BMJ Open Quality最新文献

{"title":"Evaluating physician associate students' perceptions of an online team-based learning session on stroke medicine.","authors":"Basaam Aweid, Allison Wiseman, Anna Russell, Anjaly Mirchandani, Natalie Parnis, Preman Rajalingam","doi":"10.1136/bmjoq-2024-002966","DOIUrl":"10.1136/bmjoq-2024-002966","url":null,"abstract":"<p><strong>Background and aims: </strong>Team-based learning (TBL) is an effective, active learning strategy that has been validated and used in medical schools. It consists of three phases; preparation, readiness assurance tests and application exercise. It follows a 'flipped classroom' model where assessment takes place at the beginning and encourages team discussions that emulate clinical practice. TBL has been used in medical education; however, there is a lack of literature on its use specifically in physician associate (PA) education. We therefore explored the perceptions of a Stroke TBL session among PA students in a UK PA Programme.</p><p><strong>Methods: </strong>The study took place during the COVID-19 pandemic; therefore, TBL was implemented virtually using online video conferencing platforms. The students' perceptions were then analysed using anonymous online questionnaires sent to them shortly after the session. The questionnaire included specific questions comparing TBL to other teaching methods such as problem-based learning (PBL).</p><p><strong>Results: </strong>Overall, the students felt that TBL was an effective teaching method that was better than other methods such as lectures and PBL.</p><p><strong>Conclusions: </strong>This was a small study of a single TBL session that provided rich qualitative data around students' perceptions. It is a good foundation for developing TBL further in UK PA Programmes. We encourage further use of this strategy with further studies in this area.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690842","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 laboratory delays in blood culture pathogen identification: a quality improvement project.","authors":"Fenella D Halstead, Goran Pinjuh, Grazia Antonacci, Nathan Proudlove","doi":"10.1136/bmjoq-2024-003153","DOIUrl":"10.1136/bmjoq-2024-003153","url":null,"abstract":"<p><p>Sepsis is a medical emergency caused by bacteria in the bloodstream and a dysregulated immune response. It is important to identify the bacteria rapidly so that the patient receives effective antibiotics. Delays are associated with higher mortality levels and poorer clinical outcomes.Guidance requires full bacterial identification (ID) from bottle flagging positive, within 48 hours with older technology and 24 hours with modern platforms. Before this quality improvement project, we were using old technology including Analytical Profile Index (API) biochemical tests. Analysis highlighted very poor performance (mean 60 hours to ID), resulting in limited clinical utility and clinical incidents. There was great frustration among laboratory and clinical staff.This project aimed to reduce the time taken to obtain ID for positive blood cultures to meet the guidance within 6 months. Analysis led to a business case which helped secure funding for new equipment: a Matrix Assisted Laser Desorption Ionisation (MALDI) platform, to replace the time-consuming API process. MALDI uses time-of-flight mass spectrometry producing rapid ID of bacteria in minutes, indirectly (from agar plate colonies) or directly from blood.MALDI was introduced through two Plan-Do-Study-Act cycles, first with indirect analysis, then with direct. This spread the scientific staff training burden. The new process has dramatically reduced the mean time from flagging to pathogen ID to an average of 10.2 hours, and availability of ID within 24 hours has improved from 0% to 95%.We identified other change ideas for improvement (increasing staff availability and new technology for later stages), but these were parked due to time and funding pressures.Although there remain limitations (especially in terms of staffing hours and the onward communication of the ID result), the MALDI platform has revolutionised the sepsis service we can provide, so represents a substantial improvement in the quality of care that our patients can receive.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690981","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":"Leveraging principles of behavioural economics to encourage patient engagement with population health screening programmes.","authors":"Eric Bressman, Alexander Fanaroff, Katy Mahraj, Laurie Norton, Samantha Coratti, David Farraday, Carolina Garzon Mrad, Mikael Avery, Ayisha Arshad, Aileen John, David A Asch, Kevin G Volpp","doi":"10.1136/bmjoq-2024-003146","DOIUrl":"10.1136/bmjoq-2024-003146","url":null,"abstract":"<p><p>Cardiovascular disease is a leading cause of morbidity and mortality worldwide. We leveraged behavioural economics principles to encourage screening for cardiovascular disease risk factors. In a pilot, 60 high-risk patients were offered a complimentary home BP monitor and a lipid test through more convenient means (local lab, home phlebotomy, or self-test), along with financial incentives. Of these, 43.3% submitted the required BP readings, compared with 30.0% in a historical control group; 30.0% completed the lipid panel, versus 18.1% historically. While these results suggest that convenience and incentives can increase participation, over half of participants still did not complete the screenings, indicating a need for additional strategies to fully engage at-risk populations.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690977","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 illness and death: comparison of Load and QALY models.","authors":"Tim Benson","doi":"10.1136/bmjoq-2024-003190","DOIUrl":"10.1136/bmjoq-2024-003190","url":null,"abstract":"<p><strong>Background: </strong>When allocating resources health decision-makers make trade-offs between different outcomes, such as morbidity and mortality. The Load and QALY (quality-adjusted life year) models are two approaches that have been developed to help value health and care outcomes.</p><p><strong>Methods: </strong>I briefly describe preference judgements, the Load and QALY models.</p><p><strong>Results: </strong>The same preference judgement, based on the standard gamble, is applied to a single hypothetical individual's lifetime, who dies at age 75 after 3 years of illness. In this example, the morbidity/mortality ratio using the Load model is 50 times higher than using the QALY model.</p><p><strong>Conclusions: </strong>These findings, placing greater value on illness, call for further exploration, and in particular, whether the Load model can reshape healthcare policies and resource allocation.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>'</i>Monday's feel calmer when creative practitioners are here': a quality improvement project exploring whether creative-practitioner sessions on adult inpatient mental-health wards reduce levels of violence and aggression.","authors":"Luise V Marino, Sophie-Jo Peel, Lauren Iredale, Subha Thiyagesh, Wajid Khan, Vicki Whyte, Victoria Humble, David McQuillan","doi":"10.1136/bmjoq-2024-003122","DOIUrl":"10.1136/bmjoq-2024-003122","url":null,"abstract":"<p><strong>Background: </strong>Violence and aggression (V&A) are commonplace on mental-health wards and may lead to restrictive practice interventions (RPI), having a detrimental impact on patients and staff. In the 12 months preceding this quality improvement (QI) project, there was a mean V&A incidence of 52.7±113.0 and RPI of 37.6±84.1 per 1000 bed days.</p><p><strong>Methods: </strong>Using QI methodology, a project involving creative practitioners was codeveloped to provide a range of activities delivered via a 7-day service, across 13 inpatient mental-health wards in five hospital settings, using levels of V&A and RPI as outcome measures. The creative practices used drew on successful projects arising from a linked charity, Creative Minds. Three plan-do-study-act cycles were completed. (1) Coproduction with ward staff, patients and creative practitioners of 4-week session plans, including an induction training package for creative practitioners. (2) Streamlined and centralised communication between creative practitioners and participating wards using a project coordinator. (3) Implementation of a creative-practitioner Rota to better support ward activity planning, staff and patient expectation setting.</p><p><strong>Results: </strong>During the 12-month project wards with creative practitioners experienced statistically significant reduction in V&A levels (F (1, 168)=5.72, p=0.017) and RPI (F (1, 168)=8.40, p=0.0042). Wards not involved in the project, V&A levels (F (1, 142) =3.34, p<0.069) and RPI (F (132, 142)=0.99, p=0.52) remained unchanged. Ward length-of-stay was used as a balancing measure with no difference pre 45.0±4.9 days and post 46.9±5.0 days intervention (p=0.18). At the project peak, creative practitioners delivered around 300 hours per week of creative activity, which appears to be associated with reduced number of V&A/RPI incidents.</p><p><strong>Conclusions: </strong>Recommendations for the project's next steps are to secure sustained funding for creative practitioners to further enhance patients/staff well-being, as well as the coproduction of a creative-practitioner implementation guide to be tested in other mental-health inpatient settings as a part of a research study to better understand the impact of the type/timing of activities (ie, day/evening/weekends) on important patient outcomes and staff well-being.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656111","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":"Increasing take-home naloxone kit distribution to patients with substance use disorder before hospital discharge: a quality improvement project.","authors":"Daniel Wong, Lingsa Jia","doi":"10.1136/bmjoq-2024-002908","DOIUrl":"10.1136/bmjoq-2024-002908","url":null,"abstract":"<p><p>The ongoing drug toxicity crisis is a growing public health challenge in many countries across the world. Despite the WHO's recommendation of take-home naloxone (THN) kits as a cost-effective harm reduction strategy to prevent drug toxicity deaths, the Addiction Medicine Consult Team (AMCT) at Burnaby Hospital found that only 51% of their eligible patients were receiving a kit before discharge. In response, the AMCT created a quality improvement (QI) team with the aim of increasing their THN kit distribution rate on two hospital wards from 51% to over 80% within 10 months.Change ideas were implemented with the aim of targeting various components of the THN kit distribution process. Changes included adjusting THN kit inventory on wards, hosting education sessions for nurses, creating just-in-time training using nursing station whiteboards, streamlining the documentation process for nurses and standardising the ordering process for providers. The QI team collaborated with hospital interest holders including senior executives, nursing and pharmacy groups to facilitate change ideas. The project culminated with 4 months of sustained THN kit provision above 80%.The QI team is currently in talks with hospital operations to ensure that an effective documentation system will be integrated into the new electronic medical record system when the hospital transitions away from paper charting in 2025.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647070","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":"Economic case for reducing inequities in patient safety.","authors":"Luke Aaron Munford, Christopher J Armitage, Roger T Webb, Darren M Ashcroft","doi":"10.1136/bmjoq-2024-003042","DOIUrl":"10.1136/bmjoq-2024-003042","url":null,"abstract":"","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630112","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 time for vascular access salvage: initial results from a single institution's clinical practice improvement programme.","authors":"Kai Siang Chan, Enhui Yong, Li Zhang, Shufen Neo, Xueping Zhou, Joana Marie Eugenio Gray, Diomampo Katriz Abanto Elah, Ee Ling Ong, Ying Pan, Qiantai Hong, Malcolm Han Wen Mak, Lester Rhan Chaen Chong, Glenn Wei Leong Tan, Sundeep Punamiya, Gavin Lim, Gabriel Chan, Krishna Gummalla, Lawrence Han Hwee Quek, Pua Uei, Bien Peng Tan, Justin Kwan, Enming Yong","doi":"10.1136/bmjoq-2024-003138","DOIUrl":"10.1136/bmjoq-2024-003138","url":null,"abstract":"<p><strong>Background: </strong>One of the most common causes of arteriovenous fistula (AVF) and/or arteriovenous graft (AVG) failure is thrombosis. Guidelines recommend early AVF salvage within 24-48 hours. Our institution reported poor compliance with these recommendations, with a median of 3 days prior to vascular access (VA) salvage. We present our initial results following the implementation of a clinical practice improvement programme (CPIP) to reduce delay to VA salvage.</p><p><strong>Methods: </strong>The CPIP was conducted in three phases: pre-CPIP (23 January to 30 April 2023), CPIP pre-intervention (22 May to 3 September 2023) and CPIP post-intervention (4 September 2023 to 7 January 2024). Root cause analysis was performed to identify factors resulting in VA salvage delay. Measures implemented included a platform for multidisciplinary communication on cases requiring VA salvage, implementation of a structured workflow and regular reminders to ensure compliance. Early salvage was defined as <48 hours from triage at the emergency department. Time from admission to VA salvage, length of stay, incidence of femoral catheter (FC) insertion and overall cost savings were collected.</p><p><strong>Results: </strong>There were 82 patients (90.1%) who received VA salvage during the CPIP period. The median age was 67 years with a male predominance (64%). There were 45 patients (54.9%) who received early VA salvage during CPIP. The run chart showed a median early VA salvage rate of 6.1% for pre-intervention and 81.0% for post-intervention. The median length of stay pre-intervention and post-intervention was 5.65 days and 2.92 days, respectively. The incidence of FC insertion was 17.1% (n=6/35) during CPIP for thrombosed VA. Eight patients failed to obtain early VA salvage during the post-intervention period. Overall hospitalisation cost savings per patient were SGD$3144 lower post-intervention.</p><p><strong>Conclusion: </strong>We report the successful implementation of our CPIP through the involvement of stakeholders and stepwise implementation of measures using a structured protocol.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630131","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":"Validation and application of a tool to assess self-confidence to do improvement.","authors":"Annette Richardson, Jon Rees","doi":"10.1136/bmjoq-2024-003130","DOIUrl":"10.1136/bmjoq-2024-003130","url":null,"abstract":"<p><strong>Introduction: </strong>Increasing improvement capability in the workforce is vital within healthcare. The type of quality improvement training to increase capability varies. One way to measure the impact of improvement training is self-confidence to do improvement.</p><p><strong>Objectives: </strong>Our objectives were to validate a tool to assess self-confidence to do improvement and to observe the degree of change before and after improvement training. We aimed to assess the degree of impact on self-confidence associated with varying exposure to quality improvement training.</p><p><strong>Methods: </strong>We used an online 10-item and 4-point scale to assess self-confidence before and after improvement training. Reliability analysis using Cronbach's alpha was performed. The nature of the underlying construct was investigated using exploratory factor analysis and a full set of pre and post measures were used, and to compare individual question changes, a series of paired Wilcoxon tests were performed with Bonferroni post hoc corrections for multiple comparisons. To assess the differing lengths of programmes, individual results from each programme were combined meta-analytically with course duration added as a moderator.</p><p><strong>Results: </strong>252 completed questionnaires were analysed at baseline and a full set of pre and post measures were available for 128 participants. Cronbach's alpha for the tool was satisfactory at 0.93 (0.92-0.94) and measured a single underlying construct with an eigenvalue of 6.17. A significant increase in confidence to improve from before to after intervention was found (t(127) = 14.36, p<0.001, d=1.27 (95% CI 1.03-1.50)). Post-testing differences were significant (F(6,125) = 2.89, p=0.02) with shorter courses having significantly smaller increases in confidence.</p><p><strong>Conclusions: </strong>This manuscript provides a validated self-confidence tool to help assess improvement capability. Our tool offers a way to measure the impact of improvement capability on varying training durations and inform decisions about allocating staff time to this activity.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630005","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":"Mobility matters: a protocol to improve mobility and reduce length of stay in hospitalised older adults.","authors":"Fuyin Li, Kiat Sern Goh, Xia Yu, Gek Kheng Png, Teong Huang Samuel Chew, Guat Cheng Ang, Xuan Han Koh, Jismy Jose, Eleanor Stevenson","doi":"10.1136/bmjoq-2024-003084","DOIUrl":"10.1136/bmjoq-2024-003084","url":null,"abstract":"<p><p>Functional decline in hospitalised older adults aged 65 and above is a significant clinical problem. Despite its adverse outcomes, the problem of not mobilising older adult patients in clinical settings remains. Existing evidence suggests that a mobility protocol can be effective in addressing this concern. The aims of this quality improvement project were to determine whether a nurse-driven, multidisciplinary collaborative mobility protocol would increase the daily out-of-bed episodes, improve mobility level and reduce hospital length of stay (LOS). A nurse-driven mobility protocol was implemented in three phases. This five-component protocol included mobility assessment using the Johns Hopkins Highest Level of Mobility (JH-HLM) scale, documentation of mobility score, implementation of out-of-bed activities three times per day, communication of mobility score and goal at daily huddle, and indication of mobility score and goal on the board at patient's bed. Data were collected before and after the implementation. 142 patients were recruited from an acute geriatric unit. There were 72 patients from the pre-implementation group and 70 patients from the post implementation group. Comparing the pre-implementation and post implementation groups, the mean out-of-bed episodes per patient day increased from 0.80 to 3.59 (p<0.001). JH-HLM scores at discharge with ambulation status increased from 51.4% to 71.4% (p<0.001). Patients had improved JH-HLM scores with a median 2.00 (B 2.00, 95% CI 1.35 to 2.65, p<0.001) higher at discharge in the post implementation group after adjusting for score at admission. Increased mobility did not lead to any fall incidents. The mean hospital LOS was reduced from 15.67 (SD 11.30) days to 13.07 (SD 7.18) days (p=0.069). In conclusion, the implementation of a nurse-driven mobility protocol resulted in increased frequency of out-of-bed episodes and improved mobility, and reduction in LOS.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630113","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}