BMJ Open Quality最新文献

{"title":"Improving accurate documentation for reducing restraint use: a quality improvement project in a Dutch academic hospital.","authors":"Liesbeth de Boer, Jeroen Scheepers, Christianne Vertommen, Dorthe O Klein, Tessa Rietbergen, Roland A Bal","doi":"10.1136/bmjoq-2024-003046","DOIUrl":"10.1136/bmjoq-2024-003046","url":null,"abstract":"<p><p>During a patient's hospital stay, restraint use in the Netherlands-defined as 'interventions that have restrictive consequences for the individual freedom of patients'-may be necessary to protect the individual from harm, provided it is applied proportionally, effectively, safely and with subsidiarity. Restraint use can have physical and psychological effects on patients and should therefore only be used when necessary and in accordance with established guidelines and regulations. In the Netherlands, five categorisations of restraints are used. The least invasive restraints are classified in category 1, and the most restrictive are classed into category 5. Accurate documentation is crucial to gain insight into restraint use, but it is often lacking. The aim of the project was to improve the documentation of restraint use for adult patients on a general nursing ward in a Dutch academic hospital. Three Plan-Do-Study-ACT (PDSA) cycles with follow-up measurements were undertaken to assess whether documentation was carried out correctly and completely.Medical record review (describing indication, consultation with a second nurse and physician, consent of the patient's and/or legal representative and applied restriction) has been conducted to establish the baseline measurement.The first PDSA cycle started after implementing a new form of documentation. The second PDSA cycle was performed after implementing a multifaceted intervention to improve documentation and increase knowledge on restraint use among nursing and medical staff. The third and final PDSA cycle took place after the medical record reviews were conducted and communicated to the leaders of the nursing teams. The nursing teams were asked to focus on restraint use at the departmental level.Introducing a new form of documentation for restraint use improved documentation from 0% to 55.9% during the course of the study.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186515","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 initial vital signs assessment and documentation in the emergency department of regional hospital, Bhutan: quality improvement project.","authors":"Sherab Wangdi, Kashap Guragai, Pema Namgay, Jamyang Dorji, Kesang Wangchuk","doi":"10.1136/bmjoq-2024-003151","DOIUrl":"10.1136/bmjoq-2024-003151","url":null,"abstract":"<p><strong>Background: </strong>Vital signs are key indicators of a patient's physiological status. It includes blood pressure, temperature, pulse rate, respiration rate and oxygen saturation (SPO₂). Derangements in vital signs are associated with an increased risk of morbidity and mortality, and thus serve as important indicators for risk stratification and early detection of clinical deterioration. Despite this, several studies have indicated that vital signs are not consistently recorded, which can have a significant impact on the effectiveness of the rapid response system. A baseline study in our emergency room showed that the rate of complete assessment and documentation is only 40%.</p><p><strong>Method: </strong>A quality improvement initiative was undertaken to improve the initial vital signs assessment and documentation in the Emergency Department of a Regional Referral hospital for a duration of 10 weeks. Our team implemented four cycles of intervention which were based on a baseline survey, analysis of plan-do-study-act cycles, previous similar projects and discussion within the group.</p><p><strong>Intervention: </strong>The interventions included sensitisation about the vital signs, making monitoring equipment easily available and redesigning areas for assessment and documentation.</p><p><strong>Result: </strong>The rate of complete assessment and documentation of vital signs increased significantly from 40% to 97% at the end of the 10 week period.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186513","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":"Assessment of the quality of care provided to women with gestational diabetes mellitus by different hospitals in Karachi, Pakistan.","authors":"Javeria Mansoor, Shafaq Alvi, Romaina Iqbal, Narjis Rizvi, Sabahat Naz","doi":"10.1136/bmjoq-2025-003362","DOIUrl":"10.1136/bmjoq-2025-003362","url":null,"abstract":"<p><strong>Background: </strong>Since gestational diabetes mellitus (GDM) prevalence is increasing in Pakistan, the quality of care provided to women with GDM is crucial for improving maternal and neonatal outcomes. Therefore, our study aimed to assess the quality of existing healthcare services related to GDM management across different hospitals in Karachi, Pakistan.</p><p><strong>Methods: </strong>We used Donabedian's model to evaluate the input, process and output phases. The first two phases were assessed through a cross-sectional design, while the output was evaluated via in-depth interviews. The study included six hospitals, one public and five private. We interviewed department heads (n=6) to assess the workforce and facilities (input) and nurses (n=17) and doctors (n=8) to examine qualifications for GDM management protocols (process). The output phase involved interviewing postpartum women with GDM (n=6) about their understanding of GDM, its complications and lifestyle modifications. We report frequencies and percentages for quantitative and thematic analysis for qualitative data.</p><p><strong>Results: </strong>Monthly, 9000 women sought antenatal care (ANC) services, with 500 deliveries in public hospitals, while 2000-5500 sought ANC services, with 160-461 deliveries in private hospitals. All hospitals, except the public one, had standard GDM protocols. Three hospitals had neonatal intensive care units, six employed an endocrinologist, three had a dietician and only one appointed nursing staff as GDM counsellors. Two hospitals provided blood glucose monitoring charts, three offered diet charts and five gave breastfeeding instructions. While all doctors attended GDM education, no nurses participated. Thematic analysis highlighted postpartum women's lack of knowledge about GDM, its complications and the importance of lifestyle modification postdelivery.</p><p><strong>Conclusion: </strong>Our study identified gaps in GDM care and highlighted the need for policies to develop and implement standardised GDM screening and management protocols, ensure mandatory training for healthcare providers and integrate multilingual educational material in healthcare settings to improve health outcomes for mothers and children.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186514","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":"Protocol for implementation of intraoperative adverse event recording during WHO checklist sign-out.","authors":"Katrin Burri-Winkler, Anne C Auderset, Dieter Hahnloser, Christoph S Burkhart, Valentin Neuhaus, Jörn-Markus Gass, Andreas P Vogt, Giorgio Prouse, Judith Winkens, Guy Haller, Amanda Van Vegten, Zuzanna Kita, Monika Finsterwald, Christian Schindler, Nico Streit, Lisa M Willms, Luzius A Steiner, Lauren Clack, Salome Dell-Kuster","doi":"10.1136/bmjoq-2024-003286","DOIUrl":"10.1136/bmjoq-2024-003286","url":null,"abstract":"<p><strong>Introduction & aim: </strong>Intraoperative adverse events (iAEs) increase postoperative complications, which are devastating to patients and costly to healthcare systems. To optimise patient outcomes, the WHO Surgical Safety Checklist (WHO SSC) was introduced in 2008, but adherence, especially to its third part (sign-out), is low, and iAEs are currently not routinely assessed. This gap between evidence supporting the use of the WHO SSC, current inconsistent sign-out practice and the lack of standardised reporting of iAEs warrants applying an implementation science approach. Hence, this project aims to simultaneously evaluate the effectiveness and implementation of the sign-out, including systematic recording and discussion of iAEs during the sign-out.</p><p><strong>Methods & analysis: </strong>Using a hybrid effectiveness-implementation approach, this prospective before-and-after-cohort project includes five surgical disciplines within nine Swiss hospitals. Following an extensive context analysis, this project is set up in three phases: (1) recruitment of 40 patients per surgical discipline and site (approx. 900 in total) for baseline assessment; (2) implementation based on a multifaceted, tailored implementation strategy (including formation of implementation teams, comprehensive education of healthcare professionals, top-down leadership, regular feedback rounds and tailoring implementation to local needs); and (3) recruitment of 40 patients per discipline to assess the changes after implementation (approx. 900). Implementation (eg, checklist fidelity composed of completion and quality) and effectiveness outcomes (ie, clinical patient outcomes) will be analysed using a mixed regression model.</p><p><strong>Discussion & conclusion: </strong>By enhancing adherence to the WHO SSC sign-out, including standardised reporting of iAEs, we expect to further improve perioperative patient outcomes. Based on the context analysis, we will provide a widely applicable implementation plan to support and sustain the required behavioural change, which will support roll-out in further hospitals. Meanwhile, clinical and implementation science expertise is meeting the challenges of the complex environment of perioperative care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186516","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 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}