BMJ Open Quality最新文献

{"title":"Reducing routine group and save testing in emergency laparoscopic appendicectomy surgery: a quality improvement project assessing the triple bottom line.","authors":"Cyra Mackintosh, Emanuele Gammeri, Vrettos Ierodiakonou, Dominic Furniss","doi":"10.1136/bmjoq-2024-003120","DOIUrl":"10.1136/bmjoq-2024-003120","url":null,"abstract":"<p><strong>Introduction: </strong>There is compelling evidence supporting the omission of routine group and save (G&S) testing pre-operatively in emergency laparoscopy where appendicitis is suspected. Most studies are retrospective; however, one study prospectively demonstrated safe application in laparoscopic cholecystectomies only. We sought to assess safety, cost, and environmental and social savings-the triple bottom line-of omitting routine G&S testing in laparoscopic appendicectomies, by undertaking a quality improvement project at a busy district general hospital.</p><p><strong>Methods: </strong>All patients who underwent an emergency laparoscopy +/- appendicectomy, between 1 November 2020 and 31 October 2021, were retrospectively reviewed, and cross-referenced to haematological testing and blood product dispensation data. A cost of £15 was applied to processed G&S samples and £1.89 to rejected samples. A carbon cost of 1,066 g CO₂ emissions (CO₂ ^e) was applied to all samples. We then prospectively undertook a 6-month pilot intervention to omit routine G&S testing in these cases. Patients from either cohort who required blood transfusions underwent a deep dive to identify risk factors.</p><p><strong>Results: </strong>Pre-intervention, 281/392 (71.7%) of patients had valid G&S samples prior to their procedure and no patient required blood products during their episode. Post-intervention, 56/189 (29.1%) patients had valid G&S samples. One patient with chronic anaemia required a preoperative blood transfusion. Pre-intervention, G&S testing cost £22.24 and 1.7 kg CO₂ ^e per laparoscopy. Post-intervention, the cost reduced to £9.78 and 0.7 kg CO₂ ^e per laparoscopy. The intervention saved £5,021 and 353 kg CO₂ ^e, and our institution has adopted a selective approach, based on clinical risk, for these cases indefinitely.</p><p><strong>Conclusion: </strong>Routine G&S testing in emergency laparoscopy +/- appendicectomy is unnecessary, costing money and time and producing carbon emissions. With effective communication of risk-mitigating factors, practice can shift from high to low rates of preoperative testing. There are further savings accessible by applying this method to other surgical procedures using a risk-based approach.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976402","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 food insecurity: a paediatric academic advocacy collaborative quality initiative.","authors":"J Blakely Andrews Amati, Shivani Mehta, Talia Buitrago Mogollon, Lizmarie Maldonado, Kerry K Sease, Debra Best, Kimberly Montez, Emily Vander Schaaf, Elizabeth Erickson, Jeffrey Holloway, Kristina Gustafson, James Roberts, Carolyn Avery","doi":"10.1136/bmjoq-2024-003083","DOIUrl":"10.1136/bmjoq-2024-003083","url":null,"abstract":"<p><strong>Objective: </strong>This quality improvement (QI) initiative aimed to address food insecurity (FI) by improving FI identification and referral to food assistance programmes for the families served by the eight paediatric academic institutions in North and South Carolina.</p><p><strong>Methods: </strong>The primary process measures were screening 80% of eligible families for FI and coding for FI. The outcome measure was referring 80% of families identified with FI to appropriate resources. The balancing measure was maintaining a rate below 20% of missed opportunities for referral. Change ideas were organised into four main key drivers. The eight teaching clinics of the Carolinas Collaborative completed monthly chart audits using the Quality Improvement Data Aggregator (QIDA). Baseline was December 2020 and implementation occurred January 2021-May 2022. Creation of run charts was later transferred to statistical process control charts. Standard probability or Montgomery rules were used to identify special cause variation. Sites used individual QIDA data to conduct Plan-Do-Study-Act cycles; aggregated data were shared during bimonthly meetings.</p><p><strong>Results: </strong>A total of 4270 eligible charts were audited, 3430 patients screened and 525 identified as having FI. The rate of FI screening shifted from 68.5% to 86%. The rate of FI identified remained at 15%, and food referrals were consistently offered 90% of the time. While FI diagnostic coding did not reach the 80% goal, there was a shift from 38.3% to 70.5%. The balancing measure remained well below the goal of less than 20% of missed opportunities to discuss positive FI (centreline of 9.5%).</p><p><strong>Conclusions: </strong>A paediatric academic collaborative QI initiative focused on FI demonstrated collective improvement and allowed for rapid implementation, dissemination and spread.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953216","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":"Comparative study between the Patient Participation Culture Tool and the Hospital Survey on Patient Safety Culture using retrospective data from 2014 to 2021.","authors":"Marlies Claesen, Evelyne Punnewaert, Simon Malfait, Kristof Eeckloo, Ann Van Hecke, Ward Schrooten","doi":"10.1136/bmjoq-2024-003200","DOIUrl":"10.1136/bmjoq-2024-003200","url":null,"abstract":"<p><strong>Introduction: </strong>Patient participation and safety are pivotal in healthcare quality, internationally acknowledged for enhancing health services. This study examines the correlation between two assessment tools, the Patient Participation Culture Tool (PACT) and the Hospital Survey on Patient Safety Culture (HSPSC), using retrospective data from 2014 to 2021<i>.</i> METHOD: For the main analysis, dimensional scores of the HSPSC and domain scores of the PACT were aggregated according to hospital and specific wards. In a second step, we used aggregated scores by hospital and profession. Descriptive statistics outlined the sociodemographic characteristics of participants. Spearman's rank correlation coefficient was employed to evaluate relationships between continuous variables represented by PACT domain and HSPSC dimensional scores among study participants.</p><p><strong>Results: </strong>Data from 17 hospitals were analysed. The participants were distributed across 43 wards, and a match based on staff positions resulted in 37 different groups, predominantly comprised of nurses (>89%). At ward level, five PACT domains correlated significantly with ten different HSPSC dimensions (p<0.05), while a significant correlation was found between four PACT domains and seven HSPSC dimensions based on function. The correlation graphs demonstrate strong internal coherence within safety and participation culture measurements, highlighting the distinctiveness and validity of each questionnaire in capturing intricacies within patient safety and participation culture, supporting their construct validity.</p><p><strong>Conclusions: </strong>This study compared the PACT and the HSPSC, revealing their connections and unique features. Using Spearman's correlation, it positively linked patient participation and safety culture, finding significant correlations, mainly moderate, between their specific aspects. It highlighted how patient involvement positively influences safety practices in healthcare, valuable for enhancing overall quality.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967906","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":"Reducing inappropriate investigations for minor lower limb cellulitis.","authors":"Leer Liang, Daryl Yin Keong Lo, Elaine Jing-Mei Pang, Elizabeth Ming Jing Tan, Adrian Chung Thien Lim, Calyn Marini Eng Lian Yap, Poh Yong Tan","doi":"10.1136/bmjoq-2024-003079","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003079","url":null,"abstract":"<p><p>Lower limb cellulitis is a frequently encountered condition in the acute hospital setting, yet many patients with only mild lower limb cellulitis undergo unnecessary collection of blood cultures and X-ray imaging. This leads to increased healthcare costs and prolongation of the length of hospitalisation.A retrospective review of electronic medical records was performed to determine the frequency of blood cultures and lower limb X-rays performed for patients with lower limb cellulitis presenting to the Department of Emergency Medicine and admitted to the Department of Internal Medicine, in a national tertiary hospital.Quality improvement methods were implemented to increase accessibility to and awareness of lower limb cellulitis management guidance among clinical staff, to empower appropriate and rationalised decision-making in the management of patients with lower limb cellulitis. The percentage of patient encounters with blood cultures performed subsequently improved from a baseline median of 73.3% to a post-intervention median of 52.3%, with direct healthcare cost savings and additional ancillary beneficial effects for patients and healthcare staff. However, no reduction in the frequency of imaging performed was observed, for which the opportunity arises for further root-cause analyses and intervention.Encouraging small changes in individual clinicians' routine daily clinical practice through quality improvement initiatives results in significant impacts when multiplied across healthcare staff and departments. Initiatives implemented need to be accessible, realistic and pragmatic to maximise real-world on the ground effects and facilitate a sustained impact.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972205","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 interprofessional collaboration in pain clinics through simulation: a longitudinal Readiness for Interprofessional Learning Scale assessment.","authors":"John Mekail, Ysaac Zegeye, Quinn Lanners, Muhammad Farooq Anwar, Peter K Yi","doi":"10.1136/bmjoq-2024-003199","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003199","url":null,"abstract":"<p><strong>Background: </strong>Interprofessional collaboration (IPC) is vital for delivering safe, holistic patient care, particularly in outpatient interventional pain clinics where precision and teamwork are crucial. Despite its importance, IPC within outpatient pain medicine remains understudied, and the Readiness for Interprofessional Learning Scale (RIPLS) has not been used longitudinally in outpatient pain medicine.</p><p><strong>Objectives: </strong>The primary objective of this quality improvement (QI) project was to evaluate and enhance readiness for interprofessional learning among clinical staff in an outpatient pain clinic, measured over 6 months in an outpatient pain clinic.</p><p><strong>Methods: </strong>This initiative took place from October 2021 to April 2022 in an academic institution's hospital-based outpatient pain clinic. We administered the RIPLS survey to 15 participants of various clinical roles at baseline and again 6 months after a simulation-based intervention. The simulation included small group didactic sessions and immersive clinical scenarios depicting acute complications in interventional pain procedures. We used descriptive statistics to compare preintervention and postintervention survey responses, stratifying by professional role. Qualitative feedback was collected to explore participants' perceptions of the training and its impact.</p><p><strong>Results: </strong>Both physician and non-physician groups reported high baseline RIPLS scores, with no statistically significant difference between or within groups over 6 months. Although mean RIPLS scores did not significantly change, participants consistently described positive attitudes towards collaborative practice. Qualitative feedback underscored the importance of structured simulation for reinforcing team roles, communication strategies and crisis management skills.</p><p><strong>Conclusion: </strong>This project demonstrates that simulation-based training can sustain high levels of interprofessional readiness among outpatient pain clinic staff over time, suggesting utility for maintaining collaborative behaviours in a setting where safety and teamwork are paramount. Future efforts could investigate whether similar interventions improve IPC in clinics with lower baseline readiness, as well as explore longer follow-up periods or larger sample sizes to detect nuanced changes in collaboration metrics.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953514","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":"Implementing the Child Oral Health Initiative (COHI): improving access to preventive dental care to achieve Saudi Vision 2030 healthcare goals.","authors":"Heba A Alkarimi, Amal Jawadi, Shaimaa Tayeb, Ramysh Ismail, Esraa J AlShareef, Nouf Sherbini","doi":"10.1136/bmjoq-2024-003070","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003070","url":null,"abstract":"<p><strong>Background: </strong>Dental caries is one of the most important health concerns in Saudi Arabia. It poses a substantial burden considering the clinical outcomes and treatment costs. Oral health is an integral part of general health, and primary healthcare providers may contribute to the primary prevention of caries by initiating early referrals, dental screening and early diagnosis of caries with regular medical visits.</p><p><strong>Objectives: </strong>This project aimed to integrate the Child Oral Health Initiative (COHI) into regular paediatric healthcare services to effectively promote oral health and improve access to preventive dental care services. However, referrals to the dental department were primarily paper-based targeting dental clearance, emergencies and treatments. This referral system impaired the accessibility and manageability of medical records, necessitating the need for a traceable robust referral system to successfully screen children.</p><p><strong>Methods: </strong>The first phase of the project was to develop an electronic referral system for the COHI (ECOHI-referrals) to improve communication between the COHI dental team and other hospital teams, increase dental preventive screening rates and to track referrals. Four Plan-Do-Study-Act (PDSA) cycles were used to initiate and track the new referral system and improve the screening rate of referred children.</p><p><strong>Results: </strong>After implementation, the number of ECOHI-referrals for caries prevention in the paediatric ward increased from 0 to 351 during the project period. The dental team received 351 ECOHI-referrals out of 420 (83.5%) eligible children in the paediatric ward. Of the referred 351 children, 317 (90.3%) underwent dental screening. Of the screened children, 263 (82.9%) established an ongoing dental home, and 98 (30.9%) children received fluoride applications.</p><p><strong>Conclusion: </strong>Quality improvement methods facilitated the successful integration of COHI into hospital inpatient settings, increasing dental prevention visits to the paediatric ward, improving tracking of e-referrals, establishing dental homes for children and enhancing communication between teams.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953500","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 urgent investigative images transfer effectiveness from trauma and orthopaedic to neurosurgery department: a quality improvement project.","authors":"Marwa Khan, Tahir Khaleeq, Kanthan Theivendran","doi":"10.1136/bmjoq-2024-003126","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003126","url":null,"abstract":"<p><strong>Background: </strong>Neurosurgical emergencies, including cauda equina syndrome, traumatic spinal cord injuries and traumatic brain injuries, require timely diagnosis and intervention to prevent severe morbidity and mortality. Delays in these cases often stem from inefficiencies in transferring investigational images from district hospitals to external neurosurgery units.</p><p><strong>Aims: </strong>This quality improvement project aimed to reduce image transfer time at Sandwell and West Birmingham Hospitals Trust (SWBH) to the Queen Elizabeth Hospital Birmingham neurosurgery unit. It sought to empower Trauma and Orthopaedics (T&O) doctors to independently transfer images using an image exchange portal (IEP) software, bypassing reliance on traditional picture archiving and communication teams.</p><p><strong>Methods: </strong>Over three Plan-Do-Study-Act cycles (February and September 2024), T&O registrars and junior doctors were trained to use the IEP. Additional instructional resources were provided following low compliance. Image transfer times and neurosurgical response times were compared preintervention and postintervention.</p><p><strong>Results: </strong>The intervention reduced the average time from referral to image transfer from 18 hours to 3.6 hours across the cycles. The proportion of images transferred within 1 hour increased from 36% to 59%, and 87% of images were reviewed by neurosurgery within 6 hours by the final cycle. Operational cost savings were achieved by reducing reliance on IT services, radiographers and length of stay.</p><p><strong>Conclusions: </strong>This project improved the timeliness of image transfer and neurosurgical care at SWBH. Although IEP software proved effective locally, its broader applicability across UK hospitals remains uncertain. The findings highlight the need for a national solution to streamline image transfers and further research to enhance technologies supporting rapid investigative imaging. Empowering front-line clinicians with appropriate tools provides a replicable model for addressing similar challenges in other institutions.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967679","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":"Prehospital to emergency department handoff: can team-based reporting improve markers of clinical efficiency in an adult emergency department?","authors":"Christopher L Gross, Corey D Cowgill, Brent A Selph, Jessica M Cowgill, Ziad Saqr, Brandon R Allen, Frederick S Southwick, Charles W Hwang","doi":"10.1136/bmjoq-2024-002948","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002948","url":null,"abstract":"<p><p>Interdisciplinary communication is a critical component of quality patient care. On emergency medical services (EMS) arrival to the emergency department (ED), the pre-existing opportunity-based reporting (OBR) handoff paradigm may result in disjointed, repetitive and incomplete transition of patient care to the ED, adversely impacting patient care. This quality improvement study was conducted at a tertiary care, academic university hospital ED and evaluated the impact of team-based reporting (TBR) during EMS patient handoff in the ED on several markers of clinical efficiency (CE). The standard OBR handoff protocol was compared with the TBR protocol, which brings the patient's ED care team to bedside shortly after patient arrival, allowing EMS to give a single, synchronous handoff. The use of TBR during prehospital-ED handoffs was associated with statistically and clinically significant improvement across multiple CE quality indicators. A team-based handoff strategy is a low-cost policy intervention that provides meaningful improvements related to CE and quality care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976486","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":"Comparing remote and in-person interpretation experiences for clinicians and Spanish-speaking patients with limited English proficiency: a mixed methods study.","authors":"Alondra Ruiz, Jacob Chen, Timothy T Brown, Xiaoyu Cai, Paola Hernandez Fernandez, Hector P Rodriguez","doi":"10.1136/bmjoq-2024-003227","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003227","url":null,"abstract":"<p><strong>Objective: </strong>There is concern that remote medical interpretation is not as patient-centred as in-person interpretation, but limited evidence exists comparing interpreter service delivery methods. Using mixed methods, remote and in-person professional medical interpretation were examined from the perspectives of Spanish-speaking patients with limited English proficiency and community health centre (CHC) clinicians.</p><p><strong>Design: </strong>Patient experience survey data from Spanish-speaking patients and interviews of primary care clinicians assessed their experiences of using remote versus in-person interpretation. Multivariable regression models estimated the association of the interpreter method with patient-reported experiences of (1) clinician communication and (2) interpreter support.</p><p><strong>Setting: </strong>Three CHC organisations in California, USA.</p><p><strong>Intervention: </strong>Remote versus in-person medical interpretation.</p><p><strong>Primary outcomes: </strong>Patients' and clinicians' experiences of using in-person versus remote professional medical interpretation.</p><p><strong>Results: </strong>We recruited 303 Spanish-speaking patients (mean age: 40.4, % female: 69.0%) to complete a survey assessing their experiences with professional medical interpretation and 19 clinicians who used professional medical interpretation for interviews. In regression analyses of patient experience survey data, no evidence of an association between the interpreter method used and patient-reported experiences of clinician communication or interpreter support was found. In interviews, however, clinicians strongly preferred in-person interpreters and highlighted operational and communication challenges associated with using remote interpreters. Interviews revealed six themes related to interpreter services delivery methods: (1) in-person interpretation supports effective communication and clinician-patient relationships, (2) in-person interpretation enhances operational efficiency, (3) cost-effectiveness of delivery methods depends on language demand and clinic needs, (4) in-person interpretation enhances quality control and reduces privacy risks, (5) considerations when integrating external personnel and (6) the availability of and limited use of audio-video medical interpretation.</p><p><strong>Conclusions: </strong>To meet the operational needs of CHCs, policymakers and healthcare payers should consider expanding payment models that enable the provision of interpreter services using multiple methods.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956788","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":"Striking the right balance between accountability and quality improvement: a discharge summary timeliness tale.","authors":"Mark Goldszmidt, Tsan-Hua Tung, Alan Gob, George Dresser, Louise Moist","doi":"10.1136/bmjoq-2024-003259","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003259","url":null,"abstract":"<p><strong>Background: </strong>The timely distribution of discharge summaries within 48 hours can play an important role in ensuring safe patient care transitions and reducing readmission. Like other academic centres, we struggled with achieving a regulator mandated outcome of discharge summary authentication within 48 hours.</p><p><strong>Study aim: </strong>To increase the percentage of discharge summaries authenticated within 48 hours from a baseline of 62% to 75% over 1 year on six acute medicine teams.</p><p><strong>Methods: </strong>The model for improvement guided this quality improvement (QI) initiative. Outcome measures included the percentage of discharge summaries authenticated within 48 hours, and the average time from discharge to authentication. Balancing measures were a high-level process measure related to quality; editing behaviours before authentication. Data were analysed using a pre-post design and represented via statistical process control charts, P chart and XbarS charts.</p><p><strong>Results: </strong>While the primary aim was achieved, it was not sustained. By contrast, the time to authentication decreased from 53 hours to 38 hours and was sustained. The percentage of editing of summaries also exhibited significant variability. The 38% who demonstrated considerable improvement in time to authentication had decreased rates of consultant and trainee editing. In contrast, those who edited before authentication took longer to authenticate with a median difference of 5 hours (p<2.2e-16) and were less likely to meet the 48-hour target (OR 0.67, 95% CI 0.6028, 0.7521).</p><p><strong>Discussion: </strong>Our findings are important for both regulators and QI practitioners and highlight the importance of defining clinically meaningful targets while also considering their impact on quality and education. While we cannot be certain that summary quality was compromised in those without editing, the association between time to authentication and editing behaviour is highly suggestive. Moreover, it was also associated with a decrease in trainee editing, which is concerning from an educational perspective.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959837","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}