457 results match your criteria BMJ open quality[Journal]


Improving diagnostic specimen management systems in an oral medicine department.

BMJ Open Qual 2020 Jul;9(3)

Oral Medicine, Dental Hospital, Cardiff and Vale University Health Board, Cardiff, UK.

Histological, haematological and microbiological investigations are essential in the field of oral medicine and are a crucial adjunct to clinical findings, often being relied on to obtain a definitive diagnosis. Importantly, in some cases, these investigations can help exclude or confirm the presence of malignancy. This project highlighted some problems regarding labelling and recording of specimens in an oral medicine department and a lack of clear specimen management processes. Read More

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http://dx.doi.org/10.1136/bmjoq-2020-000926DOI Listing

Evaluation of a learning collaborative to advance team-based care in Federally Qualified Health Centers.

BMJ Open Qual 2020 Jul;9(3)

Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA.

Practising team-based primary care allows Federally Qualified Health Centers (FQHC) in the USA to be accredited as patient-centred medical homes, positioning them for value-based models of shared savings in healthcare costs. Team-based care (TBC) involves redesign of staff roles and care delivery processes to improve efficiency and effectiveness, which requires a systematic and supportive approach to practice change over time. Thirteen FQHC primary care teams participated in an 8-month learning collaborative with a goal of providing teams with the knowledge, skills and coaching support needed to advance TBC in their organisations. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000794DOI Listing

Lessons learned: using adverse incident reports to investigate the characteristics and causes of prescribing errors.

BMJ Open Qual 2020 Jun;9(2)

Department of Medical Education, NHS Lanarkshire, Bothwell, Scotland, UK.

Introduction: Prescribing errors are a principal cause of preventable harm in healthcare. This study aims to establish a systematic approach to analysing prescribing-related adverse incident reports, in order to elucidate the characteristics and contributing factors of common prescribing errors and target multifaceted quality improvement initiatives.

Methods: All prescribing-related adverse incident reports submitted across one NHS board over 12 months were selected. Read More

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http://dx.doi.org/10.1136/bmjoq-2020-000949DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326251PMC

Development of quality indicators for departments of hospital-based physiotherapy: a modified Delphi study.

BMJ Open Qual 2020 Jun;9(2)

IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.

Background: International hospital accreditation instruments, such as Joint Commission International (JCI) and Qmentum, focus mainly on hospital policy and procedures and do not specifically cover a profession such as hospital-based physiotherapy. This justifies the need for a quality system to which hospital-based physiotherapy can better identify, based on a common framework of quality indicators for effective quality management.

Objective: This study aimed to identify the most important quality indicators of a hospital-based physiotherapy department in the eyes of hospital-based physiotherapists and their managers. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312452PMC

Improving transitions from acute care to home among complex older adults using the LACE Index and care coordination.

BMJ Open Qual 2020 Jun;9(2)

Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.

Background: Improving transitions in care is a major focus of healthcare planning. The objective of this study was to determine the improvement in transitions from an intervention identifying complex older adult patients in acute care and supporting their discharge into the community.

Methods: This was a quality assurance study evaluating an intervention on high-risk patients admitted in an acute care hospital. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311032PMC

Improving quality of care in less than 1 min: a prospective intervention study on postoperative handovers to the ICU/PACU.

BMJ Open Qual 2020 Jun;9(2)

Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow Klinikum and Charité Centrum Mitte (CVK/CCM), Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin, Institute of Health, Berlin, Germany.

Purpose: Standardisation of the postoperative handover process via checklists, trainings or procedural changes has shown to be effective in reducing information loss. The clinical friction of implementing these measures has received little attention. We developed and evaluated a visual aid (VA) and >1 min in situ training intervention to improve the quality of postoperative handovers to the intensive care unit (ICU) and postoperative care unit. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311016PMC

Processes and tools to improve teamwork and communication in surgical settings: a narrative review.

BMJ Open Qual 2020 Jun;9(2)

Safety Improvement and Capability Building, Canadian Patient Safety Institute, Ottawa, Ontario, Canada.

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http://dx.doi.org/10.1136/bmjoq-2020-000937DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304801PMC

How do we encourage a change of behaviour around colleagues taking breaks?

BMJ Open Qual 2020 Jun;9(2)

Data Specialist and Advisor, Improvement Team, Musgrove Park Hospital, Taunton, UK.

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http://dx.doi.org/10.1136/bmjoq-2020-000968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299031PMC

'I've got a little list'-the scourge of a surgical junior. A quality improvement project to change the surgical patient list in a district general hospital.

BMJ Open Qual 2020 Jun;9(2)

Quality Improvement Academy, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.

Background: Junior doctors at the Royal Devon and Exeter Hospital spend hours every day creating and updating patient lists for all surgical specialties on Microsoft Excel spreadsheets. This not only consumes time that should be spent on clinical tasks, it allows for human errors, system errors and patient safety concerns. Our aim was to reduce time spent on the list and reduce the chance for error. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299038PMC

Development and pilot testing of quality improvement indicators for integrated primary dementia care.

BMJ Open Qual 2020 Jun;9(2)

Department of Geriatric Medicine, Radboud university medical center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands

Background: Implementation of integrated primary care is considered an important strategy to overcome fragmentation and improve quality of dementia care. However, current quality indicator (QI) sets, to assess and improve quality of care, do not address the interprofessional context. The aim of this research was to construct a feasible and content-wise valid minimum dataset (MDS) to measure the quality of integrated primary dementia care. Read More

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http://dx.doi.org/10.1136/bmjoq-2020-000916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295433PMC

Improving VTE risk assessment and prophylaxis prescribing rate in medical patients: integrating risk assessment tool into the workflow.

BMJ Open Qual 2020 Jun;9(2)

Acute and General Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.

Medical inpatients often have important risk factors for venous thromboembolism (VTE). In our institution, VTE prophylaxis in this group was underused. The main barriers identified were inattention to VTE prophylaxis, competing priorities and lack of confidence in the decision-making. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295437PMC

A detailed analysis of patients included in the Summary Hospital-level Mortality Indicator (SHMI) for myocardial infarction (MI)-all is not what it seems?

BMJ Open Qual 2020 Jun;9(2)

Cardiology, Birmingham City Hospital, Birmingham, West Midlands, UK.

Background: The Summary Hospital-level Mortality Indicator (SHMI) for Myocardial Infarction (MI) is the ratio of the observed to the expected number of deaths due to MI. We aimed to assess (1) the accuracy of MI as a diagnosis in the SHMI for MI and (2) the healthcare received by patients with type 1 MI included in the SHMI for MI.

Methods: Retrospective review of patients included in SHMI for MI from April 2017 to March 2018. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000836DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292047PMC

Checklists in community care: reducing differences in care delivery between regular and relief staff to improve consistency and client experience.

BMJ Open Qual 2020 Jun;9(2)

Peel Senior Link, Mississauga, Ontario, Canada.

Background: Today, healthcare is more complex than just ensuring clients receive quality care; it also involves consistently delivering excellent client experience. A non-profit community support services agency conducted an extensive diagnostic journey to determine root causes of inconsistent care delivery between regular and relief frontline staff.

Local Problem: Clients and family caregivers noted lower satisfaction in care delivery when a relief staff (ie, internal staff or an external agency that is covering a shift) provided service in comparison with their regular staff. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282392PMC

Improving venous thromboembolism prophylaxis through critical thinking and health informatics.

BMJ Open Qual 2020 Jun;9(2)

Internal Medicine, Mafraq Hospital, Abu Dhabi, United Arab Emirates.

Venous thromboembolism (VTE) is a leading cause of preventable morbidity and mortality in hospitalised patients. Mafraq Hospital, a 450-bed tertiary-level hospital in Abu Dhabi, United Arab Emirates, has identified VTE prevention as a critical patient safety measure and VTE prophylaxis as a key performance indicator (KPI). Mafraq Hospital VTE prevention policy states that all admitted adult patients 18 years and above should receive a VTE risk assessment, and all patients identified at risk of VTE with no contraindications should receive appropriate VTE prophylaxis within 24 hours of admission. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269548PMC

Improving asthma care with Asthma-COPD Afterhours Respiratory Nurse at Emergency (A-CARE).

BMJ Open Qual 2020 Jun;9(2)

Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.

Background: Emergency departments (ED) are important providers of asthma care, particularly after-hours. We identified gaps for quality improvement such as suboptimal adherence rates to three key recommendations from the Global Initiative for Asthma (GINA) guidelines for discharge management asthma guidelines. These were: the prescription of oral and inhaled corticosteroids (OCS and ICS) and issuance of outpatient follow-up for patients discharged from the ED. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265035PMC

'Team capital' in quality improvement teams: findings from an ethnographic study of front-line quality improvement in the NHS.

BMJ Open Qual 2020 May;9(2)

Health Services Research Unit, University of Aberdeen, Aberdeen, UK.

Background: Teamwork is important in the design and delivery of initiatives in complex healthcare systems but the specifics of quality improvement (QI) teams are not well studied.

Objective: To explain the functioning of front-line healthcare teams working on patient-centred QI using Bourdieu's sociological construct of capital.

Methods: One medical ward from each of six NHS Trusts in England participated in the study, purposively selected for a range of performance levels on patient experience metrics. Read More

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http://dx.doi.org/10.1136/bmjoq-2020-000948DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7259840PMC

What is the feasibility and observed effect of two implementation packages for stroke rehabilitation therapists implementing upper limb guidelines? A cluster controlled feasibility study.

BMJ Open Qual 2020 May;9(2)

Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia.

Background: Hand and arm activity after stroke improves with evidence-based rehabilitation. Therapists face known barriers when providing evidence-based rehabilitation and require support to implement guidelines. The aim of this study was to investigate the feasibility of two implementation packages on guideline adherence by occupational therapists and physiotherapists, and explore effect on patient upper limb outcomes. Read More

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http://dx.doi.org/10.1136/bmjoq-2020-000954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252969PMC

Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative.

BMJ Open Qual 2020 05;9(2)

Improvement Team, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.

Background: The COVID-19 outbreak has placed the National Health Service under significant strain. Social distancing measures were introduced in the UK in March 2020 and virtual consultations (via telephone or video call) were identified as a potential alternative to face-to-face consultations at this time.

Local Problem: The Royal National Orthopaedic Hospital (RNOH) sees on average 11 200 face-to-face consultations a month. Read More

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http://dx.doi.org/10.1136/bmjoq-2020-000985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247397PMC

Understanding quality systems in the South African prehospital emergency medical services: a multiple exploratory case study.

BMJ Open Qual 2020 May;9(2)

Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.

Introduction: In South Africa (SA), prehospital emergency care is delivered by emergency medical services (EMS) across the country. Within these services, quality systems are in their infancy, and issues regarding transparency, reliability and contextual relevance have been cited as common concerns, exacerbated by poor communication, and ineffective leadership. As a result, we undertook a study to assess the current state of quality systems in EMS in SA, so as to determine priorities for initial focus regarding their development. Read More

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http://dx.doi.org/10.1136/bmjoq-2020-000946DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247383PMC

Using Lean Six Sigma methodologies to reduce risk of warfarin medication omission at hospital discharge.

BMJ Open Qual 2020 May;9(2)

Operations Improvement, Memorial Health System, Springfield, Illinois, United States

Unintended omission of warfarin, an anticoagulant used to prevent and treat thromboembolic events, can lead to serious medical complications. These complications include increased medical costs, hospitalisations and significant patient harm, including increased risk of thrombosis and mortality. Chart review of discharged patients at our institution revealed an average of one patient/month with warfarin omitted from the discharge plan despite intention to continue therapy. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245401PMC

Improving the use of the 'COUGH' bundle in Surgical High Dependency Unit, Ninewells Hospital, Dundee.

BMJ Open Qual 2020 May;9(2)

Surgical High Dependency Unit, Ninewells Hospital, NHS Tayside, Dundee, UK.

Developing respiratory complications postoperatively is one of the major determinants of longer hospital stay, morbidity, mortality and increased healthcare costs. The incidence of postoperative respiratory complications varies from 1% to 23%. Given that postoperative respiratory complications are relatively common and costly, there have been various studies which look at ways to reduce the risk of these occurring. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245369PMC

Towards patient-centred care in Ghana: health system responsiveness, self-rated health and experiential quality in a nationally representative survey.

BMJ Open Qual 2020 May;9(2)

Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.

Introduction: Person-centredness, including patient experience and satisfaction, is a foundational element of quality of care. Evidence indicates that poor experience and satisfaction are drivers of underutilisation of healthcare services, which in turn is a major driver of avoidable mortality. However, there is limited information about patient experience of care at the population level, particularly in low-income and middle-income countries. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228562PMC

Improving the paediatric surgery patient experience: an 8-year analysis of narrative quality data.

BMJ Open Qual 2020 May;9(2)

Department of Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.

Background: Narrative data about the patient experience of surgery can help healthcare professionals and administrators better understand the needs of patients and their families as well as provide a foundation for improvement of procedures, processes and services. However, units often lack a methodological framework to analyse these data empirically and derive key areas for improvement. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is aimed at improving the quality of surgical care by collecting patient data and reporting risk-adjusted surgical outcomes for each participant hospital in the programme. Read More

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http://dx.doi.org/10.1136/bmjoq-2020-000924DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223344PMC

Losing the wait: improving patient cycle time in primary care.

BMJ Open Qual 2020 May;9(2)

Gehr Family Centre for Health Systems Science and Innovation, USC Keck School of Medicine, Los Angeles, California, USA.

Inefficient clinic systems leading to prolonged wait times at primary care clinics are a source of frustration for patients, physicians, staff and administration. Measuring and shortening cycle time has the potential to improve patient experience, staff satisfaction and patient access by moving more patients through in a shorter cycle time. Limited studies have demonstrated that improvements can be made to cycle time and may result in improved patient satisfaction. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223280PMC

Reducing caesarean rates in a public maternity hospital by implementing a plan of action: a quality improvement report.

BMJ Open Qual 2020 May;9(2)

Maternal Fetal Department, Hospital Israelita Albert Einstein, Sao Paulo, São Paulo, Brazil.

Background: Caesarean rates increased in different parts of the world, rising from 20% to 33% in the USA and from 40% to 55% in Brazil between 1996 and 2011; however, there was no reduction in morbimortality rates. Several factors have been suggested as responsible for this increase, such as health judicialisation, fear of the painful process on the patients' part and reduction of medical training in vaginal delivery and labour complications. It is urgent to reverse this process and, therefore, a model of actions was created with the intention of engaging the team in order to reduce caesarean rates in a Brazilian hospital. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223294PMC

Effect of a formalised discharge process which includes electronic delivery of prescriptions to pharmacies on the incidence of delayed prescription retrieval.

BMJ Open Qual 2020 May;9(2)

Division of Cardiology, London Health Sciences Centre and St. Joseph's Health Care, London, Ontario, Canada.

Background: Lack of prescription adherence after discharge from the inpatient hospital setting is a barrier to the delivery of optimal patient care. Non-adherence to medication for cardiac diseases can lead to substantial morbidity, mortality and healthcare costs. Electronic delivery of prescriptions by fax is a potential method of improving patient satisfaction and reducing pharmacy wait times. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228567PMC

Framework for patient, family-centred care within an Australian Community Hospital: development and description.

BMJ Open Qual 2020 Apr;9(2)

Executive Management, Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, Queensland, Australia.

Objective: To describe the development of a patient and family-centred care (PFCC) conceptual framework within a small community Australian Hospital.

Methods: A scoping review of scientific and grey literature and community hospital stakeholder discussions were used to identify and design a conceptual framework for PFCC across five core pillars of leadership, engagement, service delivery, learning and environment.

Results: 107 publications were identified and 76 were included for data extraction. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213886PMC

Implementing the patient care collaborative model in three general internal medicine units: a mixed-methods healthcare improvement initiative.

BMJ Open Qual 2020 Apr;9(2)

St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada

Background: As part of the scale-up of the Patient Care Collaborative (PCC) at our institution, we explored staff perceptions and patient outcomes at different levels of model implementation in three general internal medicine units.

Methods: We conducted a mixed-methods embedded experimental healthcare improvement initiative. In the qualitative strand, we conducted five focus group discussions. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213873PMC

Assessment of the quality, content and perceived utility of local maternity guidelines in hospitals in England implementing the saving babies' lives care bundle to reduce stillbirth.

BMJ Open Qual 2020 Apr;9(2)

St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK

Introduction: The UK Department of Health have targeted a reduction in stillbirth by 50% by 2025; to achieve this, the first version of the Saving Babies' Lives Care Bundle (SBLCB) was developed by NHS England in 2016 to improve four key areas of antenatal and intrapartum care. Clinical practice guidelines are a key means by which quality improvement initiatives are disseminated to front-line staff.

Methods: Seventy-five clinical practice guidelines covering the four areas of antenatal and intrapartum care in the first version of SBLCB were obtained from 19 maternity providers. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254132PMC

Improving patient safety during intrahospital transportation of mechanically ventilated patients with critical illness.

BMJ Open Qual 2020 Apr;9(2)

Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan.

Aim: Intrahospital transportation (IHT) of patients under mechanical ventilation (MV) significantly increases the risk of patient harm. A structured process performed by a well-prepared team with adequate communication among team members plays a vital role in enhancing patient safety during transportation.

Design And Implementation: We conducted this quality improvement programme at the intensive care units of a university-affiliated medical centre, focusing on the care of patients under MV who received IHT for CT or MRI examinations. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202726PMC

Reducing readmissions and improving patient experience following urological surgery, through early telephone follow-up.

BMJ Open Qual 2020 Apr;9(2)

Department of Urology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK.

Readmission from urological surgery is common, with a readmission rate for day case surgery of 3.7% and 26% for robot-assisted cystectomy. Readmission to secondary care and representation to primary care are both expensive and preventable. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199917PMC

Designing and implementing an all Wales postpartum haemorrhage quality improvement project: OBS Cymru (the Obstetric Bleeding Strategy for Wales).

BMJ Open Qual 2020 Apr;9(2)

Haematology, University Hospital of Wales, Cardiff, UK.

Background: Postpartum haemorrhage (PPH) contributes to substantial maternal morbidity. Research into PPH has led to improvements in care which have been incorporated into the Obstetric Bleeding Strategy for Wales.

Intervention: A national quality improvement team supported local teams in implementing multiple interventions including risk assessment, objective measurement of blood loss, multiprofessional assessment (at the bedside at 1000 mL blood loss) and point-of-care (POC) testing of coagulation to guide blood product resuscitation during PPH. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326295PMC

Opioid stewardship: implementing a proactive, pharmacist-led intervention for patients coprescribed opioids and benzodiazepines at an urban academic primary care centre.

BMJ Open Qual 2020 Apr;9(2)

Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.

In 2017, almost 4000 Canadians died from opioid-related causes. Coadministration of opioids and benzodiazepines is a risk factor for overdose. Few studies have evaluated leveraging pharmacists to address opioid-benzodiazepine coprescribing. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170545PMC

Reducing time to treatment of bacterial sexually transmitted infections in an HIV cohort.

BMJ Open Qual 2020 Apr;9(2)

Brownlee Centre, Gartnavel General Hospital, Glasgow, Glasgow, UK.

Sexually transmitted infections (STIs) are known to increase the risk of transmission of HIV and care of sexual health needs should form part of routine HIV care. Delayed treatment of STIs can lead to complications and avoidable onward transmission. Management of acute STIs in UK specialist sexual health services usually involves a multidisciplinary approach to ensure patient recall, antimicrobial treatment and partner notification. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170538PMC

Partnering with patients to improve access to primary care.

BMJ Open Qual 2020 Apr;9(2)

Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.

Continuity and timely access are hallmarks of high-quality primary care and are important considerations for urgent concerns that present both during the day and after-hours. It can be especially difficult to ensure continuity of primary care after-hours in urban settings where walk-in clinics offer patients easy and convenient access. Patients of our large, multisite primary care practice in inner-city Toronto, Canada were reporting that they were not easily able to access after-hours care from their team without having to use outside services. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170539PMC

Novel team-based approach to quality improvement effectively engages staff and reduces adverse events in healthcare settings.

BMJ Open Qual 2020 Apr;9(2)

MEERQAT Pty Ltd, St Kilda, Victoria, Australia.

Background: Despite significant attention to safety and quality in healthcare over two decades, patient harm in hospitals remains a challenge. There is now growing emphasis on continuous quality improvement, with approaches that engage front-line staff. Our objective was to determine whether a novel approach to reviewing routine clinical practice through structured conversations-could improve engagement of front-line staff in quality improvement activities and drive improvements in indicators of patient harm. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170544PMC

'Real time' monitoring of antipsychotic prescribing in patients with dementia: a study using the Clinical Record Interactive Search (CRIS) platform to enhance safer prescribing.

BMJ Open Qual 2020 Mar;9(1)

Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, London, UK

Background: The use of antipsychotic drugs in dementia has been reported to be associated with increased risk of cerebrovascular events and mortality. There is an international drive to reduce the use of these agents in patients with dementia and to improve the safety of prescribing and monitoring in this area.

Objectives: The aim of this project was to use enhanced automated regular feedback of information from electronic health records to improve the quality of antipsychotic prescribing and monitoring in people with dementia. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170541PMC

Reduction of early inpatient transfers and rapid response team calls after implementation of an emergency department intake huddle process.

BMJ Open Qual 2020 Mar;9(1)

Center for Health Care Improvement Science, Virginia Mason Medical Center, Seattle, Washington, USA.

Patients admitted to the hospital and requiring a subsequent transfer to a higher level of care have increased morbidity, mortality and length of stay compared with patients who do not require a transfer during their hospital stay. We identified that a high number of patients admitted to our intermediate care (IMC) unit required a rapid response team (RRT) call and an early (<24 hours) transfer to the intensive care unit (ICU). A quality improvement project was initiated with the goal to reduce subsequent early transfers to the ICU and RRT calls. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000862DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170542PMC

Community-based prehabilitation before elective major surgery: the PREP-WELL quality improvement project.

BMJ Open Qual 2020 Mar;9(1)

Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK.

Optimising health and well-being before elective major surgery via prehabilitation initiatives is important for good postoperative outcomes. In a busy tertiary centre in North East England, the lack of a formal prehabilitation service meant that opportunities were being missed to optimise patients for surgery. This quality improvement project aimed to implement and evaluate a community-based prehabilitation service for people awaiting elective major surgery: PREP-WELL. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206908PMC

Testicular cancer: improving outcomes with national quality performance indicators.

BMJ Open Qual 2020 Mar;9(1)

Beatson West of Scotland Cancer Centre, Glasgow, UK.

Testicular cancer is the most common malignancy in young adult men. The prognosis is excellent in limited disease and cure is possible even in advanced disease. Quality performance indicators (QPI) are used in many developed countries as a measure of healthcare performance. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206916PMC

Improving the documentation quality of point-of-care ultrasound scans in the emergency department.

BMJ Open Qual 2020 Mar;9(1)

Emergency Department, Princess Royal University Hospital, Orpington, Kent, UK.

A point-of-care ultrasound scan (POCUS) is a core element of the Royal College of Emergency Medicine (RCEM) specialty training curriculum. However, POCUS documentation quality can be poor, especially in the time-pressured environment of the emergency department (ED). A survey of 10 junior ED clinicians at the Princess Royal University Hospital (PRUH) found that total POCUS documentation was as low as 38% in some examinations. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206901PMC

Improving blood pressure screening and control at an academic health system.

BMJ Open Qual 2020 Mar;9(1)

University of California Davis Health, Sacramento, California, USA.

The goal of the University of California Davis Health Blood Pressure (BP) Quality Improvement Initiative was to improve the diagnosis, management and control of high BP. Patients aged 18-85 years were included in the initiative. Lean A3 problem solving was used to implement the following evidence-based interventions based on stakeholder interviews, value stream mapping and the Centers for Disease Control and Prevention's Million Hearts Initiative: staff training on accurate BP measurement, visual cues and reminders for BP screening, virtual case-based videoconferences, standardised clinical management algorithm, academic detailing visits, clinical decision support tools, access to pharmacists for medication comanagement, clinician workflow modification, patient education and access to home BP monitors. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000614DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206904PMC

Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital.

BMJ Open Qual 2020 Mar;9(1)

Center for Healthcare Transformation, Avalere Health, Washington, DC, USA.

As many as 50% of hospitalised patients are estimated to be malnourished or at risk of malnutrition on hospital admission, but this condition often goes unrecognised, undiagnosed and untreated. Malnutrition is associated with an elevated need for continued medical interventions, higher costs of care and increased patient safety risks. Tampa General Hospital (TGH), a large teaching hospital in the southeastern USA, initiated a project to improve the quality of patient care at its institution. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170540PMC

Accuracy of medical billing data against the electronic health record in the measurement of colorectal cancer screening rates.

BMJ Open Qual 2020 Mar;9(1)

Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, United States

Objective: Medical billing data are an attractive source of secondary analysis because of their ease of use and potential to answer population-health questions with statistical power. Although these datasets have known susceptibilities to biases, the degree to which they can distort the assessment of quality measures such as colorectal cancer screening rates are not widely appreciated, nor are their causes and possible solutions.

Methods: Using a billing code database derived from our institution's electronic health records, we estimated the colorectal cancer screening rate of average-risk patients aged 50-74 years seen in primary care or gastroenterology clinic in 2016-2017. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000856DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103821PMC

Closing the gap: actualising shared decision-making through effective medication abortion patient follow-up care.

Authors:
Erin Fagot

BMJ Open Qual 2020 Mar;9(1)

Frontier Nursing University, Hyden, Kentucky, USA

Background: Effective care dearth in USA healthcare systems can be augmented by patient engagement and shared decision-making (SDM). These effective care strategies can facilitate medical abortion follow-up care (ensuring patients are not experiencing a continuing pregnancy) and follow-up options access.

Local Problem: The quality improvement project clinic had a state-mandated waiting period, requiring additional visits. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103833PMC

Development and application of 'systems thinking' principles for quality improvement.

BMJ Open Qual 2020 Mar;9(1)

Medical Directorate, NHS Education for Scotland, Glasgow, UK

Introduction: 'Systems thinking' is often recommended in healthcare to support quality and safety activities but a shared understanding of this concept and purposeful guidance on its application are limited. Healthcare systems have been described as complex where human adaptation to localised circumstances is often necessary to achieve success. Principles for managing and improving system safety developed by the European Organisation for the Safety of Air Navigation (EUROCONTROL; a European intergovernmental air navigation organisation) incorporate a 'Safety-II systems approach' to promote understanding of how safety may be achieved in complex work systems. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000714DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103793PMC