BMJ Open Quality最新文献

{"title":"Failure mode and effects analysis of fuel and LPG shortage impacts on hospital operations: a framework for healthcare resilience in conflict-related supply disruptions.","authors":"Anup Radhakrishna Warrier, Jyothi Antony","doi":"10.1136/bmjoq-2026-004441","DOIUrl":"10.1136/bmjoq-2026-004441","url":null,"abstract":"<p><strong>Objectives: </strong>To conduct a proactive failure mode and effects analysis (FMEA) of patient safety risks arising from acute fuel and liquefied petroleum gas (LPG) shortage at a quaternary-care hospital in a modelled geopolitical conflict scenario and to produce a tiered preparedness framework.</p><p><strong>Design: </strong>Proactive process FMEA using the Institute for Healthcare Improvement (IHI) Healthcare FMEA framework. Risk priority numbers (RPNs) were computed as severity (S)×occurrence (O)×detection (D), each scored 1-10.</p><p><strong>Setting: </strong>A 455-bed quaternary-care hospital in South India.</p><p><strong>Methods: </strong>A multidisciplinary team (infectious diseases, quality, engineering, dietetics, nursing, pharmacy) mapped 10 hospital departments across six structured sessions. The hazard scenario modelled a US-Iran war causing Strait of Hormuz closure and acute national fuel and LPG supply shock. Each failure mode was scored on S, O and D; RPN risk bands were defined as Critical (≥200), High (150-199), Medium (100-149) and Low (<100).</p><p><strong>Results: </strong>62 failure modes were identified across 10 departments (RPN range 70-252; mean 143.3). 5 failure modes were Critical, 17 High, 34 Medium and 6 Low. The Generator/Power Backup department recorded the highest mean RPN (171.0), functioning as a systemic root-cause amplifier propagating risk across seven other departments. Laundry Services contained the highest-scoring individual failure mode (operating theatre/intensive care unit linen sterilisation failure, RPN 240); Kitchen Services-entirely LPG-dependent-recorded a mean RPN of 163.4. Critical clinical consequences, including ventilator failure, haemodialysis shutdown and emergency surgical cancellation, were traceable upstream to generator dependency.</p><p><strong>Conclusions: </strong>Fuel and LPG shortage in a conflict scenario generates cascading, multisystem patient safety failures. Generator continuity is the paramount mitigation target. Kitchen and laundry services carry infection-control risks comparable in magnitude to clinical departments. A proactively constructed, RPN-stratified response framework is essential for hospital resilience in geopolitical emergencies.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988056","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 for minimising red blood cell unit wastage at a secondary referral hospital in Malawi.","authors":"Brany Mithi, Edson Mzumara, Kwame Chisi, Robert Fungurani, Jean Nyondo, Arnold Jumbe","doi":"10.1136/bmjoq-2026-004290","DOIUrl":"10.1136/bmjoq-2026-004290","url":null,"abstract":"<p><p>Poor blood bank stock management can result in excess or understocking of blood units for transfusion. A retrospective analysis of blood bank records from 2020 to 2024 at a secondary referral hospital in Malawi revealed a consistently high number of expired red blood cell units. This quality improvement project (QIP) was implemented to reduce blood unit wastage from over 4% to zero of the total blood units received per month.We developed an intervention package to address gaps in blood bank inventory stock management. The package comprised change ideas such as adjusted blood ordering mechanism, strict adherence to the First Expire First Out (FEFO) strategy, improved coordination and staff coverage for the blood bank. The iterative Plan-Do-Study-Adjust (PDSA) cycle guided the implementation of the change ideas. Key outcomes from the pre-intervention and post-intervention phases were compared to evaluate the effectiveness of the interventions.Overall, five PDSA cycles were completed in the implementation phase. Baseline assessment uncovered multiple non-conforming practices, including non-adherence to standard methods for issuing blood cell units and over-ordering of blood units, a practice driven by long distance and transport logistical challenges. The mean expiry rate of blood units for the pre-intervention period (March-July 2024) was 4.16% (37/890 units), with March recording the highest wastage (5.4%). Following implementation of QIP strategies, a significant decline in wastage of blood units was observed (1% (6/520), p=0.007), with zero-unit expiries recorded from September 2024 to March 2025. The proportion of ward returned blood units declined from 1.1% (8 of 713) to 0.7% (4 of 570) (p=0.45).Our QIP identified and addressed operational gaps contributing to blood unit wastage. Through a step-by-step implementation of a multifaceted strategy, to improve staff coverage, coordination and compliance with blood bank standard practices, blood unit wastage due to expiry was reduced to zero.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975704","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":"Referral delays in metastatic breast cancer care: barriers and facilitators across a fragmented pathway.","authors":"Thanarpan Peerawong, Tharin Phenwan, Sojirat Supanichwatana, Naowanit Siammai, Prakaidao Sunthorn, Nicola M Gray","doi":"10.1136/bmjoq-2026-004452","DOIUrl":"10.1136/bmjoq-2026-004452","url":null,"abstract":"<p><strong>Background: </strong>The proportion of women diagnosed with metastatic breast cancer (mBC) in Southern Thailand has remained stable at 10.5-11.7% over the past decade. Healthcare system-level and provider-level barriers contributing to these delays remain poorly understood.</p><p><strong>Objectives: </strong>To identify patient-related and healthcare system-related factors influencing referral delays for mBC in Southern Thailand, and to co-design implementation strategies with stakeholders to address these barriers.</p><p><strong>Methods: </strong>This co-produced qualitative study, developed in partnership with a breast cancer survivor support group, employed Force Field Analysis to identify barriers and facilitators influencing mBC referral in Health Region 12. Data were generated through semi-structured interviews with 8 women living with mBC and 13 medical interns, documentary analysis of 3 national policy documents and a stakeholder co-design workshop. Reflexive thematic analysis was undertaken, with findings synthesised across macro, organisational and micro levels.</p><p><strong>Results: </strong>Four barriers and three facilitators were identified. At the macro level, inequities in insurance scheme restrictions and the incomplete implementation of national guidelines created structural filters that delayed access to specialist care. At the organisational level, limited diagnostic resources, fragmented medical information systems and a culture of caution surrounding referral further compounded delays. At the micro level, socioeconomic constraints and reliance on traditional medicine interacted with system-level barriers, indicating that late presentation is more reflective of systemic dysfunction than of individual health literacy deficits. Facilitators were informal, fragile and largely dependent on individual clinician initiative.</p><p><strong>Conclusions: </strong>Referral delays are driven by cumulative and reinforcing structural barriers rather than patient-level factors alone. Through co-design, stakeholders prioritised two key interventions: a regional integrated queue system to enable urgency-based access, and a digital health platform to enhance care coordination. Future research should focus on feasibility testing and pilot implementation of these interventions to evaluate improvements in timeliness, equity and sustainability of cancer care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975654","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":"From screen to scalpel: safety, efficiency and diagnostic performance of a direct-to-surgery teledermatology pathway.","authors":"Shahd Nour, James Sullivan-McHale, Anastasia Tzatzidou, Ye Theng Yap, Le Thanh Tra Nguyen, Venkat Ramamurthy, Manju Paul, Kamal Bisarya","doi":"10.1136/bmjoq-2025-004129","DOIUrl":"10.1136/bmjoq-2025-004129","url":null,"abstract":"<p><strong>Introduction: </strong>Teledermatology is increasingly used to triage urgent suspected skin cancer referrals. A direct-to-surgery pathway allows selected patients to proceed directly to biopsy or excision without a preliminary face-to-face consultation. This study evaluated the safety, efficiency and diagnostic performance of a direct-to-surgery teledermatology pathway within a large National Health Service (NHS) skin cancer service.</p><p><strong>Methods: </strong>A service evaluation was conducted at the University Hospitals of North Midlands. All teledermatology referrals received between February 2022 and July 2024 were reviewed. Demographics, pathway intervals, surgical outcomes, cancellations, histopathology and complications were extracted from electronic records. The primary outcome was compliance with the 28-day Faster Diagnosis Standard. Secondary outcomes included compliance with the 62-day referral-to-treatment target, surgical complications, cancellation rates and diagnostic concordance between teledermatology assessment and histopathology.</p><p><strong>Results: </strong>Of 18 587 teledermatology referrals, 5120 were triaged to the direct-to-surgery pathway. Following exclusion of 20 miscoded entries and 1 duplicate record, 5099 patients were included. A total of 4830 patients underwent surgery and 4825 had definitive histopathological diagnoses. The median time from referral to histology reporting was 46 days. Compliance with the 28-day Faster Diagnosis Standard was 99.86% (5092/5099), substantially exceeding the national target of 75%. Among patients diagnosed with melanoma or squamous cell carcinoma, 75.5% (440/583) commenced treatment within the 62-day referral-to-treatment target. Histopathology identified malignant pathology in 35.5% of lesions and premalignant pathology in a further 15.5%. Among lesions with both a recorded teledermatology diagnosis and definitive histology, overall concordance was 41.5% (1113/2679) with fair agreement (Cohen's κ=0.34). The overall complication rate was 1.3%.</p><p><strong>Conclusions: </strong>This large single-centre evaluation demonstrates that a direct-to-surgery teledermatology pathway can safely support high-volume skin cancer surgery while achieving excellent compliance with the Faster Diagnosis Standard. Low complication rates and efficient progression through the diagnostic pathway support the use of teledermatology as an effective risk-stratification tool within contemporary skin cancer services.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954936","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":"Optimising data visualisation formats for reporting medication-related care quality indicators: residential aged care staff preferences, interpretations and actions.","authors":"Isabelle Carmen Meulenbroeks, Rachel Urwin, Andrea Timothy, Ben Newell, Tracy Bucknall, Sangita Neupane, Tim Badgery-Parker, Karla Seaman, Johanna I Westbrook","doi":"10.1136/bmjoq-2025-003897","DOIUrl":"10.1136/bmjoq-2025-003897","url":null,"abstract":"<p><strong>Introduction: </strong>Data visualisations are widely used to communicate complex performance information within healthcare quality improvement feedback cycles. When tailored to their intended audience, these visualisations have the potential to stimulate change to improve care quality. This study assessed which data visualisation formats Australian residential aged care (RAC) staff interpret correctly, prefer and find informative enough to prompt action to improve care quality.</p><p><strong>Methods: </strong>A 37-item survey was administered via REDCap to Australian RAC staff between September and November 2024. The survey included demographic and data visualisation questions. Participants evaluated five cross-sectional data visualisation formats-table, star rating, bar chart, funnel plot and caterpillar plot-and two longitudinal data visualisation formats-box plot and line graph-based on interpretability, preference and actionability. Quantitative data were analysed descriptively, while qualitative responses underwent content analysis.</p><p><strong>Results: </strong>42 RAC staff participated in the survey. Respondents favoured bar charts for reporting cross-sectional data (n=23, 55%) with 79% (n=33) interpreting them correctly. For longitudinal data, 30 respondents (91%) favoured line graphs, with 71% (n=24) interpreting them accurately. Star ratings were the least preferred cross-sectional data visualisation format due to insufficient contextual information. In open-ended responses, respondents suggested that data visualisations would prompt them to review outliers, conduct medication reviews and educate staff. However, some respondents indicated that more contextual information, such as facility size and resident characteristics, was required in visualisations before they would take action to improve care quality.</p><p><strong>Conclusion: </strong>Bar charts and line graphs appeared to be the most suitable visualisation formats to convey medication-related care quality information to RAC staff for cross-sectional and longitudinal data respectively, as they were generally interpreted correctly with relative ease, were perceived as actionable and were preferred by most participants. In contrast, complex visualisations, such as funnel and box plots, were not preferred and were misinterpreted by half or more of the participants.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910713","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 governance of waiting list management in a CAMHS neurodevelopmental service using a digital workflow: a quality improvement project.","authors":"Robin Willmott","doi":"10.1136/bmjoq-2026-004496","DOIUrl":"10.1136/bmjoq-2026-004496","url":null,"abstract":"<p><p>Reliable management of waiting lists is a key component of governance in child and adolescent mental health services (CAMHS). Within neurodevelopmental services, fragmented systems for referral and waiting list management may introduce risks to data reliability, service oversight and timely access to care.In the City & Hackney Specialist CAMHS Neurodevelopmental Team, referral and waiting list processes relied on multiple spreadsheets and manual data entry across screening, waiting list allocation and assessment tracking stages. This created duplication, risk of data loss and limited visibility of patient progression.A quality improvement project was undertaken to implement a digital workflow using Microsoft Forms, Lists and Power Automate. The system created a single structured dataset tracking patient progression from referral to report completion, replacing multiple spreadsheets and manual processes, and enabling clinicians and administrative staff to directly access waiting list information without reliance on manual retrieval.Over a 13-month period, the system was used in 803 searches by 20 individual users with 5-9 active users per month, indicating sustained adoption. The intervention created a single structured operational dataset supporting referral, waiting list and assessment management, reducing duplication of data entry, improving accessibility of waiting list information and enabling an estimated reduction of approximately 66.9-133.8 hours of administrative time.This project demonstrates how low-cost digital infrastructure can support governance and data-driven service management within CAMHS.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905040","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":"Antenatal magnesium sulphate for neuroprotection of preterm babies: data analysis of inequities in treatment in England 2014 to 2024.","authors":"Hannah B Edwards, Lauren J Scott, Cheryl McQuire, Isobel L Ward, David Odd, Frank de Vocht, Karen Luyt","doi":"10.1136/bmjoq-2026-004143","DOIUrl":"10.1136/bmjoq-2026-004143","url":null,"abstract":"<p><strong>Objectives: </strong>To identify (a) Sociodemographic differences in treatment with antenatal magnesium sulphate (MgSO4) for fetal neuroprotection in preterm birth and (b) Whether any sociodemographic differences have reduced over time, in conjunction with implementation of a national quality improvement (QI) programme to improve use of MgSO4.</p><p><strong>Design: </strong>Retrospective cohort study using routinely collected data.</p><p><strong>Setting: </strong>NHS England maternity units from 2014 to 2024.</p><p><strong>Participants: </strong>Mothers with a preterm baby born from 24 to under 30 weeks' gestation and admitted to an NHS neonatal unit.</p><p><strong>Outcomes: </strong>Receipt of antenatal MgSO4.</p><p><strong>Results: </strong>Before implementation of the National <i>PReCePT</i> (Preventing Cerebral Palsy in Pre-Term Labour) Programme (NPP) in 2018, mothers from the North of England had lower odds of MgSO4 treatment than mothers from the South of England (OR 0.60, 95% CI 0.49 to 0.74). Following implementation of the NPP, there was no longer evidence for regional differences in treatment (OR 0.87, 95% CI 0.70 to 1.08). Pre-NPP, mothers from more deprived areas had lower odds of treatment than women from more affluent areas (OR 0.87, 95% CI 0.80 to 0.95), but again, post-NPP, there was no longer evidence for difference in use by deprivation status (OR 1.02, 95% CI 0.92 to 1.14, p value for interaction=0.022). White British mothers may have had slightly lower odds of treatment than mothers of other ethnic groups (OR 0.93, 95% CI 0.87 to 1.00), and this potential difference did not appear to change from pre to post-NPP (p value for interaction=0.235). There was little evidence that maternal age affected the odds of treatment.</p><p><strong>Conclusions: </strong>Previous sociodemographic differences in receipt of antenatal MgSO4 treatment for preterm birth appear to have equalised in England. This follows, and could be due in part to England's universal implementation of the National <i>PReCePT</i> QI programme.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905022","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 a quality improvement model to reduce pressure injury and skin integrity incidences in the operating theatre.","authors":"Asha Ali Abdi, Fatime Kasem ElAhmad, Ashwaq Ali Haji Nuuh, Ajitha Rajendran Rajendran","doi":"10.1136/bmjoq-2025-003398","DOIUrl":"10.1136/bmjoq-2025-003398","url":null,"abstract":"<p><p>Hospital-acquired pressure injuries (HAPIs) are localised damage to the skin resulting from pressure either alone or in combination with shear and microclimate. These injuries have a significant impact on patients' well-being and healthcare systems. Prolonged surgery significantly increases the risk of developing HAPIs. The adoption of preventive measures in the operating theatre (OT) can reduce the incidence of HAPIs in this context. This report presents the maintenance of a quality improvement project for HAPI prevention in the OT from 2019 to 2023 and evaluates the impact of the preventive measures on reducing HAPI and overall skin integrity incidents.A retrospective data analysis (from 2016-2017) was conducted to gather baseline information on all skin injuries particularly HAPIs reported in the OT. Upon completion of a needs analysis, a phased improvement project was implemented in 2018 and maintained until 2023. Comparative data from 2016 to Q1 2018 (preimplementation) and Q2 2018 to Q4 2023 (postimplementation) were analysed.A reduction in HAPI and skin integrity incident rate was observed over time (from 1.58 in 2016 to 0.13 in 2023). No pressure injury incidences were reported in 2021 and 2022. Other skin integrity events showed a significant reduction of 38.5%, following the start of this initiative, with steady numbers until 2019 (39 other skin integrity events in 2016 reduced to 24 events in 2018). A major reduction of 82.6% was observed in 2020, with a reduction from 23 other skin integrity events in 2019 to four in 2020, which was sustained as minimal incidents until 2023.The quality improvement project was effective in reducing HAPI in the OT, which was sustained in the following years, resulting in a reduction of global skin integrity issues due to staff awareness, continuous evaluation and implementation of corrective actions.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890882","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 medical record management: effective implementation of operational standards at Wallaga University Comprehensive Specialized Hospital, 2025.","authors":"Gedefa Bayisa, Meseret Belete Fite, Asfawu Degefe, Ganna Gobena, Milkiyas Baki Aga, Ketema Badasa, Amsalu Takele, Asefa Negari, Tesfaye Shibiru, Misganu Teshoma Regasa, Lammii Gonfaa, Dereje Chala Diriba, Adisu Tilahun","doi":"10.1136/bmjoq-2025-004081","DOIUrl":"10.1136/bmjoq-2025-004081","url":null,"abstract":"<p><strong>Background: </strong>Effective medical record management is crucial for timely access to patient information and quality care. Issues like loss, misplacement and delays in retrieval lead to longer wait times and reduced staff efficiency yet these operational challenges are often neglected in healthcare improvement efforts.</p><p><strong>Aim of the project: </strong>This project seeks to improve medical record management at Wallaga University Comprehensive Specialized Hospital, increasing the baseline from 35% to 90% between 15 September and 10 December 2025.</p><p><strong>Methods: </strong>A quality improvement approach was implemented using sequential plan-do-study-act (PDSA cycles. Key interventions included staff training on filing and tracking, numerical reorganisation of folders, separation of active/inactive files, a digital tracking system, assignment of folder responsibilities, privacy measures and routine audits with feedback. Effectiveness was evaluated using quantitative indicators (retrieval rates, lost folder rates, waiting times, satisfaction surveys) and qualitative feedback from stakeholders.</p><p><strong>Results: </strong>Performance improved significantly from 41% to 95% over seven PDSA cycles. Lost folders decreased from 13% to 2%, delayed retrieval dropped from 25% to 3% and timely folder provision rose from 72% to 95%. Patient satisfaction increased from 40% to 90%, while healthcare provider satisfaction grew from 60% to 85%. Qualitative feedback highlighted reduced conflicts, improved workflow, enhanced accountability and fewer duplicate records.</p><p><strong>Conclusion: </strong>The structured quality improvement intervention effectively enhanced medical record management, showcasing the efficacy of PDSA cycles combined with practical interventions. Sustained improvements are anticipated with ongoing monitoring and staff engagement. This model can be adapted by other hospitals facing similar challenges, contributing to more efficient, patient-centred healthcare delivery.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890877","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":"Assessing the use of the input of care users in long-term care homes during 2020-2023 in the Netherlands: an exploratory study.","authors":"Flora Palimetaki, Roel Schouteten","doi":"10.1136/bmjoq-2025-004130","DOIUrl":"10.1136/bmjoq-2025-004130","url":null,"abstract":"<p><strong>Background: </strong>Healthcare inspectorates are increasingly expected to involve care users during assessments of long-term care (LTC). Although healthcare inspectorates promise to improve the involvement of care users' experiences, they struggle to address this expectation. This study aims to explore the advancements in the participation of care users or informal caregivers during assessments of LTC homes, as reported in the Dutch Health and Youth Care Inspectorate reports in the Netherlands between 2020 and 2023.</p><p><strong>Objective: </strong>This study aims to explore the advancements in the participation of care users or informal caregivers during assessments of LTC homes in the Netherlands between 2020 and 2023.</p><p><strong>Methods: </strong>This study comprised 273 publicly accessible inspection reports concerning LTC homes from 2020 to 2023. The frequency with which care users or informal caregivers were cited as sources of information was examined and compared across years.</p><p><strong>Results: </strong>The results show a significant increase in reporting the use of positive citations from care users for 3 items out of 16 of the assessment instrument between 2020 and 2023. In particular, significant differences in positive citations from care users were found only for items regarding the theme of attention to person-centred care.</p><p><strong>Conclusions: </strong>The study concludes that although care users are particularly increasingly cited in inspection reports on LTC homes, there is still room for increasing the incorporation of care users' experiences in the reports on assessing quality of care in LTC homes.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879141","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}