BMJ Open Quality最新文献

{"title":"Improving the suspected cauda equina syndrome pathway at a district general hospital: a quality improvement project.","authors":"Andreas Conte, Aranghan Lingham, Suruthy Nagulendran, Urooj Chaudhary, Sultan Alsayeh, Bipin Malkania, Sucheta Sharma, Peter Watts, Martin Mitchell, Alison Davis, Marion Mueller","doi":"10.1136/bmjoq-2024-003081","DOIUrl":"10.1136/bmjoq-2024-003081","url":null,"abstract":"<p><p>Cauda equina syndrome (CES) is a surgical emergency caused by acute compression of the lumbosacral nerve roots, requiring urgent surgical decompression. Delays in management can lead to permanent bowel and bladder incontinence, sexual dysfunction, lower limb paralysis and chronic pain.The Getting it Right First Time (GIRFT) National CES Pathway 2023 mandates that patients with red flag symptoms require an 'emergency MRI as soon as possible, certainly within 4 hours of request'. However, an audit at Medway Hospital (MH) showed that despite achieving this target, patients still experience delays from emergency department (ED) attendance (time of arrival) to MRI scan (median 5.9 hours).In response, MH launched a CES working group of orthopaedic surgeons, radiologists, emergency doctors and managers. Having identified time to MRI request as a major driver of delays, the team altered the GIRFT target to a SMART primary aim of 4 hours from ED presentation to MRI. Two key interventions were planned: (1) the translation of the GIRFT guidelines into a standard operating procedure (SOP), cotargeting a secondary outcome improvement of more accurately identifying those at risk of CES, thus reducing unnecessary MRIs for those that did not meet those guidelines and (2) the extension of MRI operational hours.The new SOP was implemented across three plan-do-study-act cycles, but MRI operational hours were not extended. The primary outcome of reduction in time from ED presentation to MRI was not achieved (5.9 to 5.7 hours). Secondary aim improvements include a reduction of unnecessary MRIs (38% to 18%), CES MRI scans/day (0.5/day to 0.4/day), time to analgesia (5.3 to 4.2 hours) and incorrect referrals to the General Practitioner-led Medway on Call Care service (9% to 0%).Suggestions for further improvements within district general hospitals include a 24-hour emergency MRI service and a standardised CES MRI request form.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179592","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":"How does QI work? A trust-building framework in African healthcare: primary evidence from Kenya and Malawi.","authors":"Mary B Adam, Naomi Wambui Makobu, Kedar Mate, Tod Newman, Angela Joy Donelson","doi":"10.1136/bmjoq-2025-003330","DOIUrl":"10.1136/bmjoq-2025-003330","url":null,"abstract":"<p><p>Trust is fundamental to the effective functioning of healthcare systems, influencing access, utilisation and adherence to evidence-based practices. While quality improvement (QI) processes are widely recognised for addressing technical challenges, their role in fostering trust and relationships within health systems remains underexplored. This study examines the relationship dynamics in QI teams and how trust-building frameworks align with adaptive processes in healthcare settings. We conducted a qualitative study involving 30 healthcare workers from six African countries, recruited through the Africa Consortium for Quality Improvement in Frontline Healthcare. Data were collected through semistructured interviews, transcribed and analysed using both inductive and deductive methods. Deductive analysis was guided by a published trust-building framework, while insights from a large language model were incorporated in addition to a traditional analysis to provide an unbiased perspective. Results identified three theoretically described dimensions of trust-building within QI teams: common goals, self-interest and gratitude/indebtedness. Common goals fostered teamwork, multidisciplinary collaboration and effective communication, while self-interest motivated personal and professional growth. Gratitude and recognition reinforced team cohesion and sustained motivation. Participants highlighted the importance of trust in achieving project success, noting that robust relationships within teams correlated with improved outcomes. The study underscores the dual nature of QI processes, which simultaneously address technical improvements and adaptive challenges, including trust and relationship-building. Trust-building, framed as an iterative process of aligning common goals, recognising contributions and addressing individual interests, complements technical QI methodologies like Plan-Do-Study-Act cycles. These findings support expanding QI frameworks to emphasise relational dynamics, contributing to more sustainable and impactful healthcare improvements. Further research should continue to explore the adaptive dimensions of QI, integrating recent research on culturally relevant frameworks prioritising kindness in healthcare systems, to enhance trust and collaboration within healthcare systems.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179909","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":"Deprescribing vitamin B6 in a Singapore community hospital.","authors":"Alvin Shao Qiang Ong, Keith Zhong Hui Lee, Yee Shiang Wong, Eng Fui Lim, Dalvin Wan Hong Koh, Hui Yun Soh, Tsui Pik Chan, Gabriel Gerald Wenjun Yee, Yu Xian Loo, Cheryl Yan Fang Tan","doi":"10.1136/bmjoq-2024-003289","DOIUrl":"10.1136/bmjoq-2024-003289","url":null,"abstract":"<p><strong>Introduction: </strong>Vitamin B6 is commonly prescribed in hospitals in Singapore, although the clinical benefits are unclear. The Singapore Health Science Authority released a safety alert on high-dose vitamin B6 and the risk of peripheral neuropathy in May 2023.</p><p><strong>Methods: </strong>Patient case notes were reviewed at the beginning of the project, revealing that vitamin B6 was successfully deprescribed in 15.2% of eligible patients at our hospital.We used a swimlane diagram to map processes and cause-and-effect diagrams to identify root causes. We brainstormed for interventions using 72 change concepts, aiming to streamline medication management practices for deprescribing vitamin B6.</p><p><strong>Results: </strong>The percentage of patients with successfully deprescribed vitamin B6 increased from 15.2% to 100% during the project period. This corresponded to an 84.8% improvement. The additional 22 patients who had vitamin B6 deprescribed amounted to cost-savings of 1686 Singapore Dollars (SGD) per year. The projected savings over 1 year based on the current rate of deprescribing can be estimated to be SGD 13 567 per year. Furthermore, the new protocol that helped identify suitable patients for deprescribing has also led to positive feedback from the medical and pharmacy teams.</p><p><strong>Conclusion: </strong>In conclusion, this project facilitated a significant increase in the percentage of patients with successful vitamin B6 deprescription, reducing patients' pill burden, side effects and medication costs. It also resulted in a new protocol guideline for our healthcare teams to consider vitamin B6 deprescription in suitable patients.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179516","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":"Collaborative quality improvement initiative to enhance adult asthma management.","authors":"Ramona Sharma, Selina K Brandse, Terri L Riffle","doi":"10.1136/bmjoq-2024-003265","DOIUrl":"10.1136/bmjoq-2024-003265","url":null,"abstract":"<p><strong>Background: </strong>Adult asthma is a prevalent chronic condition that is suboptimally managed in primary care settings.</p><p><strong>Local problem: </strong>Uncontrolled asthma rates were noted in our local clinic where adult patients with asthma receive care.</p><p><strong>Methods: </strong>We used a structured intervention to improve adult asthma management, with the primary objective of increasing the percentage of patients at our clinic with an updated Asthma Action Plan (AAP) during a 1-year period. Data were collected through electronic health record audits and patient surveys and were analysed by using run charts. This quality improvement initiative was based on the chronic care model, which emphasises self-management support, clinical decision support and clinic systemic changes.</p><p><strong>Intervention: </strong>An approach involving a multidisciplinary team (ie, clinicians, nurses, panel managers and front desk personnel) was used to increase the percentage of adult patients (18-50 years old) at our clinic with an updated AAP (ie, reviewed within the past 12 months). The 1-year intervention period was from February 2023 through January 2024. The nursing team reviewed patients' problem lists to ensure updated information. In addition, the Asthma Management Questionnaire and Asthma Control Test were pushed through the patient portal for previsit completion or were administered during the rooming process by nursing staff. During the visit, clinicians followed up with patients to complete an AAP.</p><p><strong>Results: </strong>Adherence to asthma management guidelines was improved during the intervention period. The percentage of patients with updated AAPs increased from 7.5% (n=120) in February 2023 to 43.4% (n=152) in January 2024. The percentage of patients with optimal asthma control also increased from 40.0% (n=120) in February 2023 to 55.2% (n=165) in August 2023 and 66.4% (n=152) in January 2024.</p><p><strong>Conclusions: </strong>This quality improvement project led to measurable improvements in asthma care, highlighting the effectiveness of a structured intervention in the primary care setting.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156820","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 cardiac care with Positive Health and lifestyle interventions: a patient journey in a peripheral hospital setting.","authors":"Koster van Hogen, Mark Derks, Martine Veehof","doi":"10.1136/bmjoq-2024-003284","DOIUrl":"10.1136/bmjoq-2024-003284","url":null,"abstract":"<p><p>The increasing focus on health promotion and preventive healthcare is essential in reducing cardiovascular disease burdens. Positive Health (PH), centred on adaptability and self-management, presents a promising approach to enhance cardiac care. This study explores the integration of PH and lifestyle interventions within cardiac care, pinpointing areas for improvement through a patient journey analysis. This qualitative observational study uses a patient journey approach to analyse the integration of PH principles in cardiac care. A qualitative approach included a semistructured interview with a cardiac patient and a focus group with ten healthcare professionals, segmented into three stages: initial signal and examination, diagnosis and treatment and post-treatment follow-up. Thematic analysis revealed three key themes: communication, self-direction and personalised lifestyle modifications. Communication gaps among healthcare providers and towards the patient led to inefficiencies in care delivery. Although self-direction in care was encouraged, maintaining lifestyle changes proved difficult due to limited personalised support and motivation. Strengthening communication and providing tailored, sustainable lifestyle interventions are crucial to enhancing patient satisfaction, promoting enduring behavioural changes and achieving better cardiac outcomes. The patient journey method offers valuable insights into patient needs, facilitating the collaborative, integrated care improvements.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141315","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 improve cardiovascular risk screening in patients with rheumatoid arthritis.","authors":"Monique Hoekstra, Harriet de Vries, Clarinda van den Bosch-Schreuder, Mireille Edens","doi":"10.1136/bmjoq-2024-003018","DOIUrl":"10.1136/bmjoq-2024-003018","url":null,"abstract":"<p><strong>Significance and background: </strong>Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that is associated with an increased cardiovascular (CV) risk.Additional CV risk screening is advised in several national and international guidelines, but is performed inadequately. The CV risk screening in the Netherlands is performed by the general practitioner (GP).</p><p><strong>Purpose: </strong>The aim of our project was to increase the CV risk screening of patients with RA, performed by the GP, from 46% to 65% of the selected patients of 40 years and older, within the time frame of our project (18 months).</p><p><strong>Context: </strong>The project was carried out at the outpatient rheumatology clinic at Isala Zwolle, a large teaching hospital, in an area with 106 GP practices. Patients with RA, aged 40 years and older, who did not already participate in a cardiovascular risk management (CVRM) programme in general practice were included.</p><p><strong>Intervention: </strong>A multicomponent improvement strategy was developed and implemented. A prospective cohort follow-up study was performed, with measurements at T=0, 6, 12, 14, 16 and 18 months. The multicomponent strategy included patient education, a standard CVRM text in the electronic patient record (EPR) as a reminder, an educational meeting about CVRM in general practice for the rheumatologists and nurses, as well as feedback sessions with the rheumatologists, showing current data.</p><p><strong>Results: </strong>In our project, 784 RA patients were included. At time T=0, a CV risk analysis had been performed in the past 5 years in 46.4% of the patients with RA, who were not already participating in a CVRM protocol.This was significantly increased to 55.4% at 18 months in a prospective observational follow-up study. The primary goal, however, was not reached within the time frame of our project.</p><p><strong>Discussion: </strong>The availability of patient education cards and the feedback sessions with rheumatologists significantly contributed to the improvement. The implementation of an automatic standard text in the EPR, serving as an electronic reminder, did not perform as well as was anticipated.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the quality of induction of labour in maternity services.","authors":"Mohamed Elnasharty, Raweya Al-Dabbagh, Iman Makramallah, Abdelhameed Ismail","doi":"10.1136/bmjoq-2024-002757","DOIUrl":"10.1136/bmjoq-2024-002757","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Induction of labour (IOL) is the most common obstetric intervention with an incidence up to 30%. It can have a major impact on a woman's birth experience. A common cause of women's dissatisfaction with care is the discrepancy between their expectations and actual birth experience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Local problem: &lt;/strong&gt;High rates of IOL, which were associated with a considerable number of complaints as a result of women's dissatisfaction with increased referrals to debrief clinics. Staff feedback showed inconsistencies with the service provided. Feedback from staff and women showed avoidable delays, stress and anxiety. Inadequate patient information leaflets provided the women with unrealistic expectations about the IOL process.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;Improving the quality of the IOL process from the point women are offered IOL till delivery, reducing the avoidable delays, standardising the process and ultimately improving women's experience between July 2020 and July 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We followed the quality improvement methodology; Plan, Do, Study, Act. The project started with baseline data collection with multidisciplinary engagement with stakeholders and service users, including pregnant women, asking for their experience and expectations. This identified the root causes and drivers for change. We identified inconsistencies in the labour induction process as it was not in line with the national guideline, resulting in avoidable delays. Then we started implementing the required changes with continuous engagement with staff and service users, followed by an evaluation of the services.Quality improvement is a continuous process. Hence, the induction of labour working group evaluates the process monthly through the maternity dashboard, women's feedback and satisfaction survey with the help of the quality improvement team.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;(1) Multidisciplinary IOL working group was established, including a consultant obstetrician, deputy head of midwifery, consultant midwife, senior midwife and senior registrar. (2) Engagement with stakeholders and service users. (3) Develop IOL guidelines to standardise the process. (4) Develop IOL booking pro forma. (5) Update the patient information leaflets and use of technology to help easy access to information and develop a dedicated team for booking of pregnant patients for IOL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion and conclusion: &lt;/strong&gt;A high rate of IOL is associated with a higher rate of women's dissatisfaction as a result of the difference between women's expectations and their experience. This occurred due to a lack of standardisation and avoidable delays. Implementation of service changes can be challenging; however, listening and engaging with service users is essential to overcome these challenges. The main keys for improvement were developing standard guidelines, pathways, IOL packs and multidisciplinary team engagement. Providin","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126535","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":"One step on the QI journey: team perspectives on surveys for improvement.","authors":"Julie E Reed, Cassandra B Iroz, Julie K Johnson, Marjorie M Godfrey","doi":"10.1136/bmjoq-2024-003230","DOIUrl":"10.1136/bmjoq-2024-003230","url":null,"abstract":"<p><strong>Background: </strong>Surveys are widely used in healthcare to gather knowledge and information about services provided. There is a recognised gap between survey findings and their impact on practice, particularly for standardised surveys conducted at the national or organisational level. Findings are more likely to be acted on where there is a culture and infrastructure supportive of quality improvement (QI), but little is known about the experiences of local QI teams designing and using surveys in practice.</p><p><strong>Objective: </strong>To understand the experiences of QI teams designing and using surveys within a national QI collaborative, including perceived value and challenges.</p><p><strong>Methods: </strong>Using an interactive research approach, 14 semistructured interviews were conducted with members of the Cystic Fibrosis Lung Transplant Transition Learning and Leadership Collaborative. Data were analysed through multiple rounds of coding and inductive thematic analysis.</p><p><strong>Results: </strong>Collaborative participants viewed surveys positively as an improvement tool. The design and use of surveys was a team-based effort, embedded within the structure of the collaborative. Surveys illuminated local, microsystem and mesosystem data and provided patient and staff insights. As one step in the QI journey, surveys helped shape the direction of local QI work, resulting in positive changes in areas such as working relationships, patient interactions, staff education and work processes.Challenges experienced included: response rates and survey design, inability to act on findings, issues of sensitivity and anonymity, expertise to design surveys, time requirements, and survey fatigue.</p><p><strong>Conclusions: </strong>Surveys played a crucial role in driving QI efforts, leading to impactful changes in practice. Used within a supportive collaborative context, surveys became an essential tool for ongoing learning and improvement, highlighting the distinct needs of surveys used in QI compared with research.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126536","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":"Implementation and sustainability study of a patient's own medications management policy in the hospital using the RE-AIM framework.","authors":"Camille Hoornaert, Larissa Zubryckyj, Christophe Lelubre, Sophie Lorent, Stéphanie Pochet","doi":"10.1136/bmjoq-2024-003072","DOIUrl":"10.1136/bmjoq-2024-003072","url":null,"abstract":"<p><strong>Objective: </strong>The main objective was to develop a policy for the management of patients' own medications (POM) in a tertiary university hospital and to evaluate the outcomes of its implementation. The secondary objective was to explore the effects of introducing a policy on the incidence and severity of drug-related problems (DRPs).</p><p><strong>Methods: </strong>The implementation evaluation was based on the mixed method using the RE-AIM model (reach, effectiveness, adoption, implementation and maintenance). Each POM was analysed to identify the cause and severity of the DRP (pre-implementation and after 1 week, 3 months and 1 year). Three months after the implementation, an interview with hospital providers explored barriers and facilitators of the POM management policy as well as factors impacting the programme's sustainability.</p><p><strong>Results: </strong>205 patients were included pre-implementation, and over the three post-implementation periods, a total of 586 additional patients were included in the quantitative study. 17 interviews were conducted. Approximately 60% of the included patients brought their POM to the hospital during each period (reach). There was a statistically significant decrease in the percentage of POM self-administered (p<0.001), the percentage of POM used by nurses to administer doses (p<0.001), the rate (p=0.005) and severity (p=0.008) of DRP when compared with the situation before and after 1 week and 3 months of policy implementation (effectiveness, implementation). The rate (p=0.074) and severity (p=0.062) of DRP decrease after 1 year of policy implementation was not significant (maintenance).</p><p><strong>Conclusions: </strong>This study presents a POM management policy and highlights the unique challenges of implementing and, in particular, maintaining it in the hospital setting. A POM management policy reduces the incidence and severity of DRP caused by POM if the policy is fully communicated and staff are appropriately trained.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreasing prevalence of anaemia in pregnant women at delivery: a quality improvement initiative.","authors":"Tanisha Gupta, K Aparna Sharma, Aditya Sarkar, Srinidhi Y Reddy, Swati Sharma, Anushka Rathi, Nambrath Sunita, Joby Titto, Vidushi Kulshrestha, Neena Malhotra","doi":"10.1136/bmjoq-2024-003300","DOIUrl":"10.1136/bmjoq-2024-003300","url":null,"abstract":"<p><p>Anaemia in pregnancy is a critical public health challenge associated with adverse maternal and neonatal outcomes. Despite national programmes and guidelines, India continues to face high anaemia prevalence during pregnancy, with 42.2% in Delhi (National Family Health Survey-5). Addressing gaps in systematic screening, timely diagnosis and effective management is essential to reduce anaemia at delivery and improve maternal health outcomes. At AIIMS, New Delhi, baseline data revealed a 35.57% prevalence of anaemia among booked pregnant women at delivery. Key issues included limited screening, inconsistent management and poor patient adherence to anaemia treatment protocols. This prospective quality improvement (QI) initiative employed the Plan-Do-Study-Act (PDSA) cycle methodology to address anaemia in pregnancy. Interventions focused on systematic screening of women at 30-34 weeks gestation using point-of-care haemoglobin testing (HemoCue), the establishment of a dedicated anaemia management room and the development of standardised operating procedures for diagnosis and management. Weekly team meetings facilitated the identification of challenges and iterative improvements. Sustainability measures, such as structured intern orientation, real-time monitoring through WhatsApp and enhanced team communication, addressed barriers like frequent staff rotations and workflow integration. Over four PDSA cycles, screening coverage reached 95%-100%, with a median anaemia prevalence of 20.04% at delivery, reduced from 35.57% at baseline. Sustained improvements were achieved, with a 3-month median prevalence of 15%. Challenges included integrating workflows and ensuring continuity with rotating staff, mitigated through structured protocols and team reorientation. This QI initiative demonstrates a successful model for reducing anaemia at delivery through systematic screening, effective management and multidisciplinary collaboration. The findings provide a replicable framework for addressing anaemia in resource-limited settings, aligning with national initiatives like the 'T4 Anemia Room' concept.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085608","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}