BMJ Open Quality最新文献

{"title":"Understanding online hospital patient reviews: a nationwide cross-sectional analysis of polarity, actionability and themes.","authors":"Siu Yu Zoe Lau, Matthew P Tse, Irfan Dhalla, Dhruv Nayyar","doi":"10.1136/bmjoq-2025-004117","DOIUrl":"10.1136/bmjoq-2025-004117","url":null,"abstract":"<p><strong>Background: </strong>Patient experience data can support hospital quality improvement initiatives. Unsolicited online hospital reviews have emerged as an alternative data source in addition to traditional survey methods. However, the content and actionability of qualitative online reviews for Canadian hospitals are unknown.</p><p><strong>Methods: </strong>We conducted a nationwide cross-sectional study analysing Google Review text comments of Canadian acute care hospitals from 2017 to 2022. We analysed a random sample of 1000 comments from June 2017 to June 2022. We characterised the polarity, actionability and thematic content of these comments.</p><p><strong>Results: </strong>Patients were more likely to leave negative reviews (47.9%) than mixed (19.8%) or positive (32.3%) reviews. Most reviews (74.0%) were semiactionable or very actionable. Negative or mixed reviews were generally more actionable than positive reviews (p<0.001). Lastly, patients were most likely to comment on interpersonal interactions with staff and wait times for care.</p><p><strong>Conclusions: </strong>Qualitative online patient reviews contain actionable feedback. This can provide a source of real-time data to monitor and improve on patient experience.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535130","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":"Embedding human factors and systems thinking in patient safety education: the Contributing factors, Analysis, and Recommendation Education (CARE) Tool.","authors":"Erika Petersen, Sanjeef Thampinathan, Joseph A Cafazzo, Laura D Pozzobon","doi":"10.1136/bmjoq-2025-003968","DOIUrl":"10.1136/bmjoq-2025-003968","url":null,"abstract":"<p><strong>Background: </strong>Despite the recognised need, there remains a deficit of professionals skilled in the application of human factors theory and methods in patient safety incident reviews in healthcare. Addressing this gap by embedding human factors theory into quality and safety education is needed to develop professional who can drive sustainable and meaningful patient safety improvement.</p><p><strong>Objective: </strong>Develop an educational tool to support graduate students in developing knowledge and skills in the practical application of human factors frameworks to real-world patient safety challenges.</p><p><strong>Methods: </strong>The tool was iteratively developed and used within a graduate-level human factors course using case-based learning to facilitate a theory-to-practice application.</p><p><strong>Result: </strong>We developed the <i><u>C</u>ontributing factors, <u>A</u>nalysis, and <u>R</u>ecommendation <u>E</u>ducation (CARE) Tool-</i>a practical, integrated tool designed to support students and professionals in applying human factors theory to complex and real-world patient safety challenges. The CARE Tool combines three human factors frameworks: Systems Engineering Initiative for Patient Safety, Human-Tech Ladder and Hierarchy of Intervention Effectiveness (HIE). The CARE Tool's primary use is to guide users through a structured patient safety incident review process grounded in systems thinking. In this paper, we describe the development and use of the tool by a group of interdisciplinary students during a graduate-level course in human factors.</p><p><strong>Conclusion: </strong>The CARE Tool was designed to facilitate practical understanding of human factors principles. Importantly, the CARE Tool contributes to addressing the need to develop professionals who can embed systems thinking into patient safety incident review methods. Beyond the classroom, the tool may be used by those analysing incidents in healthcare settings and/or developing mitigations.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468789","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":"Creating change through short-term pilots and rapid cycle testing: a case of cardiovascular risk reduction.","authors":"Laura Ellen Ashcraft, Katy Mahraj, Laurie A Norton, Marguerite Balasta, Kayla Clark, Karen Glanz, John Wood, Wendell Kellum, Carolina Garzon Mrad, Jordan Sigler, Yaphet Getachew, Alexander C Fanaroff, Shivan J Mehta, David A Asch, Kevin G Volpp","doi":"10.1136/bmjoq-2025-004001","DOIUrl":"10.1136/bmjoq-2025-004001","url":null,"abstract":"<p><p>Despite the availability of safe, effective and low-cost diagnosis and treatment options for atherosclerotic cardiovascular disease (ASCVD) and a significant decrease in death rates in the past several decades, ASCVD remains the leading cause of morbidity and mortality in the USA. Scalable, evidence-based strategies have not achieved a level of success that optimally lowers cardiovascular risk. In this case study, we describe the first three years of the ASCVD Risk Reduction Initiative at a large academic health system, an effort to develop, evaluate and scale a heart disease prevention programme for patients whose modifiable risk remains high despite having access to care. The Initiative models a learning health system, combining traditional randomised controlled trials with quality improvement projects, iterative rapid cycle testing, data analyses, incorporation of learnings from concurrent projects at other institutions and user research to test a variety of approaches to cardiovascular risk reduction. This approach could be generalised to other important population health improvement challenges. In this article, we detail our pilot study process, results to date and challenges experienced in this example of care delivery innovation in action.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454323","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":"Patient safety culture from the perspective of home healthcare providers and family caregivers: a qualitative study.","authors":"Abolfazl Etebarian Khorasgani, Mansoureh Ashghali Farahani, Hamid Sharif Nia, Mostafa Gholami, Fateme Golestan, Tahereh Najafi Ghezeljeh","doi":"10.1136/bmjoq-2025-004100","DOIUrl":"10.1136/bmjoq-2025-004100","url":null,"abstract":"<p><strong>Background: </strong>Patient safety culture (PSC) in home healthcare centres (HHCs) remains insufficiently examined compared with hospital settings. HHCs are licensed facilities that coordinate and deliver skilled nursing, rehabilitation and other professional services directly to patients' own homes. The present study investigates the dimensions of PSC in HHCs from the perspectives of both healthcare providers and family caregivers.</p><p><strong>Methods: </strong>This study was conducted using a qualitative approach and the conventional content analysis method (Graneheim and Lundman). Participants (n=15) included managers, nurses, physiotherapists, physicians, a nurse assistant and family caregivers recruited by purposive sampling. Data were collected through semi-structured interviews (45-90 min), participant observations (15 hours total) and field notes. Data collection continued until saturation was achieved. We extracted 1103 initial codes and grouped them into 32 primary subcategories, 15 subcategories and three main categories. Trustworthiness was ensured based on Lincoln and Guba's criteria, addressing credibility, transferability, dependability and confirmability.</p><p><strong>Result: </strong>Three main interconnected categories emerged (1): professional competency of healthcare staff for patient safety (values and beliefs, professional commitment, skill and technical proficiencies, individual-level risk assessment and management) (2); safety governance and organisational support (leadership commitment, supervision, open communication, learning from errors, training, policy development, teamwork climate, resource allocation, competency assurance); and (3) patient and family engagement (patient-centred empowerment and family-centred empowerment, involvement in care planning and risk management).</p><p><strong>Conclusions: </strong>The PSC in HHCs is shaped by the collaboration of skilled professionals, supportive organisational structures and the active participation of patients and their families. Concurrent attention to these three domains is essential for strengthening PSC in this rapidly growing sector.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444249","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":"Organisational responses to patient complaints in healthcare service delivery in low- and middle-income countries: a scoping review.","authors":"Suleyman Mohammed Arage, Mirkuzie Woldie, Adane Kebede, Lake Yazachew, Asmamaw Atnafu","doi":"10.1136/bmjoq-2025-004070","DOIUrl":"10.1136/bmjoq-2025-004070","url":null,"abstract":"<p><strong>Introduction: </strong>Patient complaints reveal gaps in quality, safety and patient-centred care, yet many low- and middle-income countries (LMICs) health systems respond inadequately, resulting in dissatisfaction, disengagement and ongoing service problems.</p><p><strong>Objectives: </strong>This scoping review maps the causes of patient complaints, evaluates existing organisational response mechanisms and policies and identifies gaps in the current evidence.</p><p><strong>Methods: </strong>The study was conducted following the Joanna Briggs Institute scoping review methodology. It focused on the causes of complaints, organisational response mechanisms, existing policies and frameworks, limitations and recommendations identified in the literature. A comprehensive search was conducted across PubMed, Embase, Web of Science, Scopus, the Cochrane Library, Advanced Google Scholar and other grey literature sources. Study selection and screening were performed using Rayyan software, with two independent reviewers applying predefined eligibility criteria. Data were extracted using a standardised table and the findings were presented through tables, graphs and narrative synthesis. Reporting adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for Scoping Reviews (PRISMA-ScR) guidelines.</p><p><strong>Results: </strong>The review includes 37 studies from various regions. These studies found that the main cause of complaint was categorised into five main domains, mainly management, followed by relationship, clinical, environmental, patient rights and others. Moreover, regarding response mechanisms, the review highlights complaint response mechanisms in healthcare that operate across three interlinked levels: national, institutional and frontline care, each with distinct approaches. Furthermore, regarding policy, the review showed that there are a few national-level and institutional-level policies on complaint handling. However, there needs to be greater focus on methodological diversity research in LMIC, as suggested by the literature on limitations and recommendations.</p><p><strong>Conclusions: </strong>This scoping review identified gaps in evidence on patient complaints, organisational responses and policies, providing a foundation for research on healthcare complaints in LMICs.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418592","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":"Bridging perspectives: experiences and future directions for patient involvement in clinical registries - a survey-based study.","authors":"Lars van de Sanden, Jacqueline Ter Stege, Jitske Tiemensma, Dominique Sprengers, Liesbeth M Timmermans, Misha D P Luyer, Mira S Staphorst","doi":"10.1136/bmjoq-2026-004228","DOIUrl":"10.1136/bmjoq-2026-004228","url":null,"abstract":"<p><strong>Background: </strong>In the Netherlands, patient participation is mandatory in clinical registries. However, the practical implementation of this requirement remains unclear, and collaboration between patient representatives, chairs of Clinical Audit Boards (CABs) and registry coordinators has not been examined from a multistakeholder perspective.</p><p><strong>Objective: </strong>To explore experiences, perceptions and needs regarding collaboration between patient representatives, CAB chairs and registry coordinators and to identify strategies to strengthen patient participation in clinical registries.</p><p><strong>Methods: </strong>An online survey across 26 clinical registries was distributed in 2025 to three stakeholder groups: patient representatives, chairs of CABs and registry coordinators from the Dutch Institute for Clinical Auditing. The questionnaire assessed frequency and quality of collaboration, perceived value of patient input, challenges and improvement needs. Responses were analysed using descriptive statistics and thematic analysis.</p><p><strong>Results: </strong>48 respondents participated. Overall, attitudes towards patient participation were positive. CAB chairs expressed the most favourable views on collaboration, whereas registry coordinators reported more mixed experiences, reflecting their intermediary role between governance and daily operational practice. Key challenges included limited structural clarity and role definition, methodological complexity of indicator development and data interpretation, questions of representativeness and differences between patient-identified priorities and registry requirements. Across all groups, there was a strong call for improved onboarding, training and more structured and consistent engagement.</p><p><strong>Conclusions: </strong>Although patient participation in clinical registries is formally established, experiences with its implementation vary widely across stakeholder groups. Strengthening structural support, mutual understanding and feedback mechanisms is essential to move from symbolic to substantive participation. Developing and evaluating a structured framework for patient engagement in clinical registries may enhance the contribution of these registries to learning, quality improvement and shared decision-making in clinical practice.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13347807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410527","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 opioid substitution therapy in the acute hospital setting: implementation of a best practice guideline.","authors":"Michael Trent Herdman, Brihitejas Patel, Poppy Pierce, Vedika Apte, Zainab Mashal Hussain Wasti, James Norman, Agnes Niemet, Kate Robinson, Iona Martin, Marisha Wickremsinhe, Nerissa Tilouche, Adrian 'Bean' Noctor, Jennifer Scott, Dan Lewer, Adam Holland, Magdalena Harris, Michael Brown","doi":"10.1136/bmjoq-2026-004153","DOIUrl":"10.1136/bmjoq-2026-004153","url":null,"abstract":"<p><strong>Background: </strong>Delayed provision of opioid substitution therapy (OST) in acute hospitals contributes to patient distress, opioid withdrawal and discharge against medical advice (DAMA). We aimed to improve access to opioid substitution therapy (OST) for hospital inpatients, using the iHOST ('improving hospital opioid substitution therapy') clinical guidelines, developed through a deliberative consensus process in partnership with clinical, academic and peer experts with professional body oversight.</p><p><strong>Methods: </strong>This pre-post quality improvement study evaluates implementation of the iHOST guideline at a tertiary hospital serving inner city London, UK between 2021 and 2023. Clinical records of all patients administered OST in the 12 months before and 11 months after the policy's introduction were evaluated for measures of process (reducing urine drug screening, improving time-to-administration), balancing (avoiding emergency naloxone administration, avoiding increased mortality) and outcome (discharge against medical advice).</p><p><strong>Results: </strong>Among 259 patients pre-policy and 194 post-policy, the median time to first methadone dose fell from 18.1 hours to 14.8 hours and the proportion of patients waiting more than 24 hours reduced from 32% to 21% (OR 0.57, 95% CI 0.37 to 0.88). Urine drug screening was one-sixth as likely to be performed on admission. There was no change in the likelihood of discharge against medical advice, which occurred for 24% of admissions during both periods (p=0.96). Naloxone was required for only 2% of admissions (five pre-policy, four times post p=1.00), indicating no compromise of patient safety.</p><p><strong>Conclusions: </strong>Implementing the iHOST guideline successfully reduced unnecessary delays to methadone administration without increasing the risk of opioid toxicity. While high rates of DAMA, even after improving access to OST, point to an ongoing need for patient-centred engagement strategies, successful implementation of the iHOST guideline supports its wider use: it is now under evaluation in two additional hospitals, after which it will be optimised to assess its utility for nation-wide practice.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403628","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":"Interdisciplinary strategies to reduce surgical site infections in operating rooms: a scoping review.","authors":"Dominique Joubert, Sylvain Boloré, Carelle Baroni, Anne-Sophie Hans, Selin Kivrak, Audrey Ringot, Claude Dussart","doi":"10.1136/bmjoq-2025-004018","DOIUrl":"10.1136/bmjoq-2025-004018","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical site infections (SSIs) are among the most frequent healthcare-associated infections, causing major morbidity, mortality and costs. In Switzerland, SSIs represent up to 30% of hospital-acquired infections, yet adherence to prevention measures remains suboptimal.</p><p><strong>Objective: </strong>To map research on interdisciplinary strategies for SSI prevention and assess their impact on adherence and outcomes.</p><p><strong>Design: </strong>Scoping review following Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.</p><p><strong>Data sources: </strong>CINAHL, Embase, MEDLINE and Cochrane Library (2016-2026), plus manual searches. English and French studies included.</p><p><strong>Eligibility: </strong>Using the Participants-Concept-Context framework: surgical teams with ≥3 professional groups (participants), interdisciplinary strategies targeting SSI prevention (concept), adult surgical procedures in the OR (context). Experimental, quasi-experimental, observational and cross-sectional designs were eligible.</p><p><strong>Methods: </strong>Data were charted using a WHO-informed tool. Five reviewers appraised studies with Joanna Briggs Institute checklists. Results synthesised narratively.</p><p><strong>Results: </strong>From 2058 records, 22 studies were included across 9 countries and 8 specialties, mostly high-income settings. Bundled interventions were associated with improved adherence and reductions in SSI rates of up to 50%. Success depended on leadership, collaboration, audit-feedback and contextual adaptation. No study reported coordination triggers or nursing frameworks; patient involvement was mainly informational.</p><p><strong>Conclusions: </strong>Interdisciplinary bundles improve adherence and reduce SSI rates but show variable effectiveness. No defined model ensures consistent gains. Future research should integrate synchronisation mechanisms, triggers and structured task-sharing to strengthen sustainability and impact.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403596","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 social determinants of health in anaesthesiology: a series of simulation cases for resident trainees.","authors":"Katrina J Hon, Ashley Thomson, Amanda Boornazian Taylor, Aaryn Sophia Toles, Danielle R Pitchon, Mindy Kim, Amanda H Kumar, Jennnifer Dominguez, Reade Tillman, Peter Yi","doi":"10.1136/bmjoq-2025-004094","DOIUrl":"10.1136/bmjoq-2025-004094","url":null,"abstract":"<p><strong>Background: </strong>Social determinants of health (SDH), non-medical factors that shape health and care access, play a critical role in perioperative safety and surgical outcomes. However, anaesthesiology residency programmes often lack structured training on communicating about and addressing SDH during routine clinical encounters. We developed a simulation-based curriculum to enhance anaesthesiology trainees' preparedness in recognising and responding to SDH-related challenges in perioperative care.</p><p><strong>Methods: </strong>An educational intervention consisting of three simulated perioperative case scenarios was integrated into an existing residency training course. Standardised patients were used to recreate realistic social and clinical challenges encountered in preoperative clinic, obstetric and paediatric settings. Sessions were followed by facilitated debriefings including the acting resident, observing peers, and a simulation faculty member to reflect on performance and key learning points. Post-simulation surveys assessed residents' perceived confidence, communication skills and awareness of institutional support resources related to SDH. Quantitative responses were summarised using descriptive statistics, and open-ended items elicited qualitative feedback.</p><p><strong>Results: </strong>42 anaesthesiology residents participated in this pilot. Following the intervention, residents reported increased confidence engaging patients and caregivers in discussions about social needs, improved familiarity with resource pathways such as social work and care coordination, and improved preparedness for sensitive conversations. Participants described the scenarios as authentic, relevant to clinical practice and valuable for observing peer communication approaches.</p><p><strong>Conclusions: </strong>This pilot project suggests that simulation may be a feasible and acceptable approach for introducing SDH-focused communication training in anaesthesiology education. Integrating realistic scenarios into perioperative curricula may help residents develop skills needed to identify social barriers and collaborate with interdisciplinary partners to promote equitable care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403633","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":"Strengthening emergency care capacity to increase inpatient admissions: a single-centre quality improvement project in Tokyo.","authors":"Tatsuo Yanagawa, Miki Tamura, Minako Inui, Kazumi Fukumoto, Matsuko Sato, Koichiro Azuma, Naoto Kurihara","doi":"10.1136/bmjoq-2025-003997","DOIUrl":"10.1136/bmjoq-2025-003997","url":null,"abstract":"<p><strong>Background: </strong>Stabilising inpatient volume is essential for acute care hospitals to sustain operations. Despite Japan's high national bed supply, Nerima Ward in Tokyo has a low bed-to-population ratio, limiting acute care access. At our 224-bed hospital, ambulance acceptance and admissions remained stagnant despite regional demand, suggesting a capacity mismatch. The aim of this study was to evaluate whether centralising admission coordination improves hospital admissions and operational efficiency, while ensuring that staff workload remains manageable and patient safety is maintained.</p><p><strong>Methods: </strong>We conducted a single-centre, observational before-and-after study using monthly data from January 2024 to July 2025. Outcomes included inpatient numbers, ambulance arrivals/admissions, discharges, bed occupancy, length of stay and surgeries. Nursing overtime and patient safety indicators served as balancing measures. Changes before and after the intervention were compared using the Welch t-test. The core intervention was centralised admission coordination. Multivariable regression identified predictors of inpatient volume and statistical process control (SPC) with moving range charts assessed process stability.</p><p><strong>Results: </strong>After the operational change, mean monthly inpatients increased significantly (+49.3, p=0.003), a relative increase of approximately 10%. Ambulance-based admissions (+29.0, p<0.001), arrivals (+60.1, p=0.001) and discharges (+39.6, p=0.018) also rose significantly. Bed occupancy remained stable, as the increase in admissions balanced the shorter length of stay. Regression analysis identified ambulance-based admissions (β=+1.24, p<0.001) and surgeries (β=+1.09, p=0.002) as independent predictors of inpatient volume (adjusted R²=0.725). SPC demonstrated a sustained process shift in ambulance admissions, indicating stable systemic improvement. Although nursing overtime increased modestly (+1.14 hours/month, p<0.001), patient safety indicators, including falls and severe adverse events, remained stable.</p><p><strong>Conclusions: </strong>Enhancing emergency care capacity-primarily through increased ambulance acceptance and centralised coordination-substantially boosted inpatient volume and improved acute care access. These gains were achieved without imposing excessive additional workload or compromising patient safety.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403215","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}