BMJ Open Quality最新文献

{"title":"Optimising timely and safe oxygen delivery systems for enhanced patient care: a quality improvement project at Wallaga University Comprehensive Specialized Hospital, 2024.","authors":"Gedefa Bayisa, Dechassa Edessa, Kebena Limenu, Meskerem Deyasa, Ganna Gobana, Dereje Obsa, Temesgen Tilahun, Gurmessa Enkossa, Amsalu Takele, Lammii Gonfaa, Tsega Abera, Olbirat Dereje, Misganu Teshoma Regasa","doi":"10.1136/bmjoq-2024-003059","DOIUrl":"10.1136/bmjoq-2024-003059","url":null,"abstract":"<p><p>In a hospital setting, the supply and utilisation of oxygen are crucial for high-quality healthcare. This quality improvement project aimed to increase the rate of timely and safe oxygen delivery from 30% to 75% at Wallaga University Comprehensive Specialized Hospital from 1 January to 30 June 2024.Using the Plan-Do-Study-Act (PDSA) cycle, the project team identified root causes through fishbone and driver diagrams. Key interventions included staff orientation on safe handling of oxygen devices, clear job descriptions for compliance, improved handover processes between shifts, regular maintenance and inventory checks, increasing the number of oxygen cylinders, using hospital vehicles for transport and establishing a communication system with suppliers for timely requests.Results showed that the inventory of regular oxygen delivery devices improved to 76%, with equipment checks conducted 65% of the time. Emergency preparedness reached 20%, and onsite training for staff achieved 75%. Oxygen usage monitoring was nearly perfect at 99%, with delivery times reduced to 1 day for 70% of orders. A standard protocol for oxygen supply and use was established, resulting in a significant increase in timely and safe oxygen delivery from 30% to 75%.This project effectively optimised oxygen supply management, highlighting the importance of proactive management, communication and continuous monitoring in building a reliable oxygen therapy service. Improvements in inventory management and delivery efficiency were facilitated by a dedicated dashboard, standardised operating procedures and comprehensive staff training.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499108","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":"Holistic Integrated Care in Ovarian Cancer (HICO)-reducing inequalities due to age, frailty, poor physical and mental health.","authors":"Jonathan Frost, Claire Newton, Lucy Dumas","doi":"10.1136/bmjoq-2023-002714","DOIUrl":"https://doi.org/10.1136/bmjoq-2023-002714","url":null,"abstract":"<p><p>Older patients have disproportionally poorer survival outcomes for ovarian cancer in the UK. Half of new diagnoses occur in those aged >65 years. Older patients are more likely to have other medical comorbidities reducing their fitness to receive chemotherapy or undergo cytoreductive surgery resulting in fewer patients receiving treatment. The Holistic Integrated Care in Ovarian Cancer (HICO) programme introduced a structured holistic patient assessment with both universal and targeted interventions to improve physical function and psychological well-being to reduce inequalities due to age, frailty, physical and psychosocial problems. The aim of the project was to evaluate the feasibility and impact of the intervention in patients being considered for the treatment of ovarian cancer. During the implementation of the project, all recruited patients underwent a holistic assessment followed by prehabilitation and rehabilitation support from physiotherapists, occupational therapists, dietitians, geriatricians, nurse specialists and psychologists according to need. The HICO intervention was successfully integrated into the patient pathway in both trusts. Patients who participated in the HICO project provided positive feedback. Overall global health scores improved in 59.6% of the 57 patients who undertook at least two assessments (p=0.006). The proportion of patients who underwent platinum doublet chemotherapy in the HICO cohort was higher (76.2%) compared with a retrospective cohort (57.6%) (p=0.0189). However, no significant difference in the rate of cytoreductive surgery was shown. The proportion of patients alive at 1 year from diagnosis was higher in the HICO intervention group (88.9%) compared with the historical cohort (80.0%) despite higher stage in the HICO group. Although not statistically significant (p=0.289), these data are not yet mature and further study is ongoing. Initial data on costs of ovarian cancer care demonstrated no increase, although the data are not yet mature. This pilot project was funded through the Ovarian Cancer Action IMPROVE UK Pilot Award scheme.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498613","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":"Northern Ireland ovarian cancer prehabilitation project.","authors":"Josh Courtney McMullan, Davinia Lee, Lisa Ranaghan, Nicola Gowan, Lisa McWilliams, Bernie McGreevy, Danielle O'Hagan, Brenda Nugent, Stephen Dobbs","doi":"10.1136/bmjoq-2024-002851","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002851","url":null,"abstract":"<p><p>Patients with ovarian cancer are often diagnosed late, in advanced stages (stages III-IV) and are often deconditioned due to disease burden. Frailty is reported in up to 60% of gynaecological oncology patients and many report malnutrition, anxiety and depression. As surgery is the mainstay of treatment for ovarian cancer, with maximum surgical effort being a priority, patients are at increased risk of perioperative morbidity and mortality.Multimodal prehabilitation aims to improve the functional capacity of surgical patients. Prehabilitation commonly includes physical, nutritional, medical optimisation, smoking cessation and emotional well-being interventions. Many surgical specialties have well established evidence for the use of prehabilitation showing a reduction in length of stay and perioperative complications. There is, however, limited evidence for the use of prehabilitation in the surgically vulnerable group of patients with advanced ovarian cancer.This project aimed to introduce a multimodal prehabilitation pathway for patients with advanced ovarian cancer. All patients with advanced ovarian cancer were included, regardless of the treatment modality decided at the regional gynaecological oncology multidisciplinary team meeting. The pathway included exercise, nutritional and psychological interventions. The outcome measures included the Rockwood Frailty Score, 6 min Walk Test (6MWT), 30 s Chair to Stand test, grip strength and Eastern Cooperative Oncology Group performance status as a measure of functional capacity. Nutritional intervention outcomes included the Malnutrition Universal Screening Tool (MUST) score, Body mass index and mid-arm circumference. The psychological intervention outcomes included a holistic needs assessment, the distress thermometer and EQ-5D-5L quality of life status.Of the 75 patients enrolled, 45 (60%) completed the project. In patients who completed the project improved 6MWT and 30-CST was observed in 67% and 44%, respectively, while 67% of patients with moderate to extreme anxiety/depression scores reported lowering from baseline level and 71% of patients with medium to high-risk MUST scores baseline weight was maintained or increased.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498902","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":"Scottish ovarian cancer forum.","authors":"Mary Cairns, Nidal Ghaoui Dit Ebef","doi":"10.1136/bmjoq-2023-002715","DOIUrl":"https://doi.org/10.1136/bmjoq-2023-002715","url":null,"abstract":"<p><p>The project was to set up a multicentre collaborative real-time multidisciplinary review of women with advanced ovarian cancer (stages 3/4) being considered for surgery (upfront or interval). The forum met weekly via TEAMS with input from all relevant disciplines from the two cancer networks: North Cancer Alliance and South East Scotland Cancer Network. This included radiology, medical oncology, gynaecological oncology, clinical nurse specialists, colorectal and hepato-pancreatico-biliary surgeons. It was an educational forum to review radiology and assess the feasibility of surgical resection. The aim was to stratify and standardise surgical decision-making and increase surgical rates.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498912","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":"Promoting equitable genetic testing in ovarian cancer: the demonstration of improvement for molecular ovarian cancer testing (DEMO) project.","authors":"Elaine Yl Leung, Ionut Gabriel Funingana, Lisa Bird, Marie-Lyne Alcaraz, Anuji Evans, Anna Considine, Susan Freeman, Mercedes Jimenez-Linan, Catherine Spencer, Kiran Phanasan, Julie Winning, Joo Ern Ang, Christine Parkinson, Kai Ren Ong, Samantha Butler, Oliver Ridgway, Ian Charles, Rachel Pannell, Parveen Abedin, William Boyle, Jamie Emery, Jayne Salter-Scott, Sarah Williams, Raji Ganesan, Sudha Sundar, Janos Balega, James D Brenton","doi":"10.1136/bmjoq-2023-002720","DOIUrl":"10.1136/bmjoq-2023-002720","url":null,"abstract":"<p><p>Parallel genetic testing (testing for both tumour and germline gene changes) after the diagnosis of ovarian cancer should be considered the standard of care and is crucial to support treatment decisions. The demonstration of improvement for molecular ovarian cancer testing (DEMO) project aimed to develop patient-focused tools to promote equitable genetic care in diverse communities with high proportions of patients with limited English proficiency and biopsy guidelines to address the variations in specimen quality in different geographical regions in the UK. Our three work packages (WP) aimed to promote awareness by addressing the information gaps in different community groups (WP1), develop infrastructure to evaluate the different tissue collection pathways in different regions (WP2) and support continuing professional development (CPD) to encourage best practices with the involvement of patients (WP3). Our output included a multimedia multilanguage information package with paired National Health Service-branded written materials to support genetic testing after ovarian cancer diagnosis (https://ovarian.org.uk/demo-uk/), a scalable database to enable a multisite audit of parallel genetic testing pathways and a collection of CPD events that had patient involvement as an essential component. In addition, we have collaborated with patient and community groups to contribute to a national consensus guidance on genetic testing in ovarian cancer. Our co-production work has been recognised by local and regional awards as an exemplar for patient and public involvement (PPI). This has supported the start of a legacy co-production group in gynaeoncology (https://www.dhlnetwork.com/gohildas) to address the critical unmet need for sustainable and equity-oriented PPI to advocate for underserved communities. The DEMO project has contributed to raising awareness of the importance of equitable genetic care in ovarian cancer. We will continue to build on this groundwork to support future quality improvement projects and research, with the ultimate goal of improving the outcomes of patients with ovarian cancer.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498908","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 the quality and reliability of clinical reviews of psychotropic PRN medicines in a large English mental health Trust.","authors":"James Innes, Uju Ugochukwu, Julie Trenholm, Leo Boswell","doi":"10.1136/bmjoq-2024-003094","DOIUrl":"10.1136/bmjoq-2024-003094","url":null,"abstract":"<p><strong>Background: </strong>Psychotropic medicines are commonly prescribed as when required (PRN) prescriptions for inpatients for anxiety, insomnia or as part of a strategy to de-escalate situations that may lead to violence and aggression. While these medicines can provide benefit, safeguards need to be in place to ensure they are regularly reviewed and not overused.</p><p><strong>Aim and methodology: </strong>To (1) establish baseline practice around the clinical review of psychotropic PRN medicines for inpatients and (2) improve clinical practice around the clinical review of PRN medicines from baseline and the end of the improvement programme.Centrally coordinated, locally driven, improvement programme taking place over a 5-month period between February and June 2024. The programme employed a learning system approach to enable doctors to test change ideas and share areas of good practice as they sought to understand the problem, test different approaches and focus on holding the gains.</p><p><strong>Findings: </strong>21 wards participated and at an aggregate level achieved both aims with the recording of clinical reviews in the notes increasing from 89% to 90% and the quality of what was recorded in the notes increasing from 51% to 72%. There were signs of increased adjustments to psychotropic PRN medicines during the programme and in some wards decreased rates of psychotropic PRN administration to patients. However, while overall levels of psychotropic PRN medicine administration benchmarked lower than those reported in other studies, there were significant differences in clinical reviews, prescription and administration rates between a group of wards that fully engaged and partially engaged in the improvement programme.</p><p><strong>Conclusions: </strong>Employing a learning system approach helped create a context suitable for improvement and led to improvements in the review of psychotropic PRN medicines. Exploring the variation between wards in fully engaged and partially engaged groups of wards could be a next step for the Trust.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499095","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":"All Wales Ovarian Cancer Prehabilitation Project (AWOCPP).","authors":"Josh Courtney McMullan, Catherine Smith, Rosalind Jones, Caryl Butterworth, Christine Davies, Helen Long, Jacqueline Pottle, Claire Jarrom, Richard Peevor, Rachel Jones, Preeti Gupta, Louise Hanna, Emma Hudson, Sadie Jones","doi":"10.1136/bmjoq-2024-002770","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002770","url":null,"abstract":"<p><p>Over 50% of patients with ovarian cancer are diagnosed with advanced disease (stage 3+) in Wales when treatment typically involves chemotherapy, combined with cytoreductive surgery. Postoperative morbidity is common resulting in prolonged hospital stays and delays in returning to chemotherapy. Patients with advanced ovarian cancer commonly have modifiable risk factors that can be targeted for improvement with personalised prehabilitation. Multimodal personalised prehabilitation has been shown to have a positive impact on perioperative outcomes and length of stay (LOS).Quality improvement methods were used to implement a multimodal prehabilitation programme for all patients with advanced ovarian cancer planned for surgery in Wales. A unique approach to determining an individual patient's modifiable risk factors was devised that enabled a personalised prehabilitation programme to be created including exercise, smoking cessation, medical and nutritional optimisation and emotional support. Data were collected to enable future health economic evaluation of the programme in anticipation of national role out as standard of care. To evaluate if the prehabilitation intervention was impacting the quality of care, the following outcome measures were assessed: LOS, postoperative complications and surgery to chemotherapy interval (SCI). These measures were compared with a historical Welsh data set from 2018 to 2019 when access to prehabilitation was not available.Following the implementation of prehabilitation for ovarian cancer, the median LOS reduced from 6 to 5 days (p=0.29). There was a reduction in postoperative complications: from 16.9% to 12.7% (Grade 2), 4.4% to 1.8% (Grade 3), 0.6% to 0% (Grade 4+5). The median SCI following prehabilitation was 43.5 days (range 27-91) compared with 40 days (range 15-182 (p=0.65)).Prehabilitation has had a positive impact on the treatment pathways for advanced ovarian cancer in Wales. Means of improving patient engagement and establishing cost-effective delivery need to be developed to make this intervention standard of care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498242","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":"Assessing the effectiveness of leader rounding for high reliability: a quality improvement initiative.","authors":"John S Murray, Joan Clifford","doi":"10.1136/bmjoq-2024-003101","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003101","url":null,"abstract":"<p><p>High reliability organizations in healthcare are responsible for consistently maintaining high levels of safety and quality over extended periods of time and across multiples service lines and settings. In order to accomplish this, transparent and bi-directional communication across service lines and teams with organizational leaders is essential. Leader rounding for high reliability helps to ensure effective communication takes place. Developing and implementing an evidence-based process for leader rounding for high reliability is important as is determining effectiveness over time. We describe an initiative for assessing effectiveness after an evidence-based process for leader rounding for high reliability was created and implemented for the Veterans Affairs Bedford Healthcare System.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499073","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":"Developing a platform to investigate the heterogeneity of outcomes for patients with ovarian cancer.","authors":"Kathryn Baxter, J Booth, A Hawarden, N Wood, A Fisher, N Bhagat, J Morrison, V Cullimore, R Newhouse, I Yagel, A Shah, J Yap, H Woodman, T Olaoye, V Do, M MacDonald, E Long, L WIbmer, C Fotopoulou, Richard Edmondson","doi":"10.1136/bmjoq-2024-002742","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002742","url":null,"abstract":"<p><strong>Background: </strong>The geographical variation in treatment patterns for patients with ovarian cancer is profound, long-standing and worrying. Although these variations were highlighted in a recent UK registry audit, granular data to provide explanations for these variations have been lacking.</p><p><strong>Methods: </strong>A consortium of six UK centres was generated to curate and submit data for all patients treated at their centre for a 2-year period. Descriptive statistics were combined with Cox regression and Kaplan-Meier analysis to confirm the findings from the national registry audit and identify possible drivers of the heterogeneity previously described.</p><p><strong>Results: </strong>Records for 1117 patients treated in six centres in 2018 and 2019 were collated. Although there were differences in the clinical characteristics of patients between centres, these were not enough to account for the significant variation in survival outcomes between centres (p<0.001). Treatment rates varied between centres with between 30% and 76% of patients receiving combination therapy but in Cox models 'treatment centre' remained a predictor of 1 year survival independent of patient, tumour factors and treatment choice.</p><p><strong>Conclusion: </strong>Variations in outcome seen between UK centres are not related solely to casemix but rather to the approach and ethos of each centre towards advanced ovarian cancer treatment options. Although important, differences in treatment patterns do not completely explain the variations seen and further work is required to understand the drivers of difference seen.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498480","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 compliance with conducting HEADSS biopsychosocial assessment for adolescents in a paediatric inpatient setting.","authors":"Juliet Sher Kit Tan, Jeslyn Hwee Teng Neo, Sarah Hui Wen Yao, Kent Mun Loh, Ragavendra Kalyanasundaram, Amelia Suan-Lin Koe, Charlene Yuen Shuan Kho, Nurazila Rahmat, Joyce Soo Ting Lim, Yong Hong Ng, Sam Chang Hoe Koh, Alvin Shang Ming Chang, Elaine Chu Shan Chew","doi":"10.1136/bmjoq-2024-003000","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003000","url":null,"abstract":"<p><p>Adolescence is a period during which teenagers are at a high risk of developing mental health problems. Early recognition and intervention for mental health symptoms can prevent progression of high-risk behaviours or worsening of serious psychiatric conditions. The HEADSS assessment is an internationally recognised tool used to facilitate the biopsychosocial evaluation of an adolescent comprising domains in home, education, eating behaviours, activities, drug exposure, sexual activity, sleep, mood and suicidality. A self-administered HEADSS screening tool, comprising 11 questions, was developed and implemented in our hospital for all adolescents admitted to inpatient wards. The HEADSS screening tool is initiated by a nurse and, when screened positive, triggers a HEADSS assessment performed by a clinician to evaluate various domains of HEADSS. A hospital-wide audit reflected poor compliance with HEADSS assessments being conducted, despite domains of concern being flagged during HEADSS screening. A multidisciplinary team was created to address this issue. Following a root cause analysis, the team implemented the following interventions: improving the clarity and specificity of the HEADSS screen, improving communication between nursing and medical staff via educational update sessions and automated handover reports and implementing a targeted HEADSS assessment to focus on domains of concern. There was a statistically significant improvement in the median percentage of compliance to HEADSS assessment to 85% (from 40% at baseline) after implementing these measures. This improvement in compliance with HEADSS assessments resulted in an increase in referrals to mental health and allied health professionals, providing at-risk youth with necessary mental health support and interventions at the early stages of their difficulties.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499085","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}