BMJ Open Quality最新文献

{"title":"Impact of educational videos and user guide on indwelling pleural catheter caregiver training and unplanned healthcare encounters.","authors":"Si Ling Young, Brian Lee Wei Chua, Qiao Li Tan, Carrie Kah-Lai Leong, Ivana Gilcrist Chiew Sian Phua, Jane Jing Yi Wong, Wen Ting Lim, Kendra Jing Ying Tang, Aaron Jun Jie Tan, Fena Ming Qin Lee, Ken Junyang Goh","doi":"10.1136/bmjoq-2024-003108","DOIUrl":"10.1136/bmjoq-2024-003108","url":null,"abstract":"<p><strong>Background: </strong>Indwelling pleural catheters (IPCs) are an effective first line option for the management of symptomatic malignant pleural effusions. However, patients with IPCs often require unplanned healthcare encounters (UHEs) due to complications or concerns with IPC care and drainage.</p><p><strong>Local problem: </strong>There is a lack of readily accessible IPC-specific educational material to support caregiver training (CGT). As IPC care and drainage are performed primarily by patients and caregivers in our country due to the lack of community nursing support, ineffective CGT may lead to increased UHEs due to caregiver knowledge gaps or poor confidence in managing and caring for IPCs.</p><p><strong>Aims: </strong>We aim to reduce the number of IPC-related UHEs.</p><p><strong>Methods and interventions: </strong>We used a 5-why diagram and identified a lack of appropriate educational material as a key factor contributing to repeated UHEs. We therefore produced and employed IPC-specific educational videos and user guides, using a 'Plan-Do-Study-Act' approach, into our CGT programme. Patient demographics and clinical outcomes were collected prospectively for 166 consecutive patients with IPC insertions, with 72 patients in the preintervention group and 94 in the postintervention group. Survey questionnaires addressing caregiver competency and confidence were also administered after CGT using these tools.</p><p><strong>Results: </strong>There was a significant decrease in the proportion of patients who had ≥2 (8.5% vs 40.9%, p<0.001) or ≥3 UHEs (3.2% vs 31.8%, p<0.001) in the intervention group. There was also a higher caregiver competency score achieved in the intervention group (7 (IQR: 7-7) vs 5 (IQR: 5-7), p<0.001). There was no difference in overall complication and IPC-related infection rates between groups.</p><p><strong>Conclusion: </strong>IPC-specific educational videos and resources, which are readily accessible and easily implemented into CGT programmes, reduce UHEs due to IPC-related issues and may improve caregiver knowledge and competency in IPC care and drainage.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing prematurity-related neonatal mortality: a quality improvement project in Gandhi Memorial Hospital, Addis Ababa, Ethiopia.","authors":"Biniam Yohannes Wotango, Wubet Mihretu Workneh, Tariku Deressa Abdana, Hailegebriel Kidane, Mahlet Alemayehu, Dawit Niku, Birtukan Alene, Aynekulu Aragaw, Zafu Belay, Tigist Adenew, Gebremeskel Tamene Hailu, Yeneneh Getachew Haile","doi":"10.1136/bmjoq-2024-003058","DOIUrl":"10.1136/bmjoq-2024-003058","url":null,"abstract":"<p><strong>Background: </strong>Neonatal deaths refer to infants who die within the first 28 days of life, and they account for almost 50% of all child deaths under the age of 5 globally. Preterm birth is the primary reason for neonatal deaths, and it can lead to various complications that may prove fatal for newborns, such as respiratory distress syndrome, sepsis and intracranial haemorrhages. There was a high rate of neonatal mortality at Gandhi Memorial Hospital. 57.7% of neonatal deaths were caused by premature-related problems according to Pareto chart analysis. The baseline mortality rate among premature neonates admitted to the Neonatal Intensive Care Unit (NICU) was 20.7%. The objective of this quality improvement project was to reduce prematurity-related neonatal death at Gandhi Memorial Hospital.</p><p><strong>Methods: </strong>A multidisciplinary quality improvement team used a fishbone diagram to analyse the causes of neonatal deaths related to prematurity. We used the Institute for Healthcare Improvement (IHI) model for improvement, using Plan-Do-Study-Act cycles to measure progress and make data-driven decisions.</p><p><strong>Interventions: </strong>Transporting premature neonates born in the labour ward to NICU with CPAP, increasing the use of a continuous positive airway pressure (CPAP) device with an integrated oxygen concentrator, blender and compressor, and implementing the infection prevention checklist with four components were the implemented change ideas.</p><p><strong>Results: </strong>The run chart showed a 25.6% reduction in prematurity-related neonatal mortality after implementing three interventions, and evidenced by a shift below the baseline median.</p><p><strong>Conclusion and recommendation: </strong>The quality improvement project involving three interventions which are transporting premature neonates from labour ward to NICU with CPAP, using a CPAP device with an integrated oxygen concentrator, blender and compressor for preterm neonates and infection prevention checklist use with four components at Gandhi Memorial Hospital effectively reduced prematurity-related neonatal death. To improve neonatal outcome in premature neonates, we recommend that hospitals should prioritise implementing a standardised CPAP transport protocol, increasing a CPAP device with an integrated oxygen concentrator, blender and compressor use in the NICU, and fully implementing the infection prevention Checklist.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439975","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 and family engagement interventions for enhancing patient safety in the perioperative journey: a scoping review.","authors":"Ayshe Seyfulayeva, Bianca Ferreira Fonte, Ana Margarida Alho, Anum Shaikh, Ana Beatriz Nunes, Pedro Gonçalves Carvalho Casaca, Andreia Leite, Ayda Taha, Neelam Dhingra-Kumar, Paulo Sousa","doi":"10.1136/bmjoq-2024-002986","DOIUrl":"10.1136/bmjoq-2024-002986","url":null,"abstract":"<p><strong>Background: </strong>Surgical procedures present intricate challenges within healthcare delivery, often associated with higher risks of adverse events compared with non-surgical contexts. Patient and family engagement (PFE) throughout the perioperative journey is a possibility to enhance care quality, safety and patient-centredness. However, literature addressing PFE across the entirety of the perioperative journey remains sparse.</p><p><strong>Objective: </strong>The current scoping review aims to comprehensively map the existing interventions with PFE approach focused on improving patient safety across various types of surgical procedures throughout the perioperative journey. In addition, the review aims to understand the level and type of PFE approach adopted in this context.</p><p><strong>Eligibility criteria: </strong>Articles published in indexed peer-reviewed journals from 2003 to 2023, written in English, Portuguese or Spanish, that report on interventions with PFE approach targeting adult surgical patients, their families, caregivers, patient advocates and patient champions. The review includes articles reporting on both inpatient and ambulatory surgical patients.</p><p><strong>Methods: </strong>Following Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews framework, this review systematically searched PubMed, Web of Science, SCOPUS, CINAHL, and PsycINFO for relevant articles. Eligible interventions were categorised using PFE framework regarding the level of engagement and mapped according to the WHO Global Patient Safety Action Plan 2021-2030.</p><p><strong>Results: </strong>Out of 765 records initially identified, 32 met the eligibility criteria for data extraction and analysis, of which 40% originated from the USA, followed by the UK (18%) and Canada (12%). 47% of the interventions targeted 'multiple/all types' of procedures, 19% focused on cardiothoracic surgeries and 9% on gynaecological procedures or organ transplant. The majority of the interventions (88%) focused on PFE at the direct care level, predominantly adopting a consultation-based approach. Furthermore, 81% of eligible interventions emphasised patient information and education, 16% addressed codevelopment of policy and 3% of interventions focused on patient advocacy.</p><p><strong>Conclusion: </strong>The findings show a predominant focus on PFE interventions targeting patient safety at the direct care level, particularly in the provision of patient information and education. However, interventions at organisational and policy-making levels are notably scarce. Further investment is required to promote interventions engaging patients and families at broader organisational and policy-making levels.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439974","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":"Resident encounters with disruptive workplace behaviours in Japan: findings from a national cross-sectional study.","authors":"Takashi Watari, Virginia Sheffield, Ashwin Gupta, Kaori Taniguchi, Yasuharu Tokuda, Yuji Nishizaki","doi":"10.1136/bmjoq-2024-003093","DOIUrl":"10.1136/bmjoq-2024-003093","url":null,"abstract":"<p><strong>Importance: </strong>Disruptive workplace behaviours (DWBs) between healthcare professionals compromise patient care quality and organisational culture, impacting staff morale, communication and teamwork. Residents are particularly vulnerable to it from nurses and supervisors.</p><p><strong>Objective: </strong>Elucidate factors associated with DWBs experienced by residents.</p><p><strong>Design: </strong>Nationwide cross-sectional study using a web-based survey.</p><p><strong>Setting: </strong>Japanese postgraduate clinical training hospitals.</p><p><strong>Participants: </strong>First- and second-year postgraduate residents were surveyed between 15 and 31 January 2023, immediately after participating in the nationally administered computer-based residency exam.</p><p><strong>Exposure: </strong>None.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes include previously published eight types of DWBs experienced by residents. Resident characteristics at the time of the study were used. Hospital data (location of the training hospital, number of beds, number of emergency transports, average length of hospital stays, number of outpatients per day and the actual number of residents, full-time physicians and nurses) were obtained from Japan's largest hospital information database.</p><p><strong>Results: </strong>Of 5403 residents analysed, 68.3% were males, and 84.9% were under 28 years of age. Residents reported encountering DWBs from physicians and nurses approximately 35% of the time, a roughly equivalent percentage from both groups. After multivariate logistic regression analysis, the likelihood of encountering DWBs from nurses increased with hospital size (>700 beds; adjusted OR (aOR) 2.19; 501-700 beds; aOR 1.45 and 301-500 beds; aOR 1.26, all statistically significant). Furthermore, DWBs from nurses were significantly more prevalent in settings with higher admissions per nurse (aOR 1.70). DWBs from physicians were significantly more prevalent towards male (vs female) residents (aOR 1.60) and less likely among the second-year postgraduate (vs first-year postgraduate) residents (aOR 0.87).</p><p><strong>Conclusions: </strong>DWBs from nurses are significantly more common with increasing hospital bed numbers and increase with the number of admissions per nurse. No such correlation was observed with DWBs from physicians. Male residents experience more DWBs than female residents.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432523","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":"Successful posthospitalisation oncology workflow implementing LACE+ score to stratify and reduce readmissions within a safety-net hospital.","authors":"Cindy M Pabon, Janine Wong, Marcela Perez, Jessica Jimenez-Abarca, Lianchun Xiao, Lymesia Jackson, Anne Park, Anjali Lankford, Vinita Akula, Saumil Datar, Taylor Hopper, Yaser Alkhatib, Terri Earles, Tejal Patel","doi":"10.1136/bmjoq-2024-003068","DOIUrl":"10.1136/bmjoq-2024-003068","url":null,"abstract":"<p><strong>Background: </strong>Patients with advanced cancers visit the emergency room and get hospitalised frequently, with potentially half of these visits being avoidable. Our institution provides comprehensive, low-cost cancer treatment to a safety-net population in Texas. We performed a retrospective review of hospital readmission patterns amongst our oncology patients and developed a posthospitalisation workflow to reduce readmissions.</p><p><strong>Method: </strong>Following discharge, oncology patients were risk stratified based on their Length of stay, Acuity of admission, Charlson comorbidity index score and Emergency department visits+index in the past 6 months. The higher the score, the quicker the outpatient oncology follow-up. In addition to addressing acute issues related to hospitalisation, patients were also able to receive newly translated resources while in clinic.</p><p><strong>Results: </strong>The preintervention 30-day-readmission rate was 17.3% (June 2022-December 2022) (95% CI 13.4% to 21.8%). Meanwhile, the postintervention 30-day-readmission rate was 14.7% (June 2023-December 2023) (95% CI 10.9% to 19.2%). While a 2.6% reduction in readmissions was achieved, this decrease was not statistically significant (-2.6%; 95% CI -8.4% to 3.2%; p value=0.375). Emergency use utilisation decreased from 90% to 15%.</p><p><strong>Conclusions: </strong>Our team was able to facilitate and coordinate outpatient care for oncology patients following hospitalisation. The expedited care allowed providers to ensure that the care plan after hospitalisation was well understood and accessible to the patient. Furthermore, language-appropriate resources were provided to patients at that time. Our intervention was feasible, easy to implement and quick to produce tangible improvements in patient care. More time is needed to determine whether this will create a statistically significant impact on readmission rates.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413187","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 follow-up visits among individuals with hypertension: Quality Improvement project in the District Hospital, Seoni, Madhya Pradesh, India, 2021-2022.","authors":"Rupali Bharadwaj, Mogan Kaviprawin, Namita Neelkanth, Vinod Kumar Navkar, Mohamed Jainul Azarudeen, Ganeshkumar Parasuraman, Archana Ramalingam, Prabhdeep Kaur","doi":"10.1136/bmjoq-2024-003124","DOIUrl":"10.1136/bmjoq-2024-003124","url":null,"abstract":"<p><strong>Background: </strong>In India, to achieve a 25% relative reduction in the prevalence of raised blood pressure (BP) by 2025, approximately 4.5 crore additional people with hypertension will need to have their BP effectively treated. We conducted a Quality Improvement (QI) initiative to improve follow-up and reduce missed visits among individuals with hypertension registered under India Hypertension Control Initiative, District Hospital, Seoni, Madhya Pradesh, India, in 2022.</p><p><strong>Methods: </strong>We conducted a quasiexperimental study from January to September 2022 in the District Hospital in Seoni, Madhya Pradesh. Following the Ishikawa diagram, the major root causes for missed visits were identified, and countermeasures were developed. The packages under Plan-Do-Study-Act (PDSA) included (i) training urban Accredited Social Health Activists to conduct house visits for individuals with missed visits and (ii) triangulating the follow-up records from various information systems. The review meetings for QI initiatives were conducted fortnightly to follow-up PDSAs. We calculated the proportion of individuals who were followed-up monthly, and the proportion of missed visits among those registered quarterly.</p><p><strong>Results: </strong>Cumulatively, 2850 individuals were registered with hypertension till September 2022. Following the intervention, the monthly follow-up proportion increased from 21% in January to 37% in September 2022. Missed visit proportion decreased from 66% (228/345) in quarter four, 2021, to 22% (40/180) in quarter three, 2022. Of the 1438 individuals counselled by ASHA home visits, 74.9% returned for follow-up.</p><p><strong>Conclusion: </strong>In our setting, QI initiatives suggested that missed visits decreased during the intervention period. However, the interventions must be implemented continuously for better monitoring and use in similar settings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413182","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":"Developing and piloting a peer quality improvement coaching protocol for front-line healthcare staff.","authors":"Petar Popivanov, Siobhan Eithne McCarthy, Mairead Finn","doi":"10.1136/bmjoq-2024-002967","DOIUrl":"10.1136/bmjoq-2024-002967","url":null,"abstract":"<p><strong>Background: </strong>Improving the quality of patient care remains a global necessity. Despite system and professional benefits, current evidence indicates that the spread of improvement principles among front-line healthcare workers remains poor.While education and training alone are unlikely to result in consistent improvement practice, coaching can play a critical role in sustainable, evidence-based improvement implementation. Peer quality improvement coaching (PQIC) places the power and agency in the shared relationship between coach and coachee to shape coachee quality improvement (QI) outcomes.Study objective was to develop and pilot an evidence-based protocol for implementation and evaluation of a PQIC for front-line staff engaged in small to intermediate improvement efforts.</p><p><strong>Methods: </strong>We conducted a multistage case-study design and implementation process. First, a systematised literature review identified themes about the theory and practice of QI coaching (QIC). Second, these themes guided the development of a PQIC protocol. Finally, the protocol was piloted and evaluated among staff in a single-centre tertiary maternity hospital. PQIC effectiveness was assessed using evaluation tools identified in the literature.</p><p><strong>Results: </strong>Effectiveness; strategies and models; moderating factors and methods for evaluation of QIC emerged from the literature. Together with Bloom's taxonomy and Kirkpatrick's educational model, these themes informed the development of this PQIC protocol. It was piloted in three steps: education, coaching and evaluation. A survey revealed that the participants in the education step achieved excellent scores. Following the coaching journey, the coached multidisciplinary team leaders completed their improvement initiatives and demonstrated increased QI knowledge and skills measured by the 'IHI improvement advisor self-assessment tool' and 'IHI assessment scale for collaboratives'.</p><p><strong>Conclusion: </strong>Built on established education, peer coaching and QI concepts, this evidence-based PQIC protocol adds to international evidence on how to support front-line healthcare workers in their improvement efforts. Future research needs to assess protocol effectiveness across different settings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the implementation of a multicomponent intervention to improve faecal immunochemical test-based (FIT) colorectal cancer screening in primary care.","authors":"Kamala Adhikari, Muhammad Kashif Mughal, James Whitworth, Danica Hignell, Barbara Moysey, Jawad Chishtie, Gary F Teare","doi":"10.1136/bmjoq-2024-003004","DOIUrl":"10.1136/bmjoq-2024-003004","url":null,"abstract":"<p><p>Screening has proven effective at reducing the incidence and mortality of colorectal cancer (CRC). The faecal immunochemical test (FIT) is recommended for screening people aged 50-74 years at average risk of CRC in Alberta, Canada. This project implemented a multicomponent intervention in real-world, primary care settings in Alberta to improve the FIT participation rate and evaluated the reach, effectiveness and implementation outcomes.The multicomponent intervention comprised of in-clinic FIT kit distribution, patient education and reminder calls, was implemented in four primary care clinics. Reach was measured as the proportion of patients receiving the intervention. Effectiveness was measured by comparing the proportion of patients completing FIT during preintervention and perintervention periods. Implementation was measured by the perceived acceptability, appropriateness and feasibility of providers in implementing the intervention. Data were collected from electronic medical records and validated survey tools.Four clinics implemented the intervention during an 8-month study period (September 2021 to April 2022); 99% of eligible patients received a FIT kit. The baseline FIT completion rate across participating clinics was 62%, which increased by 13 percentage points to 75% during the intervention period. Of the 75% who completed the FIT, 56% did without a reminder call, whereas 19% did so after receiving one or more reminders. More than 90% of providers perceived the intervention implementation as acceptable, feasible and appropriate.The multicomponent FIT intervention was perceived as acceptable, feasible, and appropriate and improved the FIT screening rates in pilot clinics. An implementation guidance document has been developed and tested to communicate the implementation process for use by other primary care clinics and aid in the spread of the intervention across Alberta. Implementing this intervention in routine practice can help decrease the incidence and mortality of CRC.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373452","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 quality and outcomes of extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest: the Phoenix ECPR project.","authors":"Waqas Akhtar, Eftychia Galiatsou, Sofia Pinto, Maria Comanici, Emanuele Gerlando, Timothy Pitt, Joe Hughes, Olaf Maunz, Elia Keating, Michael Taylor, Anthony McKay, Julia Gangata, Sumesh Thiruthalil, Eleanor Ross, Sophie Avetoom, Jane Durrant, Jill Smith, Ciara Collins, Majid Akhtar, Anand Jothidasan, Maria Monteagudo-Vela, Mark Mason, Ian McGovern, Jerry Mitchell, Hatem Soliman Aboumarie, Orinta Kviatkovske, Caroline Bullen, Sachin Mehta, Sundeep Kaul, Donna Hall, Clara Hernandez Caballero, Ana Hurtado, Nick Lees, Vasileios Panoulas, Alex Rosenberg","doi":"10.1136/bmjoq-2024-002934","DOIUrl":"10.1136/bmjoq-2024-002934","url":null,"abstract":"<p><strong>Background: </strong>Survival for cardiac arrest remains poor, and the use of extracorporeal cardiopulmonary resuscitation (ECPR) has been suggested as a potential therapy to improve outcomes. Harefield Hospital has been performing ECPR for over a decade; however outcomes have been historically poor.</p><p><strong>Methods: </strong>A retrospective analysis was performed of all ECPR cases at Harefield Hospital between April 2018 and April 2023. A new structured system including a systematic screening process, strict exclusion criteria, assessment of resuscitation adequacy through physiological stop criteria, drilled and standardised cannulation process, post-resuscitation care and neuroprognostication was rolled out on 1 April 2023. A comparison of ECPR performed pre and post was undertaken.</p><p><strong>Results: </strong>With the institution of the new system, 13 patients were treated with ECPR over 1 year; of which nine (69.2%) survived with good neurological outcomes at 6 months. In the preceding 3 years, there had been 22 cases; of which, two survived (9.1%). This was a statistically significant higher survival with HR of 4.56 (CI 2.1, 10.2, p<0.05).The average length of hospital stay in the new system was 61.3 days; of which, 32.4 days were in the intensive care unit.</p><p><strong>Conclusions: </strong>This study shows that it is possible to significantly improve outcomes in ECPR in a single centre by introducing into standard practice, a high-quality bundle of care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363507","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":"What about physician wellness? Impact of a quality improvement intervention.","authors":"Pamela Mathura, Isabella Pascheto, Jennifer Ringrose, Gillian Ramsay","doi":"10.1136/bmjoq-2024-003078","DOIUrl":"10.1136/bmjoq-2024-003078","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) consultations with general internal medicine (GIM) are required when patients need admission, assistance with safe disposition or evaluation and management of complex or acute medical needs. GIM physicians often balance responsibilities between hospital wards and the ED, which can lead to delayed ED consultations, difficulty balancing workload and potential burn-out. To address this issue, a quality improvement (QI) initiative was trialled, establishing a dedicated GIM ED consultation service to manage these duties independently. This study aimed to evaluate the impact of this intervention on physician wellness.</p><p><strong>Methods: </strong>A pre-post design was used, with two questionnaires adapted from the validated Mini Z version 2.0 (Zero Burnout Program) Worklife measure for clinicians. These were distributed via Google Forms to collect feedback from participating GIM physicians before and after the intervention. Data were analysed using descriptive statistics and the Mini Z outcome measurement scale.</p><p><strong>Results: </strong>13 physicians completed the surveys. Applying the Mini Z scale, the GIM ED consultation service had no impact on physician well-being or burn-out. There was a minor increase in satisfaction (1 point) and stress levels (2 points), and the working environment worsened slightly (1 point). Comparing preintervention and postintervention survey responses, job satisfaction improved (36%), while reports of 'burn-out' (23%) and 'beginning to burn out' (8%) decreased. Postintervention, physicians reported decreased time for documentation (23%), a perception of a more chaotic work environment (23%) and an increase in work encroaching on personal time (15%) when on the ED consultation service. Additionally, there was a 23% reduction in the likelihood of needing to reduce clinical teaching unit service weeks.</p><p><strong>Conclusion: </strong>When conducting QI initiatives, consider measuring the wellness of physicians and other healthcare providers. Proactively integrating wellness strategies into interventions requires further exploration which may enhance participant experience and initiative sustainability.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073803","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}