BMJ Open Quality最新文献

{"title":"Improving the compliance of orthopaedic wrist and hand referrals against the musculoskeletal recommendations from the 2018 Evidence-based Interventions programme, along with local guidance in Greater Manchester: A quality improvement project.","authors":"Dylan L Woodhead, Peter C Goodwin, Eula Miller","doi":"10.1136/bmjoq-2025-003323","DOIUrl":"10.1136/bmjoq-2025-003323","url":null,"abstract":"<p><strong>Background: </strong>The National Health Service Long-Term Workforce Plan calls for improving clinical pathways for surgery. Four wrist and hand surgeries, including carpal tunnel syndrome release, Dupuytren's contracture release, ganglion excision and trigger finger release, are described as procedures of limited clinical value and are included in the 2018 Evidence-based Interventions programme, as well as local guidance in Greater Manchester (GM).</p><p><strong>Local problem: </strong>A pre-scoping exercise audit at a single musculoskeletal service in GM conducted from May 2021 to June 2023 highlighted that clinician compliance rates for these referrals were 15% below the service provider's internal national average and 25% below the service provider's internal national target, demonstrating the need for a quality improvement project.</p><p><strong>Methods: </strong>The Model for Improvement was implemented using four Plan-Do-Study-Act (PDSA) cycles. These cycles were executed over 14 weeks and aimed to improve compliance through educational sessions, clinical resources, interactive learning and practical tools.</p><p><strong>Intervention: </strong>The project comprised four PDSA cycles: PDSA 1 introduced educational sessions and case discussions, PDSA 2 implemented a clinical flowchart to guide decision-making, PDSA 3 included a knowledge retention quiz and PDSA 4 involved a repeat quiz and further discussions to consolidate learning. The target was to increase compliance rates from 70% to 85% or more.</p><p><strong>Results: </strong>The project successfully improved compliance rates by 30%, with the final compliance rate reaching 100%, surpassing the service provider's internal national average and target, respectively. 100% compliance was achieved and sustained during PDSA 4 until the end of the project. Clinician confidence and quiz scores also increased during the intervention.</p><p><strong>Conclusions: </strong>Educational initiatives, combined with practical tools like clinical flowcharts and quizzes, significantly improved compliance rates. The project provides a scalable model that can be adapted by other community healthcare services to enhance compliance with orthopaedic referrals.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173532","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 adherence to CDC public health guidance for screening newly arrived refugee children through clinical decision support implementation: a primary care-based quality improvement study.","authors":"Riley Phyu, Katherine Yun, Mary B Fabio, Meera B Siddharth, Muzhda N Ayazi, Mohammad Iqbal Mir Wali Khan, Jeremy Michel","doi":"10.1136/bmjoq-2024-002941","DOIUrl":"10.1136/bmjoq-2024-002941","url":null,"abstract":"<p><strong>Introduction: </strong>Many refugee children arrive in the USA from regions with higher risks of health conditions such as elevated blood lead or latent tuberculosis, making comprehensive health screening on arrival crucial for child health. Despite Centers for Disease Control and Prevention (CDC) screening guidance, clinical implementation challenges persist. To address this, we developed a clinical decision support (CDS) toolkit to support screening within the Children's Hospital of Philadelphia's refugee health programme. This quality improvement project evaluated the CDS toolkit's effectiveness in improving clinician adherence to screening guidance for newly arrived refugee children across two Plan-Do-Study-Act (PDSA) cycles.</p><p><strong>Methods: </strong>We retrospectively evaluated health screening for refugee children aged 6 months to 21 years seen in a primary care-based refugee child health programme from 1 January 2011 to 30 September 2023. We assessed completion of recommended screenings for elevated blood lead level (EBLL), tuberculosis, hepatitis B, anaemia, HIV and eosinophilia. The CDS toolkit was updated during the second PDSA cycle to streamline order sets and align with updated CDC guidance. Screening rates were compared across three periods: baseline, first PDSA cycle and second PDSA cycle.</p><p><strong>Results: </strong>Among 830 refugee children, initial screening completion remained high at 90.12%. Follow-up lead testing improved from 21.46% at baseline to 36.92% in the second PDSA cycle, though 43.08% of eligible children still missed timely follow-up. EBLL prevalence at arrival increased from 7.43% to 15.69%, reflecting changes in screening thresholds and demographics. These findings demonstrate the CDS toolkit's effectiveness in maintaining high initial screening rates while highlighting persistent challenges in follow-up care.</p><p><strong>Conclusions: </strong>The updated CDS toolkit maintained high completion rates for initial screening, and after two PDSA cycles, it correlated with improvements in follow-up testing for EBLL. This project underscores the need for further interventions to improve follow-up care and supports the potential of CDS toolkits to enhance refugee health screening.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147668","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":"Using I-PASS to improve nursing handoffs across the continuum of care at a tertiary oncology hospital.","authors":"Mohamed Ait Aiss, Delmy Vesho, Christi Bowe, Maria C Franco Vega, Son Chau, Jeff Beno, Marina George, Carol Porter, Diane Bodurka","doi":"10.1136/bmjoq-2025-003443","DOIUrl":"10.1136/bmjoq-2025-003443","url":null,"abstract":"<p><strong>Background: </strong>Communication failures can cause medical errors that harm patients. Handoffs occur frequently every day-every time a patient is transferred from one nurse to another (eg, shift change, hospital location). At our comprehensive cancer centre, handoffs became a priority focus area in our institution.</p><p><strong>Purpose: </strong>We implemented the evidence-based handoff tool I-PASS (Illness Severity, Patient Summary, Action List, Situation Awareness and Contingency Planning, and Synthesis by Receiver) for all nurses at our comprehensive cancer centre and assessed the uptake of the new framework and subsequent compliance and safety outcomes.</p><p><strong>Methods: </strong>Our team comprised representatives from nursing education, operations and informatics; a healthcare systems engineer; and electronic health record (EHR) analysts. Based on our observations of handoffs in different settings and feedback from focus group sessions, we developed an I-PASS handoff workflow in our EHR with the engagement of frontline staff and unit leaders. Various education modalities were implemented, and compliance was monitored through an EHR dashboard. Handoff audits were conducted for over a year after I-PASS was implemented to observe compliance with I-PASS reports for verbal handoffs. The institution's regularly administered safety culture survey results were assessed in the category of handoffs and information exchange.</p><p><strong>Results: </strong>Our process measures, all nurses were trained to use I-PASS by 28 November 2022. Compliance in documenting I-PASS handoffs varied between 86% and 88% of all handoffs between December 2022 and April 2024. I-PASS elements were present in above 95% of verbal handoffs between April 2023 and April 2024. The percentage of clinical nurses who reported favourable handoffs in our institutional safety culture survey improved from 64% in 2022 to 72% in 2024. For our outcome measure, a rate of zero high-harm events was maintained during the same period.</p><p><strong>Conclusion: </strong>The dissemination method led to the full implementation of I-PASS across all nursing areas and improved handoff quality.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and evaluating a proof-of-concept patient safety training programme for health workers in North Macedonia.","authors":"Elizabeta Zisovska, Válter R Fonseca, Margarita Spasenovska, Robert Velickovski, Damir Ivanković, Joao Breda","doi":"10.1136/bmjoq-2025-003473","DOIUrl":"10.1136/bmjoq-2025-003473","url":null,"abstract":"<p><strong>Background: </strong>Patient safety is a global health priority, yet formal training in patient safety principles for healthcare workers remains limited in many countries, particularly in low-resource or transitional health systems. Similar to other countries in South-Eastern Europe, North Macedonia faces patient safety challenges-including a prevailing blame culture and gaps in standard safety practices. We designed, delivered and evaluated a context-tailored patient safety training programme for healthcare workers in North Macedonia and assessed its impact on participants' immediate knowledge gains of key patient safety topics.</p><p><strong>Methods: </strong>A 4-day interactive training workshop was developed following a situational analysis of national safety gaps. Day 1 included awareness-raising sessions for institutional managers. Eighty-five healthcare workers, physicians, nurses and midwives, participated in a 3-day workshop that followed. The curriculum covered priority patient safety domains, such as incident reporting, infection prevention, medication safety and surgical and obstetric safety, delivered through lectures and case-based group exercises. Immediate knowledge gains were measured using a 20-item multiple-choice test administered pretraining and post-training. Pre-training and post-training scores were analysed and compared.</p><p><strong>Results: </strong>Baseline knowledge was suboptimal with a mean pretest score of 37% of correct answers. Immediately after the training, overall knowledge improved markedly. The mean post-test score reached 72%, a gain of 35 percentage points. All topic areas showed significant knowledge gains. Large improvements were observed in domains with the lowest baseline scores-mean correct responses in surgical safety domain increased from 19% to 76%, in obstetric safety from 18% to 67% and in infection control domain from 31% to 87%.</p><p><strong>Conclusions: </strong>This proof-of-concept quality improvement research initiative suggests that focused educational interventions could help address patient safety knowledge gaps. Sustaining and expanding such training, by integrating it into routine workforce development and licensing, may help strengthen patient safety culture and practices in similar settings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129925","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":"Multidisciplinary initiative to reduce 30-day readmissions in heart failure: a quality improvement perspective.","authors":"Sharin Koshy Varghese, Tina Francis, Jassim Zaheen Shah, Poonam Gupta, Elavarasi Velusamy, Blessy Susan Varghese, Sathiya Priya Selvaraj, Lija Koshy Renyn, Indirani Savarimuthu, Menandro Mahinay, Maha Kassim Al-Amri, Afnan Abdul Azeem Arnoos, Parthasarathi Thangaraj, Sasikala Natarajan, Amr Mohamed Hamed Badr, Ashfaq Patel","doi":"10.1136/bmjoq-2025-003382","DOIUrl":"10.1136/bmjoq-2025-003382","url":null,"abstract":"<p><strong>Aim: </strong>Hospitalisation for heart failure (HF) carries a high risk of readmission and adverse patient outcomes. We noticed a higher rate of readmissions for HF patients in a tertiary cardiac centre in Doha, Qatar. This study is focused on using a multidisciplinary and quality improvement approach to reduce the HF patients' 30-day readmission rate to the high dependency unit C in Heart Hospital, Doha, Qatar, by 10% by December 2020 and 20% by December 2021.</p><p><strong>Methods: </strong>In collaboration with the Institute for Healthcare Improvement, we worked on this initiative as a multidisciplinary team and tested several changes. A model for improvement framework was used and rapid, weekly, plan-do-study-act cycles were applied to test changes. Multiple measures were implemented serially, which included follow-up telephone consultations by a HF clinical nurse specialist 1 week after hospital discharge, early follow-up in a dedicated HF clinic (within 2 weeks of discharge), the availability of medical guidance over the telephone, comprehensive health coaching and education, patient functional activity engagement and cardiac depression screenings.</p><p><strong>Results: </strong>The readmission rate reduced from 25.5% in 2019 to 5.6% in 2021 (p<0.001). The results achieved have been sustained over time, with readmission rates recorded at 7.87% to date. The study demonstrated a decrease in 30-day readmission rates for HF patients after implementing a multidisciplinary quality improvement initiative.</p><p><strong>Conclusions: </strong>Reducing readmission rates underscores the importance of comprehensive patient education, tailored care plans, consistent follow-up and integrated team-based care in managing HF patients. The success of this initiative highlights the potential of multidisciplinary strategies in improving patient outcomes in chronic conditions like HF.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129953","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":"On the same (evaluation) page: a novel approach to enhance mixed-methods implementation evaluation.","authors":"Laura Ellen Ashcraft, Amanda D Peeples, Daniel Hall, Mary Elizabeth Bowen, Rebecca T Brown, Judith A Long, Kirstin Manges Piazza, Octavia K Goodman, Connor M Warren, Lindsay R Pelcher, Rachel M Werner, Robert E Burke","doi":"10.1136/bmjoq-2023-002620","DOIUrl":"10.1136/bmjoq-2023-002620","url":null,"abstract":"<p><p>Quality improvement and implementation science evaluations are often complex mixed methods approaches conducted by interdisciplinary teams. These efforts are challenging in normal circumstances; the COVID-19 pandemic and subsequent shift to remote work have posed additional challenges to this type of work. Novel approaches, tools, and processes may be needed to improve the rigor and cohesion of mixed methods evaluations, especially with a team working remotely.Quality improvement and implementation science evaluations are often complex mixed methods approaches conducted by interdisciplinary teams. These efforts are challenging in normal circumstances; the COVID-19 pandemic and subsequent shift to remote work have posed additional challenges to this type of work. Novel approaches, tools, and processes may be needed to improve the rigor and cohesion of mixed methods evaluations, especially with a team working remotely.Our aim was to create a rigorous evaluation plan for a large hybrid type III implementation-evaluation trial implementing new evidence-based processes at nine medical centers. Given the trial's complexity and a geographically-distributed remotely-working interdisciplinary team, we found that existing tools did not meet our needs. We thus created a novel process for developing a rigorous evaluation plan that others could replicate.This process has seven steps: 1) select a template and identify point person; 2) complete initial development; 3) obtain targeted asynchronous feedback; 4) identify and analyze gaps; 5) conduct targeted virtual synchronous discussion; 6) finalize working document; and 7) apply the plan and solicit ongoing feedback.Interdisciplinary quality improvement and implementation science project teams need tools and processes to ensure clear communication, well-ordered workflow, and rigorous operationalization of evaluation aims. The seven-step evaluation plan tool not only helped to enhance the rigor and execution of a large program evaluation, but the process also served an important convening function to enhance coordination between remote team members. Our work builds on existing processes for evaluation plan development while incorporating team science approaches.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129922","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":"Safe and effective genomic medicine implementation in hospitals: a scoping review.","authors":"Luisa Clucas, Cate Kelly, Trang Thu Do, Inez Beadell, Belinda Dawson-McClaren, Clara L Gaff","doi":"10.1136/bmjoq-2025-003359","DOIUrl":"10.1136/bmjoq-2025-003359","url":null,"abstract":"<p><strong>Background: </strong>Genomic medicine is rapidly changing routine clinical care in a range of specialties. Effective clinical governance is essential for safe implementation of emerging clinical practice, including genomic medicine. Frameworks exist for national implementation of genomics but lack the granularity needed by hospitals to guide local implementation of national policy.We aimed to identify if a framework suitable to support the safe, effective implementation and use of genomic medicine at a hospital level exists.</p><p><strong>Methods: </strong>A systematic search using scoping review methodology was performed, searching three databases (Medline, Embase and PubMed), from 2009 to 2022, to identify structured approaches to the clinical governance of genomics at a meso (hospital/hospital consortia) level.</p><p><strong>Results: </strong>No frameworks were identified that provided a holistic clinical governance approach to hospital-level implementation of genomics. Eight publications included components relevant to the implementation of genomics. While the clinical governance components included in the eight publications varied, all identified one or more of the following as important to effective implementation: optimal leadership of genomic care; ensuring an effective workforce; ensuring safe, effective clinical practice; the importance of quality metrics and the criticality of consumer partnerships. No publication explicitly discussed risk management, but all identified processes which would serve to minimise risk.</p><p><strong>Conclusions: </strong>Institutional-level change is essential for the implementation of genomic medicine throughout a health system. Yet, there is a lack of evidence-based frameworks to support integrated clinical governance of genomic medicine and its implementation by hospitals and their executive leaders. Our results can contribute to the design of an approach which supports hospital planning and decision-making by integrating all elements of clinical governance. Without this, implementation will be piecemeal, access to genomic medicine across a health system inequitable, and patients may receive inefficient, ineffective, slow and potentially unsafe care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124206","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 detection and documentation of suspected cauda equina syndrome: a quality improvement project.","authors":"Maiar Elhariry, Tahir Khaleeq, Rachna Prem, Kanthan Theivendran","doi":"10.1136/bmjoq-2025-003450","DOIUrl":"10.1136/bmjoq-2025-003450","url":null,"abstract":"<p><strong>Background: </strong>Cauda equina syndrome (CES) is a rare but critical neurological emergency. Prompt diagnosis and accurate documentation are essential to avoid permanent neurological impairment. This quality improvement project aimed to improve the accuracy and completeness of neurological examination documentation for patients presenting with suspected CES.</p><p><strong>Methods: </strong>Using three Plan-Do-Study-Act (PDSA) cycles, a digitally prompted documentation tool '#CES' was developed and implemented in the electronic patient record system. The tool was designed in alignment with the 2019 GIRFT Spine Report and 2023 GIRFT National CES Pathway. It included red flag symptoms and neurological assessment criteria from the ASIA classification. A teaching session on its use was delivered in January before the second data collection period (19 September 2024-20 October 2024), and it was later incorporated into resident doctor induction in December before the third data collection period (5 January 2025-5 February 2025).</p><p><strong>Results: </strong>In the initial cycle (May-August 2024), documentation was inconsistent, particularly for sensory (0%) and reflex (4.9%) examination. Following implementation and a teaching session (September 2024), documentation improved in the second cycle (September-October 2024): sensation (81.3%), reflexes (57.1%), though tone and motor documentation declined. In the third cycle (January-February 2025), full template use rose to 80% (from 25%) and documentation further improved: sensation (94.1%), motor (64.7%), reflexes (64.7%), tone (64.7%), vascular (58.8%).</p><p><strong>Conclusions: </strong>A CES-specific, digitally prompted template significantly improved documentation quality. Integration of GIRFT red flags, clinician codesign and repeated education enhanced uptake and accuracy. Further PDSA cycles will focus on sustainability, time-to-diagnosis metrics and addressing clinician workload concerns.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091090","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":"Decreasing blood culture contamination rates in a rural emergency department: a quality improvement initiative.","authors":"Priya Patel, Maria Johnson, Ashley Ayers, Makayla Ayres, Megan Andersen, Kathleen Spears, Scott Folk","doi":"10.1136/bmjoq-2024-003144","DOIUrl":"10.1136/bmjoq-2024-003144","url":null,"abstract":"<p><p>Blood culture contamination rates have been consistently above the national benchmark of 3% in the emergency department (ED) at Mosaic Life Care in St. Joseph, Missouri, USA. Contaminations contribute to negative patient outcomes including unnecessary antibiotic exposure, antibiotic resistance, prolonged hospital stays and delayed treatment plans. Reducing contamination rates is imperative to improving outcomes for both patients and the hospital. This study aimed to decrease blood culture contamination rates at a single, rural hospital institution in 7 months. Quality improvement frameworks guided the construction and implementation of the various countermeasures. Analysis of contamination data was conducted monthly and visualised in a run chart. Contamination rates decreased from 4.42%-3.51% (p<0.002) between September 2023 and October 2023 with Countermeasure 1. Rates fell to 2.9% in January 2024 through implementation of Countermeasure 2. Rates rose briefly to 3.5% in March 2024 but decreased to 2.8% in May 2024 following implementation of Countermeasure 3. Blood culture contamination rates in the ED declined significantly by increasing caregiver awareness via strategic environmental signage and renovating orientation education. The sustainability of this progress requires continued efforts. Maintenance of contamination rates below the national benchmark is targeted with continuous collaboration between clinical partners. This initiative demonstrated the importance of interdepartmental collaboration and communication with all stakeholders involved in quality improvement measures.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079678","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":"Evaluation of a tailored implementation strategy for audit-generated improvements in perinatal care.","authors":"Ien van der Woerdt-Eltink, Andrea Drost, Gera Welker, Ageeth Rosman, Jan Jaap Erwich, Esteriek de Miranda","doi":"10.1136/bmjoq-2025-003421","DOIUrl":"10.1136/bmjoq-2025-003421","url":null,"abstract":"<p><strong>Background: </strong>Perinatal audit identifies substandard factors in perinatal care for quality improvement of care. However, not all identified improvement objectives achieve effective implementation. The ACTion method, using a 7-step Plan-Do-Check-Act cycle, was developed for local perinatal care professionals to enhance tailored implementation by interactive learning, training and coaching of implementation and behaviour change principles.This study aimed to evaluate the efficacy of the ACTion method within all perinatal cooperation groups (PCGs) in the northern region of the Netherlands.</p><p><strong>Methods: </strong>A mixed-methods design was used for effect and process evaluation. Descriptive and inferential statistical methods were applied to analyse participants' knowledge; skills; motivation; and the number, nature and implementation stage of improvement objectives. Additionally, influencing factors were examined through inductive thematic analysis.</p><p><strong>Results: </strong>A multidisciplinary ACTion team was formed in all 11 PCGs. From the initially 93 participating ACTion team members, 86% completed the full training.Knowledge and skills after implementation of the ACTion method improved significantly, with mean scores increasing from 2.53 to 3.70 on a 1-5 Likert scale (p<0.001, r=0.9). ACTion teams addressed 3-19 improvement objectives, with implementation ranging from 14% to 67%, depending on time of start of the project and influencing factors. In total, 98 improvement objectives were addressed, of which 46 (47%) were fully implemented and secured. As emerged from interviews, a proactive key person and ongoing coaching during the follow-up phase were instrumental in driving these efforts. The multidisciplinary approach and collaborative efforts in regional obstetric care enhanced mutual understanding and cooperation across disciplines. Impeding factors included limited time, manpower and lack of commitment within the PCG.</p><p><strong>Conclusion: </strong>A locally tailored approach, involving interactive learning, training and coaching in the ACTion method, provides a valuable framework for implementing audit-driven improvement objectives in maternal and perinatal care, while simultaneously fostering interprofessional cooperation.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079734","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}