BMJ Open Quality最新文献

{"title":"Improving hydration among hospitalised older adults in an acute geriatric ward with a bundled multi-component intervention.","authors":"Shawn Lien Ler Tan, Aines Manickam, Nurulhuda Abdullah, Woon Fung Chai, Sarasuathi Gloria Encio Subramaniam, Long Xia Yuan, Magdalene Kim Choo Ng, Rachel Qiao Ming Ng","doi":"10.1136/bmjoq-2024-002805","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002805","url":null,"abstract":"<p><p>Dehydration compromises patient safety. Hospitalised frail older adults are at risk of dehydration, which can result in significant morbidity and mortality. However, current clinical practice workflows do not adequately address the issue of poor oral hydration. This study aims to analyse this problem and test solutions to increase the percentage of hospitalised older adults who consume at least 1 L of oral fluid per day from 15% to 60% in an acute geriatric ward over 3 months. A work group was formed to conduct this service improvement project. Extensive literature was searched and reviewed, brainstorming of workflow gaps along with discussions was carried out, and strategic solutions were developed. A series of implementations was carried out sequentially and cumulatively to target vital root causes. The implementations include the introduction of a bedside hydration flip chart, individualised fluid schedule chart, hydration rounds, posters to create a visual workplace and regular in-service talks for healthcare staff. The number of patients who met the minimum fluid intake was collected daily over 4 months to monitor for intervention success and sustainability. Implementing a bundled multi-component intervention increased the percentage of older adults who meet the minimum oral fluid intake of 1 L/day by 45%, making it a needful part in the management of geriatric inpatients to prevent dehydration.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953464","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":"Exploring the potential of geospatial mapping of emergency call data to improve ambulance services for older adults: a feasibility study in the south central region of England.","authors":"Carole Fogg, Phil King, Vivienne Parsons, Nicola Dunbar, Marcel Woutersen, Julia Branson, Helen Pocock, Patryk Jadzinski, Chloe Lofthouse-Jones, Bronagh Walsh, Dianna Smith","doi":"10.1136/bmjoq-2024-002977","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002977","url":null,"abstract":"<p><strong>Background: </strong>Ambulance trusts across the UK serve vast and varied regions, impacting equitable healthcare access, especially for older patients facing urgent, non-life-threatening conditions. Detailed variation in demand and service provision across these regions remains unexplored but is crucial for shaping effective care policies and organisation. Geospatial mapping techniques have the potential to improve understanding of variation across a region, with benefits for service design.</p><p><strong>Aim: </strong>To explore the feasibility of using geospatial techniques to map emergency 999 calls and outcomes for older adults within an academic-healthcare collaboration framework.</p><p><strong>Methods: </strong>The study used administrative and clinical data for patients aged ≥65 who made urgent calls to a regional ambulance service within 1 year. This data, aggregated by geographical area, was analysed using geospatial software (ArcGIS) to create detailed choropleth maps. These maps displayed metrics including population demographics, number of calls, response times, falls, dementia cases and hospital conveyance rates at the middle-layer super output area level. Feedback was solicited from internal stakeholders to enhance utility and focus on service improvements.</p><p><strong>Results: </strong>The analysis unveiled significant regional disparities in emergency call frequencies and ambulance requirements for older adults, with notable variations in hospital conveyance rates, ranging from 22% to 100% across different areas. The geographical distribution of falls and calls for people with dementia corresponded with the older population's distribution. Response times varied by location. Stakeholders recommended additional data incorporation for better map utility and identified areas for service enhancement, particularly in addressing conveyance rate disparities for falls.</p><p><strong>Conclusions: </strong>Leveraging aggregated ambulance service data for geospatial mapping of older adults' care demand and provision proves to be both feasible and insightful. The significant geographical variances in hospital conveyance highlight the need for further research. The development of academic-healthcare partnerships promotes resource and sharing of expertise, which should substantially benefit patient care for this vulnerable group.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962752","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 postoperative care for neurosurgical patients by a standardised protocol for urinary catheter placement: a multicentre before-and-after implementation study.","authors":"Jeanne-Marie Nollen, Anja H Brunsveld-Reinders, Ewout W Steyerberg, Wilco Peul, Wouter R van Furth","doi":"10.1136/bmjoq-2024-003073","DOIUrl":"10.1136/bmjoq-2024-003073","url":null,"abstract":"<p><strong>Introduction: </strong>Urinary catheterisation, including indwelling and clean intermittent catheterisation, is common in perioperative and postoperative care. Despite guidelines, practice variation is significant. Inappropriate catheterisation risks include urinary tract infections and reduced mobility, leading to prolonged hospital stays and increased antibiotic use. This study aims to improve postoperative care through appropriate catheterisation in neurosurgical groups frequently subjected to catheterisation.</p><p><strong>Methods: </strong>We conducted a multicentre, before-and-after study in four Dutch hospitals from June 2021 to January 2023, including adult neurosurgical patients who underwent pituitary gland tumour or spinal fusion surgery. Exclusion criteria included conditions requiring chronic catheter use. A multifaceted strategy was implemented, focusing on a uniform protocol, an educational programme and department-specific champions. The primary outcome was inappropriate catheterisation, analysed with ordinal logistic regression. Secondary outcomes included total catheterisations, urinary tract infections and length of hospital stay. Ethical approval was obtained. Strengthening the Reporting of Observational Studies in Epidemiology and SQUIRE checklists were used.</p><p><strong>Results: </strong>Among 3439 patients screened, 2711 were included, with 544 in the after group. The percentage of patients without inappropriate indwelling catheterisation increased from 46% to 57%, and the proportion without inappropriate clean intermittent catheterisation rose from 34% to 67%. Additionally, overall catheter use decreased: the percentage of patients not receiving an indwelling catheter increased from 54% to 64%, while those not requiring clean intermittent catheterisation rose from 89% to 92%. Infection rates and hospital stay were similar (1.4% and 1.3%; 4.9 and 5.1 days, respectively).</p><p><strong>Conclusions: </strong>Implementing a uniform protocol may significantly reduce inappropriate and overall catheterisation in neurosurgical patients, aligning with patient-centred, less invasive healthcare. Ongoing education and adherence to standardised protocols are crucial. Future research should assess the long-term sustainability of these strategies.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966053","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":"Mobile phone bacterial contaminations, associated factors and antimicrobial susceptibility pattern of bacteria isolates from health professionals' working in public health facilities of West Guji zone, Southern Ethiopia.","authors":"Alqeer Aliyo, Chaltu Bekele, Tibeso Gemechu, Wako Dedecha, Mekdes Getachew","doi":"10.1136/bmjoq-2025-003321","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003321","url":null,"abstract":"<p><strong>Background: </strong>Mobile device use in healthcare facilities is a concern because they can act as vehicles to transmit pathogenic bacteria that can cause infections. Thus, nosocomial infections are a significant health problem that affects more than a quarter of patients worldwide, particularly in developing countries. On the other hand, the increasing pattern of antimicrobial resistance of bacteria poses a major health concern.</p><p><strong>Objective: </strong>This study aimed to determine the prevalence, antimicrobial susceptibility patterns and associated factors of bacteria isolates among mobile phone of health professionals in public health facilities in the West Guji zone, Southern Ethiopia.</p><p><strong>Methods: </strong>A cross-sectional study was carried out on 240 mobile phones belonging to health professionals from May to June 2024. The study population was selected using a simple random sampling technique, and data were collected using a self-administered questionnaire. The samples were collected and tested using microbiological analysis to isolate and identify bacteria. Antimicrobial susceptibility tests were done by the Kirby-Bauer disk diffusion method on Mueller-Hinton agar. Data were entered into Epi-Data V.3.1 and exported to SPSS V.25 for bivariate and multivariate analyses. The factors with a p value <0.05 were considered statistically significant.</p><p><strong>Results: </strong>The overall prevalence of bacterial contamination on mobile phones was 102 (42.5%) (95 CI 36.3% to 48.8%). The bacteria isolates were <i>Coagulase-negative staphylococci</i> (CONS) 68 (65.4%), <i>Bacillus spp</i> 21 (20.2%) and <i>S. aureus</i> 15 (14.4%). The study revealed that being medical laboratory professionals (AOR=6.52, CI 95%, 1.33 to 31.93), mobile phones cleaned after every use and once daily were 94% and 98% less likely to be contaminated, and lack of handwashing practice before attending to the patients (AOR=12.91, CI 95%, 2.95 to 56.44) were factors statistically significantly associated with mobile phone contamination. Isolated <i>CONS</i> and <i>S. aureus</i> showed sensitivity to higher Sulphamethoxazole and Trimethoprim, while all <i>Bacillus spp</i> isolates were sensitive to Ciprofloxacin and Gentamicin.</p><p><strong>Conclusion: </strong>This study shows that mobile phones of health professionals were contaminated with various bacteria species. The highest resistance isolates were shown against tetracycline. We recommend promoting regular cleaning of mobile phones and proper hand washing practices when attending to patients.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12015704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963627","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":"Right approach: improvement in cleaning and disinfection of medical equipment in use - Sheikh Shakhbout Medical City (SSMC) experience.","authors":"Reham Jafer Al Hajjeh, Prameela Maniamma Maniamma, Joselita L Rego, Mohammad Awwad, Emmanuel Fru Nsutebu","doi":"10.1136/bmjoq-2024-002958","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002958","url":null,"abstract":"<p><strong>Background: </strong>In 2021, Sheikh Shakhbout Medical City (SSMC) faced an increase in hospital-onset multidrug-resistant organisms; <i>Candida auris</i> increased to 1.4 per 1000 patient days, within critical care areas. This rise prompted the infection prevention and control team to enhance cleaning and disinfection practices, aiming to reduce infection transmission risks. The focus was on adherence to a structured cleaning protocol, which included high standards of equipment disinfection, regular audits and the establishment of roles and responsibilities for staff involved in cleaning and disinfection.</p><p><strong>Methods: </strong>To improve compliance, the team initiated regular audits starting in May 2021, which revealed an initial compliance rate of 49%. These audits assessed adherence to infection control standards for equipment cleaning, including the thoroughness of cleaning for high-touch areas on medical devices. A multidisciplinary team met regularly to develop a risk-based categorisation system for equipment, providing clear guidelines on cleaning practices. In parallel, targeted training programmes were rolled out for environmental service personnel and nurses. By October 2023, a tagging system was implemented to streamline protocols and improve adherence by marking equipment with specific cleaning instructions.</p><p><strong>Results: </strong>The audits showed progressive improvements in compliance, reaching a peak of 100% by late 2022. However, staffing changes and turnovers affected adherence, with a temporary drop to 78% compliance in January 2023. The introduction of the tagging system in October 2023 contributed to a stabilised compliance rate exceeding 90% by early 2024, demonstrating the effectiveness of systematic interventions. The hospital-onset multidrug-resistant organism \"<i>C. auris\"</i> decreased to 0.5 per 1000 patient days in 2024.</p><p><strong>Discussion: </strong>Transferring cleaning responsibilities and implementing new tools emphasised the need for continuous training and communication. The risk-based categorisation and tagging systems were particularly effective in reinforcing cleaning protocols, even as staff turnover posed challenges.</p><p><strong>Conclusions: </strong>Through these strategic initiatives, SSMC significantly improved the cleaning and disinfection of medical equipment in critical care, reducing the presence of hospital-onset <i>C. auris</i> and enhancing patient safety. Ongoing evaluation and adaptation remain vital for sustaining high standards in infection control.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12015705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959288","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":"Enhancing patient satisfaction and experience through bedside interdisciplinary rounds: a quality improvement study.","authors":"Wael Ghali, Amer Abu-Shanab, Hardikkumar Bhanderi, Kelly Lewis, Elesia Grant, Kenneth Granet","doi":"10.1136/bmjoq-2025-003314","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003314","url":null,"abstract":"<p><strong>Introduction: </strong>Interdisciplinary rounds (IDRs) involve collaborative patient care where healthcare professionals from various disciplines meet to discuss and plan patient management. In this project, bedside IDRswere introduced at our hospital to enhance care quality, improve communication among medical teams and increase patient satisfaction.</p><p><strong>Methodology: </strong>After educating the staff, bedside IDRs were implemented with a team consisting of hospitalists, medical residents, nurses, nurse leaders, nutritionists, case managers and social workers, who gathered at each patient's bedside to discuss treatment plans and involve patients and their families in real-time discussions. Patient satisfaction was evaluated using Press Ganey (PG) scores over a 7-month period, comparing them with pre-implementation scores. Additionally, staff feedback on workflow and communication was gathered through pre- and postsurveys.</p><p><strong>Results: </strong>Over 7 months, bedside IDRs led to significant improvements in patient satisfaction and physician-patient communication, as reflected in PG scores. Patients reported feeling more respected and listened to, with a greater understanding of their disease and treatment plan. Staff surveys showed notable improvements in inter-departmental communication and discharge planning effectiveness.</p><p><strong>Discussion: </strong>Bedside IDRs improved key patient care aspects, including communication, respect and understanding of treatment plans. By involving the entire healthcare team in patient discussions, a more collaborative and patient-centred approach was fostered, leading to patients feeling heard and respected. A clearer, unified treatment plan improved patients' understanding of their care. Despite initial coordination challenges, these were addressed with standardised scheduling. Overall, bedside IDRs resulted in better communication among providers, more comprehensive care plans, timely discharges and increased patient satisfaction, ultimately enhancing healthcare delivery.</p><p><strong>Conclusion: </strong>Ultimately, bedside IDRs contributed to improved healthcare delivery, with positive outcomes on different aspects. These findings highlight the potential of bedside IDRs to improve the quality of care and patient satisfaction in hospital settings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12015713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982097","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 PJ paralysis for hospitalised patients: a quality improvement initiative.","authors":"Frances Carr, Pamela Mathura, Jennifer Symon","doi":"10.1136/bmjoq-2024-003195","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003195","url":null,"abstract":"<p><strong>Introduction: </strong>PJ paralysis refers to the negative effects experienced by hospitalised patients who remain inactive and dressed in hospital clothing, and is a serious problem, affecting one-third of hospitalised older adults. This study evaluated the impact of a multicomponent hospital-based intervention to get patients out of bed, dressed in non-hospital attire, and moving around/mobilised.</p><p><strong>Methods: </strong>A 3-month quality improvement initiative was conducted at one hospital unit in Western Canada, which aimed for 50% of all patients to be dressed in their own clothing by midday, sitting up in a chair for all meals and mobilising to activities. Healthcare providers, patients and family members received PJ paralysis education, and a new patient dress code care standard and physician patient care order were implemented. Measures included: daily percentage of patients dressed and up for meals, weekly mobilisation rates, patient and provider satisfaction, and complication rates. Descriptive statistics were completed.</p><p><strong>Results: </strong>From July to October 2019, 70 patients participated. Approximately 14.3% of patients were dressed in their own clothing daily, 6.4% were sitting for all three meals, and the weekly mean number of patients mobilising to activities was 0.9 (SD 0.7) and mobilising for other reasons was 4.5 (SD 1.3). Five physician care orders were written. A trend was observed towards decreased falls, with minimal change in the number of staff, nursing assessment time and complication rates. Patient feedback revealed improvement in their self-identity.</p><p><strong>Conclusion: </strong>Alleviating PJ paralysis in hospitalised older patients requires a complex multifactorial approach. Despite not achieving the project aim, the intervention demonstrated positive impacts without complications or additional workload, and ease of implementation suggests feasibility and (potential) long-term sustainability. Further research is needed to explore the experiences and perceptions of patients and healthcare providers to identify facilitators and barriers, which may aid in enhancing and implementing future interventions.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12015703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979280","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":"Scaling up thrombectomy care in transitioning health systems: a qualitative study of stroke centres in Canada.","authors":"Tanaporn Jaroenngarmsamer, Borwornsom Leerapan, Rosalie V McDonough, Vivek Bodani, Syed Uzair Ahmed, Arshia Sehgal, Alexandre Poppe, Mayank Goyal, Timo Krings, Sirintara Singhara Na Ayudhaya","doi":"10.1136/bmjoq-2024-003149","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003149","url":null,"abstract":"<p><strong>Introduction: </strong>Endovascular thrombectomy has shown significant benefits for patients with large-vessel ischaemic stroke. However, many countries face challenges establishing effective thrombectomy delivery systems, even when thrombolysis services are already in place. Moreover, there is limited research on implementing thrombectomy care delivery, particularly for scale-ups in low- and middle-income countries. This study identifies the key drivers of enhancing thrombectomy delivery systems in three Canadian regions and provides lessons for health systems in transition.</p><p><strong>Methods: </strong>A qualitative research design with a phenomenological approach was employed. From January to December 2022, at three comprehensive ischaemic stroke centres in Canada, we involved non-participant observation and in-depth interviews with 91 key informants, including care providers and administrators engaged in large-vessel stroke care. Guided by the Behaviour Change Wheel and Theoretical Domains Framework, the data were transcribed and analysed using thematic content analysis.</p><p><strong>Results: </strong>Three critical themes emerged. First, establishing a cohesive, goal-oriented, multidisciplinary patient care team with an egalitarian culture is vital. Second, integrating specific feedback data is essential for continuous quality improvement and for optimising workflow through collective leadership. Lastly, even with existing thrombolytic services, centralised regional planning and outreach to local thrombectomy implementers is necessary. Development must occur at stroke centres and their associated peripheral hospitals to build effective thrombectomy care delivery systems.</p><p><strong>Conclusions: </strong>Enhancing thrombectomy care delivery systems requires a stepwise approach: first, establishing multidisciplinary teams at the micro-level; next, fostering collective leadership for continuous quality improvement at the meso-level and finally, coordinating regional outreach and centralised planning at the macro-level. The Canadian experience highlights the importance of addressing these interconnected levels and underscores the critical role of central planning and collaboration between policymakers and care providers. These strategies offer a structured pathway for improving stroke care globally, particularly in transitioning health systems.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961978","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":"Roads diverge: mapping the journey towards diagnostic health equity.","authors":"Lakshmi Krishnan, Yvonne Commodore-Mensah, Kelly T Gleason, David P W Rastall, David E Newman-Toker, Kathy McDonald","doi":"10.1136/bmjoq-2024-003135","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003135","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic disparities significantly impact health outcomes, with various factors influencing differential access and treatment across communities. This paper explores the complex landscape of diagnosis and of variable diagnostic journeys, focusing on the multifaceted nature of diagnostic inequities and proposing a socioecological model to understand and address these disparities.</p><p><strong>Methods: </strong>The authors employed an interdisciplinary approach, synthesising insights from their respective knowledge domains. Through iterative discussions, visual diagramming and narrative development, a new framework was constructed to address the complexity of diagnostic inequities.</p><p><strong>Results: </strong>The 'diagnostic environment' model was developed, conceptualising diagnosis beyond the biomedical process to include three levels of influence: atmospheric (broad, pervasive societal factors), surface (direct healthcare interactions) and subterranean (underlying, often invisible societal norms and biases). This model integrates process, social phenomena and multilevel influences to more comprehensively address diagnostic disparities. Two additional frameworks: diagnostic journeys within this environment and issue constellations guiding navigation and intervention were developed.</p><p><strong>Conclusions: </strong>Diagnostic processes are influenced by a range of factors from individual to systemic levels, often leading to significant disparities in health outcomes. The proposed model offers a framework for understanding these disparities and suggests targeted interventions to address them. By integrating diverse perspectives and focusing on multilevel influences, the framework aims to improve diagnostic equity.</p><p><strong>Implications: </strong>This study highlights the need for a more holistic approach to diagnosis, acknowledging the complex interplay of factors that contribute to diagnostic disparities. The socioecological model provides a basis for future research and policy interventions aimed at reducing these disparities and improving overall diagnostic accuracy and equity.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978290","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":"Technology-based challenges of informal clinical communication in an Australian tertiary referral hospital: a survey-based assessment of user perspectives.","authors":"Graeme K Hart, Lorelle Martin, Julia Todd, Nicole Hosking","doi":"10.1136/bmjoq-2024-002976","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002976","url":null,"abstract":"<p><strong>Background: </strong>Clinical communication failures result in errors, misdiagnosis, inappropriate treatment and poor care. Communication errors contribute to sentinel events and are an underlying factor in healthcare system issues.Formal clinical communication (FCC) tools, such as ISBAR (Identify, Situation, Background, Assessment, Response/Recommendation), improve patient outcomes. FCC governance is focused on electronic medical records (EMRs); however, much informal clinical communication (ICC) occurs outside of the EMR.ICC involves disparate platforms including pagers, SMS texts, encrypted messaging apps, phones and local radio networks. Documentation of ICC in the clinical record is low quality and not easily or routinely audited.</p><p><strong>Local problem: </strong>In 2019, our institution commenced a clinical governance assessment of ICC processes against version 2, Australian National Accreditation Standards for clinical communications. Process mapping of ICC indicated a paucity of relevant policy and procedures to govern ICC practices, with highly variable and overly complex processes.</p><p><strong>Aims: </strong>To document the technology used in informal communication between clinical and/or administrative staff.To document the self-perceived impact on staff of current communications methods.To document the self-perceived potential efficiency and safety impact of current communications methods.To identify key factors for consideration in organisation-wide informal clinical communication improvement.</p><p><strong>Method: </strong>Multidisciplinary online staff cross-sectional survey using Microsoft Forms.</p><p><strong>Results: </strong>115 self-selected clinical and administrative staff completed the survey. Multiple communication channels are used for ICC. Respondents noted high levels of frustration, delay, interruption and inefficiency. Desired communication improvements and use considerations were identified.</p><p><strong>Conclusions: </strong>There are gaps in governance standards for ICC. Sequential additions to technology platforms contribute to a high-risk communications environment. Staff perceptions of inefficiency, delay, frustration and a high level of patient safety risk were consistent across professions. This work informed the requirements for a subsequent development of an enterprise platform dedicated to improving ICC.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969791","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}