BMJ Open Quality最新文献

{"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}

{"title":"qREDS score compared with the REDS and NEWS2 scores to risk-stratify emergency department suspected sepsis patients for in-hospital mortality and 168-hour survival probability: a retrospective cohort study.","authors":"Narani Sivayoham, Oliver Mason, Adil N Hussain, Ashvni Sivanandan, Cameron Fleming","doi":"10.1136/bmjoq-2026-004168","DOIUrl":"10.1136/bmjoq-2026-004168","url":null,"abstract":"<p><strong>Background: </strong>The Risk-stratification of Emergency Department suspected Sepsis (REDS) score requires external validation. The six dichotomous variables and lactate can be accurately extracted electronically unlike refractory hypotension (RH), where the recording of the fluid-bolus and blood pressure measurement may be inaccurate. The impact of excluding RH is not known.</p><p><strong>Objectives: </strong>To develop the quick-REDS (qREDS) score, by removing RH from the REDS score and to validate its prognostic performance in comparison to the original score and the National Early Warning Score (NEWS)2 score, for all-cause in-hospital mortality and 168-hour survival probability (SP).</p><p><strong>Methods: </strong>Vital signs, blood results, outcome at 168 hours and at discharge, were extracted from the electronic records of emergency department (ED) adults admitted after intravenous antibiotics for an infection. The REDS, qREDS and NEWS2 scores were calculated, receiver operating characteristic (ROC) curves constructed for in-hospital all-cause mortality, the area under the ROC (AUROC) curves compared and cut-off points noted. Test-characteristics at cut-off points ≥1, ≥3, ≥5 and ≥7 were studied. Kaplan-Meier (KM) curves were constructed for all the scores for SP at 168 hours for score bands 0-2, 3-4 and ≥5.</p><p><strong>Results: </strong>Of 3202 patients, 433 died in hospital and 209 died at 168 hours. AUROC curve: REDS 0.74 (95% CI 0.72 to 0.75) and qREDS 0.73 (95% CI 0.71 to 0.75); both greater than NEWS2 0.66 (95% CI 0.65 to 0.68); p<0.0001. Cut-off points: REDS ≥3, qREDS ≥3 and NEWS2 ≥6. Specificity for in-hospital mortality of score ≥5; REDS 89.2% (95% CI 88.0% to 90.3%), qREDS 90.6% (95% CI 89.4% to 91.6%) and NEWS2 43.9% (95% CI 42.1% to 45.8%). All KM curves were significant, log-rank test p<0.0001. SP at 168 hours: whole population 93.4% (SE 0.4); SP at ≥5points: REDS 78.3% (SE 1.2), qREDS 78.0% (SE 2.0) and NEWS2 90.6% (SE 0.7). SP trends were similar at 24, 48 and 72 hours.</p><p><strong>Conclusion: </strong>qREDS is a valid surrogate for the REDS score and had significantly better prognostic performance than the NEWS2 score for in-hospital mortality and 168-hour survival probability, in ED patients with suspected sepsis.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395855","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":"Impact of integrating Quality Control Circle, Disease-Specific Care Certification and Enhanced Recovery After Surgery on perioperative outcomes in joint replacement.","authors":"Tuoh Wu, Wo-Jan Tseng, Cheng-Yo Lai, Tze-Hong Wong, Ying-Chi Wu, Wei-Tso Chia, Tung-Kung Wu","doi":"10.1136/bmjoq-2026-004147","DOIUrl":"10.1136/bmjoq-2026-004147","url":null,"abstract":"<p><strong>Background: </strong>Enhanced Recovery After Surgery (ERAS) programmes improve perioperative outcomes, but real-world adherence varies widely across institutions, limiting their effectiveness. Disease-Specific Care Certification (DSCC) provides governance and standardisation but lacks operational mechanisms for frontline implementation. This study evaluates an integrated Quality Control Circle (QCC) model aligned with DSCC and ERAS protocols to improve perioperative reliability and patient-centred outcomes in joint replacement.</p><p><strong>Methods: </strong>A pre-post quasi-experimental study was conducted involving 515 patients undergoing elective total joint replacement. A multidisciplinary QCC team employed root-cause analysis, Pareto prioritisation and iterative Plan-Do-Study-Act cycles to refine processes. DSCC governance principles were used to structure standardised pathways, unify documentation and reinforce interdisciplinary communication. Outcomes included ERAS compliance, length of stay (LOS), preoperative discomfort (thirst, dry mouth), unnecessary blood preparation, complications and staff competency.</p><p><strong>Results: </strong>ERAS compliance increased from 80.9% to 100% after implementation. Preoperative thirst (p=0.0156) and dry mouth scores (p=0.0073) improved significantly. LOS decreased from 6.63 to 5.98 days. Unnecessary blood preparation was reduced from 237 units to zero. Staff competency improved across all domains. No increase in postoperative complications or readmissions was observed.</p><p><strong>Conclusions: </strong>Integration of QCC operational tools, DSCC governance and ERAS clinical elements yielded substantial improvements in perioperative reliability, efficiency and patient comfort. The QCC-DSCC-ERAS hybrid model is feasible, scalable and potentially generalisable to other institutions seeking high-reliability perioperative care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395901","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 compliance with curative radiotherapy for cervical cancer in a high-volume centre in India: a bundled workflow (AID-CARE) quality improvement project.","authors":"Sreenivasa Rao Bonala, Bala Venkata Subramanian, Cherwin Venati, Henita Selvamary, Naveen Bhargav Talatoti, Gongada Sindhu","doi":"10.1136/bmjoq-2025-003874","DOIUrl":"10.1136/bmjoq-2025-003874","url":null,"abstract":"<p><p>Timely completion of curative chemoradiotherapy within 56 days is a key determinant of oncological outcomes in cervical cancer; however, achieving this target remains challenging in high-volume public-sector settings in low- and middle-income countries (LMICs). At a tertiary public-sector cancer centre in South India, routine clinical observations identified poor compliance with recommended radiotherapy timelines, with delays and treatment defaults occurring at multiple points along the care pathway. In response, a quality improvement project was undertaken to improve treatment timeliness and completion.A retrospective baseline audit confirmed substantial delays and high default rates among patients receiving curative-intent external beam radiotherapy, followed by intracavitary brachytherapy. Root cause analysis identified system-, staff- and patient-related factors contributing to poor compliance. Based on these findings, a bundled workflow intervention (AID-CARE) was developed, incorporating early brachytherapy assessment, planned interdigitation, accelerated schedules for delayed cases, structured patient counselling, staff education and prospective patient tracking. The intervention was implemented using sequential Plan-Do-Study-Act cycles, followed by a prospective re-audit and sustainment phase. The primary outcomes were compliance with an overall treatment time of ≤56 days and treatment default rates assessed over time using run charts.At baseline, only 18.6% of patients completed treatment within 56 days, whereas 46.2% defaulted and 35.2% experienced prolonged treatment duration. Following implementation, compliance with the recommended treatment timeline improved to 70.1%, with a marked reduction in treatment defaults to 6.2%. These improvements were maintained during the sustainment phase. No increase in acute treatment-related toxicity was noted.This quality improvement initiative demonstrates that a structured, workflow-driven and resource-conscious approach can substantially and sustainably improve compliance with recommended radiotherapy timelines for cervical cancer in high-volume public-sector settings, with potential applicability to similar centres in LMICs.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395850","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}