BMJ Quality & Safety最新文献

{"title":"From measurement to improvement: new evidence towards reducing emergency diagnosis of cancer.","authors":"Marta Berglund, Matthew E Barclay, Georgios Lyratzopoulos","doi":"10.1136/bmjqs-2025-019417","DOIUrl":"10.1136/bmjqs-2025-019417","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"366-369"},"PeriodicalIF":6.5,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595951","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":"Digital quality measure of potentially avoidable emergency presentations among patients with colorectal cancer.","authors":"Natalia Khalaf, Basim Ali, Andrew Zimolzak, Yan Liu, Li Wei, Fasiha Kanwal, Hardeep Singh","doi":"10.1136/bmjqs-2025-019084","DOIUrl":"10.1136/bmjqs-2025-019084","url":null,"abstract":"<p><strong>Background: </strong>We previously developed a digital quality measure (dQM) of emergency presentations (EPs) in colorectal cancer (CRC) and found it to be associated with worse outcomes. Potentially avoidable EPs were common in this cohort, but identifying them required time-intensive chart reviews. We aimed to enhance the existing dQM to automate the detection of potentially avoidable EPs.</p><p><strong>Materials and methods: </strong>We defined potentially avoidable EPs as those preceded by a CRC red flag (iron-deficiency anaemia or haematochezia ≥60 days prior, or positive stool-based screening test ≥180 days prior). The enhanced dQM was applied to a national cohort of incident CRC cases diagnosed in the Veterans Affairs healthcare system from 2017 to 2021. We examined associations with cancer stage, treatment and mortality.</p><p><strong>Results: </strong>The enhanced dQM had a positive predictive value of 92% (95% CI 85.5% to 95.7%) for identifying potentially avoidable EPs. Among 9096 CRC cases, 28.1% were identified as EPs. Of these, 31.6% were classified as potentially avoidable. These patients were more likely to have advanced-stage disease (adjusted OR 1.50; 95% CI 1.27 to 1.78), less likely to receive treatment (adjusted OR 0.58; 95% CI 0.48 to 0.70) and had higher mortality (adjusted HR 1.58; 95% CI 1.40 to 1.79) compared with other patients with CRC.</p><p><strong>Conclusions: </strong>The enhanced dQM accurately identified potentially avoidable EPs, which were associated with worse outcomes. This measure is unique in its focus on cases of preventable care delays, which can help guide future efforts to improve diagnostic timeliness and reduce EPs among patients with CRC.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"380-392"},"PeriodicalIF":6.8,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197824","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 validation study of a large language model approach to screening for intraabdominal surgical site infections for quality and safety reporting.","authors":"Logan Pierce, Christy Pak, Kim Stanley, Lusha Wang, Caroline Erickson, Deborah S Yokoe, Elizabeth Wick","doi":"10.1136/bmjqs-2025-019493","DOIUrl":"10.1136/bmjqs-2025-019493","url":null,"abstract":"<p><p>Surgical site infections (SSIs), particularly intra-abdominal (IAB) infections, are challenging to identify and remain a resource-intensive focus of infection prevention programmes. Current automated screening measures rely on discrete data from the electronic health record (EHR), such as microbiology results, diagnosis codes and/or return to the operating room. This approach has poor specificity, and therefore surveillance methods depend heavily on additional manual chart review by trained infection preventionists. Large language models (LLMs) offer an opportunity to improve surveillance by synthesising complex clinical documentation alongside structured data elements.We evaluated the performance of a locally hosted LLM (gpt-35-turbo-16k) to improve IAB SSI screening using perioperative clinical notes and microbiology results. The model analysed documentation across the perioperative period (3 days before through 30 days after surgery) to generate case-level SSI summaries and likelihood assessments. We compared the performance of this tool against the current EHR-based screening workflow.Among 1977 abdominal surgical cases, including 56 with confirmed IAB SSIs, the LLM screened 104 cases as high risk, identifying all infections (negative predictive value (NPV) 100%) and achieving a positive predictive value (PPV) of 53.8%. In contrast, the EHR-based workflow identified 288 cases for further review, with a PPV of only 19.4% and the same NPV of 100%. Analysis of 57 224 notes required ~107 million tokens, translating to approximately USD 0.05 per case.An LLM-based approach to SSI surveillance has the potential to substantially improve efficiency while remaining highly accurate and cost-effective. By reducing reliance on manual chart review, this strategy could allow infection preventionists to shift their attention from surveillance toward quality improvement and patient safety initiatives.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"424-427"},"PeriodicalIF":6.5,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145803280","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":"Metrics used in quality improvement publications addressing environmental sustainability in healthcare: a scoping review.","authors":"Colin Sue-Chue-Lam, Sezgi Yanikomeroglu, Darius Baginskis, Doulia M Hamad, Brian M Wong, Nicole Simms, Karen B Born","doi":"10.1136/bmjqs-2025-018519","DOIUrl":"10.1136/bmjqs-2025-018519","url":null,"abstract":"<p><strong>Objective: </strong>Quality improvement (QI) practices and scholarship are increasingly concerned with environmental sustainability given the negative health outcomes caused by the ecological crisis, as well as the environmental impacts of healthcare delivery itself. A core component of QI activities is measuring change. How sustainability metrics have been used in QI is unclear. We conducted a scoping review of metrics used in published sustainability-focused QI initiatives.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, CINAHL and Scopus from 2000 to 2023.</p><p><strong>Eligibility criteria: </strong>Published healthcare QI initiatives intended to address environmental sustainability with at least one quantitative sustainability metric.</p><p><strong>Data analysis: </strong>Publication, study, measurement and QI intervention characteristics were charted from included studies. Data items were synthesised and presented narratively as well as quantitatively.</p><p><strong>Results: </strong>We screened 6294 studies and included 90 full-text publications. The studies were published from 2000 to 2023, with the majority (61%, 55/90) published since 2020. Publications originated from a wide range of clinical disciplines with most QI projects situated in the inpatient setting (78%, 70/90). Environmental sustainability metrics were subcategorised into activity data and environmental impact indicators. Some papers included more than one category of activity data, with the most common being cost (88%, 79/90), hospital waste (52%, 47/90), anaesthetic gases (49%, 44/90), disposable use (24%, 22/90) and distance travelled (14%, 13/90). Fewer publications included environmental impact indicators, with global warming potential dominating this category (53%, 48/90).</p><p><strong>Discussion: </strong>There is a need to align QI efforts with environmental sustainability. However, there is limited guidance specific to healthcare QI on how to measure environmental impacts of these efforts. This review illuminates that sustainability-focused QI efforts to date have used a relatively narrow set of sustainability metrics. QI scholars and practitioners can benefit from further education, measurement frameworks and guidelines to effectively incorporate environmental sustainability metrics into QI efforts.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"405-413"},"PeriodicalIF":6.8,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141222","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":"Tailoring improvement to the evidence-practice relationship.","authors":"Ryan Howard","doi":"10.1136/bmjqs-2025-019847","DOIUrl":"10.1136/bmjqs-2025-019847","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"428-430"},"PeriodicalIF":6.5,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793253","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":"414-423"},"PeriodicalIF":6.8,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217040/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What do people do in the aftermath of healthcare-related harm? A qualitative study on experiences and factors influencing decision-making.","authors":"Lavanya Thana, Helen Crocker, Shivali Modha, Linda Mulcahy, Catherine Pope, Charles Vincent, Helen Hogan, Michele Peters","doi":"10.1136/bmjqs-2024-018214","DOIUrl":"10.1136/bmjqs-2024-018214","url":null,"abstract":"<p><strong>Objectives: </strong>To capture experiences of people self-reporting harm and contrast responses and actions between those who do or do not take formal action.</p><p><strong>Design: </strong>Semi-structured qualitative interview study.</p><p><strong>Setting: </strong>People self-reporting harm experienced in the National Health Service (NHS) or their family/friends identified from a general Great British population survey.</p><p><strong>Participants: </strong>49 participants.</p><p><strong>Results: </strong>There were commonalities in experiences after harm whether formal action (including making a formal complaint or litigation) was taken or not. Many participants reported raising concerns informally with NHS staff, trying to access explanations or support, but were usually unsuccessful. Decision-making on action was complex. There were multiple reasons for not pursuing formal action, including fears of damaging relationships with clinicians, being occupied coping with the consequences of the harm or not wanting to take action against the NHS. NHS advocacy services were not regarded as helpful. Knowledge of how to proceed and feeling entitled to do so, along with proactive social networks, could facilitate action, but often only after people were spurred on by anger and frustration about not receiving an explanation, apology or support for recovery from the NHS. Those from marginalised groups were more likely to feel disempowered to act or be discouraged by family or social contacts, which could lead to self-distancing and reduced trust in services.</p><p><strong>Conclusions: </strong>People actively seek resolution and recovery after harm but often face multiple barriers in having their needs for explanations, apologies and support addressed. Open and compassionate engagement, especially with those from more marginalised communities, plus tailored support to address needs, could promote recovery, decrease compounded harm and reduce use of grievance services where other provision may be more helpful.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"334-345"},"PeriodicalIF":6.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180133","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":"When students run the clinic, who's watching? A call for a framework to evaluate student-run clinics.","authors":"Nicholas Peoples, Alireza Ahmadvand","doi":"10.1136/bmjqs-2025-019604","DOIUrl":"10.1136/bmjqs-2025-019604","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"358-362"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910430","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":"Physician participation in pre-emptive patient safety huddles.","authors":"Allison Bond, Andrew D Auerbach","doi":"10.1136/bmjqs-2025-019350","DOIUrl":"10.1136/bmjqs-2025-019350","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"297-299"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676317","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":"Understanding factors influencing sustainability and sustainment of evidence-based bronchiolitis management of infants in Australian and New Zealand hospital settings: a qualitative process evaluation.","authors":"Victoria Ramsden, Franz E Babl, Libby Haskell, Catherine Wilson, Elizabeth McInnes, Sandy Middleton, Lisa Kuhn, Alexandra Wallace, Elyssia Bourke, Faye Jordan, Julian Wong, Kai Steinmann, Lauren Shumack, Lisa Kane, Natalie Phillips, Paige Marsh, Shefali Jani, Trevor Kuang, Yvonne Janiszewski, Ed Oakley, Anna Lithgow, Peter Wilson, Rachel Schembri, Stuart Dalziel, Emma Tavender","doi":"10.1136/bmjqs-2025-019007","DOIUrl":"10.1136/bmjqs-2025-019007","url":null,"abstract":"<p><strong>Background: </strong>The 2017 Paediatric Research in Emergency Departments International Collaborative (PREDICT) Bronchiolitis Knowledge Translation (KT) Study, a cluster randomised trial in 26 Australasian hospitals, found targeted interventions provided over one bronchiolitis season effectively de-implemented five low-value practices (salbutamol, glucocorticoids, chest radiography, antibiotics and epinephrine) by 14.1% (adjusted risk difference, 95% CI 6.5% to 21.7%; p<0.001). A 2-year follow-up study found de-implementation was sustained. This process evaluation aimed to identify factors that influenced sustainability of de-implementation of these five low-value practices in PREDICT Bronchiolitis KT Study intervention hospitals and examine fidelity and/or adaptation of the targeted interventions over 4 years post intervention delivery (sustainment).</p><p><strong>Methods: </strong>Semistructured qualitative interviews were conducted, over 2021 and 2022, with a purposive sample of emergency department (ED) and paediatric inpatient clinicians. Data were analysed thematically into facilitators and barriers using the Consolidated Framework for Sustainability Constructs in Healthcare (CFSCH). The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies was used to explore fidelity and adaptation.</p><p><strong>Results: </strong>50 clinicians (nurses: n=26; doctors: n=24) from 12 intervention hospitals were interviewed. Eight themes were identified and mapped to three CFSCH domains: (1) organisational setting; (2) initiative design and delivery and (3) people involved. Facilitators were a culture of evidence-based practice, ongoing multimodal education, strong clinical leadership as unofficial champions and the previous effectiveness of the PREDICT Bronchiolitis KT Study interventions. Barriers were lack of paediatric trained ED staff, assumptions by senior clinicians that junior doctors can provide evidence-based bronchiolitis management, bronchiolitis not a current improvement priority and lack of bronchiolitis education sessions. Use of the targeted interventions reduced over time and, when used, was adapted locally.</p><p><strong>Conclusion: </strong>This study provides insights into factors influencing the sustainability of de-implementation of low-value care in acute care settings. Fostering an evidence-based practice culture, supported by senior leadership and ongoing multimodal education, supports sustainability of improvements in this setting.</p><p><strong>Trial registration number: </strong>Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"316-325"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231514","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}