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BMJ Open Quality

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[This corrects the article DOI: 10.1136/bmjoq-2017-000042.].
2019: BMJ Open Quality
Nermin Ghith, Juan Merlo, Anne Frølich
Background: Studies assessing institutional performance regarding quality of care are frequently performed using single-level statistical analyses investigating differences between provider averages of various quality indicators. However, such analyses are insufficient as they do not consider patients' heterogeneity around those averages. Hence, we apply a multilevel analysis of individual-patient heterogeneity that distinguishes between 'general' ('latent quality' or measures of variance) and 'specific' (measures of association) contextual effects...
2019: BMJ Open Quality
Serena Michelle Ogunwole, Jason Phillips, Amber Gossett, John Richard Downs
Background: Despite improvements in length of stay and mortality, congestive heart failure (CHF) remains the most common cause of 30-day readmissions to the hospital. Though multiple studies have found that early follow-up after discharge (eg, within 7 days) is critical to improving 30-day readmissions, implementation strategies are challenging in resource-limited settings. Here we present a quality improvement initiative aimed at improving early follow-up while maximising available resources...
2019: BMJ Open Quality
Anette Storesund, Arvid Steinar Haugen, Hilde Valen Wæhle, Rupavathana Mahesparan, Marja A Boermeester, Monica Wammen Nortvedt, Eirik Søfteland
Introduction: Surgical safety checklists may contribute to reduction of complications and mortality. The WHO's Surgical Safety Checklist (WHO SSC) could prevent incidents in operating theatres, but errors also occur before and after surgery. The SURgical PAtient Safety System (SURPASS) is designed to intercept errors with use of checklists throughout the surgical pathway. Objective: We aimed to validate a Norwegian version of the SURPASS' preoperative and postoperative checklists for use in combination with the already established Sign In, Time Out and Sign Out parts of the WHO SSC...
2019: BMJ Open Quality
Andrea Smeraglio, Paul A Heidenreich, Gomathi Krishnan, Joseph Hopkins, Jonathan Chen, Lisa Shieh
Objective: To compare patients' and providers' views on contributors to 30-day hospital readmissions. Design: Analysis of a qualitative interview survey between 18 May-30 June 2015. Setting: Interviews were conducted during the 30-day readmission hospitalisation at a single tertiary care academic hospital. Participants: We conducted 178 interviews of readmitted patients. Measures: We queried opinions of what factors patients believed contributed to their rehospitalisation and compared this with the perspective of the index admission provider...
2019: BMJ Open Quality
David Hamilton, Ian Bugg
There is global concern over increasing antibiotic resistance rates due to poor antimicrobial stewardship, particularly in low-income and middle-income countries where there are limited diagnostic facilities, fewer doctors per capita and inadequate control over the production and sale of antibiotics. This quality improvement project was designed to improve the antimicrobial prescriptions practices of paramedical staff in the outpatient department of a rural district general hospital in Masanga, Sierra Leone, West Africa...
2018: BMJ Open Quality
Sophie Stanger, Mark Dahill, Charlotte Hillary, Robert Whitham, Andrew Tasker
Patients value effective pain relief. Complications of inadequate pain control include increased risk of infection, decreased patient comfort and progression to chronic pain, all of which have significant socioeconomic consequence. Accessibility to analgesia is vital to effective administration. This improvement project aimed to improve the consistency and adequacy of analgesia prescribing for trauma inpatients over a 12-month period. Four PDSA ('plan, do, study, act') cycles resulted in sustained and significant improvements in analgesia prescription...
2018: BMJ Open Quality
Rachael Logan, Peter Davey, Alison Davie, Suzanne Grant, Vicki Tully, Achyut Valluri, Samira Bell
In 2009, a National Confidential Enquiry into Patient Outcome and Death report detailed significant shortcomings in recognition and management of patients with acute kidney injury (AKI). As part of a national collaborative to reduce harm from AKI, the Scottish Patient Safety Programme developed two care bundles to improve response ('SHOUT') and review ('BUMP') of AKI. Baseline data from eight patients with AKI on the acute medical unit (AMU) in Ninewells Hospital showed 62% compliance with SHOUT. However, most patients were transferred from AMU within 24 hours so BUMP could not be assessed...
2018: BMJ Open Quality
Thomas Robert Edward Jones, Kim Nurse
Darlington Memorial Hospital is a district general hospital in the North East of England. The acute medical unit (AMU) takes referrals from the emergency department and also direct from general practitioners (GPs) in the region. Research shows that early recognition and management of sepsis is key to improving outcomes and significantly decreases mortality. Having observed several cases of delayed sepsis management in patients referred from their GP, we aimed to improve time to antibiotic therapy in patients identified as having sepsis as per the National Institute for Health and Care Excellence 2016 NG51 sepsis guidelines...
2018: BMJ Open Quality
Tooba Arif
Introduction: Hepatitis B is a vaccine-preventable disease, and hepatitis C is amenable to treatment. Both are highly prevalent in the prison population. This project provides a comprehensive evaluation of current hepatitis services at Her Majesty's Prison Birmingham, assessing progress since previous work and proposing further suggestions for improvement. Methods: A review of hepatitis services was undertaken in 2013, in the context of underperformance against national targets...
2018: BMJ Open Quality
Christine Lee, Casey Phillips, Jason Robert Vanstone
Objective: To determine if an educational intervention can decrease the inappropriate antibiotic treatment of long-term care (LTC) residents with asymptomatic bacteriuria (ASB). Design: Prospective chart audit between May and July 2017. Setting: Seven LTC facilities in Regina, Saskatchewan, Canada. Participants: Chart audits were performed on all LTC residents over 18 years of age with a positive urine culture. Educational sessions and tools were available to all clinical staff at participating LTC facilities...
2018: BMJ Open Quality
Alexander Carpenter, Sabrina Sargent
Background: Direct current cardioversion (DCCV) is a safe and effective treatment for recent-onset atrial fibrillation (AF) or flutter and when performed in the emergency department (ED), it can provide an excellent treatment option for patients as well as reducing unnecessary hospital admissions and healthcare costs. However, appropriate periprocedural anticoagulation is absolutely essential to reduce the risk of adverse outcomes, chiefly thromboembolic stroke. Our intention was for 100% of patients undergoing DCCV in the ED to receive appropriate periprocedural anticoagulation...
2018: BMJ open quality
Diane Baylis, Julie Price, Paul Bowie
Background and aims: Laboratory test results management systems are a complex safety issue in primary care settings worldwide. Related failures lead to avoidable patient harm, medicolegal action, patient complaints and additional workload to problem solve identified issues. We aimed to review and learn from 50 clinical negligence cases involving system failures related to the management of test results. Methods: The Medical Protection Society database was searched and a convenience sample of 50 claims identified from a 3-year period covering 2014-2016...
2018: BMJ Open Quality
Shahram Zaheer, Liane R Ginsburg, Hannah J Wong, Kelly Thomson, Lorna Bain
Background: There is growing evidence regarding the importance of contextual factors for patient/staff outcomes and the likelihood of successfully implementing safety improvement interventions such as checklists; however, certain literature gaps still remain-for example, lack of research examining the interactive effects of safety constructs on outcomes. This study has addressed some of these gaps, together with adding to our understanding of how context influences safety. Purpose: The impact of staff perceptions of safety climate (ie, senior and supervisory leadership support for safety) and teamwork climate on a self-reported safety outcome (ie, overall perceptions of patient safety (PS)) were examined at a hospital in Southern Ontario...
2018: BMJ Open Quality
Luke A Turcotte, Jake Tran, Joshua Moralejo, Nancy Curtin-Telegdi, Leslie Eckel, John P Hirdes
Background: Health information systems with applications in patient care planning and decision support depend on high-quality data. A postacute care hospital in Ontario, Canada, conducted data quality assessment and focus group interviews to guide the development of a cross-disciplinary training programme to reimplement the Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 comprehensive health assessment into the hospital's clinical workflows. Methods: A hospital-level data quality assessment framework based on time series comparisons against an aggregate of Ontario postacute care hospitals was used to identify areas of concern...
2018: BMJ Open Quality
Lynne Sykes, Smeeta Sinha, Janet Hegarty, Emma Flanagan, Liam Doyle, Chedia Hoolickin, Lewis Edwards, Paul Ferris, Elizabeth Lamerton, Dimitrios Poulikakos, Darren Green, Robert Nipah
Acute kidney injury (AKI) is a common syndrome that is associated with significant mortality and cost. The Quality Improvement AKI Collaborative at Salford Royal Foundation Trust was established to review and improve both the recognition and management of AKI. This was a whole-system intervention to tackle AKI implemented as an alternative to employing separate AKI nurses. Our aims were to reduce the overall incidence of AKI by 10%, to reduce hospital-acquired AKI by 25% and to reduce the progression of AKI from stage 1 to stage 2 or 3 by 50%...
2018: BMJ open quality
Orhan Uzun, Julia Kennedy, Colin Davies, Anthony Goodwin, Nerys Thomas, Delyth Rich, Andrea Thomas, David Tucker, Bryan Beattie, Michael J Lewis
Objectives: This study describes the design, delivery and efficacy of a regional fetal cardiac ultrasound training programme. This programme aimed to improve the antenatal detection of congenital heart disease (CHD) and its effect on fetal and postnatal outcomes. Design setting and participants: This was a prospective study that compared antenatal CHD detection rates by professionals from 13 hospitals in Wales before and after engaging in our 'skills development programme'...
2018: BMJ Open Quality
Laila Nasser, Alix Stosic, David Price
Purpose: To evaluate the McMaster Family Health Team (MFHT) as part of a Continuous Quality Improvement initiative using a set of provincial performance metrics to demonstrate which measures of assessment are actually clinically meaningful in context and where system-level changes might be implemented to improve operational practice. Methods: Measures were selected from the Primary Care Performance Measurement Framework based on data availability for the MFHT and provincial comparators...
2018: BMJ Open Quality
Amy Dehn Lunn
Inappropriate antibiotic use is a key factor in the emergence of antibiotic resistance. The majority of antibiotics are prescribed in primary care, where upper respiratory tract infection (URTI) is a common presentation. Inappropriate antibiotic prescribing in URTI is common globally and has increased markedly in developing and transitional countries. Antibiotic stewardship is crucial to prevent the emergence and spread of resistant microbes. This project aimed to reduce inappropriate antibiotic prescribing in URTI in a non-governmental organisation's primary care outreach clinics in Kolkata, India, from 62...
2018: BMJ Open Quality
David John Lowe, Cameron Kay, Dagshagini Taylor, Nicola Littlewood, Scott Hepburn, Paul Bowie
Maintaining quality of care and meeting patient expectations in the face of rising demand within emergency departments (ED) is a significant challenge for clinicians. This study tested the Always Events (AE) approach as a means to identify AE's relevance to patient care in the ED and act on this to address patient concerns. The project team looked to identify aspects of care patients would like to see improved within the minor injuries stream (MIS). Following triage, patients typically have presentations that do not require admission and require a single interaction with a clinician...
2018: BMJ Open Quality
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