BMJ Open Quality最新文献

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Local problem: </strong>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.</p><p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Intervention: </strong>(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.</p><p><strong>Discussion and conclusion: </strong>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}

{"title":"Monitoring the safe delivery of new invasive interventional procedures and devices: an analysis of NHS organisation policies.","authors":"Lucy Wallis, Sian Cousins, Phei Yi Lim, Hollie S Richards, Leila Rooshenas, Jane M Blazeby","doi":"10.1136/bmjoq-2024-003301","DOIUrl":"10.1136/bmjoq-2024-003301","url":null,"abstract":"<p><strong>Background: </strong>The introduction and monitoring of innovative invasive procedures and devices (IP/Ds) was included in the Independent Medicines and Medical Devices Safety (IMMDS) Review led by Baroness Cumberlege. Currently, innovative IP/Ds may be undertaken with local National Health Service (NHS) organisation approval via new procedure committees (NPCs) or approval from the Health Research Authority (HRA). The National Institute for Health and Care Excellence Interventional Procedures Advisory Committee (NICE IPAC) provides guidance for appropriate approvals. Outcome monitoring is performed to inform decisions about continuing with the new IP/D or abandoning/pausing if safety data show signals of harm; this is the responsibility of local hospitals. Hospital policies for this process have hitherto not been investigated.</p><p><strong>Aim: </strong>To explore local hospital NPC processes for monitoring clinical and safety outcomes and decision-making regarding the delivery of new IP/Ds.</p><p><strong>Methods: </strong>NHS organisation policies for the introduction of new IP/Ds from England and Wales were systematically examined using a standardised extraction form developed a priori. All policies and associated documents were analysed using the principles of content analysis, and information extracted included (1) the collection of safety and outcome data for approved IP/Ds; (2) requirements to adhere to NICE guidance and (3) how committees decide to abandon/pause the use of new IP/Ds.</p><p><strong>Results: </strong>All policies (n=113) included information about monitoring outcomes of new IP/Ds. Substantial variation between hospitals in monitoring requirements was observed. Just 66 provided details of safety reporting oversight methods. Only 72 policies explicitly recommended following NICE IPAC guidance for the IP. Information about how decisions were made to abandon/pause new IP/Ds was included in 25 policies.</p><p><strong>Conclusion: </strong>There is a disparity among hospitals in how outcome and safety data of new IP/Ds are monitored. This has implications for patient safety. Our findings support the IMMDS report recommendations for the need for better oversight and governance of innovative IP/Ds, including collecting and sharing robust outcome data to inform decision-making.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085525","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":"Optimisation of aetiological examination processes for enhanced quality and efficiency in hospitalised patients prior to antimicrobial therapy: a multicentre quasi-experimental study.","authors":"Xiao Zhong, Li-Hua Xiao, Yan Liu, Lan-Fang Mo, Shan-Wen Yang, Lan-Fang He, Qin-Fei Wu, Xiao-Feng Luo, Mei Lin","doi":"10.1136/bmjoq-2024-003257","DOIUrl":"10.1136/bmjoq-2024-003257","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to optimise the aetiological examination process in hospitalised patients to enhance pathogen detection quality and efficiency. The hypothesis was that process management strategies would improve specimen submission rates, quality, timeliness and antimicrobial use adjustment.</p><p><strong>Design: </strong>A multicentre quasi-experimental pre-post comparison design was used, with baseline and postoptimisation phases.</p><p><strong>Setting: </strong>Two hospitals in Guangming District, Shenzhen, China.</p><p><strong>Participants: </strong>34 790 inpatients in the baseline and 34 361 in the postoptimisation phase, across all departments.</p><p><strong>Interventions: </strong>Implemented process clarification, standardisation of specimen collection/submission and multidisciplinary collaboration, with comprehensive staff training.</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcome measures were the pathogen submission rate before antimicrobial therapy. The secondary outcome measure was the adjustment rate of antimicrobial use based on test results, specimen qualification rate and specimen submission time. These measures were evaluated before and after process optimisation.</p><p><strong>Results: </strong>Postoptimisation, key metrics improved significantly: pathogen submission rate (50.82%-71.77%), specimen qualification rate (90.20%-98.71%), submission time (192-104 min) and antimicrobial adjustment rate (74.11%-93.24%; all p<0.001).</p><p><strong>Conclusions: </strong>Process management effectively enhanced aetiological examination quality and efficiency, with potential for widespread adoption.</p><p><strong>Trial registration number: </strong>Not applicable as this was a quasi-experimental study.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085527","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":"Experiences of the development and use of a Paediatric Oncology Trigger Tool.","authors":"Charlotte Engvall, Maria Unbeck, Margaretha Stenmarker, Axel Ros, Ann-Christine Andersson","doi":"10.1136/bmjoq-2025-003306","DOIUrl":"10.1136/bmjoq-2025-003306","url":null,"abstract":"<p><strong>Background: </strong>Trigger tools are widely used for detecting adverse events. Within the multicentre study Patient Safety in Paediatric Oncology, a trigger tool was created to address the unique needs of paediatric oncology. Although trigger tools are highly valued for detecting adverse events, concerns about their usability and reliability persist. Understanding the perspectives of medical record reviewers using these tools may provide valuable insights for improving their usability and reliability. This study aimed to explore the experiences of medical record reviewers involved in the development and use of a Paediatric Oncology Trigger Tool.</p><p><strong>Methods: </strong>A descriptive qualitative case study was conducted to investigate the experiences of medical record reviewers participating in the development and use of the Paediatric Oncology Trigger Tool. Data were collected through a semi-structured focus group interview conducted via Zoom, involving six reviewers with varying levels of experience in paediatric oncology and trigger tool methodology. The interview was audio-recorded and transcribed verbatim. The written text was analysed in its entirety using reflexive thematic analysis.</p><p><strong>Results: </strong>The analysis revealed an overarching theme of <i>knowledge building</i> with three themes: <i>competencies</i>, <i>resources</i> and <i>usefulness</i>. The findings highlight the importance of collaborative learning, expert support and adequate resources, while also noting challenges such as time consumption and the emotional impact of reviewing medical records of critically ill children.</p><p><strong>Conclusions: </strong>This study offers a comprehensive examination and clarity regarding the development and use of a patient safety instrument, a process marked by both challenges and facilitators from the perspective of medical record reviewers. The study underscores the need for resources, training and support during the review process to ensure the reliability and usefulness of the trigger tool.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085619","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":"Rapid review of the ideal clinic realisation and maintenance programme among primary healthcare providers in the Gauteng Province, South Africa.","authors":"Dorina Onoya, Idah Mokhele, Refiloe Cele, Nozipho Musakwa, Sharon Kgowedi, Khumbo Shumba, Cornelius Nattey, Nelly Jinga, Alice Kono, Jacqui Miot","doi":"10.1136/bmjoq-2024-003212","DOIUrl":"10.1136/bmjoq-2024-003212","url":null,"abstract":"<p><strong>Background: </strong>The ideal clinic realisation and maintenance (ICRM) programme in South Africa aims to elevate primary healthcare clinic (PHC) service quality in preparation for the National Health Insurance rollout. This study investigated ICRM implementation from clinic workers' and patients' experiences in the Gauteng province.</p><p><strong>Methods: </strong>A mixed-methods cross-sectional survey was conducted across 45 Gauteng PHCs. Anonymous semistructured interviews with 335 clinic staff explored their knowledge and experiences with the ICRM programme. Facility assessments captured structural factors impacting ICRM implementation. Log-binomial regression was used to assess factors related to confidence in ICRM implementation and improvements in ICRM certification, and thematic analysis examined patient and staff experiences.</p><p><strong>Results: </strong>While 86.9% of clinical/management staff (95% CI 75.1 to 93.6) reported understanding ICRM, only 41.9% (95% CI 32.6 to 53.0) could cite specific guidelines. Enablers included guideline training (reported by 47.9% of staff, 95% CI 39.6 to 56.3) and support from district teams (44.6%, 95% CI 36.6 to 52.8). Barriers included facility size (32.9%, 95% CI 25.7 to 40.9) and infrastructure challenges (28.4%, 95% CI 21.6 to 36.2). Staff confidence in ICRM implementation was moderate (63.1%, 95% CI 56.1 to 69.6), higher when ICRM champions were present (relative risk ratio (RRR) 2.3 vs not present, 95% CI 1.0 to 5.2), guidelines were clear to staff (RRR 2.3, 95% CI 1.1 to 5.0) and sufficient training was perceived (RRR 2.7, 95% CI 1.4 to 5.3). From 2018 to 2021, 60.3% of facilities (95% CI 43.8 to 74.8) improved in ICRM classification. Compared with facilities with no status change, staff from clinics with downgraded stats were less likely to report clear guidelines (RRR 0.5, 95% CI 0.2 to 1.0) to identify an ICRM champion (RRR 0.3, 95% CI 0.1 to 0.7) or have a knowledgeable manager (RRR 0.01, 95% CI 0.01 to 0.3).</p><p><strong>Conclusion: </strong>Challenges in ICRM implementation persist. Staff knowledge, training and district support play significant roles, while clear guidelines, sufficient resources and effective leadership are essential for sustaining and enhancing ICRM performance.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085545","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":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/bmjoq-2025-003509","DOIUrl":"10.1136/bmjoq-2025-003509","url":null,"abstract":"","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075676","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":"Implementing a Rapid Improvement Event with anonymised individual performance reporting on benign hysterectomy care: a retrospective comparative analysis.","authors":"Jason Shau Khng Lim, Celestine Loh, Yang Lv, Jia Xuan Yeo, Rhoda Su Hui Lew, Xu Ying Leow, Hairil Rizal Abdullah","doi":"10.1136/bmjoq-2024-003172","DOIUrl":"10.1136/bmjoq-2024-003172","url":null,"abstract":"<p><strong>Introduction: </strong>Value-Based Healthcare (VBHC) aims to enhance patient outcomes while managing costs. Building on VBHC principles, the Ministry of Health Singapore introduced the Value-Driven Care programme, including initiatives like Enhanced Recovery After Surgery and Patient Blood Management. However, clinical quality remained suboptimal despite these measures due to limited clinician performance transparency. To address this, the Office of Value-Based Healthcare led a Rapid Improvement Event that implemented Individual Clinical Reports (ICRs) to provide clinicians with performance feedback. This study hypothesises that an active feedback loop using ICRs, combined with regular departmental dashboard reviews, would improve clinical quality, measured by the Clinical Quality Index (CQI).</p><p><strong>Methods: </strong>A quasi-experimental design compared pre-ICR and post-ICR implementation data, analysing improvements using Fisher's exact tests and logistic regression. Adjustments were made for multiple variables such as comorbidities, surgery type and American Society of Anesthesiologists classification.</p><p><strong>Results: </strong>ICR implementation significantly improved CQI performance (p=0.013) and reduced blood transfusion (p=0.046). Secondary outcomes, including length of stay, complications and readmission rates, also showed improvements with trends towards significance.</p><p><strong>Conclusion: </strong>An active feedback loop consisting of ICRs and multidisciplinary team discussions enhanced CQI for hysterectomy patients at a tertiary hospital in Singapore. They represent a valuable feedback tool with the potential to improve care quality in other standardised surgeries.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085522","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}