BMJ Open Quality最新文献

{"title":"Zeroing in: achieving zero complications in lumbar puncture - a quality improvement initiative to reduce complications at the University Hospital of North Norway.","authors":"Susanne Gaarden Ingebrigtsen, Agnethe Eltoft, Thomas Karsten Kilvaer","doi":"10.1136/bmjoq-2025-003327","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003327","url":null,"abstract":"<p><strong>Background: </strong>Lumbar puncture (LP) is an essential diagnostic procedure in neurology, but carries risk, with post-lumbar puncture headache being the most frequent complication. In 2017, a severe complication with intracranial haemorrhage following LP in Northern Norway led to an evaluation of LP procedures and resulted in the development of a new unified regional procedure.</p><p><strong>Local problem: </strong>At the University Hospital of North Norway (UNN), 10% of LPs performed in 2017 resulted in a complication. A survey identified gaps in protocol adherence, physician training, and patient education.</p><p><strong>Intervention: </strong>Aiming to reduce LP complication rates from 10% to 1% by January 2019, we implemented standardised protocols, introduced smaller gauge needles, enhanced physician training and improved patient education.</p><p><strong>Results: </strong>Complication rates dropped to 1%, achieving 107 consecutive complication-free procedures by January 2019, with sustained improvement over subsequent years.</p><p><strong>Conclusion: </strong>Standardised protocols, physician training, introduction of smaller gauge needles and patient education significantly reduced LP complications. Educating patients on expectations and post-procedure care was critical in preventing unnecessary admissions and outpatient visits.</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/PMC12164642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293283","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":"Beyond the individual: a qualitative case study into the systemic determinants of speaking-up behaviour in multidisciplinary team meetings.","authors":"Dimmy van Dongen, Jaco Tresfon, Frank Guldenmund, Daphne Roos, Jop Groeneweg, Irene Grossmann","doi":"10.1136/bmjoq-2025-003335","DOIUrl":"10.1136/bmjoq-2025-003335","url":null,"abstract":"<p><strong>Background: </strong>Healthcare workers (HCWs) voicing their views (speaking up) is crucial for patient safety and care quality. Yet, this is underused, especially during multidisciplinary team meetings (MDTMs), where diverse professionals collaborate to optimise patient treatment plans. Despite the benefits of open communication, HCWs face barriers such as hierarchical dynamics, time constraints and psychological risks.</p><p><strong>Aim: </strong>This study examines factors influencing HCWs' speaking-up behaviours in MDTMs, focusing on motivators, barriers and dynamics across disciplines.</p><p><strong>Method: </strong>We conducted 21 semistructured interviews with MDTM participants of a gastrointestinal surgery ward, including surgeons, residents, nurses, nursing students, dieticians, ostomy nurses and physical therapists. Data were analysed collaboratively using thematic analysis.</p><p><strong>Results: </strong>Participants are highly motivated to advocate for patients and provide optimal care. However, barriers impact speaking up during MDTMs. Three major themes were identified: (1) time pressure, (2) perception of goals and roles and (3) familiarity among team members. Structural, relational and contextual factors affect HCWs' ability to speak up, with nurses and paramedics experiencing more hesitancy than physicians. Lack of preparation time, ambiguous objectives, no formal agenda and unfamiliarity among team members hinder contributions, leading to unbalanced input.</p><p><strong>Conclusion: </strong>Findings support a systems-based approach to addressing barriers. Interventions should focus on clear goals, reduced time pressures and enhanced team cohesion, rather than placing the responsibility solely on individuals. For instance, adjusting meeting schedules to accommodate diverse availability improves participation across disciplines. Strengthening familiarity among team members fosters trust and lowers the perceived risks of speaking up, ensuring more balanced contributions during MDTMs.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274154","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 a simulation-based implementation method to support the introduction of a new invasive device: a prospective cross-over study.","authors":"Cordélia Salomez-Ihl, Claire Chapuis, Pierrick Bedouch, Pierre Albaladejo, Julien Picard","doi":"10.1136/bmjoq-2024-003029","DOIUrl":"10.1136/bmjoq-2024-003029","url":null,"abstract":"<p><strong>Study objective: </strong>The introduction of new medical devices into care units, or their replacement by new devices, is not always accompanied by implementation strategies that enable healthcare professionals to use them safely. Simulation is a relevant tool for reproducing critical care clinical situations without danger for the patients and providing training support. The aim of the study was to assess a simulation-based implementation method to accompany and reduce the risks associated with the deployment of a new invasive medical device in critical care units.</p><p><strong>Design: </strong>Prospective mono-centric cross-over study.</p><p><strong>Setting: </strong>In our hospital, the type of Invasive Arterial Blood Pressure Sensors (IABPS) for blood pressure (BP) monitoring and arterial sampling has been completely replaced by a new one with numerous differences. No specific training had been planned.</p><p><strong>Participants: </strong>66 intensive care unit (ICU) nurses from three ICUs with a total number of 39 beds were involved.</p><p><strong>Interventions: </strong>The scenario and evaluation grid were designed by multi-disciplinary teams who received in-depth training on the new IABPS from the laboratory and the institution's equipment specialists. Nurses in group A (GA) (n=33) started by using the IABPS on a simulation scenario and then received explanations on differences. Nurses in group B (GB) (n=33) received explanations and then used the IABPS on the simulation scenario. Nurses in GA and GB all had individual feedback on their errors at the end. Next, they listed the most important information they would give to a colleague if they had a few minutes to train him or her. They also completed an anonymous self-questionnaire to assess their satisfaction with the training and with the new IABPS.</p><p><strong>Main results: </strong>The mean number of errors in the act of measuring BP and taking biological samples was statistically higher for GA, demonstrating the relevance of offering a training programme to support the deployment of a new device. The mean times to BP measurement and to collection were similar. Recommendations for asepsis of the sampling site were not followed. Recurrent errors were related to the ergonomics of the IABPS. Caregivers (n=55 questionnaires) appreciated the training and the new IABPS.</p><p><strong>Conclusions: </strong>Simulation can be useful for both providing a training model and identifying the situations that would require dedicated training support. The simulation tool provided training and context to nurses before they use the new IAPBS in clinical practice. Simulation training has also led to a better understanding of the most common errors. Because of new IABPS widespread use, it was all the more important to prevent usage errors.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246357","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":"Strategies for implementing Sustainability in Quality Improvement (SusQI) education: educator perspectives.","authors":"Victoria Stanford, Kathleen Leedham-Green, Alice Clack, Siobhan Parslow-Williams, Ayoma Ratnappuli, Frances Mortimer","doi":"10.1136/bmjoq-2024-003055","DOIUrl":"10.1136/bmjoq-2024-003055","url":null,"abstract":"<p><p>The climate and ecological emergencies represent a significant threat to health, and yet healthcare is a major contributor to environmental degradation. Sustainability in Quality Improvement (SusQI) is a framework that enables healthcare professionals to improve how good health is achieved and healthcare delivered in line with social, economic and environmental sustainability goals. SusQI education provides healthcare learners with the knowledge and practical skills for sustainable clinical transformation.We interviewed 11 SusQI course leads at 10 educational sites in the UK and Ireland, exploring educator perspectives on how SusQI can be successfully implemented in diverse health educational contexts. Our aim was to identify what works, in which contexts and why. We thematically analysed the interviews and tabulated case study details.We identified four interlinked themes: choosing SusQI, getting it into the curriculum, making it work and embedding it. Each of these stages was influenced by factors related to the educators themselves, their students and their institution, as well as specific educational or curricular factors. The most successful implementations demonstrated synergistic benefits for both learners and institutions, engendering self-sustaining communities of practice.Strong institutional commitment, distributed expertise and opportunities for supported project work emerge as key success factors. Together, these fostered self-sustaining virtuous cycles of stakeholder engagement, transformative educational impacts and progress towards sustainable clinical practice.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246359","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":"Why EQ-5D and the Oxford Hip and Knee scores do not measure the same things.","authors":"Tim Benson","doi":"10.1136/bmjoq-2024-003214","DOIUrl":"10.1136/bmjoq-2024-003214","url":null,"abstract":"<p><strong>Introduction: </strong>The outcome of treatment is always paramount for patients and healthcare professionals. Patient-reported outcome measures have been developed to measure outcomes.Since 2009, all patients in England having hip and knee replacement surgery have been asked to complete the generic EuroQol EQ-5D-3L and EQ visual analogue scale (EQ-VAS) and the condition-specific Oxford Hip Score or Oxford Knee Score for hips and knees, respectively.</p><p><strong>Methods: </strong>EQ-5D-3L has five dimensions with three options each. Each combination has been scaled relative to the best conceivable health state (value 1.0) and the state of dead (value 0) to produce a relative severity score (EQ-Index) with a range from -0.594 to 1.0. This can be used to calculate quality-adjusted life-years. The EQ-VAS is a visual analogue scale from 0 (dead) to 100 (best conceivable health state).The Oxford Hip and Knee scores are similar to each other. They have 12 questions with five options each, scored 0-4. These scores are added, giving a scale with range 0 (no problems) to 48 (extreme problems on all questions).Using over 40 000 records for patients undergoing hip and knee replacements from the National Health Service patient-reported outcome measure database, we compare EQ-5D-3L with the Oxford Hip and Knee scores. To aid comparison, each score was transformed arithmetically to a common 0 (floor) to 100 (ceiling) scale.</p><p><strong>Results: </strong>EQ-Index, EQ-VAS and the Oxford scores give very different results in terms of change, effect size and correlation.</p><p><strong>Discussion: </strong>More research is needed, but some speculative ideas are put forward, which could explain these findings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246295","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 local authority financial support services for users with complex health needs: a mixed-method economic evaluation of Social Navigators in South Tyneside, UK.","authors":"Peter van der Graaf, Andrew McCarthy, Murali Krishnan Perumbakkam Subramanian, Bronia Arnott, Dilupa Samarakoon, Sarah Lee, Joanne Gray, Angela Bate","doi":"10.1136/bmjoq-2024-003290","DOIUrl":"10.1136/bmjoq-2024-003290","url":null,"abstract":"<p><p>Despite social prescribing being promoted by the UK government for the last decade, the evidence supporting social prescribing remains weak and has mainly been confined to clinical contexts. Our study aimed to evaluate the impact of a Social Navigator (SN) service in South Tyneside on the health and well-being of users who experience financial hardship with complex health needs and limited access to mental health services.Using a mixed-methods design combining secondary analysis of service data (n=330), qualitative interviews with service users (n=15) conducted by peer researchers, and a social return On investment analysis that matched service data with health economic indicators from the UK Social Value Bank.Our findings demonstrate clear value for money with a £3 return for every £1 invested in the service, with a positive return confirmed in sensitivity analysis. SNs were able to improve the confidence of service users, with statistically significant changes across all eight confidence-related outcomes, and helped them to access other advice and financial services. This resulted in one-off financial gains (average £1237) and annual financial gains (average £1703) for service users. The interviews identified that relieving financial burden and stress improved the quality of life and mental well-being of users as a result of their involvement with the service.SN can break the cycle of multiple visits to crisis teams by building trusting relationships and providing emotional and practical support, while being responsive to the service users' needs and available when they have needs. They play a key intermediary role in integrated care systems with a unique focus on the wider determinants of health and financial hardship, advocating for service users without time limits and navigating the complexities of the system across local government. Greater integration of local support services could be achieved by mapping all available pathways for support.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246358","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":"Career impact of the national interprofessional fellowship in patient safety: an alumni evaluation.","authors":"Bradley V Watts, Kathleen Carluzzo, Blake F Webb, Kelley Arredondo","doi":"10.1136/bmjoq-2024-003090","DOIUrl":"10.1136/bmjoq-2024-003090","url":null,"abstract":"<p><strong>Background: </strong>There has been a proliferation of health professions training programmes focused on quality and patient safety, but little information regarding the outcomes of these programmes. The purpose of this study was to examine the impact of an interprofessional quality and patient safety curriculum on career outcomes of interprofessional healthcare learners for the Veterans Affairs Patient Safety Fellowship.</p><p><strong>Method: </strong>We conducted a survey-based assessment of 117 alumni of the Interprofessional Fellowship in Patient Safety assessing their satisfaction with the training program and career impacts.</p><p><strong>Results: </strong>84 of 117 alumni were located and participated in the assessment. Fellows entered the training programme from a wide range of educational experiences, but most were in their early career at entry. Satisfaction with the training programme was high, with 42% (n=35) of alumni reporting being extremely satisfied with their fellowship experience. Programme alumni reported being either extremely or very knowledgeable about quality and patient safety (77%, n=65). Fellows reported considerable engagement with the academic field of patient safety and quality, with 63% (n=53) having published at least one manuscript about the topic and 75% (n=63) reporting a role teaching patient safety and quality improvement. Fellows' employments post training were quite varied, although positions focused on health profession education were most common.</p><p><strong>Conclusions: </strong>The Interprofessional Fellowship in Patient Safety is an early successful example of an interprofessional training programme that resulted in satisfied alumni who reported good knowledge and abilities in the topic of patient safety. Career pathways were varied, but a focus on health professions education post fellowship was prominent.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233094","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 an evaluation tool for the impact of consumer partnerships in healthcare governance: a coproduced mixed methods study.","authors":"Rae Parker, Jodie Nixon, Faiza El-Higzi, Melanie Lynch, Ruth Cox","doi":"10.1136/bmjoq-2024-003285","DOIUrl":"10.1136/bmjoq-2024-003285","url":null,"abstract":"<p><strong>Background: </strong>Consumer partnerships are a recent innovation in healthcare governance to diversify decision-making perspectives. These partnerships bring complexity necessitating comprehensive evaluation. This study proposes that evaluation tools should include the impact of healthcare governance partnerships. This study aimed to coproduce an impact evaluation tool for healthcare governance committee partnerships.</p><p><strong>Methods: </strong>This study used a coproduced mixed methods cross-sectional design conducted in two phases. The first study phase included an online focus group and online survey to identify stakeholder expectations and needs for an impact evaluation design. The second study phase used an adapted Jandhyala Method to determine participant awareness of governance committee partnership impacts and consensus agreement to establish an impact evaluation survey. The development of governance committee partnership impact items was guided by a capability development framework for successful staff and consumer partnerships for quality improvement and the Engage with Impact Toolkit.</p><p><strong>Results: </strong>In phase one, staff (n=4) and consumer partners (n=3) provided recommendations to improve the development and acceptance of a governance committee partnership impact evaluation. Phase two was completed by 34 participants (>90% completion). An initial online survey generated 338 statements detailing broad governance committee partnership impacts. No statistically significant difference in the count of impacts by Engage with Impact Toolkit domains was found between staff and consumer partners. A second online survey resulted in a consensus ranking of 24 impact statements for inclusion. The highest consensus impact domains are knowledge, confidence and trust, equity and inclusivity and patient outcomes and experience.</p><p><strong>Conclusion: </strong>This study pragmatically used the insights of expert staff and consumer partners to develop a prioritised list of survey items to evaluate the impact of healthcare governance committee partnering effectiveness. The resulting healthcare governance committee partnership impact evaluation item list has the potential to be used in other healthcare organisations.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214868","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":"It's raining bots: how easier access to internet surveys has created the perfect storm.","authors":"Isabelle Caven, Zhenxiao Yang, Karen Okrainec","doi":"10.1136/bmjoq-2024-003208","DOIUrl":"10.1136/bmjoq-2024-003208","url":null,"abstract":"<p><p>Online surveys are an increasingly common way to collect data from the public, with social media and financial incentives (e.g. gift cards) commonly used to increase participation rates. Anonymity, ease of response, and the potential to reach diverse demographics have also contributed to the popularity of online surveys. Health services research benefits from the increased accessibility that online survey-based data collection provides; however, fraudulent responses are of concern. The following article describes our team's experience with a national survey of Canadian healthcare providers being overrun with fraudulent responses and approach to ensure the validity of our survey data. We provide recommendations for research teams on how best to design their surveys, work with their institutions to implement safeguards within survey platforms, and screen completed responses. We also describe fraudulent open-text responses that we believe to have been produced with the help of artificial intelligence and are sounding the alarm for other researchers to be aware of this potential threat to data integrity. Informed by the learnings shared, researchers and research institutions can be better equipped to prevent and screen fraudulent responses to continue successfully engage the public in online research.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198164","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":"Impact of temporary nursing staff on communication patterns: an observation study during daily nurse huddles.","authors":"Sarah Dana Schmelzer, Sina Berger, Julia Carolin Seelandt, Zeynep Erden, Florian Liberatore","doi":"10.1136/bmjoq-2024-003242","DOIUrl":"10.1136/bmjoq-2024-003242","url":null,"abstract":"<p><strong>Background: </strong>Effective communication within healthcare teams is essential for efficient work coordination and patient safety. Communication in teams can take two forms: implicit and explicit, both of which play important roles in enhancing teamwork and output. However, within an unstable team constellation, maintaining effective communication can be challenging. There is limited empirical research on how temporary nursing staff impact team communication. The aim of this study is to evaluate the differences in communication patterns of permanent and temporary nursing staff.</p><p><strong>Methods: </strong>In this observational study, we observed communication patterns among nurses during their daily afternoon huddles. During the live observations, we used INTERACT coding software for assessing communication patterns of permanent and temporary nursing staff. Whereby we distinguish between temporary and per diem nurses. We used lag sequential analysis to explore implicit and explicit communication patterns of temporary, per diem and permanent nursing staff. We hypothesised that temporary nursing staff primarily rely on explicit communication, whereas permanent nurses tend to rely more on implicit communication.</p><p><strong>Results: </strong>Across 50 huddles with a total of 309 participating nurses, the mean huddle duration was 8.50 min and included 3074 communication transitions. We found that for per diem nurses, implicit communication was followed by explicit communication. This pattern was not observed for permanent and temporary nurses. Furthermore, for permanent and temporary nurses, preceding implicit communication was followed by implicit communication.</p><p><strong>Conclusion: </strong>Our study reveals that per diem nurses, with their lower employment levels and less consistent presence, tend to shift from implicit to explicit communication. This contrasts with temporary and permanent nurses, who maintain implicit communication patterns, likely due to more developed team mental models and greater mutual trust. These findings suggest that experience and consistency in the work environment are important factors shaping communication styles among nursing staff.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198163","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}