BMJ Open Quality最新文献

{"title":"Assessing the effectiveness of leader rounding for high reliability: a quality improvement initiative.","authors":"John S Murray, Joan Clifford","doi":"10.1136/bmjoq-2024-003101","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003101","url":null,"abstract":"<p><p>High reliability organizations in healthcare are responsible for consistently maintaining high levels of safety and quality over extended periods of time and across multiples service lines and settings. In order to accomplish this, transparent and bi-directional communication across service lines and teams with organizational leaders is essential. Leader rounding for high reliability helps to ensure effective communication takes place. Developing and implementing an evidence-based process for leader rounding for high reliability is important as is determining effectiveness over time. We describe an initiative for assessing effectiveness after an evidence-based process for leader rounding for high reliability was created and implemented for the Veterans Affairs Bedford Healthcare System.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a platform to investigate the heterogeneity of outcomes for patients with ovarian cancer.","authors":"Kathryn Baxter, J Booth, A Hawarden, N Wood, A Fisher, N Bhagat, J Morrison, V Cullimore, R Newhouse, I Yagel, A Shah, J Yap, H Woodman, T Olaoye, V Do, M MacDonald, E Long, L WIbmer, C Fotopoulou, Richard Edmondson","doi":"10.1136/bmjoq-2024-002742","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002742","url":null,"abstract":"<p><strong>Background: </strong>The geographical variation in treatment patterns for patients with ovarian cancer is profound, long-standing and worrying. Although these variations were highlighted in a recent UK registry audit, granular data to provide explanations for these variations have been lacking.</p><p><strong>Methods: </strong>A consortium of six UK centres was generated to curate and submit data for all patients treated at their centre for a 2-year period. Descriptive statistics were combined with Cox regression and Kaplan-Meier analysis to confirm the findings from the national registry audit and identify possible drivers of the heterogeneity previously described.</p><p><strong>Results: </strong>Records for 1117 patients treated in six centres in 2018 and 2019 were collated. Although there were differences in the clinical characteristics of patients between centres, these were not enough to account for the significant variation in survival outcomes between centres (p<0.001). Treatment rates varied between centres with between 30% and 76% of patients receiving combination therapy but in Cox models 'treatment centre' remained a predictor of 1 year survival independent of patient, tumour factors and treatment choice.</p><p><strong>Conclusion: </strong>Variations in outcome seen between UK centres are not related solely to casemix but rather to the approach and ethos of each centre towards advanced ovarian cancer treatment options. Although important, differences in treatment patterns do not completely explain the variations seen and further work is required to understand the drivers of difference seen.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving compliance with conducting HEADSS biopsychosocial assessment for adolescents in a paediatric inpatient setting.","authors":"Juliet Sher Kit Tan, Jeslyn Hwee Teng Neo, Sarah Hui Wen Yao, Kent Mun Loh, Ragavendra Kalyanasundaram, Amelia Suan-Lin Koe, Charlene Yuen Shuan Kho, Nurazila Rahmat, Joyce Soo Ting Lim, Yong Hong Ng, Sam Chang Hoe Koh, Alvin Shang Ming Chang, Elaine Chu Shan Chew","doi":"10.1136/bmjoq-2024-003000","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003000","url":null,"abstract":"<p><p>Adolescence is a period during which teenagers are at a high risk of developing mental health problems. Early recognition and intervention for mental health symptoms can prevent progression of high-risk behaviours or worsening of serious psychiatric conditions. The HEADSS assessment is an internationally recognised tool used to facilitate the biopsychosocial evaluation of an adolescent comprising domains in home, education, eating behaviours, activities, drug exposure, sexual activity, sleep, mood and suicidality. A self-administered HEADSS screening tool, comprising 11 questions, was developed and implemented in our hospital for all adolescents admitted to inpatient wards. The HEADSS screening tool is initiated by a nurse and, when screened positive, triggers a HEADSS assessment performed by a clinician to evaluate various domains of HEADSS. A hospital-wide audit reflected poor compliance with HEADSS assessments being conducted, despite domains of concern being flagged during HEADSS screening. A multidisciplinary team was created to address this issue. Following a root cause analysis, the team implemented the following interventions: improving the clarity and specificity of the HEADSS screen, improving communication between nursing and medical staff via educational update sessions and automated handover reports and implementing a targeted HEADSS assessment to focus on domains of concern. There was a statistically significant improvement in the median percentage of compliance to HEADSS assessment to 85% (from 40% at baseline) after implementing these measures. This improvement in compliance with HEADSS assessments resulted in an increase in referrals to mental health and allied health professionals, providing at-risk youth with necessary mental health support and interventions at the early stages of their difficulties.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol for a national intervention programme aimed to reduce unwarranted variation and overuse of shoulder arthroscopy in Norway.","authors":"Ole Tjomsland, Helena Maria Bertilsson, Geir Bjerkan, Per Jesper Blomquist, Jens Ivar Brox, Berte Marie Bøe, Ola Jøsendal, Daniel Major, Kandiah Panchakulasingam, Eva Stensland, Michael Strehle, Kristjan Valdimarsson, Christian Thoresen","doi":"10.1136/bmjoq-2024-003099","DOIUrl":"10.1136/bmjoq-2024-003099","url":null,"abstract":"<p><p>Several advice-based approaches have aimed to reduce the overuse of procedures characterised as low-value healthcare services but have so far shown marginal impact on utilisation rates. Differences in utilisation rates tend to be associated with type of healthcare provider. Commercial providers have a tendency to have higher utilisations rates compared with non-profit providers. Norway has a publicly funded universal health coverage system where healthcare services are mainly provided by publicly owned hospitals in addition to a small number of non-profit hospitals and commercial hospitals reimbursed by the regional health authorities. According to previous experiences, unwarranted variation in utilisation rates can be associated with the type of healthcare provider. The aim of the present study is to evaluate the impact of tailoring the interventions on reducing overuse of low-value care based on an analysis of the clinical pathways and the various types of healthcare providers. The National Decision Forum in Norway has decided that acromion resection in patients with impingement symptoms and repair of non-traumatic cuff rupture should not be offered as standard treatment. The present protocol describes the planned intervention to reduce the overuse of these procedures.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466856","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":"Reduced wait times for molecular-biomarker testing among patients with advanced lung cancer using parallel sample processing and closed-loop communication: the Continuous Oncopanel and ALK Status Tracking (COAST) Project.","authors":"Sarah Yeo, Jane Sun, Kelly Zibrik, Tawimas Shaipanich, Hannah Carolan, Barbara Melosky, Diana Ionescu, Deepu Alex, Stephen Yip, Ying Wang","doi":"10.1136/bmjoq-2024-003001","DOIUrl":"10.1136/bmjoq-2024-003001","url":null,"abstract":"<p><strong>Background: </strong>Given how crucial molecular-biomarker testing is to treatment decisions for advanced non-small cell lung cancer (NSCLC), guidelines recommend a turnaround time (TAT) of 14 calendar days from receiving specimen to test result, and 3 days to receive a specimen from outside pathology lab. Current TAT for molecular-biomarker testing in British Columbia (BC), Canada frequently exceeds these recommendations. Thus, we launched a quality improvement (QI) initiative to improve TAT of molecular-biomarker testing.</p><p><strong>Methods: </strong>We assembled a multidisciplinary team to identify areas contributing to delays in molecular-biomarker testing. We designed and conducted three Plan-Do-Study-Act (PDSA) cycles. Cycles 1 and 2 involved changing requisition delivery method from fax to email between BC Cancer Vancouver Centre (BCCV) and two outside hospitals with the highest volume of specimens. Cycle 3 introduced parallel processing of specimens at BCCV pathology lab and concurrent molecular-biomarker testing. TAT was evaluated before and after these process changes along with staff satisfaction via survey.</p><p><strong>Results: </strong>The average TAT from test request to specimen received by BCCV was reduced from 6.4 days prechange to 4.6 days postchange. The TAT from specimen receipt by BCCV to report availability was reduced from a median of 22-16 days. Report availability for initial medical oncology consultation increased from a median of 13%-29%. The staff satisfaction survey revealed an enhanced experience with the new process, particularly for our nurse navigator.</p><p><strong>Conclusion: </strong>The TAT for molecular-biomarker testing is an ongoing and complex challenge for healthcare systems worldwide. This QI project is a step towards addressing province-wide reduction in wait times for molecular-biomarker testing results in BC. We continue to explore further ideas to improve workflow metrics and patient care among patients with advanced NSCLC.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456736","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":"Broadening the definition of patient-safety events: lessons from a multicentre learning health system collaborative.","authors":"Jeanne M Huddleston, Daniel Whitford, Alexandra K Yaszemski, Matthew P Schrieber, Edward Pollak","doi":"10.1136/bmjoq-2024-002988","DOIUrl":"10.1136/bmjoq-2024-002988","url":null,"abstract":"<p><strong>Background: </strong>Improving safety in healthcare has been paramount for decades, yet despite major attention and investment, improvement has remained incremental. Patient safety is a major concern in US healthcare, leading to significant harm and economic losses annually. Accurately identifying safety events remains difficult due to methodological discrepancies and lack of standardisation. This study evaluated the feasibility of implementing a standardised case-review methodology and safety-event taxonomy across diverse hospital settings to assess opportunities for improvement (OFIs) and compare findings with traditional definitions.</p><p><strong>Methods: </strong>This multicentre retrospective cohort study reports data from 103 hospitals across the USA and Canada between 2016 and 2023. A multivariable logistic regression was performed to test case reviews for differences in the presence of one or more OFIs across several hospital types (bed size, academic status, urban setting, trauma level and Centres for Medicare and Medicaid Services overall star rating) and patient characteristics (age, gender, length of stay, admission and discharge code status and mortality).</p><p><strong>Results: </strong>19 181 cases were reviewed across the Learning Health System Collaborative, with a median of 107 reviews per hospital. Mortality was the most common cohort selection, studied by 91 hospitals (88%). At least one OFI was identified in 12 714 cases (66.3%). The logistic regression analysis found that all hospital characteristics and patient age, length of stay, code status and discharge disposition were significantly associated with at least one OFI. Of the 46 444 OFIs identified, 41 439 (89%) were from categories focused on omissions of care. The categories of end-of-life, documentation and treatment/care alone accounted for 25 980 OFIs (56%).</p><p><strong>Conclusion: </strong>The highest volumes of safety-related OFIs were associated with omissions of care, as opposed to the traditional definition of patient safety, which primarily includes outcomes from acts of commission.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456731","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":"Enhancing end-of-life care nursing competency: a nursing education quality improvement project in general medical wards.","authors":"Chen Na Lee, Guozhang Lee, Fung Chee Aw, Nuraishah Binte Zulkifle, Yih Shan Tan, Marianah Amanulla, Esther Hui Hui Chua, Wei Zhi Koh, Jolin Er Huan Lee, Natalie Liling Woong","doi":"10.1136/bmjoq-2024-003228","DOIUrl":"10.1136/bmjoq-2024-003228","url":null,"abstract":"<p><p>End-of-life care is a fundamental aspect of nursing that significantly affects patient outcomes and family well-being. Despite its importance, nurses in non-palliative care settings often lack relevant training and confidence to provide high-quality end-of-life care, resulting in suboptimal patient experiences. This paper presents a quality improvement initiative at Singapore General Hospital, the nation's largest tertiary acute hospital, aimed at addressing this critical gap.We conducted a targeted educational needs assessment using a modified Palliative Care Quiz that showed a low pass rate of 15% among medical ward nurses. In response, we designed and implemented a structured training programme that integrated lectures with interactive case-based discussions, focusing on practical, real-world applications of end-of-life care. Our findings demonstrate a significant increase in knowledge proficiency, with the pass rate improving to 53% post-intervention. Additionally, nurses reported significant improvements in their confidence and competence across all domains of end-of-life care. Notably, scores for non-pharmacological management increased from 49% to 86%. This domain covered non-pharmacological modalities for managing dyspnoea, secretions, delirium and nausea and vomiting.These results highlight the effectiveness of targeted educational interventions in equipping nurses with the skills and knowledge to manage the complexities of end-of-life care. Integrating targeted end-of-life training into nursing curricula and institutional practices improves nurses' confidence and competence and enhances the quality of care for patients and their families facing the end of life. This report is written based on the Standards for Quality Improvement Reporting Excellence guidelines.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448023","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 implementing a nurse-led intraoperative cell saver service in reducing allogeneic red blood cell transfusions in Singapore General Hospital.","authors":"Yingke He, Yan Ru Tan, Jing Fu, Yu Gan, Ai Leen Ang, Angelina Elisabeth, Hairil Rizal Abdullah","doi":"10.1136/bmjoq-2024-003045","DOIUrl":"10.1136/bmjoq-2024-003045","url":null,"abstract":"<p><strong>Introduction: </strong>Major perioperative blood loss often necessitates allogeneic blood transfusions, leading to adverse outcomes and straining healthcare resources. Intraoperative cell salvage (ICS) offers benefits like reduced adverse reactions, optimised blood resource allocation, and cost-effectiveness. Yet, ICS adoption remains limited. Our aim is to formalise and expand ICS as a routine service to promote wider adoption and improve patient outcomes.</p><p><strong>Methods: </strong>The model for improvement was adopted for an ICS quality improvement initiative across two Plan-Do-Study-Act cycles. Interventions followed the '4E' framework: education, empowerment, enforcement and embedding reminders. The primary outcome was the number of allogeneic red blood cell (RBC) units transfused per surgery with predicted blood loss >500 mL; the secondary outcome was the percentage of indicated surgeries using ICS. Process measure was percentage of anaesthetic unit nurses trained in ICS. Balancing measures included the number of ICS activations with no blood return and complications during and after ICS.</p><p><strong>Results: </strong>A total of 152 surgeries used ICS postintervention (January 2023 to April 2024), marking an increase from preintervention levels. The median number of monthly mean allogeneic RBC units transfused per patient demonstrated a significant reduction from 3.10 (preintervention) to 2.44 (postintervention). The percentage of indicated surgeries utilising ICS increased from 1.4% to 12.3%. Cost savings were observed, with potential annual savings close to SGD 500 000. No complications related to the use of ICS were recorded.</p><p><strong>Conclusion: </strong>The formalisation and expansion of the ICS service within our institution resulted in notable improvements, including increased ICS adoption rates, reduced reliance on allogeneic blood transfusions and potential cost savings. Future quality improvement efforts should concentrate on further promoting ICS adoption, particularly for surgeries with clinical indications.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439973","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 educational videos and user guide on indwelling pleural catheter caregiver training and unplanned healthcare encounters.","authors":"Si Ling Young, Brian Lee Wei Chua, Qiao Li Tan, Carrie Kah-Lai Leong, Ivana Gilcrist Chiew Sian Phua, Jane Jing Yi Wong, Wen Ting Lim, Kendra Jing Ying Tang, Aaron Jun Jie Tan, Fena Ming Qin Lee, Ken Junyang Goh","doi":"10.1136/bmjoq-2024-003108","DOIUrl":"10.1136/bmjoq-2024-003108","url":null,"abstract":"<p><strong>Background: </strong>Indwelling pleural catheters (IPCs) are an effective first line option for the management of symptomatic malignant pleural effusions. However, patients with IPCs often require unplanned healthcare encounters (UHEs) due to complications or concerns with IPC care and drainage.</p><p><strong>Local problem: </strong>There is a lack of readily accessible IPC-specific educational material to support caregiver training (CGT). As IPC care and drainage are performed primarily by patients and caregivers in our country due to the lack of community nursing support, ineffective CGT may lead to increased UHEs due to caregiver knowledge gaps or poor confidence in managing and caring for IPCs.</p><p><strong>Aims: </strong>We aim to reduce the number of IPC-related UHEs.</p><p><strong>Methods and interventions: </strong>We used a 5-why diagram and identified a lack of appropriate educational material as a key factor contributing to repeated UHEs. We therefore produced and employed IPC-specific educational videos and user guides, using a 'Plan-Do-Study-Act' approach, into our CGT programme. Patient demographics and clinical outcomes were collected prospectively for 166 consecutive patients with IPC insertions, with 72 patients in the preintervention group and 94 in the postintervention group. Survey questionnaires addressing caregiver competency and confidence were also administered after CGT using these tools.</p><p><strong>Results: </strong>There was a significant decrease in the proportion of patients who had ≥2 (8.5% vs 40.9%, p<0.001) or ≥3 UHEs (3.2% vs 31.8%, p<0.001) in the intervention group. There was also a higher caregiver competency score achieved in the intervention group (7 (IQR: 7-7) vs 5 (IQR: 5-7), p<0.001). There was no difference in overall complication and IPC-related infection rates between groups.</p><p><strong>Conclusion: </strong>IPC-specific educational videos and resources, which are readily accessible and easily implemented into CGT programmes, reduce UHEs due to IPC-related issues and may improve caregiver knowledge and competency in IPC care and drainage.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439972","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 prematurity-related neonatal mortality: a quality improvement project in Gandhi Memorial Hospital, Addis Ababa, Ethiopia.","authors":"Biniam Yohannes Wotango, Wubet Mihretu Workneh, Tariku Deressa Abdana, Hailegebriel Kidane, Mahlet Alemayehu, Dawit Niku, Birtukan Alene, Aynekulu Aragaw, Zafu Belay, Tigist Adenew, Gebremeskel Tamene Hailu, Yeneneh Getachew Haile","doi":"10.1136/bmjoq-2024-003058","DOIUrl":"10.1136/bmjoq-2024-003058","url":null,"abstract":"<p><strong>Background: </strong>Neonatal deaths refer to infants who die within the first 28 days of life, and they account for almost 50% of all child deaths under the age of 5 globally. Preterm birth is the primary reason for neonatal deaths, and it can lead to various complications that may prove fatal for newborns, such as respiratory distress syndrome, sepsis and intracranial haemorrhages. There was a high rate of neonatal mortality at Gandhi Memorial Hospital. 57.7% of neonatal deaths were caused by premature-related problems according to Pareto chart analysis. The baseline mortality rate among premature neonates admitted to the Neonatal Intensive Care Unit (NICU) was 20.7%. The objective of this quality improvement project was to reduce prematurity-related neonatal death at Gandhi Memorial Hospital.</p><p><strong>Methods: </strong>A multidisciplinary quality improvement team used a fishbone diagram to analyse the causes of neonatal deaths related to prematurity. We used the Institute for Healthcare Improvement (IHI) model for improvement, using Plan-Do-Study-Act cycles to measure progress and make data-driven decisions.</p><p><strong>Interventions: </strong>Transporting premature neonates born in the labour ward to NICU with CPAP, increasing the use of a continuous positive airway pressure (CPAP) device with an integrated oxygen concentrator, blender and compressor, and implementing the infection prevention checklist with four components were the implemented change ideas.</p><p><strong>Results: </strong>The run chart showed a 25.6% reduction in prematurity-related neonatal mortality after implementing three interventions, and evidenced by a shift below the baseline median.</p><p><strong>Conclusion and recommendation: </strong>The quality improvement project involving three interventions which are transporting premature neonates from labour ward to NICU with CPAP, using a CPAP device with an integrated oxygen concentrator, blender and compressor for preterm neonates and infection prevention checklist use with four components at Gandhi Memorial Hospital effectively reduced prematurity-related neonatal death. To improve neonatal outcome in premature neonates, we recommend that hospitals should prioritise implementing a standardised CPAP transport protocol, increasing a CPAP device with an integrated oxygen concentrator, blender and compressor use in the NICU, and fully implementing the infection prevention Checklist.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439975","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}