BMJ Open Quality最新文献

{"title":"Regional differences in experiences of patients with metastatic breast cancer in the Republic of Ireland and Northern Ireland: a comparative analysis (CTRIAL-IE 23-05).","authors":"Calvin R Flynn, Ann McBrien, Siobhan Gaynor, Yvonne O'Meara, Emer Mulvaney, Rachel J Keogh, Catherine S Weadick, Frances Duane, Helen Greally, Mary Jane O'Leary, Ieva Teiserskyte, Isabel Beristain, Jacinta Marron, Eibhlin Mulroe, Vicky Donachie, Sarah McLoughlin, Seamus O'Reilly","doi":"10.1136/bmjoq-2024-003254","DOIUrl":"10.1136/bmjoq-2024-003254","url":null,"abstract":"<p><strong>Introduction: </strong>Metastatic breast cancer (MBC) presents significant psychological, social and financial challenges. Differences in the healthcare systems of the Republic of Ireland (ROI) and Northern Ireland (NI) may impact patient care experiences. This study aimed to explore regional differences in the experiences of patients with MBC between ROI and NI.</p><p><strong>Methods: </strong>A patient-developed cross-sectional survey titled 'Patient-led Metastatic Breast Cancer Survey' was administered online to patients with MBC in ROI and NI from July to October 2023. The survey included 76 questions addressing demographics, understanding of diagnosis, mental health, financial burden, time spent managing cancer care (time toxicity), palliative care, sexual health, exercise and access to information. These topics were selected by patients with MBC as being most impactful. Responses from 246 patients (196 ROI, 50 NI) were analysed using descriptive and comparative statistics.</p><p><strong>Results: </strong>Psychological distress was highly prevalent in both regions; however, NI patients were more likely to receive medications for psychological distress (51% NI vs 23.7% ROI, p=0.0008). Financial strain was more pronounced in ROI, with 77.5% feeling they had no control over their medical care spending, compared with 56% of NI patients (p=0.0124). Time toxicity was also higher in ROI, where patients reported more frequent visits to oncology day wards and acute oncology service units (p=0.0012) and spent more time in these settings (p=0.038). Participation in exercise programmes was significantly higher in NI compared with ROI (p<0.0001). Additionally, palliative care referrals were more commonly accepted or considered in NI than in ROI.</p><p><strong>Conclusions: </strong>This study, the first of its kind, highlights important disparities observed in this cohort of patients with MBC across ROI and NI. Bidirectional learning could enhance patient care experiences, with NI potentially focusing on psycho-oncology integration and ROI expanding strategies to reduce time toxicity and financial burden for 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/PMC12215112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538367","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":"Interventions to improve patient safety during the COVID-19 pandemic: a systematic review.","authors":"Albert W Wu, Katelyn Trigg, Allen Zhang, G Caleb Alexander, Elliott R Haut, Clare Rock, Kathryn McDonald, William Padula, Sarah Fisseha, Rosemary Duncan, Joyce Black, David E Newman-Toker, Irina Papieva, Neelam Dhingra-Kumar, Renee F Wilson","doi":"10.1136/bmjoq-2024-003076","DOIUrl":"10.1136/bmjoq-2024-003076","url":null,"abstract":"<p><strong>Objective: </strong>To summarise the literature on healthcare interventions to reduce harm to patients caused by the COVID-19 pandemic across six domains: medication safety, diagnostic safety, surgical safety, healthcare-associated infections, pressure injuries and falls.</p><p><strong>Methods: </strong>We performed a mixed-methods systematic review, with the intention to present results narratively. We combined parallel searches and expert input across each domain of interest, identifying 13 019 unique articles across the six domains. Of these, 590 full texts were assessed for eligibility. 7 were included for the medication safety domain; 7 for diagnostic safety; 32 for surgical safety; 11 for healthcare-associated infections; 5 for the pressure injuries and 2 for falls. Overall, a total of 61 unique articles were included-4 articles were represented across more than one domain.</p><p><strong>Findings: </strong>There were few rigorous evaluations of specific interventions to reduce patient harm caused by the pandemic. Adjustments in treatments, triage and procedures, and use of risk stratification tools reduced delays and permitted more elective surgery and diagnostic testing to proceed. These changes also led to improvements in medication safety practices and prevention of healthcare-associated infections.</p><p><strong>Conclusion: </strong>There has been little research on interventions to reduce patient harm caused in healthcare settings during the COVID-19 pandemic. Interventions focused on preventing nosocomial transmission of COVID-19 and on permitting access to urgent surgical and diagnostic needs. A few studies tested strategies to reduce new risks imposed by the pandemic for medication safety, healthcare-associated infections, pressure injuries and falls. Development of high-reliability health systems and healthcare organisations to protect patients and health workers from harm will be essential to mitigating the impact of future pandemics within the objectives of the Global Patient Safety Action Plan 2021-2030.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12211853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526352","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":"Enhancing venous thromboembolism prophylaxis compliance: a quality initiative for standardised risk assessment in a hospital setting.","authors":"Emad Naji Isaid, Anwar I Joudeh, Nijab Shereef, El Hareth Sirjuddin, Naseera Aboubaker, Eiman Abdelfattah-Arafa, Rehab Mohammad, Hemalatha Charles, Joseph Macalimbon, Wissam Ghadban","doi":"10.1136/bmjoq-2024-003239","DOIUrl":"10.1136/bmjoq-2024-003239","url":null,"abstract":"<p><p>Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, poses a significant threat to hospitalised patients, affecting morbidity, mortality and healthcare costs. Despite the availability of effective prophylaxis, adherence rates remain inconsistent. At AlKhor Hospital in Qatar, only 40% of moderate-risk to high-risk patients initially received appropriate VTE prophylaxis within 24 hours of admission due to limited use of assessment tools and inconsistent documentation. To address this, a multidisciplinary team, including physicians, nurses, pharmacists and quality improvement officers, applied a quality improvement framework with multiple Plan-Do-Study-Act cycles to implement a standardised VTE risk assessment tool. Compliance rates for risk assessment completion and prophylaxis administration were monitored monthly, with hospital-acquired VTE and prophylaxis-related bleeding as balance measures. A comprehensive VTE risk assessment and prophylaxis form was integrated into the electronic medical records (EMR), and training sessions were conducted, supported by 'super users' in each department. The implementation resulted in an initial rise in compliance, with fluctuations following the EMR transition, ultimately stabilising and showing improved adherence across departments. Ongoing support and multidisciplinary champions were instrumental in sustaining these gains. Standardised assessment tools, EMR integration and regular training significantly enhanced compliance with VTE prophylaxis. This project underscores the value of structured, team-based approaches in preventing hospital-acquired VTE, providing a model for similar healthcare settings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474006","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 written handoff on inpatient medicine resident services: a resident-led safety initiative.","authors":"Sangini Tolia, Veena Janardan, Ethan Bowlin, James Haubert, Ola Al-Sous","doi":"10.1136/bmjoq-2024-003277","DOIUrl":"10.1136/bmjoq-2024-003277","url":null,"abstract":"<p><strong>Background: </strong>High-quality, standardised handoff during shift change is a key aspect of reducing preventable medical errors. At our hospital, we noticed inconsistent use of the handoff tools built into the electronic health record. The goal of our project was to increase the percentage of completed written handoffs for all new admissions on resident teaching services by 50% in 8 weeks.</p><p><strong>Methods: </strong>We designed a smart phrase tool based on the well-studied and validated I-PASS and taught all residents in small groups how to use it. We collected data weekly on the percentage of handoffs that were completed in the electronic health record. Measures were tracked via chart review and direct observation and uploaded on a run chart using Excel. Feedback was also gathered from residents and faculty.</p><p><strong>Results: </strong>We noted an upward trend in the percentage of written handoffs completed on new admissions postintervention, with the median preintervention rate of 31% and the median postintervention rate of 89% at 8 weeks, which remained sustained at the 4-month mark.</p><p><strong>Conclusions: </strong>Our intervention improved the rates of written handoff completion based on the I-PASS handoff tool. It helped all members of the team feel more confident that they had the necessary information to care for patients and had the effect of reducing handoff time and improving satisfaction.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336309","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":"Confidence in consent: the use of a patient information leaflet as a tool for consent for regional anaesthesia - a service improvement project.","authors":"Emma Lennon, Abigail Walsh, Shanika Wijayaratne, Sherife El Mahgoub","doi":"10.1136/bmjoq-2024-003241","DOIUrl":"10.1136/bmjoq-2024-003241","url":null,"abstract":"<p><p>Regional anaesthesia is increasingly used for perioperative pain management, offering benefits such as improved pain scores, reduced opioid use and early mobilisation. However, informed consent remains a critical issue, particularly given the rising litigation claims related to peripheral nerve blockade. This service improvement project evaluates the impact of introducing a patient information leaflet (PIL) on patient understanding and experience of the consent process. A structured in-person survey was administered pre and post intervention to two cohorts of 30 patients each. The results demonstrate improvements in patient recall of risks and benefits, understanding of voluntary consent and overall satisfaction with the consent process. The findings are suggestive that PILs enhance shared decision-making and should be integrated into standard consent procedures.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315870","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 venous access by using a near-infrared vein-finder device and ultrasound skill building: a quality improvement project.","authors":"Hassan Bennakhi, Mohammad Alajmi, Mahmoud Baqer, Naser Qasem, Zafeer Ul Hassan Iqbal, Nihal Abosaif, Clare Philliskirk","doi":"10.1136/bmjoq-2024-003232","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003232","url":null,"abstract":"<p><strong>Introduction: </strong>Venous access by venipuncture and cannulation is a crucial procedure in day-to-day patient care in clinical settings. Performing this procedure on difficult veins can be time-consuming and burdensome for healthcare providers and painful and uncomfortable for patients. This quality improvement project aimed to optimise venous access by using a near-infrared (NIR) vein-finder device and provide ultrasound practical skills training to facilitate venous access.</p><p><strong>Methods: </strong>The first plan-do-study-act (PDSA) cycle introduced an NIR device to hospital wards after collecting baseline data on success rate, number of attempts, procedure duration and need for help or escalation. These data were submitted by ward staff voluntarily for any venipuncture or cannulation procedure, followed by data analyses and plans for a second cycle. The second PDSA cycle involved organising a practical training session for the use of an ultrasound device for venous access. Participants voluntarily used their newly acquired ultrasound skills for difficult veins after multiple failed attempts without a device and submitted a Google form with questions about the above-mentioned success indicators.</p><p><strong>Results: </strong>In the first cycle, improvements were observed in all chosen quality indicators but were only statistically significant for the overall success rate (venipuncture and cannulations combined), the overall number of attempts and the overall duration of venous access procedures as well as for number of attempts and procedure duration for venipuncture individually. For the second PDSA cycle, after attending the ultrasound training session, participants reported an 80.95% overall success rate of venous access for difficult veins that were inaccessible before the ultrasound device was used. It also significantly reduced the number of attempts needed to get venous access when compared with attempts before using the ultrasound device.</p><p><strong>Conclusions: </strong>Based on our findings, we recommend providing an NIR vein-finder device and ultrasound training to improve venous access in hospital settings and encourage further research to evaluate their effectiveness.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301080","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":"Evaluation of a data-driven recall system in general practice.","authors":"Tim Benson, Alex Benson","doi":"10.1136/bmjoq-2024-003137","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003137","url":null,"abstract":"<p><strong>Introduction: </strong>This paper presents a mixed-methods evaluation of the spread of the Target Health Solutions data-driven recall system to seven general practices (GPs). The aim was to assess implementation success, changes in staff perceptions and impact on patient recall.</p><p><strong>Method: </strong>Data was collected about recall rates at each practice. Staff (n=128) answered surveys before (32 questions) and after (51 questions) implementation of the system.</p><p><strong>Results: </strong>Overall, there were substantial quantitative improvements in recall. Performance was lower in some practices, which continued to run their existing recall systems alongside the new system.Staff perceived significant improvement in their recall systems, although other areas were not affected. Challenges to implementation included running parallel systems, workload pressures and training.</p><p><strong>Discussion: </strong>The results suggest that strong leadership and focused implementation planning are needed for successful adoption of this type of innovation in GP.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301079","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":"Collaboration in nursing-home care: perspectives of care professionals - a qualitative study.","authors":"Roeyel J F Koldeweij, Marleen H Lovink, Anke Persoon","doi":"10.1136/bmjoq-2024-003147","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003147","url":null,"abstract":"<p><p>Interprofessional collaboration became more firmly positioned after the WHO highlighted its importance for better healthcare outcomes. In nursing homes, interprofessional collaboration refers to collaboration between teams of physicians/allied health professionals and care teams. Collaboration within care teams is known as intraprofessional collaboration. Determinants of interprofessional and intraprofessional collaboration have yet to be explored within the nursing-home context. Our exploratory qualitative study focused on the determinants considered important by professionals in seven nursing homes. We conducted 14 one-on-one, semistructured interviews with nurses and collaborating physicians/allied health professionals from seven teams of one care organisation. Data were analysed on thematic analysis, proceeding from an inductive approach. Five interacting determinants were identified. The core determinant was 'investing in each other', followed by 'roles, functions and responsibilities within care teams'; 'written policies for individual residents'; 'verbal coordination meetings'; and 'organisational influences'. One notable finding is the influence of intraprofessional collaboration within the care team on all determinants of interprofessional collaboration, including the role of the coordinating nurse. Future ethnographic and action research on intraprofessional collaboration is needed, including the perspective of nurse assistants, as well as on interventions aimed at improving interprofessional collaboration. We recommend training professionals to invest in each other as a skill that encourages relationships.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301078","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":"Return to care of children and adolescents living with HIV who missed their clinic visits or were lost to follow-up: a continuous quality improvement study in Uganda.","authors":"Ssentongo Mugerwa Saadick, Jonathan Izudi, Boniface Oryokot, Ronald Opito, Baker Bakashaba, Abel Munina, Kokas Opolot, Daniel Ogwal, Julius Ssendiwala, Kenneth Mugisha","doi":"10.1136/bmjoq-2024-003157","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003157","url":null,"abstract":"<p><strong>Background: </strong>While the UNAIDS 95-95-95 targets have been met among adults, those for children and adolescents remain suboptimal. This study aimed to improve the return-to-care rates among children and adolescents living with HIV (CALHIV) who missed clinic appointments at a county-level rural health facility in eastern Uganda.</p><p><strong>Methods: </strong>Between January 2023 and January 2024, we conducted a continuous quality improvement (CQI) study. A CQI committee was established through entry meetings and training, and quality of care gaps were identified through data reviews. We prioritised one gap for CQI through ranking, performed a root-cause analysis using a fishbone diagram, and developed and ranked improvement changes using the impact-effort matrix. The improvement changes were implemented using Plan-Do-Study-Act cycles. The changes included (1) line listing CALHIV with missed appointments and following up via phone calls; (2) weekly data reviews to harmonise missed appointments and (3) assigning community health workers (CHWs) to trace and return CALHIV to care. We tracked and plotted the proportion of CALHIV returning to care over time to assess improvements.</p><p><strong>Results: </strong>Before the implementation of CQI initiatives (August 2022-January 2023), the average return-to-care rate was 35% (baseline). Following the initiation of CQI in February 2023, the average return-to-care rate increased to 59% from February to May 2023 with the introduction of line listing (phase 1), to 69% from June to September 2023 with the implementation of weekly data reviews (phase 2), and to 88% from October 2023 to January 2024 with the involvement of CHWs (phase 3), ultimately reaching a peak of 100% in January 2024.</p><p><strong>Conclusion: </strong>The CQI approach improved the return to care of CALHIV who missed clinic appointments, allowing access to optimal care and better health outcomes. These findings should serve as preliminary data for larger randomised studies.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing credibility in government assignments: an example from Sweden of stakeholder involvement by using Concept Mapping.","authors":"Frida Smith, Katarina Fredriksson, Katrín Ásta Gunnarsdóttir, Mikael Holtenman, Christina Carlsson","doi":"10.1136/bmjoq-2024-003021","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003021","url":null,"abstract":"<p><strong>Background: </strong>The incidence of people diagnosed with cancer is increasing worldwide, in Sweden with approximately 65 000 new cases yearly. To enhance conditions for a continued good life, high-quality, accessible and equal cancer rehabilitation is required. In 2020 the National Board of Health and Welfare (NBHW) received a government assignment to investigate the conditions for the offer of cancer rehabilitation. This paper aims to highlight how the Concept Mapping (CM) methodology was strategically used by the NBHW for mutual learning to raise different perspectives and 'voices' of cancer rehabilitation.</p><p><strong>Methods: </strong>The stepwise, mixed-method CM was used. A broad selection of relevant stakeholders was invited to complete the prompt: a good and equal cancer rehabilitation requires… the stakeholders were involved in brainstorming, sorting and grading data. The research group performed multi-dimensional scaling and hierarchical cluster analysis to provide a visual presentation of the results. Two digital seminars were held: one where stakeholders did online sorting and grading of data and one where results were presented and discussed.</p><p><strong>Results: </strong>118 respondents from four stakeholder groups provided 489 original ideas. Six clusters from 67 unique ideas constituted the concept map, and a go-zone showing the 12 ideas rated as most important and feasible was obtained.</p><p><strong>Conclusion: </strong>For the first time, the NBHW has used CM in investigative work to produce development proposals and improvements that the government can use as a basis for political decisions. The method showed great potential, by allowing for stakeholder involvement as co-creators in all steps, high participation and possible direct utilisation of results. A clear learning perspective was obtained, both from the NBHW and the involved stakeholders; hence, the method can be used in further assignments where improvement perspectives are requested.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293281","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}