BMJ Quality & Safety最新文献

{"title":"Cluster randomised evaluation of a training intervention to increase the use of statistical process control charts for hospitals in England: making data count.","authors":"Kelly Ann Schmidtke, Laura Kudrna, Laura Quinn, Paul Bird, Karla Hemming, Zoe Venable, Richard Lilford","doi":"10.1136/bmjqs-2024-017094","DOIUrl":"10.1136/bmjqs-2024-017094","url":null,"abstract":"<p><strong>Background: </strong>The way that data are presented can influence quality and safety initiatives. Time-series charts highlight changes but do not clarify whether data lie outside expected variation. Statistical process control (SPC) charts make this distinction and have been demonstrated to be effective in supporting hospital initiatives. To improve the uptake of the SPC methodology by hospitals in England, a training intervention was created. The current study evaluates the effectiveness of that training against the background of a wider national initiative to encourage the adoption of SPC charts.</p><p><strong>Methods: </strong>A parallel cluster randomised trial was conducted with 16 English NHS hospitals. Half were randomised to the training intervention and half to the control. The primary analysis compares the difference in use of SPC charts within hospital board papers in a postrandomisation period (adjusting for baseline use). Trainees completed feedback forms with Likert scale and open-ended items.</p><p><strong>Results: </strong>Fifteen hospitals participated across the study arms. SPC chart use increased in both intervention and control hospitals between the baseline and postrandomisation period (29 and 30 percentage points, respectively). There was no statistically significant difference between the intervention and control hospitals in use of SPC charts in the postrandomisation period (average absolute difference 9% (95% CI -34% to 52%). In the feedback forms, 93.9% (n=31/33) of trainees affirmed learning and 97.0% (n=32/33) had formed an intention to change their behaviour.</p><p><strong>Conclusions: </strong>Control chart use increased in both intervention and control hospitals. This is consistent with a rising tide and/or contamination effect, such that the culture of control chart use is spreading across hospitals in England. Further research is needed to support hospitals implementing SPC training initiatives and to link SPC implementation to quality and safety outcomes. Such research could support future quality and safety initiatives nationally and internationally.</p><p><strong>Trial registration number: </strong>NCT04977414.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"621-630"},"PeriodicalIF":6.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139171","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":"Impact of a financial incentive on early rehabilitation and outcomes in ICU patients: a retrospective database study in Japan.","authors":"Yudai Honda, Jung-Ho Shin, Susumu Kunisawa, Kiyohide Fushimi, Yuichi Imanaka","doi":"10.1136/bmjqs-2024-017081","DOIUrl":"10.1136/bmjqs-2024-017081","url":null,"abstract":"<p><strong>Background: </strong>Early mobilisation of intensive care unit (ICU) patients has been recommended in clinical practice guidelines. Therefore, the Japanese universal health insurance system introduced an additional fee for early mobilisation and/or rehabilitation, which can be claimed by hospitals when starting rehabilitation of ICU patients within 48 hours after their ICU admission. However, the effect of this fee is unknown.</p><p><strong>Objective: </strong>To measure the proportion of ICU patients who received early rehabilitation and the impact on length of ICU stay, the length of hospital stay and discharged to home after the introduction of the financial incentive (additional fee for early mobilisation and/or rehabilitation).</p><p><strong>Design/methods: </strong>We included patients who were admitted to ICU within 2 days of hospitalisation between April 2016 and January 2020. We conducted interrupted time series analyses to assess the effects of the introduction of the financial incentive.</p><p><strong>Results: </strong>The proportion of patients who received early rehabilitation immediately increased after the introduction of the financial incentive (rate ratio (RR) 1.293, 95% CI 1.240 to 1.349). The RR for proportion of patients received early rehabilitation was 1.008 (95% CI 1.005 to 1.011) in the period after the introduction of the financial incentive compared with period before its introduction. There was no statistically significant change in the mean length of ICU stay, the mean length of hospital stay and the proportion of patients who were discharged to home.</p><p><strong>Conclusion: </strong>After the introduction of the financial incentive, the proportion of ICU patients who received early rehabilitation increased. However, the effects of the financial incentive on the length of ICU stay, the length of hospital stay and the proportion of patients who were discharged to home were limited.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"601-608"},"PeriodicalIF":6.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035165","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":"WHO research agenda on the role of the institutional safety climate for hand hygiene improvement: a Delphi consensus-building study.","authors":"Ermira Tartari, Julie Storr, Nita Bellare, Claire Kilpatrick, Maryanne McGuckin, Mitchell J Schwaber, Didier Pittet, Benedetta Allegranzi","doi":"10.1136/bmjqs-2024-017162","DOIUrl":"10.1136/bmjqs-2024-017162","url":null,"abstract":"<p><strong>Background: </strong>Creating and sustaining an institutional climate conducive to patient and health worker safety is a critical element of successful multimodal hand hygiene improvement strategies aimed at achieving best practices. Repeated WHO global surveys indicate that the institutional safety climate consistently ranks the lowest among various interventions.</p><p><strong>Methods: </strong>To develop an international expert consensus on research agenda priorities related to the role of institutional safety climate within the context of a multimodal hand hygiene improvement strategy, we conducted a structured consensus process involving a purposive sample of international experts. A preliminary list of research priorities was formulated following evidence mapping, and subsequently refined through a modified Delphi consensus process involving two rounds. In round 1, survey respondents were asked to rate the importance of each research priority. In round 2, experts reviewed round 1 ratings to reach a consensus (defined as ≥70% agreement) on the final prioritised items to be included in the research agenda. The research priorities were then reviewed and finalised by members of the WHO Technical Advisory Group on Hand Hygiene Research in Healthcare.</p><p><strong>Results: </strong>Of the 57 invited participants, 50 completed Delphi round 1 (88%), and 48 completed round 2 (96%). Thirty-six research priority statements were included in round 1 across five thematic categories: (1) safety climate; (2) personal accountability for hand hygiene; (3) leadership; (4) patient participation and empowerment and (5) religion and traditions. In round 1, 75% of the items achieved consensus, with 9 statements carried forward to round 2, leading to a final set of 31 prioritised research statements.</p><p><strong>Conclusion: </strong>This research agenda can be used by researchers, clinicians, policy-makers and funding bodies to address gaps in hand hygiene improvement within the context of an institutional safety climate, thereby enhancing patient and health worker safety globally.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"609-620"},"PeriodicalIF":6.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375103","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":"Optimising antibacterial utilisation in Argentine intensive care units: a quality improvement collaborative.","authors":"Facundo Jorro-Baron, Cecilia Inés Loudet, Wanda Cornistein, Inés Suarez-Anzorena, Pilar Arias-Lopez, Carina Balasini, Laura Cabana, Eleonora Cunto, Pablo Rodrigo Jorge Corral, Luz Gibbons, Marina Guglielmino, Gabriela Izzo, Marianela Lescano, Claudia Meregalli, Cristina Orlandi, Fernando Perre, Maria Elena Ratto, Mariano Rivet, Ana Paula Rodriguez, Viviana Monica Rodriguez, Jacqueline Vilca Becerra, Paula Romina Villegas, Emilse Vitar, Javier Roberti, Ezequiel García-Elorrio, Viviana Rodriguez","doi":"10.1136/bmjqs-2024-017069","DOIUrl":"10.1136/bmjqs-2024-017069","url":null,"abstract":"<p><strong>Background: </strong>There is limited evidence from antimicrobial stewardship programmes in less-resourced settings. This study aimed to improve the quality of antibacterial prescriptions by mitigating overuse and promoting the use of narrow-spectrum agents in intensive care units (ICUs) in a middle-income country.</p><p><strong>Methods: </strong>We established a quality improvement collaborative (QIC) model involving nine Argentine ICUs over 11 months with a 16-week baseline period (BP) and a 32-week implementation period (IP). Our intervention package included audits and feedback on antibacterial use, facility-specific treatment guidelines, antibacterial timeouts, pharmacy-based interventions and education. The intervention was delivered in two learning sessions with three action periods along with coaching support and basic quality improvement training.</p><p><strong>Results: </strong>We included 912 patients, 357 in BP and 555 in IP. The latter had higher APACHE II (17 (95% CI: 12 to 21) vs 15 (95% CI: 11 to 20), p=0.036), SOFA scores (6 (95% CI: 4 to 9) vs 5 (95% CI: 3 to 8), p=0.006), renal failure (41.6% vs 33.1%, p=0.009), sepsis (36.1% vs 31.6%, p<0.001) and septic shock (40.0% vs 33.8%, p<0.001). The days of antibacterial therapy (DOT) were similar between the groups (change in the slope from BP to IP 28.1 (95% CI: -17.4 to 73.5), p=0.2405). There were no differences in the antibacterial defined daily dose (DDD) between the groups (change in the slope from BP to IP 43.9, (95% CI: -12.3 to 100.0), p=0.1413).The rate of antibacterial de-escalation based on microbiological culture was higher during the IP (62.0% vs 45.3%, p<0.001).The infection prevention control (IPC) assessment framework was increased in eight ICUs.</p><p><strong>Conclusion: </strong>Implementing an antimicrobial stewardship program in ICUs in a middle-income country via a QIC demonstrated success in improving antibacterial de-escalation based on microbiological culture results, but not on DOT or DDD. In addition, eight out of nine ICUs improved their IPC Assessment Framework Score.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"590-600"},"PeriodicalIF":6.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987318","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":"Relative importance and interactions of factors influencing low-value care provision: a factorial survey experiment among Swedish primary care physicians.","authors":"Marta Roczniewska, Hanna Augustsson, Sara Ingvarsson, Emma Hedberg Rundgren, Kamil Szymański, Ulrica von Thiele Schwarz, Per Nilsen, Henna Hasson","doi":"10.1136/bmjqs-2024-018045","DOIUrl":"10.1136/bmjqs-2024-018045","url":null,"abstract":"<p><strong>Background: </strong>Low-value care (LVC) describes practices that persist in healthcare, despite being ineffective, inefficient or causing harm. Several determinants for the provision of LVC have been identified, but understanding how these factors influence professionals' decisions, individually and jointly, is a necessary next step to guide deimplementation.</p><p><strong>Methods: </strong>A factorial survey experiment was employed using vignettes that presented hypothetical medical scenarios among 593 Swedish primary care physicians. Each vignette varied systematically by factors such as patient age, patient request for the LVC, physician's perception of this practice, practice cost to the primary care centre and time taken to deliver it. For each scenario, we measured the reported likelihood of providing the LVC. We collected information on the physician's worry about missing a serious illness.</p><p><strong>Results: </strong>Patient requests and physicians' positive perceptions of the practice were the factors that increased the reported likelihood of providing LVC the most (by 14 and 13 percentage points (pp), respectively). When the LVC was low in cost or not time-consuming, patient requests further boosted the likelihood of provision by 29 and 18 pp. In contrast, credible evidence against the LVC reduced the role of patient requests by 11 pp. Physicians' fear of missing a serious illness was linked with higher reported probability of providing LVC, and the credibility of the evidence against the LVC reduced the role of this concern.</p><p><strong>Conclusions: </strong>The findings highlight that patient requests enhance the role of many determinants, while the credibility of evidence diminishes the impact of others. Overall, these findings point to the relevance of increased clinician knowledge about LVC, tools for patient communication and the use of decision support tools to reduce the uncertainty in decision-making.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"570-579"},"PeriodicalIF":6.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412822","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":"Retrospective analysis of preventable procedural adverse events (ICD-10 Y62-Y69) in the TriNetX network: a multiregional study before, during and after the COVID-19 pandemic.","authors":"Rosario Caruso, Marco Di Muzio, Emanuele Di Simone, Sara Dionisi, Arianna Magon, Gianluca Conte, Alessandro Stievano, Emanuele Girani, Sara Boveri, Pier Mario Perrone, Silvana Castaldi, Lorenzo Menicanti, Mary Dolansky","doi":"10.1136/bmjqs-2025-019077","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019077","url":null,"abstract":"<p><strong>Background: </strong>Healthcare-related procedural misadventures remain underreported despite decades of investment in patient safety. International Classification of Diseases, 10th Revision (ICD-10) codes Y62-Y69 capture defined preventable adverse events during medical and surgical care. This study aimed to examine temporal patterns in Y62-Y69-coded events using aggregated, precomputed data from the TriNetX Global Collaborative Network.</p><p><strong>Methods: </strong>We conducted a retrospective observational study using deidentified electronic health records from the TriNetX platform, encompassing over 135 million patients aged 0-89 (years: 2016-2024). Incidence rates for Y62-Y69-coded events were analysed globally and across four regional networks, USA, Europe-Middle East-Africa (EMEA), Asia-Pacific (APAC) and Latin America (LATAM), with additional sensitivity analyses in cardiovascular (ICD-10: I00-I99) and oncological (ICD-10: C00-D49) cohorts. Temporal trends were explored descriptively using polynomial regression (for visual pattern illustration) and the Mann-Kendall trend test.</p><p><strong>Findings: </strong>Globally, Y62-Y69 incidence rates increased from 0.04 to 0.09 per 100 000 patients between 2016 and 2024 (125% increase), with inflection in the early postpandemic phase. EMEA exhibited the steepest rise (414%), followed by APAC (225%). The USA showed a non-linear pattern detectable only through polynomial modelling. LATAM and APAC trends lacked statistical significance, likely due to high year-to-year variability. Sensitivity analyses in the disease-specific cohorts reflected similar patterns, reinforcing the consistency of findings.</p><p><strong>Interpretation: </strong>This is the first global, real-world analysis of ICD-10 Y62-Y69-coded adverse events. The findings reveal a notable postpandemic escalation in procedural harm, underscoring the fragility of safety systems under operational stress. Regional heterogeneity and non-linear trajectories highlight the importance of locally tailored interventions and the need to reinvigorate global patient safety efforts.</p><p><strong>Data availability statement: </strong>All data were extracted from the TriNetX Global Collaborative Network. Aggregated incidence rates and the R code used for statistical analysis are provided in online supplemental file 2.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144815702","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":"From complaint material to quality improvement: Exploring the use of patient complaints or compensation claims in quality improvement initiatives-a scoping review.","authors":"Sebrina Maj-Britt Hansen, Mette Kring Clausen, Nana Roust Hansen, Mette Brandt Eriksen, Anne Kragh Sørensen, Søren Bie Bogh, Søren Fryd Birkeland, Lars Morsø","doi":"10.1136/bmjqs-2025-018780","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018780","url":null,"abstract":"<p><strong>Background: </strong>There is increasing interest in how patient complaint material can be used to highlight areas requiring quality improvement (QI) in healthcare. However, knowledge of using complaint material to initiate or monitor QI is limited.</p><p><strong>Objectives: </strong>This review explored the use of complaint material in QI by identifying problems related to substandard care that were addressed by QI initiatives, exploring how complaint material was used before or after a QI initiative, and mapping changes in complaint material after QI initiatives.</p><p><strong>Methods: </strong>This scoping review followed the Joanna Briggs Institute methodology and adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews reporting guideline.</p><p><strong>Eligibility criteria: </strong>Studies were included if a QI initiative was initiated or monitored using complaint material. Eligible designs included observational studies, QI projects, pre-intervention and post-intervention studies and randomised controlled trials. Audio, online and symptom-based complaints were excluded.</p><p><strong>Information sources: </strong>A systematic search was conducted on 10 December 2024 in Embase, Medline, CINAHL and Web of Science, and additional sources, with no language or date limitations.</p><p><strong>Synthesis of results: </strong>Substandard problems targeted by QI initiatives were categorised using the Healthcare Complaints Analysis Tool by two independent coders. Findings were synthesised narratively and summarised using frequency analyses where applicable.</p><p><strong>Results: </strong>We identified 58 QI initiatives, most frequently targeting safety (n=39). Before QI, complaint material was usually analysed through review (n=19), counts (n=17), content categorisation (n=9) or root cause analysis (n=2). After QI, analyses included counts (n=34), rates (n=20), content categorisation (n=7) and review (n=4). Reviewing or categorisation methods were often unspecified. Among studies using complaints as an outcome, most reported complaint reductions (n=43), while a few reported increases (n=2) or mixed results (n=4).</p><p><strong>Discussion: </strong>The QI initiatives primarily targeted patient safety and applied simple quantitative analyses. Some studies relied on reviews or categorisations without reporting the validation or reliability of the used tools. Improved reporting standards are needed to strengthen learning. Furthermore, while QI initiatives appear to have the potential to change complaint patterns, this finding should be interpreted with caution, as this is based on a scoping review.</p><p><strong>Other: </strong>Preregistered protocol: https://osf.io/6g4qw.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803444","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":"Patient safety measures for virtual consultations in primary care: a systematic review.","authors":"Tetiana Lunova, Katherine-Helen Hurndall, Ulrik Bak Kirk, Bryony Dean Franklin, Ara Darzi, Ana Luisa Neves","doi":"10.1136/bmjqs-2025-018712","DOIUrl":"10.1136/bmjqs-2025-018712","url":null,"abstract":"<p><strong>Objectives: </strong>With the growing adoption of virtual consultations in primary care, the need for tailored metrics to evaluate their safety became increasingly urgent. This systematic review seeks to identify and review existing safety measures that could be used for safety evaluation of virtual consultations in primary care.</p><p><strong>Methods: </strong>This has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and followed a published protocol. A systematic literature search was performed in Ovid MEDLINE/PubMed, Embase and Cochrane Library databases from 2014 to 2024. Studies comparing virtual consultations with face-to-face consultations in the primary care setting were included. An inductive thematic analysis was performed to systematically extract and group the safety measures into overarching themes, with a narrative synthesis to summarise the results.</p><p><strong>Results: </strong>A total of 47 studies (31 experimental and 16 observational studies) were included (n=2 223 697 patients). All studies assessed the safety of virtual versus face-to-face consultations via one or both of the following domains: (1) factors that influence the safety of virtual consultations and (2) tangible outcomes of virtual care safety. The former were categorised into provider-related, patient-related and system-related factors. Tangible outcomes were evident through three subthemes-adverse events, health outcomes and patient perception of safety.</p><p><strong>Conclusions: </strong>This review provides a systematic synthesis of measures for the safety evaluation of virtual consultations. Further research into patient and physician perspectives is needed to identify aspects and indicators not captured in this study, followed by a consensus study to finalise safety metrics. Ultimately, having a robust methodology for safety evaluation of virtual consultations in place will enable safety monitoring, root cause analyses and safety improvement.</p><p><strong>Prospero registration number: </strong>PROSPERO CRD42023464878.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759072","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":"QIing your QI: a 13-year experience of a paediatric residency QI programme.","authors":"Adolfo Leonel Molina, Michele K Nichols, Colm P Travers, Stephanie Berger, Emily A Smitherman, David P Galloway, Rachel Kassel, Samuel Gentle, Andrea Kennedy, Chang L Wu, Susan Walley","doi":"10.1136/bmjqs-2025-018715","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018715","url":null,"abstract":"<p><strong>Introduction: </strong>QI education is essential for resident physicians with established requirements from the Accreditation Council for Graduate Medical Education outlining the necessary components. Literature supports the inclusion of both didactic and experiential learning, however, most studies review knowledge and attitude based assessments of residency QI programs. In 2012, our pediatric residency program identified a gap in resident engagement in QI, which led to the formalization of a QI education program grounded in the Institute for Healthcare Improvement (IHI) Model for improvement with objective measures of QI projects.</p><p><strong>Methods: </strong>Over 13 years, our program implemented interative interventions across three phases to enchance QI training. Initial core interventions involved the structure of didactics to teach core principles of QI and with time focusing on more individualized mentorship. Our efforts were guided through a residency QI committee. Our aim was to (1) increase the percentage of resident QI projects with SMART aims, and (2) increase the use of QI graphs (run charts and SPC charts) of resident QI projects. We tracked graduating resident exit survey satisfaction with the QI program as a balancing measure.</p><p><strong>Results: </strong>From 2012 through 2025, over 300 resident completed 390 QI projects that were reviewed. The percentage of of projects with SMART aims and QI graphs increased over time. The percentage of projects applying for American Board of Pediatrics Part IV applications and presenting at conferences also increased. Resident satisfaction remained with with an average \"Poor\" rating of only 2.6%.</p><p><strong>Conclusions: </strong>Using the model for improvement to assess objective measures in a residency QI program is both feasible and effective. This 13-year intiative demonstrates how systematic, iterative improvement can improve the rigor of resident QI projects. Future goals including leveraging informatics to further support residents with their projects and track downstream patient outcomes.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793446","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":"Examining variations in the prevalence of hazardous opioid prescribing across general practices in England: a cross-sectional study.","authors":"Teng-Chou Chen, Alex M Trafford, Matthew J Carr, Neetu Bansal, Evangelos Kontopantelis, Anthony Avery, Li-Chia Chen, Darren M Ashcroft","doi":"10.1136/bmjqs-2025-018794","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018794","url":null,"abstract":"<p><strong>Background: </strong>Prescribed opioids are potent analgesics associated with high safety risks due to their adverse effects, drug-drug and drug-disease interactions and potential for dependency. To support the implementation of prescribing indicators for further interventions, this study examined the prevalence of different types of potentially hazardous opioid prescribing (PHOP) in general practices across England and investigated underlying factors and variation between practices.</p><p><strong>Methods: </strong>We conducted a cross-sectional study focusing on adults (aged ≥18 years) at risk of triggering 17 PHOP indicators on 1 April 2021, involving 1358 general practices contributing to the Clinical Practice Research Datalink Aurum. PHOP prevalence was calculated by dividing the number of patients triggering an indicator by the total number at risk. Variation was assessed with intraclass correlation coefficients (ICCs), and multilevel mixed-effects logistic regression models identified associated factors, presented as adjusted ORs (aORs) with 95% CIs.</p><p><strong>Results: </strong>Among 3 121 852 patients observed, 361 505 (11.58%, 95% CI 11.54, 11.62) triggered at least one PHOP indicator, yielding an ICC of 0.07 (95% CI 0.06, 0.07). The prevalence of the 17 PHOP indicators ranged from 1.97% to 32.02%. Significant variability was noted across the 17 indicators, especially for persistent opioid prescriptions in patients with alcohol use issues (ICC 0.08, 95% CI 0.07, 0.09), chronic obstructive pulmonary disease or asthma (ICC 0.08, 95% CI 0.07, 0.09) and hypothyroidism (ICC 0.07, 95% CI 0.06, 0.07). Patients from the most deprived regions (aOR 1.28, 95% CI 1.22, 1.34) and the Northwest of England (aOR 1.73, 95% CI 1.66, 1.81) had a higher risk of PHOP.</p><p><strong>Conclusions and relevance: </strong>The high prevalence of PHOP, particularly among the most socioeconomically disadvantaged populations, emphasises existing prescribing risks and the need for their appropriate consideration within primary care. The high variation between practices indicates potential for improvement through targeted practice-level intervention.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788251","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}