BMJ Open Quality最新文献

{"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}

{"title":"Patient and family engagement interventions for enhancing patient safety in the perioperative journey: a scoping review.","authors":"Ayshe Seyfulayeva, Bianca Ferreira Fonte, Ana Margarida Alho, Anum Shaikh, Ana Beatriz Nunes, Pedro Gonçalves Carvalho Casaca, Andreia Leite, Ayda Taha, Neelam Dhingra-Kumar, Paulo Sousa","doi":"10.1136/bmjoq-2024-002986","DOIUrl":"10.1136/bmjoq-2024-002986","url":null,"abstract":"<p><strong>Background: </strong>Surgical procedures present intricate challenges within healthcare delivery, often associated with higher risks of adverse events compared with non-surgical contexts. Patient and family engagement (PFE) throughout the perioperative journey is a possibility to enhance care quality, safety and patient-centredness. However, literature addressing PFE across the entirety of the perioperative journey remains sparse.</p><p><strong>Objective: </strong>The current scoping review aims to comprehensively map the existing interventions with PFE approach focused on improving patient safety across various types of surgical procedures throughout the perioperative journey. In addition, the review aims to understand the level and type of PFE approach adopted in this context.</p><p><strong>Eligibility criteria: </strong>Articles published in indexed peer-reviewed journals from 2003 to 2023, written in English, Portuguese or Spanish, that report on interventions with PFE approach targeting adult surgical patients, their families, caregivers, patient advocates and patient champions. The review includes articles reporting on both inpatient and ambulatory surgical patients.</p><p><strong>Methods: </strong>Following Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews framework, this review systematically searched PubMed, Web of Science, SCOPUS, CINAHL, and PsycINFO for relevant articles. Eligible interventions were categorised using PFE framework regarding the level of engagement and mapped according to the WHO Global Patient Safety Action Plan 2021-2030.</p><p><strong>Results: </strong>Out of 765 records initially identified, 32 met the eligibility criteria for data extraction and analysis, of which 40% originated from the USA, followed by the UK (18%) and Canada (12%). 47% of the interventions targeted 'multiple/all types' of procedures, 19% focused on cardiothoracic surgeries and 9% on gynaecological procedures or organ transplant. The majority of the interventions (88%) focused on PFE at the direct care level, predominantly adopting a consultation-based approach. Furthermore, 81% of eligible interventions emphasised patient information and education, 16% addressed codevelopment of policy and 3% of interventions focused on patient advocacy.</p><p><strong>Conclusion: </strong>The findings show a predominant focus on PFE interventions targeting patient safety at the direct care level, particularly in the provision of patient information and education. However, interventions at organisational and policy-making levels are notably scarce. Further investment is required to promote interventions engaging patients and families at broader organisational and policy-making levels.</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/PMC11836844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439974","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":"Resident encounters with disruptive workplace behaviours in Japan: findings from a national cross-sectional study.","authors":"Takashi Watari, Virginia Sheffield, Ashwin Gupta, Kaori Taniguchi, Yasuharu Tokuda, Yuji Nishizaki","doi":"10.1136/bmjoq-2024-003093","DOIUrl":"10.1136/bmjoq-2024-003093","url":null,"abstract":"<p><strong>Importance: </strong>Disruptive workplace behaviours (DWBs) between healthcare professionals compromise patient care quality and organisational culture, impacting staff morale, communication and teamwork. Residents are particularly vulnerable to it from nurses and supervisors.</p><p><strong>Objective: </strong>Elucidate factors associated with DWBs experienced by residents.</p><p><strong>Design: </strong>Nationwide cross-sectional study using a web-based survey.</p><p><strong>Setting: </strong>Japanese postgraduate clinical training hospitals.</p><p><strong>Participants: </strong>First- and second-year postgraduate residents were surveyed between 15 and 31 January 2023, immediately after participating in the nationally administered computer-based residency exam.</p><p><strong>Exposure: </strong>None.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes include previously published eight types of DWBs experienced by residents. Resident characteristics at the time of the study were used. Hospital data (location of the training hospital, number of beds, number of emergency transports, average length of hospital stays, number of outpatients per day and the actual number of residents, full-time physicians and nurses) were obtained from Japan's largest hospital information database.</p><p><strong>Results: </strong>Of 5403 residents analysed, 68.3% were males, and 84.9% were under 28 years of age. Residents reported encountering DWBs from physicians and nurses approximately 35% of the time, a roughly equivalent percentage from both groups. After multivariate logistic regression analysis, the likelihood of encountering DWBs from nurses increased with hospital size (>700 beds; adjusted OR (aOR) 2.19; 501-700 beds; aOR 1.45 and 301-500 beds; aOR 1.26, all statistically significant). Furthermore, DWBs from nurses were significantly more prevalent in settings with higher admissions per nurse (aOR 1.70). DWBs from physicians were significantly more prevalent towards male (vs female) residents (aOR 1.60) and less likely among the second-year postgraduate (vs first-year postgraduate) residents (aOR 0.87).</p><p><strong>Conclusions: </strong>DWBs from nurses are significantly more common with increasing hospital bed numbers and increase with the number of admissions per nurse. No such correlation was observed with DWBs from physicians. Male residents experience more DWBs than female residents.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432523","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":"Successful posthospitalisation oncology workflow implementing LACE+ score to stratify and reduce readmissions within a safety-net hospital.","authors":"Cindy M Pabon, Janine Wong, Marcela Perez, Jessica Jimenez-Abarca, Lianchun Xiao, Lymesia Jackson, Anne Park, Anjali Lankford, Vinita Akula, Saumil Datar, Taylor Hopper, Yaser Alkhatib, Terri Earles, Tejal Patel","doi":"10.1136/bmjoq-2024-003068","DOIUrl":"10.1136/bmjoq-2024-003068","url":null,"abstract":"<p><strong>Background: </strong>Patients with advanced cancers visit the emergency room and get hospitalised frequently, with potentially half of these visits being avoidable. Our institution provides comprehensive, low-cost cancer treatment to a safety-net population in Texas. We performed a retrospective review of hospital readmission patterns amongst our oncology patients and developed a posthospitalisation workflow to reduce readmissions.</p><p><strong>Method: </strong>Following discharge, oncology patients were risk stratified based on their Length of stay, Acuity of admission, Charlson comorbidity index score and Emergency department visits+index in the past 6 months. The higher the score, the quicker the outpatient oncology follow-up. In addition to addressing acute issues related to hospitalisation, patients were also able to receive newly translated resources while in clinic.</p><p><strong>Results: </strong>The preintervention 30-day-readmission rate was 17.3% (June 2022-December 2022) (95% CI 13.4% to 21.8%). Meanwhile, the postintervention 30-day-readmission rate was 14.7% (June 2023-December 2023) (95% CI 10.9% to 19.2%). While a 2.6% reduction in readmissions was achieved, this decrease was not statistically significant (-2.6%; 95% CI -8.4% to 3.2%; p value=0.375). Emergency use utilisation decreased from 90% to 15%.</p><p><strong>Conclusions: </strong>Our team was able to facilitate and coordinate outpatient care for oncology patients following hospitalisation. The expedited care allowed providers to ensure that the care plan after hospitalisation was well understood and accessible to the patient. Furthermore, language-appropriate resources were provided to patients at that time. Our intervention was feasible, easy to implement and quick to produce tangible improvements in patient care. More time is needed to determine whether this will create a statistically significant impact on readmission rates.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413187","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}