BMJ Open Quality最新文献

{"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}

{"title":"Evaluating organisational performance in healthcare: a mixed-method study using the McKinsey 7S framework.","authors":"Imane Bounjerte, Sara Khalidy, Ilham Mazouzy, Joumana El Turk, Ibtisam Haidar, Anass Kettani, Rachid Saile, Houda Bennani","doi":"10.1136/bmjoq-2025-003317","DOIUrl":"10.1136/bmjoq-2025-003317","url":null,"abstract":"<p><strong>Background: </strong>The Moroccan healthcare sector faces numerous quality challenges. Therefore, various strategies-such as the implementation of quality management systems (QMSs)-were put into practice to improve the quality of care and reinforce the healthcare system. Among these, ISO 9001 represents one formalised QMS framework. Despite its increasing adoption, only a few studies have attempted to evaluate how ISO 9001-certified QMSs influence hospital performance and effectiveness. Our study aimed to fill this gap by exploring the impact of an ISO 9001-certified QMS on organisational performance in a hospital centre in Casablanca, Morocco.</p><p><strong>Methods: </strong>Initially, we employed the McKinsey 7S model as a diagnostic tool to evaluate organisational performance across seven key dimensions. Data were collected via structured interviews and a questionnaire administered to hospital staff. Additionally, clause 9 of the ISO 9001:2015 standard-focused on performance evaluation-was used to assess the QMS implementation. As for data analysis, the software Sphinx V5 was used for data entry, and IBM SPSS Statistics V.25 was used for reliability analysis and non-parametric tests.</p><p><strong>Results: </strong>The results indicated a positive staff perception of the QMS's performance and its impact on patient satisfaction, continuous improvement and overall hospital effectiveness. The results also highlighted gaps in organisational factors such as internal communication and staff training, suggesting areas for future improvement.</p><p><strong>Conclusions: </strong>This study provided a dual-framework approach to evaluating and enhancing hospital performance by integrating ISO 9001 standard requirements with the McKinsey 7S model. The findings show the value of combining a formal QMS (ISO 9001) with organisational diagnostic tools (7S Model) in understanding and driving quality improvements in healthcare settings.</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/PMC12083357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085615","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":"Mapping patient encounters to identify recruitment timepoints after brain tumour surgery: a cohort and cross-sectional study.","authors":"James Booker, Jack Penn, Naomi Fersht, John G Hanrahan, Michael Kosmin, Nicola Newall, Siddharth Sinha, Simon C Williams, Lewis Thorne, Ciaran S Hill, Hani J Marcus","doi":"10.1136/bmjoq-2024-003065","DOIUrl":"10.1136/bmjoq-2024-003065","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to develop a comprehensive process map for patients with brain tumours to identify opportunities for quality improvement and automated data collection. Through optimising workflows, the overall goal is to improve patient recruitment to clinical trials.</p><p><strong>Design: </strong>A two-stage mixed methods design, combining qualitative development of a process map with quantitative validation using electronic health records (EHR). Following this, a cross-sectional survey was conducted to assess how patients learn about clinical trials.</p><p><strong>Setting: </strong>A single neurosurgery centre in the United Kingdom.</p><p><strong>Participants: </strong>The process map was developed through stakeholder interviews with neuro-oncology multidisciplinary team members and patients (n=13). Clinical encounters were validated with EHR data from 50 patients. A cross-sectional survey presented the validated process map to 25 postoperative patients to identify the resources they used to learn about ongoing clinical trials.</p><p><strong>Interventions: </strong>Postoperative questionnaires were given to patients after brain tumour surgery, either on the ward or in follow-up clinic.</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcome was the percentage of the study cohort that was present at encounters on the process map. Key timepoints were defined if >80% of patients were present. They represent high-yield opportunities to offer information on clinical trial recruitment. The secondary outcome was the resources used by patients to learn about ongoing clinical trials.</p><p><strong>Results: </strong>Quantitative validation of patient pathways identified 345 encounters involving 19 discrete events, including clinics, telephone follow-ups and treatments. The flow of encounters reflected the process map with 90.7% accuracy, with key timepoints identified at imaging and biopsy/surgical procedures. A cross-sectional survey conducted during outpatient neuro-oncology clinics identified that patients predominantly used self-directed internet searches (n=17, 68%) and verbal information from their neurosurgeon (n=16, 64%) to learn about clinical trials.</p><p><strong>Conclusions: </strong>This study demonstrates the effectiveness of process mapping in identifying key timepoints for automated data collection and opportunities for quality improvement for clinical trial recruitment. Integrating online and in-clinic education strategies could enhance patient awareness and participation in clinical trials.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075678","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 routine group and save testing in emergency laparoscopic appendicectomy surgery: a quality improvement project assessing the triple bottom line.","authors":"Cyra Mackintosh, Emanuele Gammeri, Vrettos Ierodiakonou, Dominic Furniss","doi":"10.1136/bmjoq-2024-003120","DOIUrl":"10.1136/bmjoq-2024-003120","url":null,"abstract":"<p><strong>Introduction: </strong>There is compelling evidence supporting the omission of routine group and save (G&S) testing pre-operatively in emergency laparoscopy where appendicitis is suspected. Most studies are retrospective; however, one study prospectively demonstrated safe application in laparoscopic cholecystectomies only. We sought to assess safety, cost, and environmental and social savings-the triple bottom line-of omitting routine G&S testing in laparoscopic appendicectomies, by undertaking a quality improvement project at a busy district general hospital.</p><p><strong>Methods: </strong>All patients who underwent an emergency laparoscopy +/- appendicectomy, between 1 November 2020 and 31 October 2021, were retrospectively reviewed, and cross-referenced to haematological testing and blood product dispensation data. A cost of £15 was applied to processed G&S samples and £1.89 to rejected samples. A carbon cost of 1,066 g CO₂ emissions (CO₂ ^e) was applied to all samples. We then prospectively undertook a 6-month pilot intervention to omit routine G&S testing in these cases. Patients from either cohort who required blood transfusions underwent a deep dive to identify risk factors.</p><p><strong>Results: </strong>Pre-intervention, 281/392 (71.7%) of patients had valid G&S samples prior to their procedure and no patient required blood products during their episode. Post-intervention, 56/189 (29.1%) patients had valid G&S samples. One patient with chronic anaemia required a preoperative blood transfusion. Pre-intervention, G&S testing cost £22.24 and 1.7 kg CO₂ ^e per laparoscopy. Post-intervention, the cost reduced to £9.78 and 0.7 kg CO₂ ^e per laparoscopy. The intervention saved £5,021 and 353 kg CO₂ ^e, and our institution has adopted a selective approach, based on clinical risk, for these cases indefinitely.</p><p><strong>Conclusion: </strong>Routine G&S testing in emergency laparoscopy +/- appendicectomy is unnecessary, costing money and time and producing carbon emissions. With effective communication of risk-mitigating factors, practice can shift from high to low rates of preoperative testing. There are further savings accessible by applying this method to other surgical procedures using a risk-based approach.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976402","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":"Nurse stress and patient safety in the ICU: physician-led observational mixed-methods study.","authors":"Manju Mathew, Anjum John, Reshma Vazhakkalayil Ramachandran","doi":"10.1136/bmjoq-2024-003109","DOIUrl":"10.1136/bmjoq-2024-003109","url":null,"abstract":"<p><strong>Introduction: </strong>Nurses working in intensive care settings are required to maintain constant vigilance, yet they often experience high stress and burnout, which can compromise the quality of patient care.</p><p><strong>Objectives: </strong>To identify stress and burnout among intensive care nurses, contributing risk factors and impact on patient safety, while providing an opportunity for nurses to discuss their work-related challenges.</p><p><strong>Methods: </strong>Setting: Observational mixed-methods study done in intensive care unit (ICU), tertiary teaching hospital, Kerala, India in July 2024.</p><p><strong>Participants: </strong>Thirty nurses in the ICU (all females, mostly aged 25-35 years, >5 years of work experience) completed standardised questionnaires on stress levels, workload, burnout and work satisfaction. From this group, six nurses underwent structured interviews. Purposive sampling was done to capture diverse experience and roles. Reported patient safety incident data were collected.Severity of stress, workload, burnout and work satisfaction were classified into high or low levels based on predefined cut-off scores.</p><p><strong>Results: </strong>86.7% reported moderate to high levels of combined outcomes of workload, stress or burnout, with 46.7% experiencing high levels of stress. Four major themes were identified in the qualitative analysis: stress, attitudes, patient safety and nurses' unmet demands and aspirations. Positive attitudes identified were passion, motivation and empathy. Key stressors included work overload, inadequate staffing, logistics, team and management support. Coping strategy was family-centred. A perceived need for a non-punitive, learning-oriented environment was identified for fostering patient safety culture. Nurses' demands included facility safety, managerial support and better resources, both man and machine.</p><p><strong>Conclusions: </strong>Despite the specific challenges faced by ICU nurses in developing countries, they upheld positive values. Institutional leadership's commitment to implement patient safety culture and improve nurses' work environment is important. Future research should involve larger multicentre interventional studies.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962047","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":"Addressing food insecurity: a paediatric academic advocacy collaborative quality initiative.","authors":"J Blakely Andrews Amati, Shivani Mehta, Talia Buitrago Mogollon, Lizmarie Maldonado, Kerry K Sease, Debra Best, Kimberly Montez, Emily Vander Schaaf, Elizabeth Erickson, Jeffrey Holloway, Kristina Gustafson, James Roberts, Carolyn Avery","doi":"10.1136/bmjoq-2024-003083","DOIUrl":"10.1136/bmjoq-2024-003083","url":null,"abstract":"<p><strong>Objective: </strong>This quality improvement (QI) initiative aimed to address food insecurity (FI) by improving FI identification and referral to food assistance programmes for the families served by the eight paediatric academic institutions in North and South Carolina.</p><p><strong>Methods: </strong>The primary process measures were screening 80% of eligible families for FI and coding for FI. The outcome measure was referring 80% of families identified with FI to appropriate resources. The balancing measure was maintaining a rate below 20% of missed opportunities for referral. Change ideas were organised into four main key drivers. The eight teaching clinics of the Carolinas Collaborative completed monthly chart audits using the Quality Improvement Data Aggregator (QIDA). Baseline was December 2020 and implementation occurred January 2021-May 2022. Creation of run charts was later transferred to statistical process control charts. Standard probability or Montgomery rules were used to identify special cause variation. Sites used individual QIDA data to conduct Plan-Do-Study-Act cycles; aggregated data were shared during bimonthly meetings.</p><p><strong>Results: </strong>A total of 4270 eligible charts were audited, 3430 patients screened and 525 identified as having FI. The rate of FI screening shifted from 68.5% to 86%. The rate of FI identified remained at 15%, and food referrals were consistently offered 90% of the time. While FI diagnostic coding did not reach the 80% goal, there was a shift from 38.3% to 70.5%. The balancing measure remained well below the goal of less than 20% of missed opportunities to discuss positive FI (centreline of 9.5%).</p><p><strong>Conclusions: </strong>A paediatric academic collaborative QI initiative focused on FI demonstrated collective improvement and allowed for rapid implementation, dissemination and spread.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953216","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":"Comparative study between the Patient Participation Culture Tool and the Hospital Survey on Patient Safety Culture using retrospective data from 2014 to 2021.","authors":"Marlies Claesen, Evelyne Punnewaert, Simon Malfait, Kristof Eeckloo, Ann Van Hecke, Ward Schrooten","doi":"10.1136/bmjoq-2024-003200","DOIUrl":"10.1136/bmjoq-2024-003200","url":null,"abstract":"<p><strong>Introduction: </strong>Patient participation and safety are pivotal in healthcare quality, internationally acknowledged for enhancing health services. This study examines the correlation between two assessment tools, the Patient Participation Culture Tool (PACT) and the Hospital Survey on Patient Safety Culture (HSPSC), using retrospective data from 2014 to 2021<i>.</i> METHOD: For the main analysis, dimensional scores of the HSPSC and domain scores of the PACT were aggregated according to hospital and specific wards. In a second step, we used aggregated scores by hospital and profession. Descriptive statistics outlined the sociodemographic characteristics of participants. Spearman's rank correlation coefficient was employed to evaluate relationships between continuous variables represented by PACT domain and HSPSC dimensional scores among study participants.</p><p><strong>Results: </strong>Data from 17 hospitals were analysed. The participants were distributed across 43 wards, and a match based on staff positions resulted in 37 different groups, predominantly comprised of nurses (>89%). At ward level, five PACT domains correlated significantly with ten different HSPSC dimensions (p<0.05), while a significant correlation was found between four PACT domains and seven HSPSC dimensions based on function. The correlation graphs demonstrate strong internal coherence within safety and participation culture measurements, highlighting the distinctiveness and validity of each questionnaire in capturing intricacies within patient safety and participation culture, supporting their construct validity.</p><p><strong>Conclusions: </strong>This study compared the PACT and the HSPSC, revealing their connections and unique features. Using Spearman's correlation, it positively linked patient participation and safety culture, finding significant correlations, mainly moderate, between their specific aspects. It highlighted how patient involvement positively influences safety practices in healthcare, valuable for enhancing overall quality.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967906","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 inappropriate investigations for minor lower limb cellulitis.","authors":"Leer Liang, Daryl Yin Keong Lo, Elaine Jing-Mei Pang, Elizabeth Ming Jing Tan, Adrian Chung Thien Lim, Calyn Marini Eng Lian Yap, Poh Yong Tan","doi":"10.1136/bmjoq-2024-003079","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003079","url":null,"abstract":"<p><p>Lower limb cellulitis is a frequently encountered condition in the acute hospital setting, yet many patients with only mild lower limb cellulitis undergo unnecessary collection of blood cultures and X-ray imaging. This leads to increased healthcare costs and prolongation of the length of hospitalisation.A retrospective review of electronic medical records was performed to determine the frequency of blood cultures and lower limb X-rays performed for patients with lower limb cellulitis presenting to the Department of Emergency Medicine and admitted to the Department of Internal Medicine, in a national tertiary hospital.Quality improvement methods were implemented to increase accessibility to and awareness of lower limb cellulitis management guidance among clinical staff, to empower appropriate and rationalised decision-making in the management of patients with lower limb cellulitis. The percentage of patient encounters with blood cultures performed subsequently improved from a baseline median of 73.3% to a post-intervention median of 52.3%, with direct healthcare cost savings and additional ancillary beneficial effects for patients and healthcare staff. However, no reduction in the frequency of imaging performed was observed, for which the opportunity arises for further root-cause analyses and intervention.Encouraging small changes in individual clinicians' routine daily clinical practice through quality improvement initiatives results in significant impacts when multiplied across healthcare staff and departments. Initiatives implemented need to be accessible, realistic and pragmatic to maximise real-world on the ground effects and facilitate a sustained impact.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972205","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 interprofessional collaboration in pain clinics through simulation: a longitudinal Readiness for Interprofessional Learning Scale assessment.","authors":"John Mekail, Ysaac Zegeye, Quinn Lanners, Muhammad Farooq Anwar, Peter K Yi","doi":"10.1136/bmjoq-2024-003199","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003199","url":null,"abstract":"<p><strong>Background: </strong>Interprofessional collaboration (IPC) is vital for delivering safe, holistic patient care, particularly in outpatient interventional pain clinics where precision and teamwork are crucial. Despite its importance, IPC within outpatient pain medicine remains understudied, and the Readiness for Interprofessional Learning Scale (RIPLS) has not been used longitudinally in outpatient pain medicine.</p><p><strong>Objectives: </strong>The primary objective of this quality improvement (QI) project was to evaluate and enhance readiness for interprofessional learning among clinical staff in an outpatient pain clinic, measured over 6 months in an outpatient pain clinic.</p><p><strong>Methods: </strong>This initiative took place from October 2021 to April 2022 in an academic institution's hospital-based outpatient pain clinic. We administered the RIPLS survey to 15 participants of various clinical roles at baseline and again 6 months after a simulation-based intervention. The simulation included small group didactic sessions and immersive clinical scenarios depicting acute complications in interventional pain procedures. We used descriptive statistics to compare preintervention and postintervention survey responses, stratifying by professional role. Qualitative feedback was collected to explore participants' perceptions of the training and its impact.</p><p><strong>Results: </strong>Both physician and non-physician groups reported high baseline RIPLS scores, with no statistically significant difference between or within groups over 6 months. Although mean RIPLS scores did not significantly change, participants consistently described positive attitudes towards collaborative practice. Qualitative feedback underscored the importance of structured simulation for reinforcing team roles, communication strategies and crisis management skills.</p><p><strong>Conclusion: </strong>This project demonstrates that simulation-based training can sustain high levels of interprofessional readiness among outpatient pain clinic staff over time, suggesting utility for maintaining collaborative behaviours in a setting where safety and teamwork are paramount. Future efforts could investigate whether similar interventions improve IPC in clinics with lower baseline readiness, as well as explore longer follow-up periods or larger sample sizes to detect nuanced changes in collaboration metrics.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953514","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 the Child Oral Health Initiative (COHI): improving access to preventive dental care to achieve Saudi Vision 2030 healthcare goals.","authors":"Heba A Alkarimi, Amal Jawadi, Shaimaa Tayeb, Ramysh Ismail, Esraa J AlShareef, Nouf Sherbini","doi":"10.1136/bmjoq-2024-003070","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003070","url":null,"abstract":"<p><strong>Background: </strong>Dental caries is one of the most important health concerns in Saudi Arabia. It poses a substantial burden considering the clinical outcomes and treatment costs. Oral health is an integral part of general health, and primary healthcare providers may contribute to the primary prevention of caries by initiating early referrals, dental screening and early diagnosis of caries with regular medical visits.</p><p><strong>Objectives: </strong>This project aimed to integrate the Child Oral Health Initiative (COHI) into regular paediatric healthcare services to effectively promote oral health and improve access to preventive dental care services. However, referrals to the dental department were primarily paper-based targeting dental clearance, emergencies and treatments. This referral system impaired the accessibility and manageability of medical records, necessitating the need for a traceable robust referral system to successfully screen children.</p><p><strong>Methods: </strong>The first phase of the project was to develop an electronic referral system for the COHI (ECOHI-referrals) to improve communication between the COHI dental team and other hospital teams, increase dental preventive screening rates and to track referrals. Four Plan-Do-Study-Act (PDSA) cycles were used to initiate and track the new referral system and improve the screening rate of referred children.</p><p><strong>Results: </strong>After implementation, the number of ECOHI-referrals for caries prevention in the paediatric ward increased from 0 to 351 during the project period. The dental team received 351 ECOHI-referrals out of 420 (83.5%) eligible children in the paediatric ward. Of the referred 351 children, 317 (90.3%) underwent dental screening. Of the screened children, 263 (82.9%) established an ongoing dental home, and 98 (30.9%) children received fluoride applications.</p><p><strong>Conclusion: </strong>Quality improvement methods facilitated the successful integration of COHI into hospital inpatient settings, increasing dental prevention visits to the paediatric ward, improving tracking of e-referrals, establishing dental homes for children and enhancing communication between teams.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953500","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}