BMJ Open Quality最新文献

{"title":"Development of a novel rapid response event review process for quality improvement.","authors":"Michael Osnard, Rebecca R Meredith, Kara Grace Leventhal, Sonia P Dalal, Timothy M Niessen, Gigi Liu, Rebecca Engels, Cora Lehet, Michael R Cox, Ashley Haas, Marissa Proffen, Maggie Chan, Benjamin E Bodnar","doi":"10.1136/bmjoq-2023-002664","DOIUrl":"10.1136/bmjoq-2023-002664","url":null,"abstract":"<p><strong>Introduction: </strong>Rapid response team (RRT) and code activation events occur relatively commonly in inpatient settings. RRT systems have been the subject of a significant amount of analysis, although this has been largely focused on the impact of RRT system implementation and RRT events on patient outcomes. There is reason to believe that the structured assessment of RRT and code events may be an effective way to identify opportunities for system improvement, although no standardised approach to event analysis is widely accepted. We developed and refined a protocolised system of RRT and code event review, focused on sustainable, timely and high value event analysis meant to inform ongoing improvement activities.</p><p><strong>Methods: </strong>A group of clinicians with expertise in process and quality improvement created a protocolised analytic plan for rapid response event review, piloted and then iteratively optimised a systematic process which was applied to all subsequent cases to be reviewed.</p><p><strong>Results: </strong>Hospitalist reviewers were recruited and trained in a methodical approach. Each reviewer performed a chart review to summarise RRT events, and collect specific variables for each case (coding). Coding was then reviewed for concordance, at monthly interdisciplinary group meetings and 'Action Items' were identified and considered for implementation. In any 12-month period starting in 2021, approximately 12-15 distinct cases per month were reviewed and coded, offering ample opportunities to identify trends and patterns.</p><p><strong>Conclusion: </strong>We have developed an innovative process for ongoing review of RRT-Code events. The review process is easy to implement and has allowed for the timely identification of high value improvement opportunities.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11168121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141299945","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":"Correction: Promoting hot debriefing in an emergency department.","authors":"","doi":"10.1136/bmjoq-2020-000913corr1","DOIUrl":"10.1136/bmjoq-2020-000913corr1","url":null,"abstract":"","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11163616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141282982","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":"Using the Translating Research into Practice framework to develop a diabetes prevention intervention in primary care: a mixed-methods study.","authors":"Eva Tseng, Katherine Smith, Jeanne M Clark, Jodi B Segal, Jill A Marsteller, Nisa M Maruthur","doi":"10.1136/bmjoq-2024-002752","DOIUrl":"10.1136/bmjoq-2024-002752","url":null,"abstract":"<p><strong>Background: </strong>Pre-diabetes affects one-third of US adults and increases the risk of type 2 diabetes. Effective evidence-based interventions, such as the Diabetes Prevention Program, are available, but a gap remains in effectively translating and increasing uptake of these interventions into routine care.</p><p><strong>Methods: </strong>We applied the Translating Research into Practice (TRiP) framework to guide three phases of intervention design and development for diabetes prevention: (1) summarise the evidence, (2) identify local barriers to implementation and (3) measure performance. In phase 1, we conducted a retrospective cohort analysis of linked electronic health record claims data to evaluate current practices in the management of pre-diabetes. In phase 2, we conducted in-depth interviews of 16 primary care physicians, 7 payor leaders and 31 patients to elicit common barriers and facilitators for diabetes prevention. In phase 3, using findings from phases 1 and 2, we developed the core elements of the intervention and performance measures to evaluate intervention uptake.</p><p><strong>Results: </strong>In phase 1 (retrospective cohort analysis), we found few patients with pre-diabetes received diabetes prevention interventions. In phase 2 (stakeholder engagement), we identified common barriers to include a lack of knowledge about pre-diabetes among patients and about the Diabetes Prevention Program among clinicians. In phase 3 (intervention development), we developed the START Diabetes Prevention Clinical Pathway as a systematic change package to address barriers and facilitators identified in phases 1 and 2, performance measures and a toolkit of resources to support the intervention components.</p><p><strong>Conclusions: </strong>The TRiP framework supported the identification of evidence-based care practices for pre-diabetes and the development of a well-fitted, actionable intervention and implementation plan designed to increase treatment uptake for pre-diabetes in primary care settings. Our change package can be adapted and used by other health systems or clinics to target prevention of diabetes or other related chronic conditions.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11163602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260790","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":"Antenatal cardiotocography in primary midwife-led care: a budget impact analysis.","authors":"Elise Neppelenbroek, Ângela Jornada Ben, Bas S W A Nij Bijvank, Judith E Bosmans, Carola J M Groenen, Ank de Jonge, Corine J M Verhoeven","doi":"10.1136/bmjoq-2023-002578","DOIUrl":"10.1136/bmjoq-2023-002578","url":null,"abstract":"<p><strong>Objectives: </strong>In many countries, the healthcare sector is dealing with important challenges such as increased demand for healthcare services, capacity problems in hospitals and rising healthcare costs. Therefore, one of the aims of the Dutch government is to move care from in-hospital to out-of-hospital care settings. An example of an innovation where care is moved from a more specialised setting to a less specialised setting is the performance of an antenatal cardiotocography (aCTG) in primary midwife-led care. The aim of this study was to assess the budget impact of implementing aCTG for healthy pregnant women in midwife-led care compared with usual obstetrician-led care in the Netherlands.</p><p><strong>Methods: </strong>A budget impact analysis was conducted to estimate the actual costs and reimbursement of aCTG performed in midwife-led care and obstetrician-led care (ie, base-case analysis) from the Dutch healthcare perspective. Epidemiological and healthcare utilisation data describing both care pathways were obtained from a prospective cohort, survey and national databases. Different implementation rates of aCTG in midwife-led care were explored. A probabilistic sensitivity analysis was conducted to estimate the uncertainty surrounding the budget impact estimates.</p><p><strong>Results: </strong>Shifting aCTG from obstetrician-led care to midwife-led-care would increase actual costs with €311 763 (97.5% CI €188 574 to €426 072) and €1 247 052 (97.5% CI €754 296 to €1 704 290) for implementation rates of 25% and 100%, respectively, while it would decrease reimbursement with -€7 538 335 (97.5% CI -€10 302 306 to -€4 559 661) and -€30 153 342 (97.5% CI -€41 209 225 to -€18 238 645) for implementation rates of 25% and 100%, respectively. The sensitivity analysis results were consistent with those of the main analysis.</p><p><strong>Conclusions: </strong>From the Dutch healthcare perspective, we estimated that implementing aCTG in midwife-led care may increase the associated actual costs. At the same time, it might lower the healthcare reimbursement.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11163679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260788","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":"Does proactive care in care homes improve survival? A quality improvement project.","authors":"David Attwood, Suzy V Hope, Stuart G Spicer, Adam L Gordon, James Boorer, Wendy Ellis, Michelle Earley, Jillian Denovan, Gerard Hart, Maria Williams, Nicholas Burdett, Melissa Lemon","doi":"10.1136/bmjoq-2024-002771","DOIUrl":"10.1136/bmjoq-2024-002771","url":null,"abstract":"<p><strong>Background: </strong>NHS England's 'Enhanced Health in Care Homes' specification aims to make the healthcare of care home residents more proactive. Primary care networks (PCNs) are contracted to provide this, but approaches vary widely: challenges include frailty identification, multidisciplinary team (MDT) capability/capacity and how the process is structured and delivered.</p><p><strong>Aim: </strong>To determine whether a proactive healthcare model could improve healthcare outcomes for care home residents.</p><p><strong>Design and setting: </strong>Quality improvement project involving 429 residents in 40 care homes in a non-randomised crossover cohort design. The headline outcome was 2-year survival.</p><p><strong>Method: </strong>All care home residents had healthcare coordinated by the PCN's Older Peoples' Hub. A daily MDT managed the urgent healthcare needs of residents. Proactive healthcare, comprising information technology-assisted comprehensive geriatric assessment (i-CGA) and advanced care planning (ACP), were completed by residents, with prioritisation based on clinical needs.Time-dependent Cox regression analysis was used with patients divided into two groups:Control group: received routine and urgent (reactive) care only.Intervention group: additional proactive i-CGA and ACP.</p><p><strong>Results: </strong>By 2 years, control group survival was 8.6% (n=108), compared with 48.1% in the intervention group (n=321), p<0.001. This represented a 39.6% absolute risk reduction in mortality, 70.2% relative risk reduction and the number needed to treat of 2.5, with little changes when adjusting for confounding variables.</p><p><strong>Conclusion: </strong>A PCN with an MDT-hub offering additional proactive care (with an i-CGA and ACP) in addition to routine and urgent/reactive care may improve the 2-year survival in older people compared with urgent/reactive care alone.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11163642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141246918","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 door-to-analgesia timing in musculoskeletal injuries in an academic emergency department in India: a quality improvement project.","authors":"Anuusha Sadasivam S, Aswin Kumaran, S Manu Ayyan, S N Sindujaa","doi":"10.1136/bmjoq-2024-002815","DOIUrl":"10.1136/bmjoq-2024-002815","url":null,"abstract":"<p><strong>Introduction: </strong>Pain, more frequently due to musculoskeletal injuries, is a prevalent concern in emergency departments (EDs). Timely analgesic administration is paramount in the acute setting of ED. Despite its importance, many EDs face challenges in pain management and present opportunities for improvement. This initiative aimed to expedite the administration of the first analgesic in patients with musculoskeletal pain in the ED.</p><p><strong>Local problem: </strong>Observations within our ED revealed that patients with musculoskeletal injuries triaged to yellow or green areas experienced prolonged waiting times, leading to delayed analgesic administration, thereby adversely affecting clinical care and patient satisfaction.</p><p><strong>Specific aim: </strong>The aim of our quality improvement (QI) project was to reduce the time to administration of first analgesia by 30% from baseline, in patients with musculoskeletal injuries presenting to our academic ED, in a period of 8 weeks after the baseline phase.</p><p><strong>Methods: </strong>A multidisciplinary QI team systematically applied Point-of-Care Quality Improvement and Plan-Do-Study-Act (PDSA) cycle methodologies. Process mapping and fishbone analyses identified the challenges in analgesia administration. Targeted interventions were iteratively refined through PDSA cycles.</p><p><strong>Interventions: </strong>Interventions such as pain score documentation at triage, fast-tracking of patients with moderate-to-severe pain, resident awareness sessions, a pain management protocol and prescription audits were executed during the PDSA cycles. Successful elements were reinforced and adjustments were made to address the identified challenges.</p><p><strong>Results: </strong>The median door-to-analgesia timing during the baseline phase was 55.5 min (IQR, 25.75-108 min). During the postintervention phase, the median was significantly reduced to 15 min (IQR, 5-37 min), exceeding the anticipated outcomes and indicating a substantial 73% reduction (p value <0.001) from baseline.</p><p><strong>Conclusion: </strong>Implementing simple change ideas resulted in a substantial improvement in door-to-analgesia timing within the ED. These findings significantly contribute to ongoing discussions on the optimisation of pain management in emergency care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11163673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141246929","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":"Abuse in Canadian long-term care homes: a mixed methods study.","authors":"Andrea Baumann, Mary Crea-Arsenio, Victoria Smith, Valentina Antonipillai, Dina Idriss-Wheeler","doi":"10.1136/bmjoq-2023-002639","DOIUrl":"10.1136/bmjoq-2023-002639","url":null,"abstract":"<p><strong>Objective: </strong>To examine reported cases of abuse in long-term care (LTC) homes in the province of Ontario, Canada, to determine the extent and nature of abuse experienced by residents between 2019 and 2022.</p><p><strong>Design: </strong>A qualitative mixed methods study was conducted using document analysis and descriptive statistics. Three data sources were analysed: LTC legislation, inspection reports from a publicly available provincial government administrative database and articles published by major Canadian newspapers. A data extraction tool was developed that included variables such as the date of inspection, the type of inspection, findings and the section of legislation cited. Descriptive analyses, including counts and percentages, were calculated to identify the number of incidents and the type of abuse reported.</p><p><strong>Results: </strong>According to legislation, LTC homes are required to protect residents from physical, sexual, emotional, verbal or financial abuse. The review of legislation revealed that inspectors are responsible for ensuring homes comply with this requirement. An analysis of their reports identified that 9% (781) of overall inspections included findings of abuse. Physical abuse was the most common type (37%). Differences between the frequency of abuse across type of ownership, location and size of the home were found. There were 385 LTC homes with at least one reported case of abuse, and 55% of these homes had repeated incidents. The analysis of newspaper articles corroborated the findings of abuse in the inspection reports and provided resident and family perspectives.</p><p><strong>Conclusions: </strong>There are substantial differences between legislation intended to protect LTC residents from abuse and the abuse occurring in LTC homes. Strategies such as establishing a climate of trust, investing in staff and leadership, providing standardised education and training and implementing a quality and safety framework could improve the care and well-being of LTC residents.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11163654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141246822","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":"SafeVRwards: Designing a complementary virtual reality module to the Safewards framework intended to relax and manage conflict in mental health wards.","authors":"Susanna Pardini, Shua Kim, Belmir de Jesus, Marilia K S Lopes, Kristine Leggett, Thiago H Falk, Christopher Smith, Lora Appel","doi":"10.1136/bmjoq-2024-002769","DOIUrl":"10.1136/bmjoq-2024-002769","url":null,"abstract":"<p><strong>Background: </strong>Aggression and negative activation in mental health inpatient units pose significant challenges for both patients and staff with severe physical and psychological ramifications. The Safewards model is an evidence-based conflict-containment framework including 10 strategies, such as 'Calm Down Methods'. As virtual reality (VR) scenarios have successfully enhanced anxiolytic and deactivating effects of therapeutic interventions, they are increasingly considered a means to enhance current models, like Safewards.</p><p><strong>Objectives: </strong>The present participatory design investigates the feasibility and user experience of integrating VR therapy as an add-on strategy to the Safewards model, gathering preliminary data and qualitative feedback from bedside staff in an adult inpatient mental health unit.</p><p><strong>Methods: </strong>An exploratory within-subjects design combining qualitative observations, self-report questionnaires and semistructured interviews is employed with four nurse champions from the mental health unit at Michael Garron Hospital (Toronto, Canada).</p><p><strong>Results: </strong>A chronological overview of the design process, adaptations and description of the user experience is reported.</p><p><strong>Conclusion: </strong>'SafeVRwards' introduces VR as a promising conflic-containment strategy complementary to the Safewards model, which can be optimised for deployment through user-oriented refinements and enhanced customisation capacity driven by clinical staff input.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11163655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141246935","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":"Performance evaluation of ChatGPT in detecting diagnostic errors and their contributing factors: an analysis of 545 case reports of diagnostic errors.","authors":"Yukinori Harada, Tomoharu Suzuki, Taku Harada, Tetsu Sakamoto, Kosuke Ishizuka, Taiju Miyagami, Ren Kawamura, Kotaro Kunitomo, Hiroyuki Nagano, Taro Shimizu, Takashi Watari","doi":"10.1136/bmjoq-2023-002654","DOIUrl":"10.1136/bmjoq-2023-002654","url":null,"abstract":"<p><strong>Background: </strong>Manual chart review using validated assessment tools is a standardised methodology for detecting diagnostic errors. However, this requires considerable human resources and time. ChatGPT, a recently developed artificial intelligence chatbot based on a large language model, can effectively classify text based on suitable prompts. Therefore, ChatGPT can assist manual chart reviews in detecting diagnostic errors.</p><p><strong>Objective: </strong>This study aimed to clarify whether ChatGPT could correctly detect diagnostic errors and possible factors contributing to them based on case presentations.</p><p><strong>Methods: </strong>We analysed 545 published case reports that included diagnostic errors. We imputed the texts of case presentations and the final diagnoses with some original prompts into ChatGPT (GPT-4) to generate responses, including the judgement of diagnostic errors and contributing factors of diagnostic errors. Factors contributing to diagnostic errors were coded according to the following three taxonomies: Diagnosis Error Evaluation and Research (DEER), Reliable Diagnosis Challenges (RDC) and Generic Diagnostic Pitfalls (GDP). The responses on the contributing factors from ChatGPT were compared with those from physicians.</p><p><strong>Results: </strong>ChatGPT correctly detected diagnostic errors in 519/545 cases (95%) and coded statistically larger numbers of factors contributing to diagnostic errors per case than physicians: DEER (median 5 vs 1, p<0.001), RDC (median 4 vs 2, p<0.001) and GDP (median 4 vs 1, p<0.001). The most important contributing factors of diagnostic errors coded by ChatGPT were 'failure/delay in considering the diagnosis' (315, 57.8%) in DEER, 'atypical presentation' (365, 67.0%) in RDC, and 'atypical presentation' (264, 48.4%) in GDP.</p><p><strong>Conclusion: </strong>ChatGPT accurately detects diagnostic errors from case presentations. ChatGPT may be more sensitive than manual reviewing in detecting factors contributing to diagnostic errors, especially for 'atypical presentation'.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141236405","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":"Quality improvement collaborative for improving patient care delivery in Argentine public health sector intensive care units.","authors":"Cecilia Inés Loudet, Facundo Jorro Barón, Rosa Reina, María Del Pilar Arias López, Silvia Liliana Alegría, Cecilia Del Valle Barrios, Rodolfo Buffa, María Laura Cabana, Eleonora Roxana Cunto, Simón Fernández Nievas, Mariel Ayelén García, Luz Gibbons, Gabriela Izzo, María Natalia Llanos, Claudia Meregalli, José Joaquín Mira, María Elena Ratto, Mariano Luis Rivet, Javier Roberti, Ana María Silvestri, Analía Tévez, Leonardo Joaquín Uranga, Graciela Zakalik, Viviana Rodríguez, Ezequiel García-Elorrio","doi":"10.1136/bmjoq-2023-002618","DOIUrl":"10.1136/bmjoq-2023-002618","url":null,"abstract":"<p><strong>Background: </strong>The demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll.</p><p><strong>Objective: </strong>The aim was to achieve adequate personal protective equipment (PPE) use in 90% of patient encounters, to reach 90% compliance with objectives of patient flow (OPF) and to provide emotional support tools to 90% of healthcare workers (HCWs).</p><p><strong>Methods: </strong>We conducted a quasi-experimental study with an interrupted time-series design in 14 ICUs in Argentina. We randomly selected adult critically ill patients admitted from July 2020 to July 2021 and active HCWs in the same period. We implemented a quality improvement collaborative (QIC) with a baseline phase (BP) and an intervention phase (IP). The QIC included learning sessions, periods of action and improvement cycles (plan-do-study-act) virtually coached by experts via platform web-based activities. The main study outcomes encompassed the following elements: proper utilisation of PPE, compliance with nine specific OPF using daily goal sheets through direct observations and utilisation of a web-based tool for tracking emotional well-being among HCWs.</p><p><strong>Results: </strong>We collected 7341 observations of PPE use (977 in BP and 6364 in IP) with an improvement in adequate use from 58.4% to 71.9% (RR 1.2, 95% CI 1.17 to 1.29, p<0.001). We observed 7428 patient encounters to evaluate compliance with 9 OPF (879 in BP and 6549 in IP) with an improvement in compliance from 53.9% to 67% (RR 1.24, 95% CI 1.17 to 1.32, p<0.001). The results showed that HCWs did not use the support tool for self-mental health evaluation as much as expected.</p><p><strong>Conclusion: </strong>A QIC was effective in improving healthcare processes and adequate PPE use, even in the context of a pandemic, indicating the possibility of expanding QIC networks nationwide to improve overall healthcare delivery. The limited reception of emotional support tools requires further analyses.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141236409","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}