BMJ Quality & Safety最新文献

{"title":"Patient-activated escalation in hospital: patients and their families are ready!","authors":"Christian Peter Subbe, Alison V Phillips, Lorelei Jones","doi":"10.1136/bmjqs-2024-017486","DOIUrl":"10.1136/bmjqs-2024-017486","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"4-7"},"PeriodicalIF":5.6,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387873","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 work self-managing medicines: a skilled job at the sharp end of care.","authors":"Beth Fylan, Justine Tomlinson","doi":"10.1136/bmjqs-2024-017502","DOIUrl":"10.1136/bmjqs-2024-017502","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"1-3"},"PeriodicalIF":5.6,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457765","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":"What do clinical practice guidelines say about deprescribing? A scoping review.","authors":"Aili Veronica Langford, Imaan Warriach, Aisling M McEvoy, Elisa Karaim, Shyleen Chand, Justin P Turner, Wade Thompson, Barbara J Farrell, Danielle Pollock, Frank Moriarty, Danijela Gnjidic, Nagham J Ailabouni, Emily Reeve","doi":"10.1136/bmjqs-2024-017101","DOIUrl":"10.1136/bmjqs-2024-017101","url":null,"abstract":"<p><strong>Introduction: </strong>Deprescribing (<i>medication dose reduction or cessation</i>) is an integral component of appropriate prescribing. The extent to which deprescribing recommendations are included in clinical practice guidelines is unclear. This scoping review aimed to identify guidelines that contain deprescribing recommendations, qualitatively explore the content and format of deprescribing recommendations and estimate the proportion of guidelines that contain deprescribing recommendations.</p><p><strong>Methods: </strong>Bibliographic databases and Google were searched for guidelines published in English from January 2012 to November 2022. Guideline registries were searched from January 2017 to February 2023. Two reviewers independently screened records from databases and Google for guidelines containing one or more deprescribing recommendations. A 10% sample of the guideline registries was screened to identify eligible guidelines and estimate the proportion of guidelines containing a deprescribing recommendation. Guideline and recommendation characteristics were extracted and language features of deprescribing recommendations including content, form, complexity and readability were examined using a conventional content analysis and the SHeLL Health Literacy Editor tool.</p><p><strong>Results: </strong>80 guidelines containing 316 deprescribing recommendations were included. Deprescribing recommendations had substantial variability in their format and terminology. Most guidelines contained recommendations regarding for <i>who</i> (75%, n=60)<i>, what</i> (99%, n=89) and <i>when or why</i> (91%, n=73) to deprescribe, however, fewer guidelines (58%, n=46) contained detailed guidance on <i>how</i> to deprescribe. Approximately 29% of guidelines identified from the registries sample (n=14/49) contained one or more deprescribing recommendations.</p><p><strong>Conclusions: </strong>Deprescribing recommendations are increasingly being incorporated into guidelines, however, many guidelines do not contain clear and actionable recommendations on <i>how</i> to deprescribe which may limit effective implementation in clinical practice. A co-designed template or best practice guide, containing information on aspects of deprescribing recommendations that are essential or preferred by end-users should be developed and employed.</p><p><strong>Trial registration number: </strong>osf.io/fbex4.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"28-39"},"PeriodicalIF":5.6,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141092820","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":"Assessing patient work system factors for medication management during transition of care among older adults: an observational study.","authors":"Yan Xiao, Yea-Jen Hsu, Susan M Hannum, Ephrem Abebe, Melinda E Kantsiper, Ivonne Marie Pena, Andrea M Wessell, Sydney M Dy, Eric E Howell, Ayse P Gurses","doi":"10.1136/bmjqs-2024-017297","DOIUrl":"10.1136/bmjqs-2024-017297","url":null,"abstract":"<p><strong>Objective: </strong>To develop and evaluate measures of patient work system factors in medication management that may be modifiable for improvement during the care transition from hospital to home among older adults.</p><p><strong>Design, settings and participants: </strong>Measures were developed and evaluated in a multisite prospective observational study of older adults (≥65 years) discharged home from medical units of two US hospitals from August 2018 to July 2019.</p><p><strong>Main measures: </strong>Patient work system factors for managing medications were assessed during hospital stays using six capacity indicators, four task indicators and three medication management practice indicators. Main outcomes were assessed at participants' homes approximately a week after discharge for (1) Medication discrepancies between the medications taken at home and those listed in the medical record, and (2) Patient experiences with new medication regimens.</p><p><strong>Results: </strong>274 of the 376 recruited participants completed home assessment (72.8%). Among capacity indicators, most older adults (80.6%) managed medications during transition without a caregiver, 41.2% expressed low self-efficacy in managing medications and 18.3% were not able to complete basic medication administration tasks. Among task indicators, more than half (57.7%) had more than 10 discharge medications and most (94.7%) had medication regimen changes. Having more than 10 discharge medications, more than two medication regimen changes and low self-efficacy in medication management increased the risk of feeling overwhelmed (OR 2.63, 95% CI 1.08 to 6.38, OR 3.16, 95% CI 1.29 to 7.74 and OR 2.56, 95% CI 1.25 to 5.26, respectively). Low transportation independence, not having a home caregiver, low medication administration skills and more than 10 discharge medications increased the risk of medication discrepancies (incidence rate ratio 1.39, 95% CI 1.01 to 1.91, incidence rate ratio 1.73, 95% CI 1.13 to 2.66, incidence rate ratio 1.99, 95% CI 1.37 to 2.89 and incidence rate ratio 1.91, 95% CI 1.24 to 2.93, respectively).</p><p><strong>Conclusions: </strong>Patient work system factors could be assessed before discharge with indicators for increased risk of poor patient experience and medication discrepancies during older adults' care transition from hospital to home.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"8-17"},"PeriodicalIF":5.6,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046297","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":"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":""},"PeriodicalIF":5.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":""},"PeriodicalIF":5.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contextual factors that influence adoption and sustainment of self-management support in cancer survivorship care: a practical application of theory with qualitative interviews.","authors":"Nickola Pallin, John Browne, Roisin Connolly, Josephine Hegarty, Sheena McHugh","doi":"10.1136/bmjqs-2024-017561","DOIUrl":"10.1136/bmjqs-2024-017561","url":null,"abstract":"<p><strong>Background: </strong>Self-management support (SMS) is a recommended component of cancer survivorship care that improves health-related quality of life and reduces healthcare utilisation. However, widespread implementation has been difficult to achieve, with a gap in the literature on system-wide implementation efforts. This study examines contextual factors perceived to influence SMS adoption and sustainment in cancer centres in the Republic of Ireland.</p><p><strong>Method: </strong>Semistructured interviews were conducted with 47 key informants from 20 cancer organisations across community and hospital settings. Participants were asked to report the level of adoption and sustainment of SMS at their organisation. This information was used to categorise organisations as low, medium or high implementers. We conducted cross-case analysis following the principles of Framework Analysis. Using the Consolidated Framework for Implementation Research as a menu of constructs, we examined factors influencing adoption and sustainment and variation in levels of implementation.</p><p><strong>Results: </strong>National policy, external accreditation, external financing opportunities and the presence of champions in organisations are influential early in the implementation process driving adoption. Healthcare provider-led programmes and evidence of SMS improving patient outcomes and aligning with an organisation's priorities are necessary to secure buy-in, particularly among senior leadership. An organisational culture of entrepreneurship enables adoption and sustainment, with resources and a culture supporting staff well-being enabling sustainment.</p><p><strong>Conclusion: </strong>While national policy is a driver, additional factors related to programme attributes and local contextual features such as the presence of champions, organisational readiness and culture influence implementation. The results may be used for future evaluations of SMS implementation in cancer survivorship care and to inform the development of tailored implementation strategies.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614508","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":"Large-scale observational study of AI-based patient and surgical material verification system in ophthalmology: real-world evaluation in 37 529 cases.","authors":"Hitoshi Tabuchi, Naofumi Ishitobi, Hodaka Deguchi, Yuta Nakaniida, Hayato Tanaka, Masahiro Akada, Mao Tanabe","doi":"10.1136/bmjqs-2024-018018","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-018018","url":null,"abstract":"<p><strong>Background: </strong>Surgical errors in ophthalmology can have devastating consequences. We developed an artificial intelligence (AI)-based surgical safety system to prevent errors in patient identification, surgical laterality and intraocular lens (IOL) selection. This study aimed to evaluate its effectiveness in real-world ophthalmic surgical settings.</p><p><strong>Methods: </strong>In this retrospective observational before-and-after implementation study, we analysed 37 529 ophthalmic surgeries (18 767 pre-implementation, 18 762 post implementation) performed at Tsukazaki Hospital, Japan, between 1 March 2019 and 31 March 2024. The AI system, integrated with the WHO surgical safety checklist, was implemented for patient identification, surgical laterality verification and IOL authentication.</p><p><strong>Results: </strong>Post implementation, five medical errors (0.027%) occurred, with four in non-authenticated cases (where the AI system was not fully implemented or properly used), compared with one (0.0053%) pre-implementation (p=0.125). Of the four non-authenticated errors, two were laterality errors during the initial implementation period and two were IOL implantation errors involving unlearned IOLs (7.3% of cases) due to delayed AI updates. The AI system identified 30 near misses (0.16%) post implementation, vs 9 (0.048%) pre-implementation (p=0.00067), surgical laterality errors/near misses occurred at 0.039% (7/18 762) and IOL recognition at 0.29% (28/9713). The system achieved>99% implementation after 3 months. Authentication performance metrics showed high efficiency: facial recognition (1.13 attempts, 11.8 s), surgical laterality (1.05 attempts, 3.10 s) and IOL recognition (1.15 attempts, 8.57 s). Cost-benefit analysis revealed potential benefits ranging from US$181 946.94 to US$2 769 129.12 in conservative and intermediate scenarios, respectively.</p><p><strong>Conclusions: </strong>The AI-based surgical safety system significantly increased near miss detection and showed potential economic benefits. However, errors in non-authenticated cases underscore the importance of consistent system use and integration with existing safety protocols. These findings emphasise that while AI can enhance surgical safety, its effectiveness depends on proper implementation and continuous refinement.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754517","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":"Comparing safety, performance and user perceptions of a patient-specific indication-based prescribing tool with current practice: a mixed methods randomised user testing study.","authors":"Calandra Feather, Jonathan Clarke, Nicholas Appelbaum, Ara Darzi, Bryony Dean Franklin","doi":"10.1136/bmjqs-2024-017733","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-017733","url":null,"abstract":"<p><strong>Background: </strong>Medication errors are the leading cause of preventable harm in healthcare. Despite proliferation of medication-related clinical decision support systems (CDSS), current systems have limitations. We therefore developed an indication-based prescribing tool. This performs dose calculations using an underlying formulary and provides patient-specific dosing recommendations. Objectives were to compare the incidence and types of erroneous medication orders, time to prescribe (TTP) and perceived workload using the NASA Task Load Index (TLX), in simulated prescribing tasks with and without this intervention. We also sought to identify the workflow steps most vulnerable to error and to gain participant feedback.</p><p><strong>Methods: </strong>A simulated, randomised, cross-over exploratory study was conducted at a London NHS Trust. Participants completed five simulated prescribing tasks with, and five without, the intervention. Data collection methods comprised direct observation of prescribing tasks, self-reported task load and semistructured interviews. A concurrent triangulation design combined quantitative and qualitative data.</p><p><strong>Results: </strong>24 participants completed a total of 240 medication orders. The intervention was associated with fewer prescribing errors (6.6% of 120 orders) compared with standard practice (28.3% of 120 orders; odds ratio 0.18, p<0.01), a shorter TTP and lower overall NASA-TLX scores (p<0.01). Control arm workflow vulnerabilities included failures in identifying correct doses, applying maximum dose limits and calculating patient-specific dosages. Intervention arm errors primarily stemmed from misidentifying patient-specific information from the medication scenario. Thematic analysis of participant interviews identified six themes: navigating trust and familiarity, addressing challenges and suggestions for improvement, integration of local guidelines and existing CDSS, intervention endorsement, 'search by indication' and targeting specific patient and staff groups.</p><p><strong>Conclusion: </strong>The intervention represents a promising advancement in medication safety, with implications for enhancing patient safety and efficiency. Further real-world evaluation and development of the system to meet the needs of more diverse patient groups, users and healthcare settings is now required.</p><p><strong>Trial registration number: </strong>NCT05493072.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692320","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":"Results of a healthcare transition learning collaborative for emerging adults with sickle cell disease: the ST3P-UP study transition quality improvement collaborative.","authors":"Ifeyinwa Osunkwo, Jennifer S Cornette, Laura Noonan, Cheryl Courtlandt, Sarah Mabus, Patience H White, Margaret McManus, Myra M Robinson, Michelle L Wallander, James R Eckman, Elna Saah, Ofelia A Alvarez, Mark Goodwin, Leila Jerome Clay, Payal Desai, Raymona H Lawrence","doi":"10.1136/bmjqs-2024-017725","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-017725","url":null,"abstract":"<p><strong>Background: </strong>Individuals with sickle cell disease (SCD) experience poor clinical outcomes while transitioning from paediatric to adult care. Standards for SCD transition are needed. We established a Quality Improvement (QI) Collaborative that aimed to improve the quality of care for all young adults with SCD by establishing a standardised SCD transition process. This study evaluates the implementation of the Six Core Elements (6CE) of Health Care Transition, which was a fundamental component of the cluster-randomised Sickle Cell Trevor Thompson Transition Project (ST3P-UP) study.</p><p><strong>Methods: </strong>A central QI team trained 14 ST3P-UP study sites on QI methodologies, 6CE and Got Transition's process measurement tool (PMT). Site-level QI teams included a transition coordinator, clinic physicians/staff, patients/parents with SCD and community representatives. Sites completed the PMT every 6 months for 54 months and monthly audits of 10 randomly-selected charts to verify readiness/self-care assessments and emergency care plans.</p><p><strong>Results: </strong>Of a possible 100, the aggregate mean (±SD) PMT score for paediatric clinics was 23.9 (±13.8) at baseline, 95.9 (±6.0) at 24 months and 98.9 (±2.1) at 54 months. The aggregate mean PMT score for adult clinics was 15.0 (±13.5) at baseline, 88.4 (±11.8) at 24 months and 95.8 (±6.8) at 54 months. The overall QI Collaborative PMT score improved by 402%. At baseline, readiness/self-care assessments were current for 38% of paediatric and 20% of adult patients; emergency care plans were current for 20% of paediatric and 3% of adult patients. Paediatric clinics had one median readiness assessment shift (76%) and four median emergency care plan shifts (65%, 77%, 79%, 84%). Adult clinics experienced three median self-care assessment shifts (58%, 63%, 70%) and two median emergency care plan shifts (57%, 70%).</p><p><strong>Conclusions: </strong>The ST3P-UP QI Collaborative successfully embedded the 6CE of Health Care Transition into routine care and increased administration of assessments and emergency care plans for transition-aged patients with SCD.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692327","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}