BMJ Open Quality最新文献

{"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}

{"title":"Improving utilisation of the WHO surgical safety checklist at Wollega University Referral Hospital: a multidimensional quality improvement project.","authors":"Ketema Badasa, Mesfin Abera, Mulugeta Abebe, Gudetu Fikadu, Milkias Beki, Misganu Teshome, Megersa Fikadu, Amsalu Takele, Temesgen Tilahun","doi":"10.1136/bmjoq-2023-002599","DOIUrl":"https://doi.org/10.1136/bmjoq-2023-002599","url":null,"abstract":"<p><strong>Background: </strong>The WHO surgical safety checklist aims to improve patient safety by standardising the delivery of care within the operating theatre through a series of essential safety checks. It is a cost-effective tool that has been shown to improve patient safety. However, its utilisation remains low<i>.</i> OBJECTIVES: This quality improvement aimed to improve utilisation of the WHO surgical safety checklist at Wollega University Referral Hospital (WURH) from 56% to 100% from 1 July 2022 to 30 June 2023<i>.</i> METHODS: A hospital-based interventional study was conducted at WURH. A fishbone diagram and a driver diagram were used to identify root causes and how to address them. Six change ideas were developed. The Plan-Do-Study-Act cycle was used to test change ideas. The contribution of each change idea to the set objective was monitored. A run chart was used to assess whether an improved level of performance has been achieved and is being maintained. The result was presented using a run chart and graphs.</p><p><strong>Result: </strong>The percentage of WHO surgical safety checklist utilisation improved from 56% to 100%. The highest percentages of WHO safe surgery checklist utilisation were recorded during the last 2 months of the project (May (100%) and June (100%)). All nursing staff in the operation theatre have received training on the WHO surgical safety checklist.</p><p><strong>Conclusion: </strong>The compliance with WHO surgical safety utilisation was significantly improved at the study area. This was achieved through application of multidimensional change ideas related to health professionals and leadership. Therefore, we recommend the operation theatre team to make the WHO surgical safety checklist utilisation, its culture, and the hospital administration to conduct regular supportive supervisions and conducting a frequent clinical audit on its consistent utilisation. Additionally, in order to ensure the sustainability of the programme, hospital management should provide training to newly assigned staff as well as staff members who were not trained during the intervention phase.</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/PMC12067817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969853","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":"Identifying context-specific determinants to inform improvement of antimicrobial stewardship implementation in healthcare facilities in Asia: results from a scoping review and web-based survey among local experts.","authors":"Ralalicia Limato, Elza Samantha Elmira, Nguyen Hai Yen, Anh Quan Truong, Duong Hai Yen, Direk Limmathurotsakul, Abhilasha Karkey, Raph L Hamers, Twisha S Patel, Fernanda C Lessa, Elizabeth Dodds-Ashley, Deverick Anderson, H Rogier van Doorn, Huong Vu","doi":"10.1136/bmjoq-2024-003074","DOIUrl":"10.1136/bmjoq-2024-003074","url":null,"abstract":"<p><p>International guidelines are available for the assessment and improvement of antimicrobial stewardship (AMS) programmes: an important strategy to address the escalating global antimicrobial resistance problem. However, existing AMS assessment tools lack contextual specificity for resource-limited settings, leading to limited applicability in Asia. This project aimed to identify relevant themes from current guidance documents to help develop a context-specific assessment tool that can be applied by healthcare facilities (HCFs) to improve local implementation.We performed a sequential approach of a scoping review to identify relevant assessment themes for Asia and an expert survey for getting feedback on the relevance of assessment stems developed from the scoping review. We reviewed English-language published documents discussing AMS implementation or assessment at HCFs globally and in Asia. Themes were derived through content analysis and classified following the predefined context dimensions to develop assessment stems, defined as containing one identified determinant that may influence implementation outcomes. The survey consisting of identified assessment stems was reviewed by 20 locally identified experts in Asia who rated the level of relevance of these stems in AMS implementation in the region.National leadership, training and technical support, and policy and guidance were the most commonly identified themes among 100 themes identified from 73 reviewed documents. From these themes, we developed 131 assessment stems for the expert survey. Of the 131 assessment stems, 117 (89%) were considered relevant for AMS implementation in Asia by at least 80% of respondents. These stems were included in the process of developing a global AMS assessment tool to support HCFs to improve their programmes.In conclusion, national leadership and support represent a distinct and important aspect affecting AMS implementation in HCFs in Asia. The identified assessment themes have substantial value for the formulation of locally relevant implementation strategies tailored to the Asian context.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967219","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":"Quality improvement project to reduce beta-D-glucan turnaround times in an NHS pathology network.","authors":"Madeline Stone, Cassie Pope, Nathan Proudlove","doi":"10.1136/bmjoq-2024-003210","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003210","url":null,"abstract":"<p><p>Beta-D-glucan (BDG) is a cell wall component of many fungi, detecting this in patients' serum permits early diagnosis of invasive fungal infections, particularly in patients with haematological malignancy. In critically ill patients in an intensive-care unit, where the prevalence of invasive fungal infection is lower, the high negative predictive value of BDG facilitates withholding or discontinuation of empirical antifungal therapy, contributing to antifungal stewardship. However, for the results of BDG testing to impact patient management, they need to be available within a clinically useful timeframe.The South West London Pathology (SWLP) network routinely sent samples for BDG testing from hospital trusts in our area to the UK Health Security Agency Mycology Reference Laboratory (MRL) at Bristol for analysis. In 2021, the mean turnaround time (TAT) was more than two times the 5-working-days standard stated in the SWLP user handbook. In this quality improvement project (QIP), we identified that the greatest delay was the MRL posting hardcopy reports. We investigated electronic reporting, first for all patient samples, and then only for intensive-care patients. However, we found that information technology (IT) and staffing limitations meant this was not viable.We then investigated commercial solutions and identified an innovative assay, which enabled the implementation of in-house BDG testing that was a good fit with our available staffing resource and laboratory environment. Our aim was to achieve at least 90% of BDG results authorised within 5 working days of sample receipt. Our QIP improved performance on this from 0.88% to 92.8% and reduced the mean TAT from 11.6 to 2.5 days and at lower unit cost. The change has been well received by our laboratory staff, and our pathology operational leads have had very positive feedback from our clinical teams and our antifungal steward.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972140","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":"Development and implementation of paging and escalation guidelines to improve interprofessional communication on surgical units.","authors":"Michael A Kochis, Lynze R Franko, Kathleen Swierzewski, Alison Parmar, Suzanne Algeri, Rajshri M Gartland","doi":"10.1136/bmjoq-2024-002995","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002995","url":null,"abstract":"<p><strong>Introduction: </strong>Suboptimal interprofessional communication in the surgical inpatient setting has important implications for patient safety. Our departmental quality committee identified numerous safety events resulting from discordant expectations between surgical floor nurses and surgical residents or advanced practice providers (APPs) who serve as responding clinicians (RCs), and from reluctance to escalate clinical concerns. Alphanumeric paging is frequently used to communicate, but there are opportunities to enhance its effectiveness. This initiative sought to improve perceptions of communication and responsiveness between nurses and RCs by providing a shared language and set of expectations about the urgency of pages, appropriate responses and the process of escalation to other team members if necessary.</p><p><strong>Methods: </strong>An interprofessional team of surgical faculty, nurses and residents solicited input from surgical floor nurses, operating room nurses, residents, APPs and attendings on their perceptions of communication barriers among team members via online surveys and focus groups. Guidelines were iteratively developed. They specify that every page should be classified as STAT, Urgent, Please Call or FYI. Each classification is associated with an expected response time and pathway for contacting alternative team members if no response is received. After 3 months of implementation on our hospital's two main general surgery units, follow-up online surveys with multiple-choice and free-response questions assessed perceived impacts on communication and clinical care. Differences in categorical variables were assessed with χ² tests, and free text was analysed inductively.</p><p><strong>Results: </strong>After implementation, nurses reported favourable effects on communication, including significantly improved responsiveness during night shifts and timeliness from RCs during day shifts. Residents and attendings perceived the intervention to have overall neutral to mildly positive effects on communication.</p><p><strong>Conclusions: </strong>Paging and Escalation Guidelines are a feasible approach to enhance the perceptions of communication between nurses and RCs by aligning expectations, streamlining responses and decreasing barriers to escalation.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979279","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}