedback. Data were analysed using run charts and descriptive statistics following SQUIRE 2.0 guidelines.</p><p><strong>Results: </strong>During the baseline period, 10.2% of eligible postpartum mothers received IPPFP. Major barriers included inadequate counselling, limited provider training and poor documentation systems. After implementing the QI interventions, IPPFP uptake increased to 45.8% among 786 postpartum mothers over 14 weeks. Implants were the most commonly chosen method (54.2%), followed by intrauterine devices (4.4%) and bilateral tubal ligation (1.1%). Although run charts demonstrated intermittent weekly improvements, the data did not meet criteria for a sustained performance shift, reflecting variable adherence to newly introduced processes.</p><p><strong>Conclusion: </strong>Implementation of the QI intervention was associated with increased IPPFP uptake at DUTH and may have been supported by strengthened counselling, improved accountability, enhanced provider readiness and better data-driven decision making.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103818","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":"De-implementation of routine laboratory testing in a surgical intensive care unit: lessons from a two-phase quality improvement initiative.","authors":"Chloe F C Yeo, Siting Goh, Renci Zeng, Jasper Goh, Wen Jia Tan, Jia Xuan Yeo, Sui An Lie","doi":"10.1136/bmjoq-2026-004415","DOIUrl":"10.1136/bmjoq-2026-004415","url":null,"abstract":"<p><p>Excessive laboratory investigations in the intensive care units (ICUs) contribute to increased risk of line infections, iatrogenic anaemia, environmental burden and healthcare costs without clear mortality benefit. Despite Choosing Wisely recommendations advocating clinically indicated testing, overutilisation of laboratory tests in ICUs remains common. In our surgical ICU, ordering practices were driven by unclear consultant expectations, reassurance-seeking, junior doctor inexperience, ease conferred by order sets and limited awareness of value-based care.We conducted a two-phase quality improvement initiative between December 2023 and December 2025 to reduce laboratory utilisation. Root causes were identified via clinician surveys, visualised using an Ishikawa diagram and prioritised using Pareto charting. The primary outcome was the number of laboratory investigations ordered per patient-day. Counterbalance metrics included ICU mortality and length of stay (LOS).Interventions were mapped to a driver diagram. Phase 1 focused on education, visual reminders, encouraging shared decision-making, nursing empowerment to clarify orders and mid-phase audit and feedback. Phase 2 incorporated system-level strategies, including electronic prompts to reconcile investigation orders, frequent digital reminders and engagement of new junior doctors. Data were analysed using run charts according to standard healthcare improvement rules for special cause variation.During Phase 1, median laboratory investigations increased from 12.9 to 13.3 tests per patient-day despite comparable illness severity. ICU mortality was similar in the pre-intervention period (12.7%) and during our first study phase (12.9%), without a consistent temporal association with interventions. In Phase 2, laboratory utilisation returned to baseline levels with reduced ICU LOS and mortality. No sustained reduction was observed.In conclusion, educational and behavioural interventions alone were insufficient to de-implement entrenched ordering practices in a high-acuity ICU environment. Sustainable reduction likely requires stronger system redesign, including order-set modification and embedded decision support. Reporting null effects in de-implementation initiatives provides important insights into the structural and cultural barriers to reducing low-value care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079612","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":"Implementation of self-collected cervical screening in an under-screened, culturally and linguistically diverse antenatal population: a quality improvement study.","authors":"Mandy Wang, Alison Brand, Martin Plymoth, Judy Chen, Therese McGee","doi":"10.1136/bmjoq-2026-004525","DOIUrl":"10.1136/bmjoq-2026-004525","url":null,"abstract":"<p><p>Eliminating cervical cancer requires high screening participation levels. Pregnancy is an opportunity to reach under-screened women, but clinician-collected speculum examination is a barrier to uptake. Patient self-collected cervical screening tests (SC-CST) using a vaginal swab for detection of human papillomavirus (HPV) may offer a solution. The objective of this study was to evaluate the outcomes and implementation of a comprehensive programme embedding SC-CST into antenatal care.This is a prospective quality improvement study in a tertiary hospital servicing a population with one of the lowest cervical screening rates nationally. Pregnant women attending public maternity care and eligible for screening under national guidelines were included. Screening histories were obtained from the national registry to identify screen-overdue or never-screened women for SC-CST offer. Staff education and patient information encouraged participation. Test packs facilitated specimen collection. Referral pathways were created for abnormal results. Main outcome measures include reach, effectiveness, implementation and maintenance of quality improvement.From 19 February 2024 to 31 July 2025, 48.0% (2492/5190) of eligible pregnant women required a CST, 69.7% were offered SC-CST and 93.7% accepted. Cervical screening rates increased 22-fold from 3.0% prior to the programme to 65.3%. Parous women were offered SC-CST at lower rates than nulliparous women (66.5% vs 74.1%; p=0.024). Women residing in the lowest socioeconomic quintile had lower acceptance rates (91.9% vs 94.8%; p=0.024). Being overseas-born and need for interpreter were not barriers to SC-CST offer or acceptance rates. Results were high risk HPV-negative in 88.1%, HPV 16/18 positive in 1.9%, HPV non-16/18 positive in 9.1% and invalid in 0.9%. Colposcopy was performed for 41 women, with 7 cases of biopsy-confirmed high-grade squamous intraepithelial lesion requiring treatment.Introduction of SC-CST into antenatal care is an effective strategy to improve cervical screening rates and was highly acceptable to pregnant women. Programme sustainability requires additional resources, staff engagement, and timely follow-up.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079607","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":"Dual-theatre high-intensity lists (HIT) for day-case minimally invasive parathyroidectomy: a prospective service evaluation.","authors":"Christian Chess, Laura Bateman, Catherine Ashworth, Stuart Gillett","doi":"10.1136/bmjoq-2025-003918","DOIUrl":"10.1136/bmjoq-2025-003918","url":null,"abstract":"<p><strong>Background: </strong>Elective ENT waiting lists and constrained theatre capacity require pathway redesign that increases surgical throughput without compromising safety. At our trust, patients awaiting minimally invasive parathyroidectomy faced waits of approximately 52 weeks, while routine intraoperative frozen-section confirmation created predictable theatre downtime.</p><p><strong>Local problem: </strong>Minimally invasive parathyroidectomy is well suited to day-case high-intensity theatre delivery because selected patients follow a standardised pathway. However, evidence for dual-theatre models in this setting is limited.</p><p><strong>Methods: </strong>We conducted a prospective registered service evaluation of two dual-theatre, 5 hour morning high-intensity theatre sessions for day-case minimally invasive parathyroidectomy at a UK NHS trust. Predefined timings, throughput and safety/balancing outcomes were collected prospectively from routine theatre documentation.</p><p><strong>Intervention: </strong>Two adjacent theatres were allocated by operative side with staggered starts. One consultant surgeon alternated between rooms while assistants completed haemostatic checks and wound closure under supervision. Six selected day-case patients were scheduled per session; eligibility required concordant imaging and suitability for day-case surgery.</p><p><strong>Results: </strong>Twelve patients underwent successful minimally invasive parathyroidectomy across two morning sessions. Six cases were completed within each 5 hour session, and all procedures were completed by 13:00 on both days. Mean knife-to-specimen time was 18.4 min, mean frozen-section duration was 24.1 min, mean incision-to-closure time was 42.9 min, and mean call-to-incision time was 42.2 min. All patients had histological confirmation of parathyroid adenoma and postoperative biochemical improvement.</p><p><strong>Conclusions: </strong>A dual-theatre high-intensity theatre model can convert frozen-section waiting time into productive operating time and substantially increase throughput for carefully selected day-case parathyroidectomy pathways. Wider implementation requires careful patient selection, operational planning, pathology availability, staff engagement and prospective monitoring of safety, cost and workforce impact.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001046","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}