BMJ Open Quality最新文献

{"title":"Quality improvement project to reduce length of stay for patients with urinary tract infections in an NHS hospital trust.","authors":"Molly Crawford","doi":"10.1136/bmjoq-2024-002998","DOIUrl":"10.1136/bmjoq-2024-002998","url":null,"abstract":"<p><p>The bed day reduction improvement project for patients with urinary tract infections was commissioned at Frimley Health NHS Foundation Trust as inpatient length of stay (LOS) has been increasing over time, with noticeable variance between conditions and treatment pathways.A multidisciplinary group was formed with staff from infection control, urology and medicine. A3 thinking (a quality improvement method) was used to define the problem, analyse the data, complete root cause analysis and test change. The project aimed to impact the whole hospital system; however, using quality improvement methodology, the area with the biggest potential impact was focused on which was the emergency department. This is because positive changes made at the front end cause better outcomes throughout the pathway. Change ideas included reducing urine sample errors by improving labelling, increasing the number sent off by making the sample collection process easier for staff, increasing the use of Same Day Emergency Care Unit (SDEC) to avoid unnecessary admissions by raising awareness of the pathway with doctors and designing a pathway direct from triage to SDEC.A link was demonstrated, through audit, between sample errors/not sent and prolonged LOS, confirming the opportunity of reducing sample errors. White-topped urine sample errors reduced by 50% following the process change. The work done to reduce errors has led to an approximate 10 days per month bed day saving, improving patient experience, care and staff morale. There was no significant increase in urine samples sent, the urology SDEC use increased marginally and the triage pathway was implemented. The project was unable to link the individual changes to a reduction in the outcome measure of bed days.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12323514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783458","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":"Use of an electronic consultation system in an inner city general practice: a mixed-methods service evaluation.","authors":"Katherine Leung","doi":"10.1136/bmjoq-2024-002741","DOIUrl":"10.1136/bmjoq-2024-002741","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic propelled the uptake of electronic consultation (e-consultation) tools. Such tools promise to increase access and improve efficiency. Previous research has highlighted unintended consequences associated with e-consultation use.</p><p><strong>Aim: </strong>To explore patient and staff views, experiences and usage of an e-consultation tool in a general practice setting, 2 years after the start of the COVID-19 pandemic.</p><p><strong>Design and setting: </strong>A mixed-methods service evaluation of an e-consultation tool (eConsult) in an inner city general practice.</p><p><strong>Methods: </strong>E-consultations submitted between June and August 2022 (n=972) and associated electronic medical records were quantitatively analysed for the reason for query, type of response and whether it was followed by a reconsultation within 14 days. Reflexive thematic analysis on qualitative interviews with patients and staff (n=18).</p><p><strong>Results: </strong>76% of e-consultations were followed by a face-to-face or telephone encounter as the primary response type. 21% of e-consultations were followed by a reconsultation for the same problem within 14 days.E-consultations brought advantages for some patients in terms of access and convenience; however, other patients described a negative impact on expression, recognition of symptoms and the patient-doctor relationship. The access provided by eConsult surpassed practice capacity, leading to reports of clinician burnout. There was an incongruous view on the purpose of e-consultations among patients and staff.</p><p><strong>Conclusion: </strong>Evaluation of e-consultation tools is essential to ensure staff and patient needs are met. Although some benefits of e-consultations were identified, a number of unintended consequences were reported, including negative impacts on workload, patient communication and the patient-doctor relationship.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12323542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783459","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 incidents of violence and aggression and self-harm on a secure mental health inpatient ward for women with learning disabilities.","authors":"Margaret Paradza, Farayi Zichawo, Megan Georgiou","doi":"10.1136/bmjoq-2025-003397","DOIUrl":"10.1136/bmjoq-2025-003397","url":null,"abstract":"<p><p>Healthcare professionals working in inpatient settings are often challenged by behaviours associated with learning disability, autism and other mental health needs, including high levels of violence and aggression. This was the case on Oakley Ward, an integrated medium and low secure mental health service for women with a learning disability diagnosis. To affect change, a quality improvement project was initiated to reduce incidents of violence and aggression and incidents of self-harm by 25% over a 12-month period.We introduced two interventions. The first change idea was to introduce safety huddles to improve communication among staff and to enhance relationships with patients. Patients were invited to the beginning of the meeting to give their feedback and ask any questions they may have, thereby supporting coproduction and strengthening therapeutic relationships. The second change idea was a co-designed programme of activities; patients were actively involved in the selection and organisation of activities that were meaningful to them.Our baseline data demonstrated high levels of incidents. By June 2024, there was a 29% reduction in the number of incidents of violence and aggression per 1000 bed days and a 25% reduction in the number of incidents of self-harm per 1000 bed days. As a balancing measure, we observed a reduction of 55% in the number of seclusion hours. Improvements were also experienced anecdotally through staff feedback.The interventions led to substantial reductions in incidents. We have demonstrated the benefits of improved communication practices and meaningful engagement opportunities on quality of life and ward functionality. Both interventions could be easily replicated on other mental health and learning disability inpatient wards. The success of this initiative can be attributed to the collaborative efforts of multidisciplinary teams, strong leadership and proactive staff.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774668","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":"Restoring antenatal health services in a war-affected hospital: a quality improvement project.","authors":"Abebe Abrha Alene, Desalegn Tegabu Zegeye, Yeneneh Getachew Haile, Nebiyou Wondeson Hailemariam, Ibrahim Alemu Ali, Mohammed Yesuf, Abiyou Kiflie","doi":"10.1136/bmjoq-2024-003296","DOIUrl":"10.1136/bmjoq-2024-003296","url":null,"abstract":"<p><strong>Background: </strong>Health service restoration involves reinstating all previous health service components to a facility after a period of disruption caused by war, conflict or other disasters. As defined by the WHO, antenatal care (ANC) is the care provided by skilled healthcare professionals to pregnant women and adolescent girls to ensure optimal health conditions for both mother and fetus during pregnancy. Before the restoration process, the hospital senior management team, maternal and newborn health (MNH) staff and Institute for Healthcare Improvement (IHI) improvement advisors had discussions on how to restore ANC services. This quality improvement (QI) project aims to restore ANC service at the war-damaged hospital, Amhara region, Ethiopia.</p><p><strong>Methods: </strong>The model for improvement method was applied, we collected 6 months of data retrospectively to form a baseline, 1-year data were collected during implementation and a second year's data to ensure sustainability of improvement.</p><p><strong>Result: </strong>The run chart shows the percentage of pregnant mothers who received all ANC bundle elements at their first ANC visit at Jamma Primary Hospital and improved from a baseline of 0% to 94.5%.</p><p><strong>Conclusion: </strong>The project involved three interventions that worked well: using the ANC first bundle checklist, conducting exit interviews with pregnant women and checking laboratory test availability every week. Additionally, through our Plan-Do-Study-Act, we understood that engaging the community in our QI project and providing psychosocial support for healthcare providers after the conflict were helpful in improving our QI project.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759145","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":"Conceptualisation and design of a protocol for a novel social drivers and primary care screening tool in paediatric orthopaedics: a quality improvement initiative.","authors":"Devika A Shenoy, Kathryn Radulovacki, Christian Zirbes, Rachelle Shao, Giussepe Yanez, Anthony A Catanzano","doi":"10.1136/bmjoq-2025-003454","DOIUrl":"10.1136/bmjoq-2025-003454","url":null,"abstract":"<p><strong>Introduction: </strong>Paediatric patients with elevated healthcare needs have limited access to care, contributing to insufficient preventive services. Social drivers of health (SDOH), such as inadequate nutrition and poor community support, contribute substantially to paediatric health. In order to promote value-based healthcare, specialty providers like orthopaedic surgeons can serve as an entry point to connect patients to SDOH and primary care resources. The purpose of this short report is to provide a framework for other institutions for an ongoing screening programme.</p><p><strong>Overview of programme: </strong>Informed on prior initiatives, we designed a systematic screening programme for SDOH, obesity (via body mass index (BMI)) and primary care access in a paediatric orthopaedics clinic, for English-speaking and Spanish-speaking patients <18 years old. We record age, sex, race/ethnicity, language, orthopaedic condition, Area Deprivation Index and Childhood Opportunity Index from the electronic record previsit. BMI ≥95th percentile triggers referral to a paediatric obesity management programme. An institutional SDOH screen detects financial, food, transportation, housing and utility needs. A positive screen triggers a referral to institution and state-specific resources. A five-question Primary Care Access Screen identifies gaps in primary care access. A positive screen triggers an internal referral to paediatric primary care. Patients are flagged before visits, and screening results are reviewed. Students place referrals for positive screens, finalised by providers. Follow-up occurs at 6 weeks.</p><p><strong>Data collection: </strong>We assess screen positivity, referral uptake and completed appointments for all patients at 6 weeks.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759143","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 the implementation of a longitudinal cocurricular experiential quality improvement training programme for undergraduate medical students.","authors":"Katherine Bailey, Elina Farahani, Sunny Raval, Ke Xin Lin, Muhammadhasan Nasser, Jonathan Hersh, Farah Khan, Shaan Chugh, Alison Freeland, Amir Ginzburg, Nazia Sharfuddin","doi":"10.1136/bmjoq-2025-003378","DOIUrl":"10.1136/bmjoq-2025-003378","url":null,"abstract":"<p><p>Quality improvement and patient safety (QIPS) is a core competency in undergraduate medical education. While didactic and experiential learning enhance QIPS knowledge and skills, there are limited experiential opportunities. This study aims to evaluate the feasibility and effectiveness of a longitudinal didactic and experiential student-led programme, Quality Improvement Experiential Student Training (QuEST). QuEST was piloted during year 1, where learners completed online modules, didactic seminars, an experiential project and mentorship meetings with the programme's faculty chair (Plan-Do-Study-Act [PDSA] 1). We implemented a formal leadership structure, adapted the curriculum, and changed mentorship meetings to student-led in year 2 (PDSA 2). In response to reduced learner satisfaction, we reintroduced faculty-led mentorship meetings in year 3 as well as revised the experiential project screening process and decreased the cohort size to enhance programme operations. The outcome was self-reported confidence in completing a QIPS project, which we aimed to achieve at least 60% of learners reporting confidence each year. Fourteen learners were enrolled in year 1, 45 in year 2 and 18 in year 3. After year 1, 86% of learners reported confidence in completing a QIPS project (from 39% preprogramme; p<0.01), 64% in year 2 (from 16%; p<0.01) and 75% in year 3 (from 28%; p<0.01). Programme satisfaction was 4.25/5 in year 1, 4.27/5 in year 2 and 4.75/5 in year 3. Strengths included experiential learning and support from the programme. Opportunities for improvement included further check-in meetings to promote accountability and project progression. The QuEST programme equipped learners with the confidence needed to complete a QIPS project. The provision of mentorship was identified as a common driver for learner satisfaction, with the suggestion to provide further structured and unstructured mentorship opportunities embedded in the programme. Future work may consider longitudinally assessing changes to learner behaviour.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759144","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 of enhanced recovery after surgery for caesarean delivery: a quality improvement initiative.","authors":"Melissa Walker, Mara Sobel, Naveed Siddiqi, Jose C A Carvalho, Nighat Jahan, Sara Santini, Nancy Watts, Kim Dart, Stella Wang, Ella Huszti, Jackie Thomas","doi":"10.1136/bmjoq-2025-003391","DOIUrl":"10.1136/bmjoq-2025-003391","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after caesarean delivery (ERAC) is a multidisciplinary, evidence-based bundle of interventions developed from Enhanced Recovery After Surgery principles, designed to improve patient outcomes, reduce complications and save healthcare resources. Despite these benefits, the implementation of ERAC within the Canadian healthcare context is unknown. In addition, previous ERAC studies typically excluded patients undergoing unplanned caesarean deliveries (CD). The objective of our study was to evaluate the results of a quality improvement initiative that implemented a comprehensive ERAC pathway for both planned and unplanned CD in a large Canadian obstetric unit, with a specific focus on patient-reported outcomes.</p><p><strong>Methods: </strong>A pre-implementation post implementation design was used. The primary outcomes were Obstetric Quality of Recovery Score (ObsQoR-10) and patient satisfaction at 6 weeks postpartum. Secondary outcomes included postpartum length of stay, postoperative pain and maternal infectious morbidity.</p><p><strong>Intervention: </strong>Antenatal, intraoperative and postoperative ERAC bundles were developed with multidisciplinary input.</p><p><strong>Results: </strong>513 patients were included: 290 pre-implementation (149 planned CD, 141 unplanned CD) and 223 post- implementation (128 planned CD, 95 unplanned CD). Baseline demographics were similar, except the post implementation groups had significantly higher median Body Mass Index (BMI). In planned CD, ObsQoR-10 scores were on average 3.4 points higher in the post-implementation group (95% CI (-0.19 to 6.99); p-value=0.063). Patient satisfaction assessed at 6 weeks postpartum was significantly improved by 12 points in the post-implementation group (95% CI (5.58 to 18.62); p-value<0.001). In unplanned CD, implementation was not associated with ObsQoR-10 (p-value=0.92) or patient satisfaction assessed at 6 weeks postpartum (p-value=0.43). Pain scores were higher in both post-implementation groups, but there were no differences in morphine milliequivalents or requirement for breakthrough opioids. Length of stay and maternal infectious morbidity were similar.</p><p><strong>Discussion: </strong>Implementation of ERAC in a large Canadian tertiary care obstetrics unit was feasible and resulted in improved recovery and increased satisfaction in patients undergoing planned CD. There were no differences in other outcomes, including infectious morbidity; however, the contribution of BMI needs to be explored. Patients undergoing unplanned CD face additional challenges related to outcomes, recovery and satisfaction and should be targeted in future studies.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752305","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":"STAMP: surgical thromboprophylaxis adherence management programme.","authors":"Natalia Quintana-Montejo, Paulo Andres Cabrera Rivera, Stefany de Jesús Ríos Acuña, Danna Lesley Cruz Reyes","doi":"10.1136/bmjoq-2024-003063","DOIUrl":"10.1136/bmjoq-2024-003063","url":null,"abstract":"<p><strong>Introduction: </strong>Venous thromboembolism is the main cause of preventable in-hospital morbidity and mortality. Despite the recommendations available in the clinical practice guideline, there is low adherence to correct thromboprophylaxis. The implementation of strategies in other countries has had a significant effect on this shortcoming. The objective of the current study was to develop and apply a multifaceted strategy to improve adherence to the institutional protocol of thromboprophylaxis in surgical patients in a university hospital.</p><p><strong>Methods: </strong>This was a quasi-experimental before-and-after study. Adequate adherence to the institutional thromboprophylaxis guide for surgical patients was evaluated by performing an initial measurement, then a multifaceted intervention and, finally, a second measurement. The information was collected from electronic medical records. The study population was a multidisciplinary healthcare team. χ² tests and Student's t tests were used for the analysis of categorical and numerical variables.</p><p><strong>Results: </strong>In total, 192 medical records were included for the two measurements. The strategy comprised the following: inclusion of the Caprini scale in the electronic system, creation and dissemination of the institutional thromboprophylaxis booklet, conducting information sessions, creating an online course and creating an alert for high-risk and very high-risk thromboembolic patients. The implementation of the strategy significantly increased adequate adherence to the institutional thromboprophylaxis guide according to the thromboembolic risk of the patient calculated by the Caprini scale (40.2% vs 62.7%, p 0.003).</p><p><strong>Conclusion: </strong>The use of a multifaceted strategy to improve adherence to thromboprophylaxis in surgical patients should be considered locally and internationally.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752306","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":"Understanding physicians' views on patient-reported outcome measures (PROMs) in lung cancer care: a qualitative approach.","authors":"Abel García Abejas, João Marques Gomes, Maria Eduarda Andrade, Daniel Canelas, Maria Ana Sobral, Fábio Leite Costa, Àngels Salvador Vergès","doi":"10.1136/bmjoq-2025-003376","DOIUrl":"10.1136/bmjoq-2025-003376","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcome measures (PROMs) are increasingly recognised as valuable tools for personalising care pathways and improving the quality of life for patients with lung cancer. PROMs capture patients' perceptions of symptoms and functional status, while patient-reported experience measures focus on how patients perceive the care process, communication, empathy and accessibility. However, integrating PROMs into clinical practice remains challenging. This study explores physicians' perceptions of PROMs in lung cancer care, their impact and the barriers and facilitators to their implementation.</p><p><strong>Objectives: </strong>This study seeks to understand physicians' perspectives on the role of PROMs in enhancing the quality of life, dignity and autonomy of patients with lung cancer and to identify key barriers and facilitators to their integration into clinical practice.</p><p><strong>Methods: </strong>16 semistructured interviews were conducted with physicians treating patients with lung cancer. A hybrid thematic analysis was used to identify key themes and patterns in the data.</p><p><strong>Results: </strong>Three main themes emerged: (1) patient-related factors, such as health literacy and emotional distress; (2) the influence of social and family environments and (3) the role of PROMs in clinical decision-making. While PROMs were valued for their potential to improve care, barriers like digital literacy and socioeconomic factors hindered their application. Specifically, the study found that while physicians valued the potential of PROMs to improve patient care, several barriers, including patients' digital literacy and socioeconomic factors, hindered their practical application.</p><p><strong>Conclusions: </strong>PROMs offer a pathway to enhance patient-centred care in lung cancer treatment. However, their successful integration requires addressing barriers such as health literacy, digital access and multidisciplinary collaboration. Future research should focus on strategies for effective PROM integration into clinical workflows and investigate methods for effectively integrating PROMs into routine clinical workflows.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741130","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 long-term postoperative pain monitoring and follow-up for women undergoing incontinence mesh surgery: a quality improvement initiative.","authors":"Sissel Hegdahl Oversand, Tomislav Dimoski, Rune Svenningsen","doi":"10.1136/bmjoq-2025-003346","DOIUrl":"10.1136/bmjoq-2025-003346","url":null,"abstract":"<p><strong>Background: </strong>Stress urinary incontinence (SUI) affects many women, often resulting from childbirth-related injuries. Synthetic mesh SUI implants, popular since the 1990s, are effective but have raised concerns due to complications like long-term pain. In Norway, insufficient follow-up and inconsistent pain registration hinder accurate prevalence estimates. This study aimed to enhance pain registration and standardise follow-ups after sling surgery.</p><p><strong>Local problem: </strong>Routine 3-year postoperative controls, recommended by the Norwegian Female Incontinence Registry (NFIR) have been deprioritised by public hospitals for financial reasons. Less than 50% of patients undergoing sling surgeries in 2017 received follow-ups, with only half including pain data. This risks underestimating pain prevalence and impedes quality improvements.</p><p><strong>Methods: </strong>A quality improvement project (2022-2023), initiated by NFIR, included seven hospitals selected for surgical volume, location and follow-up performance.</p><p><strong>Interventions: </strong>(1) Structured 3-year telephone follow-ups with pain registration for SUI mesh surgeries between 1 April 2019 and 31 March 2020. (2) Mandatory clinical examinations for patients reporting persistent pain. (3) Improved NFIR pain monitoring to track onset and persistence. (4) Standardised patient information on postoperative pain.The NFIR pain variable was refined, with main data analyses at baseline, mid-project and finalisation.</p><p><strong>Results: </strong>Follow-up rates exceeded 80%, with pain data documented for all. Persistent pain was self-reported by 4.3%. After clinical evaluations, 1.9% could be attributed to the mesh implant. Three patients (0.7%) required treatment, one needed partial mesh removal. Interdepartmental follow-up variability decreased, and NFIR pain monitoring was revised for precision.</p><p><strong>Conclusions: </strong>Telephone-based follow-ups improved pain documentation and reduced departmental variability. Although pain prevalence was low, systematic follow-ups and refined monitoring remain crucial. Future efforts should explore electronic follow-ups and maintain interdepartmental collaboration, providing a model for similar healthcare challenges.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144727760","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}