BMJ Quality & Safety最新文献

{"title":"Improving the maternity experience for Black, African, Caribbean and mixed-Black families in an integrated care system: a multigroup community and interprofessional co-production prioritisation exercise using nominal group technique.","authors":"Sarindi Aryasinghe, Phoebe Averill, Carole Waithe, Susan Ibuanokpe, Rhianna Newby-Mayers, Nawal Lakhdar, Moussa Amine Sylla, Elizabeth Cox, Sabrina Das, Erik Mayer","doi":"10.1136/bmjqs-2024-017848","DOIUrl":"10.1136/bmjqs-2024-017848","url":null,"abstract":"<p><strong>Background: </strong>Ethnic inequities in maternity care persist in England for Black, African, Caribbean and mixed-Black heritage families, resulting in poorer care experiences and health outcomes than other minoritised ethnic groups. Co-production using an integrated care approach is crucial for reducing these disparities and improving care quality and safety. Therefore, this study aimed to understand the alignment of health and local authority professional perspectives with community needs on how to improve maternity experiences for this ethnic group within a London integrated care system (ICS).</p><p><strong>Methods: </strong>Between March and June 2024, five workshops were conducted with health professionals, local authorities, voluntary, community and social enterprise (VCSE) sector and the public from Black, African, Caribbean and mixed-Black heritage backgrounds across the North West London ICS. Using the nominal group technique (NGT), attendees prioritised ideas to improve the experience of maternity care for families from Black, African, Caribbean and mixed-Black heritage backgrounds, which were thematically synthesised using framework analysis.</p><p><strong>Results: </strong>Fifty-four attendees, covering primary, secondary, regional and national health professionals, public health teams from three local authorities, VCSE sector and the public, generated 89 potential interventions across 11 themes. All attendees prioritised improving staff knowledge and capacity in culturally competent care and communication. Community-identified needs for advocacy mechanisms and mental health support throughout the maternity pathway were not reflected in professional priorities.</p><p><strong>Conclusion: </strong>The study highlights the need for an integrated, community-centred approach beyond hospital settings when addressing ethnic inequities in maternity care, recognising key differences between community and professional priorities within an ICS. Leveraging lived experience expertise to lead the NGT community workshops was essential in building trust and buy-in of the overall prioritisation process.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"305-316"},"PeriodicalIF":5.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of text message reminders to improve paediatric immunisation rates: a randomised controlled quality improvement project.","authors":"Kyra Rosen, Holly Krelle, William C King, Nathan Klapheke, Paulo Pina, Judd Anderman, Alicia Chung, Felicia Mendoza, Ashley Bagheri, Jay Stadelman, Sarah Tsuruo, Leora Idit Horwitz","doi":"10.1136/bmjqs-2024-017893","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-017893","url":null,"abstract":"<p><p>Previous studies have demonstrated that text message reminders can improve pediatric vaccination rates, including low income & diverse settings such as those served by federally qualified health centers. In this study, we aimed to improve compliance with routine childhood immunizations via a text message intervention in a network of urban, federally qualified health centers at a large academic medical center. We targeted parents or guardians of children aged 0-2 years who were overdue or due within 14 days for at least one routine childhood immunization without a scheduled appointment. In Round 1, two versions of a text were compared to a control (no text). In subsequent Rounds, a new text was compared to a control (no text). In each round the content, wording, and frequency of texts changed. Subjects were randomized to receive a text (treatment group(s)) or to not receive a text (control group) in each round between 2020 and 2022. The primary outcome was whether overdue vaccines had been given by 12 week follow up. The secondary outcome was appointment scheduling within the 72 hours after text messages were sent. In Round 1 (n=1203) no significant differences were found between groups in overdue vaccine administration per group or per patient at follow up, or in appointment scheduling. In Round 2 (n=251) there was no significant difference in vaccine administration per group or per patient. However, significantly more patients in the intervention group scheduled an appointment (9.1% vs. 1.7%, p=0.01). In Round 3 (n=1034), vaccine administration was significantly higher in the intervention group compared to the control overall (7.0% vs. 5.5%, 0.016) and per subject (p=0.02). Significantly more patients in the intervention group scheduled an appointment compared to the control (3.3% vs. 1.2%, p=0.02). We found that text messaging can be an effective intervention to promote health service utilization such as pediatric vaccination rates, which although improved in this study, remain low.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":"34 5","pages":"339-348"},"PeriodicalIF":5.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing vaccine uptake in underserved populations using text message interventions: considerations and recommendations.","authors":"Gaby Judah","doi":"10.1136/bmjqs-2024-018245","DOIUrl":"10.1136/bmjqs-2024-018245","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"291-294"},"PeriodicalIF":5.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk-adjusted observed minus expected cumulative sum (RA O-E CUSUM) chart for visualisation and monitoring of surgical outcomes.","authors":"Quentin Cordier, Hugo Prieur, Antoine Duclos","doi":"10.1136/bmjqs-2024-017935","DOIUrl":"10.1136/bmjqs-2024-017935","url":null,"abstract":"<p><p>To improve patient safety, surgeons can continually monitor the surgical outcomes of their patients. To this end, they can use statistical process control tools, which primarily originated in the manufacturing industry and are now widely used in healthcare. These tools belong to a broad family, making it challenging to identify the most suitable methodology to monitor surgical outcomes. The selected tools must balance statistical rigour with surgeon usability, enabling both statistical interpretation of trends over time and comprehensibility for the surgeons, their primary users. On one hand, the observed minus expected (O-E) chart is a simple and intuitive tool that allows surgeons without statistical expertise to view and interpret their activity; however, it may not possess the sophisticated algorithms required to accurately identify important changes in surgical performance. On the other hand, a statistically robust tool like the cumulative sum (CUSUM) method can be helpful but may be too complex for surgeons to interpret and apply in practice without proper statistical training. To address this issue, we developed a new risk-adjusted (RA) O-E CUSUM chart that aims to provide a balanced solution, integrating the visualisation strengths of a user-friendly O-E chart with the statistical interpretation capabilities of a CUSUM chart. With the RA O-E CUSUM chart, surgeons can effectively monitor patients' outcomes and identify sequences of statistically abnormal changes, indicating either deterioration or improvement in surgical outcomes. They can also quantify potentially preventable or avoidable adverse events during these sequences. Subsequently, surgical teams can try implementing changes to potentially improve their performance and enhance patient safety over time. This paper outlines the methodology for building the tool and provides a concrete example using real surgical data to demonstrate its application.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"330-338"},"PeriodicalIF":5.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic delay: lessons learnt from marginalised voices.","authors":"Farah Acher Kaiksow","doi":"10.1136/bmjqs-2024-018192","DOIUrl":"10.1136/bmjqs-2024-018192","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"279-281"},"PeriodicalIF":5.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Audit and feedback to improve antibiotic prescribing in primary care-the time is now.","authors":"Bradley J Langford, Kevin L Schwartz","doi":"10.1136/bmjqs-2024-018081","DOIUrl":"10.1136/bmjqs-2024-018081","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"282-284"},"PeriodicalIF":5.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pragmatic randomised trial assessing the impact of peer comparison and therapeutic recommendations, including repetition, on antibiotic prescribing patterns of family physicians across British Columbia for uncomplicated lower urinary tract infections.","authors":"Greg Carney, Malcolm Maclure, David M Patrick, Jessica Otte, Anshula Ambasta, Wade Thompson, Colin Dormuth","doi":"10.1136/bmjqs-2024-017296","DOIUrl":"10.1136/bmjqs-2024-017296","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of a personalised audit and feedback prescribing report (AF) and brief educational summary (ES) on empiric treatment of uncomplicated lower urinary tract infections (UTIs) by family physicians (FPs).</p><p><strong>Design: </strong>Cluster randomised control trial.</p><p><strong>Setting: </strong>The intervention was conducted in British Columbia, Canada between 23 September 2021 and 28 March 2022.</p><p><strong>Participants: </strong>We randomised 5073 FPs into a standard AF and ES intervention arm (n=1691), an ES-only arm (n=1691) and a control arm (n=1691).</p><p><strong>Interventions: </strong>The AF contained personalised and peer-comparison data on first-line antibiotic prescriptions for women with uncomplicated lower UTI and key therapeutic recommendations. The ES contained detailed, evidence-based UTI management recommendations, incorporated regional antibiotic resistance data and recommended nitrofurantoin as a first-line treatment.</p><p><strong>Main outcome measures: </strong>Nitrofurantoin as first-line pharmacological treatment for uncomplicated lower UTI, analysed using an intention-to-treat approach.</p><p><strong>Results: </strong>We identified 21 307 cases of uncomplicated lower UTI among the three trial arms during the study period. The impact of receiving both the AF and ES increased the relative probability of prescribing nitrofurantoin as first-line treatment for uncomplicated lower UTI by 28% (OR 1.28; 95% CI 1.07 to 1.52), relative to the delay arm. This translates to additional prescribing of nitrofurantoin as first-line treatment, instead of alternates, in an additional 8.7 cases of uncomplicated UTI per 100 FPs during the 6-month study period.</p><p><strong>Conclusion: </strong>AF prescribing data with educational materials can improve primary care prescribing of antibiotics for uncomplicated lower UTI.</p><p><strong>Trial registration number: </strong>NCT05817253.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"295-304"},"PeriodicalIF":5.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-production in maternal health services: creating culturally safe spaces, respecting difference and supporting collaborative solutions.","authors":"Jennifer MacLellan, Carmen Byrne, Catherine Pope","doi":"10.1136/bmjqs-2024-018157","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-018157","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":"34 5","pages":"285-287"},"PeriodicalIF":5.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do healthcare professionals work around safety standards, and should we be worried? A scoping review.","authors":"Debbie Clark, Rebecca Lawton, Ruth Baxter, Laura Sheard, Jane K O'Hara","doi":"10.1136/bmjqs-2024-017546","DOIUrl":"10.1136/bmjqs-2024-017546","url":null,"abstract":"<p><strong>Background: </strong>Healthcare staff adapt to challenges faced when delivering healthcare by using workarounds. Sometimes, safety standards, the very things used to routinely mitigate risk in healthcare, are the obstacles that staff work around. While workarounds have negative connotations, there is an argument that, in some circumstances, they contribute to the delivery of safe care.</p><p><strong>Objectives: </strong>In this scoping review, we explore the circumstances and perceived implications of safety standard workarounds (SSWAs) conducted in the delivery of frontline care.</p><p><strong>Method: </strong>We searched MEDLINE, CINAHL, PsycINFO and Web of Science for articles reporting on the circumstances and perceived implications of SSWAs in healthcare. Data charting was undertaken by two researchers. A narrative synthesis was developed to produce a summary of findings.</p><p><strong>Results: </strong>We included 27 papers in the review, which reported on workarounds of 21 safety standards. Over half of the papers (59%) described working around standards related to medicine safety. As medication standards featured frequently in papers, SSWAs were reported to be performed by registered nurses in 67% of papers, doctors in 41% of papers and pharmacists in 19% of papers. Organisational causes were the most prominent reason for workarounds.Papers reported on the perceived impact of SSWAs for care quality. At times SSWAs were being used to support the delivery of person-centred, timely, efficient and effective care. Implications of SSWAs for safety were diverse. Some papers reported SSWAs had both positive and negative implications for safety simultaneously. SSWAs were reported to be beneficial for patients more often than they were detrimental.</p><p><strong>Conclusion: </strong>SSWAs are used frequently during the delivery of everyday care, particularly during medication-related processes. These workarounds are often used to balance different risks and, in some circumstances, to achieve safe care.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"317-329"},"PeriodicalIF":5.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142341462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomised controlled trial of audit-and-feedback strategies to reduce imaging overutilisation in the emergency department.","authors":"Karl T Chamberlin, Christopher DiTullio, Jennifer Rossman, Bruce A Barton, Martin Reznek, Kevin Kotkowski","doi":"10.1136/bmjqs-2024-018374","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-018374","url":null,"abstract":"<p><strong>Background: </strong>Evaluation of neck trauma is a common reason for emergency department (ED) visits. There are several validated clinical decision rules, such as the National Emergency X-Radiography Utilization Study (NEXUS) Cervical Spine (C-spine) Rule, that can be used to risk stratify these patients and identify low-risk patients who do not require CT imaging. Overutilisation of CT imaging exposes patients to unnecessary radiation, impairs hospital throughput and increases healthcare costs. Various audit-and-feedback strategies have been described in other settings, but it is not known whether these strategies are effective for reducing imaging overutilisation in the ED. Additionally, the effectiveness of face-to-face feedback strategies as compared with digital feedback strategies for addressing this problem has not been previously evaluated. The aim of this study was to compare audit-and-feedback strategies to reduce CT overutilisation in the ED.</p><p><strong>Methods: </strong>This was a prospective randomised controlled trial, in which emergency medicine clinicians were randomised into three arms to receive digital feedback, hybrid face-to-face/digital feedback or no feedback. Each clinician received three rounds of feedback on patient encounters in which they ordered a CT of the C-spine. Patient encounters were retrospectively reviewed to determine each clinician's overutilisation rate, defined as the percentage of patients who underwent CT of the C-spine despite being classified as low risk by NEXUS criteria.</p><p><strong>Results: </strong>A total of 78 emergency medicine clinicians were randomised into three arms. Baseline overutilisation rates for each group were 46%-47% of CT of the C-spine studies. After three rounds of audit-and-feedback strategy, the clinicians in the digital feedback group had an overutilisation rate of 33%, compared with 44% in the control group (p=0.020). The hybrid feedback group had an overutilisation rate of 36% (p=0.055 vs control; p=0.577 vs digital feedback). Over the study period, the digital group saw a reduction of 1.26 CT of the C-spine studies per provider per month (p=0.049), and the hybrid feedback group saw a reduction of 1.43 CTs per provider per month (p=0.044).</p><p><strong>Conclusion: </strong>A digital audit-and-feedback strategy is effective for reducing overutilisation of CT imaging of the C-spine in the ED, while the effectiveness of a hybrid strategy requires further investigation.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}