BMJ Open Quality最新文献

{"title":"Impact of illness and death: comparison of Load and QALY models.","authors":"Tim Benson","doi":"10.1136/bmjoq-2024-003190","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003190","url":null,"abstract":"<p><strong>Background: </strong>When allocating resources health decision-makers make trade-offs between different outcomes, such as morbidity and mortality. The Load and QALY (quality-adjusted life year) models are two approaches that have been developed to help value health and care outcomes.</p><p><strong>Methods: </strong>I briefly describe preference judgements, the Load and QALY models.</p><p><strong>Results: </strong>The same preference judgement, based on the standard gamble, is applied to a single hypothetical individual's lifetime, who dies at age 75 after 3 years of illness. In this example, the morbidity/mortality ratio using the Load model is 50 times higher than using the QALY model.</p><p><strong>Conclusions: </strong>These findings, placing greater value on illness, call for further exploration, and in particular, whether the Load model can reshape healthcare policies and resource allocation.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>'</i>Monday's feel calmer when creative practitioners are here': a quality improvement project exploring whether creative-practitioner sessions on adult inpatient mental-health wards reduce levels of violence and aggression.","authors":"Luise V Marino, Sophie-Jo Peel, Lauren Iredale, Subha Thiyagesh, Wajid Khan, Vicki Whyte, Victoria Humble, David McQuillan","doi":"10.1136/bmjoq-2024-003122","DOIUrl":"10.1136/bmjoq-2024-003122","url":null,"abstract":"<p><strong>Background: </strong>Violence and aggression (V&A) are commonplace on mental-health wards and may lead to restrictive practice interventions (RPI), having a detrimental impact on patients and staff. In the 12 months preceding this quality improvement (QI) project, there was a mean V&A incidence of 52.7±113.0 and RPI of 37.6±84.1 per 1000 bed days.</p><p><strong>Methods: </strong>Using QI methodology, a project involving creative practitioners was codeveloped to provide a range of activities delivered via a 7-day service, across 13 inpatient mental-health wards in five hospital settings, using levels of V&A and RPI as outcome measures. The creative practices used drew on successful projects arising from a linked charity, Creative Minds. Three plan-do-study-act cycles were completed. (1) Coproduction with ward staff, patients and creative practitioners of 4-week session plans, including an induction training package for creative practitioners. (2) Streamlined and centralised communication between creative practitioners and participating wards using a project coordinator. (3) Implementation of a creative-practitioner Rota to better support ward activity planning, staff and patient expectation setting.</p><p><strong>Results: </strong>During the 12-month project wards with creative practitioners experienced statistically significant reduction in V&A levels (F (1, 168)=5.72, p=0.017) and RPI (F (1, 168)=8.40, p=0.0042). Wards not involved in the project, V&A levels (F (1, 142) =3.34, p<0.069) and RPI (F (132, 142)=0.99, p=0.52) remained unchanged. Ward length-of-stay was used as a balancing measure with no difference pre 45.0±4.9 days and post 46.9±5.0 days intervention (p=0.18). At the project peak, creative practitioners delivered around 300 hours per week of creative activity, which appears to be associated with reduced number of V&A/RPI incidents.</p><p><strong>Conclusions: </strong>Recommendations for the project's next steps are to secure sustained funding for creative practitioners to further enhance patients/staff well-being, as well as the coproduction of a creative-practitioner implementation guide to be tested in other mental-health inpatient settings as a part of a research study to better understand the impact of the type/timing of activities (ie, day/evening/weekends) on important patient outcomes and staff well-being.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656111","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":"Increasing take-home naloxone kit distribution to patients with substance use disorder before hospital discharge: a quality improvement project.","authors":"Daniel Wong, Lingsa Jia","doi":"10.1136/bmjoq-2024-002908","DOIUrl":"10.1136/bmjoq-2024-002908","url":null,"abstract":"<p><p>The ongoing drug toxicity crisis is a growing public health challenge in many countries across the world. Despite the WHO's recommendation of take-home naloxone (THN) kits as a cost-effective harm reduction strategy to prevent drug toxicity deaths, the Addiction Medicine Consult Team (AMCT) at Burnaby Hospital found that only 51% of their eligible patients were receiving a kit before discharge. In response, the AMCT created a quality improvement (QI) team with the aim of increasing their THN kit distribution rate on two hospital wards from 51% to over 80% within 10 months.Change ideas were implemented with the aim of targeting various components of the THN kit distribution process. Changes included adjusting THN kit inventory on wards, hosting education sessions for nurses, creating just-in-time training using nursing station whiteboards, streamlining the documentation process for nurses and standardising the ordering process for providers. The QI team collaborated with hospital interest holders including senior executives, nursing and pharmacy groups to facilitate change ideas. The project culminated with 4 months of sustained THN kit provision above 80%.The QI team is currently in talks with hospital operations to ensure that an effective documentation system will be integrated into the new electronic medical record system when the hospital transitions away from paper charting in 2025.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647070","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":"Economic case for reducing inequities in patient safety.","authors":"Luke Aaron Munford, Christopher J Armitage, Roger T Webb, Darren M Ashcroft","doi":"10.1136/bmjoq-2024-003042","DOIUrl":"10.1136/bmjoq-2024-003042","url":null,"abstract":"","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630112","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 time for vascular access salvage: initial results from a single institution's clinical practice improvement programme.","authors":"Kai Siang Chan, Enhui Yong, Li Zhang, Shufen Neo, Xueping Zhou, Joana Marie Eugenio Gray, Diomampo Katriz Abanto Elah, Ee Ling Ong, Ying Pan, Qiantai Hong, Malcolm Han Wen Mak, Lester Rhan Chaen Chong, Glenn Wei Leong Tan, Sundeep Punamiya, Gavin Lim, Gabriel Chan, Krishna Gummalla, Lawrence Han Hwee Quek, Pua Uei, Bien Peng Tan, Justin Kwan, Enming Yong","doi":"10.1136/bmjoq-2024-003138","DOIUrl":"10.1136/bmjoq-2024-003138","url":null,"abstract":"<p><strong>Background: </strong>One of the most common causes of arteriovenous fistula (AVF) and/or arteriovenous graft (AVG) failure is thrombosis. Guidelines recommend early AVF salvage within 24-48 hours. Our institution reported poor compliance with these recommendations, with a median of 3 days prior to vascular access (VA) salvage. We present our initial results following the implementation of a clinical practice improvement programme (CPIP) to reduce delay to VA salvage.</p><p><strong>Methods: </strong>The CPIP was conducted in three phases: pre-CPIP (23 January to 30 April 2023), CPIP pre-intervention (22 May to 3 September 2023) and CPIP post-intervention (4 September 2023 to 7 January 2024). Root cause analysis was performed to identify factors resulting in VA salvage delay. Measures implemented included a platform for multidisciplinary communication on cases requiring VA salvage, implementation of a structured workflow and regular reminders to ensure compliance. Early salvage was defined as <48 hours from triage at the emergency department. Time from admission to VA salvage, length of stay, incidence of femoral catheter (FC) insertion and overall cost savings were collected.</p><p><strong>Results: </strong>There were 82 patients (90.1%) who received VA salvage during the CPIP period. The median age was 67 years with a male predominance (64%). There were 45 patients (54.9%) who received early VA salvage during CPIP. The run chart showed a median early VA salvage rate of 6.1% for pre-intervention and 81.0% for post-intervention. The median length of stay pre-intervention and post-intervention was 5.65 days and 2.92 days, respectively. The incidence of FC insertion was 17.1% (n=6/35) during CPIP for thrombosed VA. Eight patients failed to obtain early VA salvage during the post-intervention period. Overall hospitalisation cost savings per patient were SGD$3144 lower post-intervention.</p><p><strong>Conclusion: </strong>We report the successful implementation of our CPIP through the involvement of stakeholders and stepwise implementation of measures using a structured protocol.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630131","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":"Validation and application of a tool to assess self-confidence to do improvement.","authors":"Annette Richardson, Jon Rees","doi":"10.1136/bmjoq-2024-003130","DOIUrl":"10.1136/bmjoq-2024-003130","url":null,"abstract":"<p><strong>Introduction: </strong>Increasing improvement capability in the workforce is vital within healthcare. The type of quality improvement training to increase capability varies. One way to measure the impact of improvement training is self-confidence to do improvement.</p><p><strong>Objectives: </strong>Our objectives were to validate a tool to assess self-confidence to do improvement and to observe the degree of change before and after improvement training. We aimed to assess the degree of impact on self-confidence associated with varying exposure to quality improvement training.</p><p><strong>Methods: </strong>We used an online 10-item and 4-point scale to assess self-confidence before and after improvement training. Reliability analysis using Cronbach's alpha was performed. The nature of the underlying construct was investigated using exploratory factor analysis and a full set of pre and post measures were used, and to compare individual question changes, a series of paired Wilcoxon tests were performed with Bonferroni post hoc corrections for multiple comparisons. To assess the differing lengths of programmes, individual results from each programme were combined meta-analytically with course duration added as a moderator.</p><p><strong>Results: </strong>252 completed questionnaires were analysed at baseline and a full set of pre and post measures were available for 128 participants. Cronbach's alpha for the tool was satisfactory at 0.93 (0.92-0.94) and measured a single underlying construct with an eigenvalue of 6.17. A significant increase in confidence to improve from before to after intervention was found (t(127) = 14.36, p<0.001, d=1.27 (95% CI 1.03-1.50)). Post-testing differences were significant (F(6,125) = 2.89, p=0.02) with shorter courses having significantly smaller increases in confidence.</p><p><strong>Conclusions: </strong>This manuscript provides a validated self-confidence tool to help assess improvement capability. Our tool offers a way to measure the impact of improvement capability on varying training durations and inform decisions about allocating staff time to this activity.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630005","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":"Mobility matters: a protocol to improve mobility and reduce length of stay in hospitalised older adults.","authors":"Fuyin Li, Kiat Sern Goh, Xia Yu, Gek Kheng Png, Teong Huang Samuel Chew, Guat Cheng Ang, Xuan Han Koh, Jismy Jose, Eleanor Stevenson","doi":"10.1136/bmjoq-2024-003084","DOIUrl":"10.1136/bmjoq-2024-003084","url":null,"abstract":"<p><p>Functional decline in hospitalised older adults aged 65 and above is a significant clinical problem. Despite its adverse outcomes, the problem of not mobilising older adult patients in clinical settings remains. Existing evidence suggests that a mobility protocol can be effective in addressing this concern. The aims of this quality improvement project were to determine whether a nurse-driven, multidisciplinary collaborative mobility protocol would increase the daily out-of-bed episodes, improve mobility level and reduce hospital length of stay (LOS). A nurse-driven mobility protocol was implemented in three phases. This five-component protocol included mobility assessment using the Johns Hopkins Highest Level of Mobility (JH-HLM) scale, documentation of mobility score, implementation of out-of-bed activities three times per day, communication of mobility score and goal at daily huddle, and indication of mobility score and goal on the board at patient's bed. Data were collected before and after the implementation. 142 patients were recruited from an acute geriatric unit. There were 72 patients from the pre-implementation group and 70 patients from the post implementation group. Comparing the pre-implementation and post implementation groups, the mean out-of-bed episodes per patient day increased from 0.80 to 3.59 (p<0.001). JH-HLM scores at discharge with ambulation status increased from 51.4% to 71.4% (p<0.001). Patients had improved JH-HLM scores with a median 2.00 (B 2.00, 95% CI 1.35 to 2.65, p<0.001) higher at discharge in the post implementation group after adjusting for score at admission. Increased mobility did not lead to any fall incidents. The mean hospital LOS was reduced from 15.67 (SD 11.30) days to 13.07 (SD 7.18) days (p=0.069). In conclusion, the implementation of a nurse-driven mobility protocol resulted in increased frequency of out-of-bed episodes and improved mobility, and reduction in LOS.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630113","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":"Transitioning from night to day transplants: changing the transplant culture for optimisation through a province-wide quality improvement initiative.","authors":"Lucas Streith, Sean Keenan, Subin Punnen, Heidi Butler, Eric Lun, Andrew Sawka, John Yee, Vinay Dhingra, Steve Reynolds, Kenneth Ryan, Brian Yang, Ron Carere, Peter Kim","doi":"10.1136/bmjoq-2024-003164","DOIUrl":"10.1136/bmjoq-2024-003164","url":null,"abstract":"<p><strong>Background: </strong>Organ transplants, some of the most complex operations, have historically been performed overnight due to logistical challenges in healthcare systems. Overnight transplants contribute to transplant team burnout and can compromise patient outcomes. A province-wide quality improvement (QI) initiative was launched to increase the daytime operation rate to ≥80%.</p><p><strong>Methods: </strong>The project was launched in July 2020 by the Daytime Transplant Working Group, including stakeholders from the Organ Donation Organization, donor hospitals, and the two recipient hospitals to increase daytime transplants, as defined by operation start time between 07:00 and 14:00 for donor operations and 08:00 and 18:00 for recipient operations. Organ donor and recipient operation start times were collected from January 2019 to June 2020 (control period), July 2020 to December 2021 (intervention period) and January 2022 to December 2023 (maintenance period). Data were analysed using p-charts on SQCpack V.7 (PQ Systems, Dayton, OH).</p><p><strong>Results: </strong>From 696 retrieval operations, a total of 458 liver transplants, 295 lung transplants, 126 heart transplants and 1122 kidney transplants were performed. Our ≥80% target was met for liver, lung, and heart transplants; however, there was no change in kidney transplants. Daytime rates of organ donor operations increased but did not achieve the ≥80% target.</p><p><strong>Interpretation: </strong>Despite the COVID-19 pandemic impacting OR access during the intervention period, the target of ≥80% daytime operations was achieved for liver, lung and heart transplants by engaging donor and recipient hospitals. The transition to daytime surgery was improved with a dedicated team to systematically address barriers and concerns from donor hospitals.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623428","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":"Targeting insulin stacking to address overnight hypoglycaemia in hospitalised patients with diabetes.","authors":"Priyanka Moolchandani, Satya Patel, Tyler Larsen, Christopher Moriates, Jane Weinreb, Estelle Everett","doi":"10.1136/bmjoq-2024-003178","DOIUrl":"10.1136/bmjoq-2024-003178","url":null,"abstract":"<p><p>Inpatient hypoglycaemia is a significant concern in patients with diabetes due to its association with increased mortality. At the Veterans Affairs Greater Los Angeles Healthcare System, we developed a project to reduce overnight hypoglycaemia in hospitalised patients with diabetes by addressing insulin stacking, defined as insulin dosed within 4 hours of each other. By delaying the timing of bedtime correctional insulin administration in the electronic health record, we achieved a 28% reduction in the proportion of patients experiencing insulin stacking after one year. This led to significant decreases in overnight hypoglycaemia.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613268","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 screening rates for sexually transmitted and blood-borne infections among patients initiating care in a low-barrier addiction medicine clinic: a quality improvement project.","authors":"Geneviève Kerkerian, Enrique Fernandez Ruiz, Cole Stanley, Rachelle Funaro, Emma Jean Thorson Mitchell, Julia Kirsten MacIsaac","doi":"10.1136/bmjoq-2024-003088","DOIUrl":"10.1136/bmjoq-2024-003088","url":null,"abstract":"<p><p>Despite a high prevalence of sexually transmitted and blood-borne infections (STBBIs) among patients with substance use disorders, screening rates in addiction medicine settings are often low. At baseline in our addiction clinic, only 65% of patients were offered screening and only 6% completed screening blood work. This quality improvement project aimed to improve the rate of STBBI screening among new intakes in our clinic by 50%.Interventions included the creation of clinic screening guidelines to include annual screening for all patients for HIV, hepatitis B and C, syphilis, gonorrhoea and chlamydia. Additionally, an on-site phlebotomist was hired. These interventions increased screening rates to an average of 33% with the greatest improvement seen after the addition of the phlebotomist. We found that implementing a bundle of interventions improved rates of screening and detection of STBBIs in a low-barrier addiction medicine clinic. Comprehensive infection prevention, screening and linkage-to-treatment protocols are needed to close gaps in care for this vulnerable patient population.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623425","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}