We conducted a 19-month (December 2023–June 2025) mixed-methods implementation study at a tertiary academic ED in India. The Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change guided six iterative IS phases, including education, co-design, workflow optimisation and audit/feedback. Participants were EM residents. The primary outcome was the proportion of POCUS examinations achieving ≥80% compliance with ACEP documentation standards. Compliance trends were analysed across phases and summarised using proportions and medians with IQRs. Qualitative data from five focus group discussions were analysed using CFIR to identify barriers, facilitators and mechanisms of change. Quantitative and qualitative findings were integrated using a joint display.

We assessed 3074 POCUS examinations. The proportion of scans achieving ≥80% compliance increased from 0% at baseline to 35.1% postimplementation. Median compliance rose from 24% (IQR 17–34) to 69% (IQR 54–84). Compliance followed a nonlinear trajectory. Initial phases showed minimal gains (0%–8.7%) due to workflow barriers. A marked acceleration occurred during IS-5 (22.5%) following the introduction of a user-designed, single multimodal form and gamification. Qualitative analysis demonstrated a shift from initial resistance (CFIR: compatibility, complexity) to normalisation (implementation climate), although technical challenges with image archiving persisted.

User-centred co-design and peer engagement were key to the improvement, although persistent infrastructure challenges limited further gains and highlighted the need for informatics-enabled solutions. This study demonstrates that low-cost, context-sensitive strategies can enhance POCUS documentation effectively in high-volume, resource-constrained EDs.

A multifaceted, iterative IS guided by theoretical frameworks significantly improved POCUS documentation compliance. User-centred design and participatory engagement were critical mechanisms for sustainable practice change in a resource-variable EM setting.

CTRI/2024/03/063671.

To explore and identify perceived current and future safety risks and how these might be mitigated in relation to professional optometry practice in Scotland.

Study participants were all registered General Optical Council members from nine of the 14 regional health boards in Scotland. Data were collected via three online focus groups over a 2-month period during 2021 with each comprising six to eight participants. Data were transcribed with permission and then subjected to a basic thematic analysis.

16 optometrists participated in the study. Six principal themes were generated from the data analysis: (1) current overview and context (eg, perceived increased risk); (2) competency risks (eg, skills and knowledge to manage disease); (3) conduct risks (eg, behaviours of practitioners); (4) contextual risks (eg, environmental issues); (5) future risks (eg, technology) and (6) risk mitigations (eg, education and training).

Optometrists participating in this study expressed concerns that the level of perceived clinical risk in the Optometry profession is increasing, mainly related to technology, scope of practice, role development and changes in consumer demand. Multiple recommendations are made to minimise reported risks including education for new roles; increased focus on improving care quality; support to those involved in safety incidents and complaints; taking a systems approach to areas of high risk and sharing good practices.

To develop and validate an automated electronic health record (EHR)-based method for detecting potential wrong-side diagnostic imaging order errors using an adapted Retract-and-Reorder (RAR) approach and to identify associated risk factors.

Retrospective cohort study.

Six-facility health system comprising inpatient, outpatient and emergency room sites.

We screened 355 000 imaging orders with side specified, placed during 2021 across our healthcare system. We adapted the RAR methodology, originally developed to detect near-miss medication errors, by extending detection windows to 24 hours and identifying any orders switching from one side to the contralateral side, accounting for multiprovider workflows inherent in imaging. We validated the method through chart review of 100 randomly selected RAR events, then applied the query across all imaging orders. Multivariate logistic regression was used to identify risk factors associated with RAR events.

We identified 1667 RAR events (4.70 per 1000 orders). Validation yielded a positive predictive value of 87% (95% CI 79.0% to 92.2%), estimating 4.09 confirmed wrong-side errors per 1000 orders. The odds of an RAR event were significantly higher in outpatient settings compared with inpatient settings (OR 4.53; 95% CI 3.80 to 5.42) and among administrative staff compared with attending physicians (OR 2.08; 95% CI 1.73 to 2.49). CT scans showed 79% higher odds of an RAR event compared with X-rays (OR 1.79; 95% CI 1.34 to 2.39).

This validated approach offers a scalable solution for automated detection of potential wrong-side diagnostic imaging order errors. The methodology leverages commonly available EHR data to support continuous surveillance and intervention evaluation for improved diagnostic safety.

A Quality Improvement (QI) project was conducted in the Radiology Department of Saint Peter Specialized Hospital between August and November 2022. The aim was to reduce the median waiting time for ultrasound appointments from 28 days to less than 5 days. A root cause analysis (RCA) identified key contributors, including delayed start times, absence of structured scheduling, workflow interruptions and limited machine availability. Driver diagrams and prioritisation matrices informed intervention selection and tested through sequential Plan–Do–Study–Act (PDSA) cycles. Interventions included workflow optimisation, extended effective working hours, productivity enhancement, structured appointment scheduling and deployment of point-of-care ultrasound for emergency cases.

The maximum waiting time for senior radiologist ultrasound appointments decreased from 28 days to ≤5 working days. The backlog for technologist-led examinations was eliminated. Daily productivity increased from 10 to 48 scans per radiologist and from 18 to 65 scans per technologist. Run charts demonstrated progressive and sustained improvement across four PDSA cycles.

The QI project achieved significant reductions in ultrasound waiting times through organisational and workflow redesign without additional funding. Sustainability relied on staff engagement, leadership support and embedding new practices into routine operations. These low-cost, context-appropriate strategies may be applicable to other resource-constrained hospitals facing similar challenges.

We conducted a scoping review of peer-reviewed articles published between 2016 and 2025. From an initial identification of 244 articles, 18 core studies were selected for snowball sampling, resulting in a pool of 113. After screening for accessibility and relevance, 30 studies were included in the final review that explicitly addressed overlaps between implementation science, improvement science and quality improvement. Data were charted on study objectives, methodologies, frameworks and relevance to healthcare improvement, and synthesised to identify common themes, models and barriers to integration.

The integration of these three disciplines creates a robust framework for health system change: implementation science emphasises fidelity and evidence-based uptake, improvement science prioritises generalisable knowledge and quality improvement enables rapid, local problem-solving. Their combined application can enhance the scalability, sustainability and efficiency of interventions. Models such as the HIV/AIDS Bureau Implementation Science Model, Reach-Effectiveness-Adoption-Implementation-Maintenance and the Learning Evaluation framework illustrate practical integration, showing how iterative quality improvement efforts can inform broader implementation strategies. Barriers include siloed approaches, variable terminology and limited organisational capacity, highlighting the need for cross-disciplinary collaboration, training and infrastructure support.

Integrating implementation science, improvement science and quality improvement provides a pathway to accelerate evidence translation, strengthen system-wide healthcare quality and improve patient-centred outcomes in HIV care. Synthesising shared principles and alignment opportunities offers actionable guidance for healthcare systems seeking to leverage the strengths of each discipline for more effective, scalable and sustainable care delivery.

At Armed Forces Hospitals–Taif Region (Kingdom of Saudi Arabia), delays in referral to assessment by home healthcare (HHC) services led to delay in the initiation of HHC falling short of global standards.

This quality improvement project aimed to enhance the transition pathway from hospital to home care and to assess the effect of the intervention on the 30-day readmission rate and patient satisfaction among chronic patients requiring HHC follow-up.

This initiative, implemented between September 2024 and June 2025, used the Lean Six Sigma methodology (Define, Measure, Analyse, Improve and Control), the 4P patient experience model and the strength-based clinical case management model to design and implement a structured care transition pathway that included early electronic referral alerts, standardised discharge workflows, predischarge HHC assessments, individualised care plans, transition navigators, centralised coordination, virtual follow-up clinics and weekly multidisciplinary rounds.

The timely initiation of HHC improved from 51% to 89.4% for high-priority patients and 71% to 92% for low-priority patients through improving referral to HHC initiation prior to discharge, and patient satisfaction increased from 46% to 91%. The average 30-day readmission rate declined from 35.8% to 7.7%. This translated into estimated cost savings of SAR4 960 536–4 982 136 (US$1 322 809–1 328 569), attributed primarily to avoided bed-days for preventable readmissions. There was a decrease in emergency department visits with the monthly average decreasing from 2.2 visits to 1.0 visits, representing a 54.5% reduction.

Embedding structured transition workflows and leveraging multidisciplinary collaboration significantly improved care continuity, safety and outcomes for chronic patients transitioning from hospital to home.

The aim of the project was to reduce falls rate on an older adult mental health ward by 30% (from an average of 5.4 to 3.7 per 1000 occupied bed days) by September 2024.

Using quality improvement methodology, a multidisciplinary team tested interventions to enhance therapeutic engagement, strengthen supportive nursing observations, mitigate medication-related risks and improve the ward environment.

The project surpassed its aim, reducing falls rate by 74% to 1.4 falls per 1000 occupied bed days.

This project demonstrated the importance of a multidisciplinary approach to falls reduction, as well as the value of employing Plan-Do-Study-Act methodology for rapid testing and learning.

Cross-sectional analysis of interventional trials and observational studies from 2009 to 2024; multivariable logistic regression assessed study-level factors associated with reporting race and ethnicity.

Global registry of clinical studies (ClinicalTrials.gov).

58 163 studies with posted results and without early termination.

Study characteristics: sponsor trial phase, study type and country.

Reporting of race, reporting of ethnicity, reporting of both.

Among 58163 studies (mean enrolment=1215 participants), 44.8% did not report race or ethnicity to the repository (mean enrolment=1481 participants). The proportion of studies reporting both race and ethnicity rose from 7.4% in 2013 to 54.6% in 2024. In multivariable models, observational studies had lower odds of reporting race and ethnicity (OR 0.55, 95% CI 0.49 to 0.61) compared with interventional trials. Phase 4 trials were least likely phase to report race and ethnicity (OR=0.32; 95% CI 0.29 to 0.35), and studies with only National Institute of Health funding were more likely to report race and ethnicity compared with studies with any industry funding or sponsorship (OR=1.70, 95% CI 1.61 to 1.79). For studies that reported race, White participants comprised ≥50% each year based on study-level percentages; proportions of Asian participants declined, and Black participants fluctuated. ‘Not Hispanic or Latino’ remained ≥80% of reported ethnicity annually.

Race and ethnicity reporting on ClinicalTrials.gov has improved markedly yet remains incomplete, with shortfalls in late-phase and observational studies.

We conducted a scoping review using the six-stage framework by Arksey and O’Malley. A purposeful sample of 71 QIRs published in 2019 across three leading quality improvement (QI) journals—BMJ Quality & Safety, BMJ Open Quality and Joint Commission Journal on Quality and Patient Safety—was analysed. Data extraction was guided by SQUIRE V.2.0 and supplemented by additional best practices. Return-of-findings sessions with QI scholars, journal editors, frontline practitioners and an international QI conference audience refined the findings and ensured practical relevance.

Most QIRs described a local problem and intervention but only 22% articulated strong aim statements with measurable targets. Two-thirds referenced a QI methodology but many descriptions of common QI tools lacked rigour. Process and balancing measures were often missing or inadequately justified. While Plan-Do-Study-Act cycles were commonly reported, few met criteria for ‘authenticity’. Data analysis and display methods varied, with several common weaknesses. Discussion sections frequently lacked depth and contextual factors—critical for reproducibility—were inconsistently described. Eight core lessons emerged to support more rigorous, transparent and impactful reporting.

As an emerging genre of scholarly communication, many QIRs still fall short in conveying methodological rigour and transferable insights. This review provides practical recommendations, illustrated by strong examples, to help authors and educators improve the clarity and impact of QIRs across healthcare settings.

A multicentre, qualitative exploration of patients with advanced (stage III–IV) ovarian cancer with a surgical intent to treatment, who had been referred to a UK National Health Service prehabilitation programme. Using a purposive, maximum variation sampling approach, patients were invited to complete a semi-structured interview about their views and experiences of multimodal prehabilitation (exercise, nutritional, psychological and medical optimisation interventions). The interview focused on acceptability, perceived usefulness of the service and barriers and facilitators to engagement and adherence. Interviews were conducted virtually. Audio recordings of interviews were transcribed verbatim. Data were analysed thematically.

Interviews were completed with 21 patients, with a median age of 56.5 years (range 37–89 years). Four main themes were identified with associated subthemes as follows: (1) introduction to the programme (timing, volume and content of information), (2) perceived need (support system and mindset, psychological and physical health), (3) delivery of the programme (convenience of appointments, accessibility of staff, family involvement, individual components of the intervention; ie, physical, psychological, nutritional interventions and group work) and (4) future engagement (addressing postsurgical gynaecological health and closure).

Overall, prehabilitation was acceptable to patients with advanced ovarian cancer who had been referred to a multimodal prehabilitation programme. Perceived accessibility of staff and inclusion of patients’ social network facilitated engagement. Lack of perceived need for prehabilitation was a barrier to participation, particularly for those with a strong support system or self-confessed strong physical and psychological baseline fitness. Effective patient-centred communication about prehabilitation could support patients with making informed choices about engagement in prehabilitation as part of their care plan.

To implement ND-BAL as a bedside procedure for mechanically ventilated intensive care unit (ICU) patients admitted within 48 hours of hospital admission with suspected CAP, increasing the proportion receiving a respiratory sample within 6 hours of ICU admission from 38% to ≥70% over 12 months and to compare oral flora contamination between ETA and ND-BAL.

A multidisciplinary team introduced a standardised ND-BAL protocol in a tertiary ICU. Baseline audit (January–December 2023) was compared with postimplementation data (March 2024–February 2025).

The proportion of eligible patients with a respiratory sample collected within 6 hours increased from 14/40 (35%) to 34/44 (77%). ND-BAL samples demonstrated lower oral flora contamination than ETA (50% vs 90.9%). Legionella culture testing increased from 15% to 56.8%, while empiric methicillin-resistant Staphylococcus aureus and Legionella antimicrobial coverage remained similar. No ND-BAL-related adverse events were identified.

ND-BAL was feasibly integrated as a joint nursing–medical bedside procedure and improved the timeliness and quality of respiratory sampling in mechanically ventilated patients with suspected CAP. This provides a platform for future rapid molecular diagnostics and antimicrobial stewardship.

A multidisciplinary inpatient specimen management team was established to analyse the causes of inefficiencies in the collection-to-submission process of body fluid specimens. Based on these findings, targeted interventions were formulated and implemented in February 2025. The preanalytical turnaround times and unqualified specimen rate before and after implementation were compared.

After implementing the closed-loop management system, the delayed submission rate of body fluid specimens decreased from 15.62% to 5.8% and the unqualified specimen rate decreased from 0.70% to 0.39%. The improvement in submission timeliness and specimen quality was statistically significant (p<0.05). All indicators showed significant differences at 3 and 6 months after intervention compared with before intervention (p<0.05).

The implementation of a closed-loop full-process management system for body fluid specimens effectively improved the timeliness of specimen submission, reduced delays and decreased the occurrence of unqualified specimens, thereby enhancing patient safety.

A cross-sectional study was conducted with all quality improvement (QI) team members across six public hospitals in Addis Ababa participating in a perinatal QIC. Contextual factors were assessed using the validated MUSIQ tool. The primary outcome was binary QI success (met/not met a predefined target for reducing perinatal mortality/morbidity). MUSIQ scores were compared between successful and non-successful hospitals using Mann-Whitney U tests. A multivariable logistic regression model was built to identify factors independently associated with success.

Sixty-seven QI team members participated (95.7% response rate). The overall mean MUSIQ score was 121.2±15.6, indicating a ‘reasonable chance of success’. However, scores were significantly higher in successful hospitals (median 129.9 vs 118.8, p=0.002). While external support scores were uniformly high, successful hospitals demonstrated significantly stronger scores in the organisation (p=0.045) and QI team (p=0.005) domains. Regression analysis confirmed that factors within the QI team (leadership, physician involvement) and organisation (senior leadership engagement) domains were independently associated with success, after accounting for other variables.

The success of this QIC was predominantly determined by internal organisational and team factors, not by the strong external support common to many global health initiatives. This highlights a critical implementation gap: top-down QICs often fail to catalyse the necessary internal leadership and team dynamics for success. Future initiatives must invest in building internal organisational context alongside providing external technical support.

We queried PubMed and PsycInfo for PSD, IS and their synonyms (community-based system dynamics or group model building, dissemination, quality improvement, translational research or knowledge translation). USA-based empirical studies were included when they described synchronous participatory activities to define a modelling problem over time. Studies were included when PSD was used as an implementation research method or implementation practice strategy. Fifty-eight studies on concept mapping were excluded, as were 65 intervention mapping studies. Nine articles remained after full-text review.

Most studies (n=7) investigated PSD itself as the intervention for understanding an implementation problem or use it as a tool to understand how to implement an evidence-based practice (n=4) or select an IS strategy (n=3). Most articles were case studies, investigating feasibility and knowledge translation during the preparation phase.

We recommend that implementation research and practice clarify whether PSD is used as a method to uncover contextual determinants or strategy to do so. PSD has strong potential to use enhanced participant buy-in and problem definition to understand ‘how’ implementation strategies account for cyclical and temporal determinants. Greater alignment between PSD activities, participatory theory, implementation phases and outcomes is needed to strengthen evaluation of PSD’s applications in IS.

The protocol for this paper is listed in the UNC Libraries repository (https://cdr.lib.unc.edu/concern/scholarly_works/6682xg09r).

We conducted a cross-sectional survey of healthcare providers across three DPP implementation settings in Ontario, Canada. Survey measures included the Organizational Readiness for Implementing Change (ORIC) scale and a measure assessing constructs from the inner setting domain of the Consolidated Framework for Implementation Research (CFIR). Due to our low sample size, we analyzed results descriptively.

We surveyed 36 stakeholders across three implementation settings. The ORIC scale and CFIR-based measurement tool scores were relatively high (greater than 4.00 out of 5.00) across most participants. Scores were similar across service types and professional roles.

Stakeholders across three settings appear ready to implement a postpartum DPP for patients with GDM. Although those from an integrated care setting tended toward higher readiness based on change efficacy and commitment, the results of the CFIR-based measurement tool underscore the importance of using tailored approaches when implementing programs in community-based settings with lower resources.

This is a narrative review of 132 English and non-English literature (2000–2025) from academic databases, grey literature, and policy documents across the six countries that was analysed using a novel framework examining LVC landscapes (healthcare challenges and measurement), determinants (structural, organisational, clinician, patient) and reduction initiatives.

Asian systems mirror Western pressures from demographic shifts, escalating costs and a growing burden of non-communicable diseases, underscoring the urgency of reducing LVC. Despite this, systematic measurement of LVC in Asia remains limited. Common LVC determinants include fee-for-service incentives, medicolegal concerns and a ‘more is better’ cultural perception, though further research, particularly on cross-country comparisons and from the patient’s perspective, is needed. LVC reduction initiatives are still emerging in Asia, with existing approaches shaped by local cultural norms and resource constraints, suggesting that Western strategies provide valuable insights but require adaptation for successful local de-implementation.

This multicountry review establishes a foundation for further collaborative LVC research in Asia via a holistic framework linking country-specific contexts to tailor de-implementation strategies. Key priorities for LVC research in Asia include systematic LVC quantification, development of contextualised evidence-based recommendations and implementation of contextualised multicomponent interventions, supported by further research and regional collaboration.

A two-cycle retrospective audit was conducted at a major trauma centre in the UK. The first cycle (January to April 2023, n=34) established baseline compliance with seven key BOAST documentation standards. Following this, a multifaceted intervention was implemented, including staff education, the introduction of a standardised checklist and the placement of visual reminders in operating theatres. A re-audit was then conducted (May to June 2024, n=63) to measure the impact of these interventions.

Baseline documentation compliance was extremely low, with only tourniquet pressure recorded in 20.5% (7/34) and tourniquet time documented in 55.9% (19/34). Following the interventions, documentation of tourniquet pressure increased to 59.0% (37/63) and tourniquet site, padding, compressive exsanguination, skin condition, tourniquet size and tourniquet time showed modest improvements. Overall compliance, however, remained below optimal levels.

A targeted quality improvement initiative combining education and practical tools can lead to meaningful improvements in adherence to tourniquet safety guidelines. Despite these gains, persistent documentation gaps highlight the need for more robust, system-level solutions, such as integration into electronic health records, to ensure sustained compliance and enhance patient safety.

A quality improvement initiative was conducted from June 2021 to April 2022 by employing the Define, Measure, Analyze, Improve, Control (DMAIC) lean model. The effectiveness of the intervention was evaluated by comparing the aetiological submission status of 885 hospitalised patients receiving therapeutic antibiotics during the baseline period (June to October 2021) with that of 904 inpatients during the postintervention period (November 2021 to April 2022) and by evaluating whether there was a significant difference in the AS rates within the five targeting departments before and after the intervention.

The hospital-wide AS rate significantly increased from 12.43% (110/885) at baseline to 84.96% (768/904) after intervention (²=941.24, p<0.001), exceeding the target of 50%. Significant improvements (all p<0.001) were also observed in all targeting departments.

The application of lean management, specifically the DMAIC lean model, proved highly effective in enhancing the AS rate. This systematic approach provides an improvement model for antimicrobial stewardship and offers valuable experience and reference for other healthcare institutions in their antimicrobial stewardship practices.

To analyse the impact of sudden donor funding cessation, using the experience of the Health Care Accreditation Council (HCAC) as an illustrative case, and to explore implications for quality infrastructure and health system resilience.

This structured case-based policy analysis draws on institutional documentation, administrative records and publicly available reports to examine the effects of funding withdrawal on quality programmes and organisational capacity.

Funding cessation led to contraction of technical workforce capacity, scaling back of quality improvement and professional development activities, and disruption of accreditation-related support. The case exposed vulnerabilities associated with donor dependency and insufficient transition planning.

Abrupt donor withdrawal can weaken quality systems and patient safety gains. Strengthening resilience requires diversified financing, structured transition frameworks and institutional strategies that embed quality governance within nationally owned systems.

We held a community engagement session to gather input from equity-denied communities on SDoH questions, response options, preferred methods of answering and appropriate data use. Qualitative data were analysed using content analysis, guided by the Capability, Opportunity and Motivation-Behaviour (COM-B) model. We also collected patient feedback from the first six months of implementing patient-centred SDoH data collection in ambulatory services at a large academic health science centre. This feedback was collected through an anonymous Microsoft Forms survey on comfort, safety and ease of responding to the SDoH questions and was summarised using medians and frequencies.

The community engagement session included 22 participants, including eight patient advisors from diverse community organisations. Participants identified COM-B-related barriers to completing the questionnaire, such as unclear terminology, privacy concerns and mistrust of data use. Facilitators included inclusive language, multiple response methods, and transparency, particularly around data use. After integrating this feedback, the early implementation demonstrated high levels of comfort and safety. Additional feedback from the implementation highlighted opportunities to expand response methods, enhance staff engagement and education and establish ongoing partnerships with patients and communities to support the equitable use of SDoH data.

Collecting SDoH data in healthcare settings is essential for facilitating equity-informed quality improvement, research, and decision-making. Our project highlights opportunities to overcome barriers by expanding response methods, enhancing staff engagement and education and fostering ongoing partnerships with patients and communities to support equitable SDoH data use and reporting.

Mixed-methods study conducted across two UK NHS hospitals between June 2023 and June 2025. Implementation outcomes were surgical intervention rates comparing IOTA-ADNEX-guided and retrospectively calculated RMI-based management using National Institute for Health and Care Excellence/Royal College of Obstetricians and Gynaecologists thresholds and patient process metrics. 11 qualitative semi-structured interviews were conducted with NHS staff involved in OSC implementation and thematic analysis performed.

Of 334 patients, 42% (139) underwent same-day discharge. Using IOTA-ADNEX at a 10% threshold, 10% (32/334) of patients underwent surgery under the general gynaecology and cancer unit team. In comparison, 30% (94/334) would have undergone surgery under the same teams if RMI-based triage had been used. Five themes identified from qualitative analysis: organisational infrastructure, clinical decision-making, communication and pathway definition, professional collaboration and training support, and patient experience. Key facilitators included dedicated clinical leadership, timely decision-making capabilities and quality assurance sessions. Barriers included lack of standardised post-clinic pathways and insufficient staff communication about pathway changes.

IOTA-ADNEX implementation in OSC offers high same-day discharge rates and reduction in surgical rates compared with RMI triage. To ensure success, implementation should be supported by adequate infrastructure, training and clear pathways. It requires leadership, comprehensive staff training and robust communication strategies. These findings provide practical guidance for healthcare systems for wider implementation of IOTA-ADNEX.

In October 2024, Houston Methodist launched a nocturnal TeleHospitalist programme. The programme provided centralised coverage via audio-video technology, operating from 18:00 to 02:00 initially and expanding to 18:00–06:00. Adult patients admitted from the emergency department (ED) between October 2024 and August 2025 and clinical staff involved in admission workflows, were surveyed. Operational data on admission timeliness were extracted from the Epic electronic medical record, and patient and staff experiences were evaluated through structured surveys and qualitative feedback.

Over 10 months, 1575 TeleHospitalist encounters were completed (median age 65 years (IQR 49 to 75); 56% were ≥65 years). Median hospital length of stay was 38.5 hours (IQR 17.3 to 66.3), and median ED arrival-to-admission time was 7.3 hours (IQR 4.7 to 12.8). Among 311 patient respondents (19.7%; median age 66.5 years (IQR 52.3 to 75.6); 5% were ≥65 years), satisfaction scores were high (median 4 (IQR 3 to 5). Staff responses (n=29) demonstrated strong endorsement: 86% favoured continuation, 79% reported comfort with the technology and 75% rated admission processes as better than traditional workflows.

A system-wide TeleHospitalist admissions programme was feasible and well accepted by patients and staff. Older adults reported positive experiences, suggesting age is not a barrier to virtual inpatient care. Early findings indicate improved timeliness, communication and workflow efficiency while mitigating overnight staffing gaps. Future studies will evaluate long-term outcomes, cost-effectiveness and strategies to enhance privacy and patient engagement.

The National Network of PQCs conducted an online assessment of PQCs representing all 50 US states and the District of Columbia during May–July 2023. While the assessment included some historical questions, most questions asked PQCs to report on work conducted from 1 April 2022 to 31 March 2023. Descriptive statistics of assessment data—including PQC characteristics, participation, community partner engagement, QI initiatives, and activities—were calculated.

The 45 responding PQCs were primarily housed in departments of health (35.6%), academic institutions (33.3%), or non-profit organisations (22.2%). Sixty-two percent of PQCs were established within the past 10 years (2014–2023). On average, 72.6% of birthing hospitals in each state participated in their PQC. Among the 26 PQCs with neonatal intensive care unit (NICU) participation, an average of 77.1% of NICUs in the state participated in their PQC. Thirty-two PQCs (71.1%) engaged with ≥1 patient/family member, and 30 PQCs (66.7%) engaged with ≥1 community-based organisation. PQCs reported on 195 initiatives/activities that they worked on during the reporting period. Twenty-six PQCs (57.8%) were working on 3–5 initiatives/activities. Most initiatives/activities were maternal-focused (n=105, 54.4%), followed by mother–infant–dyad-focused (n=53, 27.5%), and neonatal-focused (n=30, 15.5%). The most frequent initiative/activity topics were hypertensive disorders of pregnancy; substance use disorders among pregnant women; respectful care and non-medical factors that impact health; neonatal abstinence syndrome; and mental health among pregnant/postpartum women.

These findings illustrate the breadth of PQC work and how PQCs could contribute to national efforts to improve perinatal care.

Model for Improvement method was applied. As a baseline, we collected 1 year maternal mortality data, 6 months of chart review to assess the quality of care and 1 year’s data collected during implementation.

The T-chart shows the average days between maternal deaths at Dessie Comprehensive Specialized Hospital increased from 14 days to 39 days. When we compared the absolute numbers, there were 21 maternal deaths within 1 year after implementing the interventions, which was only nine maternal deaths compared with the same period in the previous year. When we calculated the maternal mortality ratio, we reduced it from 327 per 100 000 live births to 162 per 100 000 live births.

The project involved three successful interventions: conducting consultations within 20 min, using the E-MOTIVE bundle checklist and implementing the pre-eclampsia/eclampsia bundle checklist. Additionally, through our Plan-Do-Study-Act cycles, we learnt that a short consultation process, having one intensive care unit bed ready for mothers, ensuring the availability of essential medicines like tranexamic acid, using bundles, maintaining strong communication, engaging senior management in QI activities and holding frequent meetings of the QI committee were all helpful in improving our QI project.

The national competence goals were developed in a project initiated by the Swedish National Board of Health and Welfare that commissioned a group of academics with expertise in patient safety to work on the project. The development entailed an iterative process involving both physical and digital meetings, individual work and two rounds of questionnaires. Initially, drawing on expert knowledge and international literature, a set of competence areas based on key concepts in patient safety was proposed and defined. Within each competence area, several competence goals were developed. A modified Delphi process was then employed to collect insights from two multidisciplinary panels of experts (n=23). Finally, competence areas, key concepts and competence goals were refined based on feedback from the two Delphi panels.

The project resulted in a national framework comprising 15 competence areas and 113 competence goals, highlighting key dimensions of patient safety such as foundational concepts, professional roles, systems thinking, patient involvement, human factors, communication and teamwork, organisational culture, risk awareness, learning from adverse events, evaluation, safe practices, technology, leadership, emergency preparedness and high-risk care situations.

The development of national competence areas and goals marks an advancement in establishing patient safety as a distinct scientific discipline, where they collectively provide a broad and structured set of educational goals and standards. This initiative provides a foundation for integrating patient safety curricula into national healthcare education and strengthening patient safety practices, which can serve as an inspiration to others.

Baseline data on time taken to complete conventional ward round documentation were collected over a 4-day period. The Heidi AI tool was then implemented to transcribe real-time discussions during ward rounds and automatically format the information using a structured template adapted from the SHINE Surgical Ward Round Toolkit. Documentation times using the AI system were recorded over a subsequent 4-day period.

The implementation of Heidi led to a statistically significant reduction in documentation time compared with conventional methods.

Using AI tools can not only improve timeliness of clinical records but also free resident doctors from scribing duties, allowing greater participation in patient care and enhancing educational opportunities. This intervention demonstrated the potential of AI-assisted documentation to improve workflow efficiency and patient flow while supporting resident doctor training and reducing administrative burden in a surgical setting.

The primary aim of the study was to explore clinicians’ preferences and behaviours in maternity patient safety reporting within a tertiary hospital.

We conducted a two-phase qualitative study in a UK tertiary teaching hospital maternity service. Phase 1 involved AI-supported Big Qualitative (Big Qual) thematic analysis (using Caplena and Infranodus) of the first 400 patient safety incident reports submitted via the local electronic reporting system over a 5-month period (June–November 2024). Phase 2 comprised semistructured interviews with 14 maternity clinicians conducted between April and June 2025 and informed by phase 1 findings. Interview data were analysed using a Rapid Assessment Procedure and framework-based thematic analysis. Findings from both phases were integrated at the interpretation stage to examine reporting practices, barriers and enablers and opportunities for organisational learning, drawing on sociotechnical systems and safety-II-informed concepts.

Thematic analysis of incident reports identified ten recurrent topics including staffing capacity, documentation discrepancies and communication issues. Interviews highlighted barriers such as psychological safety, form complexity and limited feedback, alongside enablers including visible learning and supportive leadership. Inconsistencies in reporting behaviours, feedback mechanisms and system integration were evident, with underreporting of near misses and staff conduct identified as key gaps.

This study offers a nuanced view on how incident reporting is enacted in practice within maternity care. By combining interview data with Big Qual incident analysis, it identifies actionable insights for improving safety and organisational learning. Recommendations include simplifying reporting systems, embedding psychological safety, standardising processes and enhancing feedback and cross-professional learning.

We conducted a rapid scoping review. Drawing on predefined eligibility criteria, we reviewed peer-reviewed and grey literature on educational resources on patient-safety-related topics aimed at PFACs in healthcare organisations. We searched three databases (PubMed, Web of Science and Scopus) as well as websites of relevant stakeholders and institutions.

Overall, we obtained 13 eligible sources. They featured resources ranging from reading materials to more intensive workshop sessions—combining active and passive learning approaches. Definition of key concepts and stakeholder roles were common topics in most sources. Yet, contents specific to patient safety showed considerable variability, likely due to context-specific approaches, local practices and lack of overall guidelines. Standardised resources tailored to PFACs’ unique needs in patient safety were largely absent.

This review highlights the limited availability of comprehensive, well-documented resources for PFACs. It further corroborates the need for systematic approaches to support patient engagement activities and meaningful involvement in patient safety.

Our findings provide a first synthesis of the literature, inform future research as well as the development of respective patient engagement initiatives in patient safety. Moreover, they underscore the importance of developing standardised, yet adaptable resources to equip PFACs for their role in fostering safer healthcare systems.

DRKS00034733.

Retrospective cross-sectional analysis of 759 149 responses from the 2023 GP Patient Survey in England. Mixed-effects logistic regression was used to examine associations between patient experience outcomes—appointment booking and healthcare professional communication—and access modes (online, telephone, in-person), adjusting for sociodemographic factors and practice-level clustering.

Online-only appointment booking methods were associated with a better experience of making an appointment (OR=1.14, 95% CI 1.11 to 1.17; p<0.001) than traditional booking methods. All patient groups, except older adults and those not reporting male or female gender identities, reported better experiences with online-only appointment booking. Inequalities narrowed by age and ethnicity, with greater improvements for younger, Asian and mixed ethnicity patients, but widened for gender as non-binary and other identities reported poorer experiences. Remote consultations were associated with a poorer experience of healthcare professional communication (OR=0.52, 95% CI 0.51 to 0.52; p<0.001) compared with face-to-face. This trend was consistent across all groups, with differences between most and least positive groups reducing for gender but remaining similar for deprivation, ethnicity and age.

Digital tools are associated with more positive experiences when contacting GP and may help reduce sociodemographic disparities, especially among groups who traditionally report poorer experience. Conversely, remote consultations are associated with worse experiences of healthcare professional communication. These patterns highlight the need for tailored approaches that offer choice across access modes, considering clinical need, urgency and patient preferences. Training for healthcare professionals should include remote communication skills. These insights can inform policies and service design aimed at modernising primary care while promoting equity.

We contacted all patients seen in the BMC between May and July 2024 and recruited 15 participants. We conducted 30 min semi-structured interviews that were audio-recorded and transcribed verbatim. Line-by-line coding was performed inductively using NVivo V.14 software, followed by a thematic analysis to identify emerging themes and subthemes.

Three main themes were identified as being related to care quality at the BMC: (1) Access, Navigation and Coordination, (2) Knowledge Translation and (3) Therapeutic Alliance. Based on these themes, three key practice recommendations were developed for care quality improvement, including (1) introducing a care navigator, (2) the provision of structured after-visit summaries and preparatory materials and (3) integrating empathy and communication training into the education of practitioners delivering this care.

The results support the need for and underscore the benefits of integrated care models in managing CBDs, such as a BMC. Future studies should evaluate the effects of implementing the proposed recommendations.

A two-cycle quality improvement project (completed audit loop) comparing preintervention and postintervention outcomes.

Elective orthopaedic clinics in a UK district general hospital (secondary care).

Patients listed for elective hip or knee replacement during two 6-week periods (25 in cycle 1; 43 in cycle 2). Patients with incomplete records or not assessed face-to-face were excluded.

Introduction of QR code-linked digital PILs between audit cycles, provided at clinic appointments. The resource included procedure information, anaesthetic options, recovery expectations and links to translation services.

Primary outcomes were documentation rates of PIL provision and key SDM domains in line with NICE NG157 (National Institute for Health and Care Excellence Guidance) and GIRFT (Getting it Right First Time) standards. Secondary outcomes were patient-reported measures of clarity, usability, accessibility and preference, obtained through an anonymous Likert-scale survey.

Documentation that a PIL had been offered increased from 7% (hip) and 9% (knee) in cycle 1 to 24% and 36% in cycle 2. Documentation of patient understanding rose from 79% to 90%, and recovery expectations from ≤9% to 36%. Survey results showed 100% of respondents found the digital information clear, 86% preferred it over paper and 71% reported greater engagement with the digital format.

QR code-linked digital PILs improved documentation, engagement and accessibility in elective orthopaedic clinics. This low-cost, scalable intervention supports national guidance on SDM, aligns with NHS (National Health Service) Green Plan sustainability goals and has potential for spread to other surgical pathways.

A "Plan-Do-Study-Act" approach was used. QI elements included: research of prior relevant publications, clinical audit for data-driven evaluation, service evaluation assessments and clinical transformation on a small scale for piloting change. Care interventions were introduced within an already established highly iterative and enhanced recovery after surgery-based programme. Intervention 1 established patient eligibility. Those eligible could be SDD once discharge criteria were met (the "Standard" cohort). Intervention 2 implemented "Enhanced Recovery Canada" (ERC) recommendations for pre-emptive nausea and pain management, and lidocaine-based regional surgical anaesthesia (the "ERC" cohort). Intervention 3 changed from epidural to spinal lidocaine for surgical anaesthesia. This cohort was evaluated as part of the ERC cohort, as well as a stand-alone Lidocaine Spinal cohort. Clinical audits were the main comparative benchmarks. Improved rates of SDD were the primary measure of success. Safety was based on rates of unscheduled hospital encounters within 30-days of surgery. Data was collected prospectively and analysed using logistic regression, adjusting for age and gender. Patient satisfaction was also surveyed.

The ERC cohort had significantly greater odds of successful SDD compared to the standard group (74.4% vs 54.3%, OR 2.51, p=0.0015). Odds were even higher for Lidocaine Spinal (80.6% vs 54.3%, OR 3.4, 95% CI (1.34 to 8.66), p=0.0102). There was no significant difference in the rates of unscheduled 30-day hospital encounters. The ERC group experienced fewer complications that prevented SDD (25.6% vs 45.7%, OR 0.41, p=0.0015). Patient satisfaction scores were high in the Spinal Lidocaine group.

Implementing ERC recommendations significantly improved SDD rates for THA without increasing postoperative complication rates. This suggests that targeted interventions can enhance the efficiency of SDD THA programmes without compromising patient safety.

To identify how situation awareness is defined, understood, measured and interpreted within the midwifery care safety context as a precursor to further research which may contribute to improvements in safety of maternity care.

A scoping review was conducted using a well-established methodological framework. A comprehensive literature search yielded 259 articles, of which 11 were included in the final review. Data from each article were extracted, charted and subjected to a thematic analysis.

All primary research papers applied Endsley’s original definition of situation awareness, either explicitly or implicitly. Team SA was viewed as an aggregate of individual clinicians’ SA. Only two of the studies attempted to measure SA; others made inferences about levels of SA based on observable features of teamwork.

Endsley’s model of SA has been applied to midwifery without full consideration of whether this theoretical construct is appropriate for this clinical context. Other extended SA models exist which could arguably provide a more informed systems-theoretic approach to maternity care safety, consistent with the current drive towards embedding systems thinking and creating a Just Culture in healthcare organisations.

A quality improvement initiative was implemented at NKHC using a Plan-Do-Study-Act approach to establish a best-practice cessation service. The study included all tobacco users attending NKHC from July 2024 to March 2025. Very brief advice was provided at each clinical encounter, and those expressing readiness to quit were enrolled in the specialised cessation clinic, where they received free behavioural and pharmacological support. All participants were followed according to the clinic protocol. The primary outcome was a quit attempt.

Before July 2024, NKHC had no operational cessation service. Between July 2024 and March 2025, 30 tobacco users attended the clinic. Over half (n=17, 56.7%) were over 40 years of age, while 16.7% were younger than 18. Most participants were male (n=29, 96.7%), married (n=23, 76.7%), employed (n=23, 76.7%) and used smoked tobacco products (n=24, 80.0%). Tobacco use frequently occurred at home (n=12, 40.0%) or with friends (n=15, 30.0%). Nearly two-thirds of tobacco users (n=19, 63.3%) were exposed to secondhand smoke. Mental health conditions were reported among 13.3% of users. Nearly half had attempted to quit previously, mostly using the cold turkey method. All participants were asked and advised to quit; 80.0% were ready to quit, and most (88.9%) made a quit attempt.

Establishing best-practice tobacco cessation services in primary healthcare can increase readiness to quit and promote quit attempts. Further studies are required to assess quit rates.

The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed throughout our study. Pub-Med, CINAHL, Web of Sciences, Google Scholar and repository databases were used for the search. Stata V.17 was used to analyse the data using the random-effects model. Forest plots were used to present the pooled results.

A total of 6583 participants were involved in 16 studies that were included in this systematic review and meta-analysis. The overall PSC for healthcare professionals working in Ethiopian public hospitals was found to be 47.78% (95% CI 44.72 to 50.84; I²=84.56%). ‘Teamwork within units’ was the only PSC dimension with a satisfactory percentage of positive responses (75.53%; 95% CI 73.57 to 77.49). Compared with other hospital settings (48.77%), PSC at referral hospitals was lower (43.49%). A positive response rate to overall PSC was significantly predicted by being a nurse or midwife (OR=3.06; 95% CI 1.27 to 7.41), participating in patient safety training (OR=3.23; 95% CI 2.33 to 4.48), having a BSc degree or higher (OR=2.62; 95% CI 1.56 to 4.38), working in medical-surgical units (OR=4.32; 95% CI 2.71 to 6.90) and having more work experience (OR=5.69; 95% CI 2.52 to 12.87).

The pooled status of PSC among healthcare professionals in Ethiopia is low. Compared with other hospital settings, the PSC was lower in referral hospitals. A higher positive response rate to the overall PSC was predicted by professional type, educational attainment, patient safety training, working units and longer work experiences. In order to promote patient safety, the Ministry of Health, hospital managers and policymakers must work collaboratively by launching initiatives to strengthen a positive PSC.

A parallel mixed-methods design was used. A rapid review profiled the focus (cost containment, efficiency and/or equity) and purpose (education, assessment, health system improvement) of health economic evaluation competencies used in healthcare education and management. In parallel, surveys were sent to senior healthcare leaders (N=528) and quality and healthcare management scholars (N=286) in Ireland. These examined knowledge, skills and experiences of using health economics in managing quality and safety, and the perceived usefulness of proposed competencies. Descriptive statistics were generated. Literature and survey findings were integrated to refine the competencies.

Of the few competencies available from the literature, most had a multiple focus and purpose. Yet, none were focused on equity and few were used to assess competence. Of 189 survey respondents, few had received training in health economics (25%) or been involved in measurement of healthcare costs (34%), value for money (29%) or budget impact (23%). Barriers were terminology and inadequate infrastructure for linking clinical and financial data. Most (90–95%) endorsed the usefulness of proposed competencies. These were refined to form four major competencies: (1) understand the relationship between cost and quality in healthcare, (2) assess the basic costs and outcomes of a QI initiative, (3) understand and apply cost-effectiveness analysis to QI initiatives and (4) advance capacity for improvement by applying cost-effectiveness analysis to decision-making. Each major competency had four to six sub-competencies.

Health economic competencies should be integral to healthcare professionals’ and managers’ education and professional development.

In this prospective observational study, 19 anaesthesia nurses at the University Hospital in Würzburg were observed during 30 field sessions. The study used the Work Observation Method by Activity Timing application for real-time recording and classification of tasks into primary activities (core clinical tasks), secondary activities (parallel tasks, ie, multitasking) and interruptions (externally triggered interruptions leading to task cessation). Spearman’s rank correlation coefficients were calculated to examine associations between observational data and subjective ratings.

Interruptions accounted for 4% of the total observation time, with secondary activities being performed during 8.5% of the time. The average duration of interruptions was 36 s. Primary activities constituted 74.36% of all tasks, with communication-related interruptions being the most frequent. Preparatory work comprised more than half of the total duration of primary activities. Communication tasks were the dominant event during secondary activities, with a significant number of steps associated with them. On a subjective level, a strong positive correlation was found between perceived stress and error potential.

Interruptions and secondary activities were common in anaesthesia nursing workflows but accounted for only a small proportion of total working time. Most interruptions involved communication required for perioperative coordination. Step-based movement estimates showed substantial physical workload, with walking activity unevenly distributed across task categories and predominantly occurring during primary activities.

For the narrative review, we searched MEDLINE and the Central Medical Library, Moscow for reports relevant to the quality of healthcare and used our collections of the grey literature for the policy review. Neither patients nor the public were involved in the design and execution of this study.

Legislation 2011 recognised clinical practice guidelines (CPGs) as an important tool in developing evidence-based practice. On top of the system are regulations of a new type—orders of medical care—which prescribe the patients’ track in the healthcare system, as well as the necessary staffing and equipment for participating organisations. CPGs describe the recommended interventions. Third, documents called ‘standards’ are derived from CPGs to calculate the average cost for costing diagnosis related groups and informing other payment decisions. At the same time, the Ministry of Health promotes the certification of medical organisations and introduces lean at the outpatient facilities. The criminal prosecution of physicians became more frequent, disturbing the profession.

A wide range of initiatives in quality assurance promise improvement in the quality of health care. Unfortunately, the insufficient and reduced funding, as well as solutions with unknown effectiveness, may limit prospects for improvement.

This project was developed and implemented by the core team of a programme manager, an administrative assistant (AA) and a psychiatrist. It was achieved without any additional funding for project management. Process mapping of various components of GAAMHS was completed and an Ishikawa diagram was created to identify factors contributing to the backlog. Quality improvement change ideas were proposed and tested using Plan-Do-Study-Act cycles. The interventions included reassessment of patient needs, implementation of an electronic data capture tool and team-based model of care, refining the referral triage process and standardising the service delivery practices of psychiatrists.

The 812 backlogged referrals were resolved in a median of 5.3 months. The average number of new consultations and total O-P visits per full-time psychiatrist per month was 10.3 ±3.6 and 74.5±15.9, respectively, in 2020; it increased to 17.1±7.9 and 80.8±21.6 in 2022 and 18.8±8.9 and 90.0±20.2 in 2023. The wait times for the new incoming referrals have continued to decrease with the median wait times in December 2023 being 102 days and the wait times for the 75th percentile being 145 days.

A combination of strategies helped resolve the backlog and reduce wait times to access acute O-P mental health.

We conducted a narrative review across four electronic databases to identify peer-reviewed studies published within the last decade. Following the stepwise selection and review procedure, thematic content analysis was performed.

A total of 26 studies was included.

We identified 55 dimensions of facilitators or barriers to AI implementation. These were classified according to the Systems Engineering Initiative for Patient Safety work system model. Key dimensions included efficiency, compatibility with local IT infrastructure, stakeholder involvement, transparency and clinician trust. Drawing upon the 25 most frequently reported dimensions of facilitators and barriers, we developed a set of recommendations.

This review consolidates the current literature on implementation challenges of AI in everyday clinical care practice to offer insights for healthcare organisations and professionals to navigate the challenges of AI implementation. Our findings provide a comprehensive overview of the sociotechnical complexities surrounding AI adoption, and our compilation of recommendations can help to guide future efforts in leveraging AI to improve clinical workflows and patient care.

By mapping the patient cohort, using their general practitioner postcode, we identified patient clusters including those in the same long-term care facilities. In tandem, accessible healthcare locations within North Central London were identified and approached.

The UCLH ITB outreach service was launched in December 2022. Over the next 15 months a total of six sites were established. In 2024, over a 12 month period, 28 outreach clinics were completed, with a total of 125 patients assessed and pumps refilled in the community. Transport and healthcare cost savings were realised, and patients reported positive, practical and emotional benefits.

This initiative improved patient care as well as creating a local strategy for joint working through forging new relationships and embracing shared learning

Based on a cluster-randomised implementation study data (ISRCTN11875357) we analysed 98 electronic patient records (EPRs) documented by 28 physiotherapists across diverse OHPC units. The intervention arm had received 3–7 days of biopsychosocial training. A stratified random sample of EPRs from individuals with LBP was reviewed using a structured researcher’s evaluation tool. Each item was scored dichotomously (yes/no) and evaluated against predefined quality criteria with stepwise thresholds for different work disability risk groups.

Step I, multidimensional biopsychosocial assessment of LBP, was documented in fewer than half of the records (36.5% in the intervention vs 16.7% in the control arm, p=0.081). The biological dimension was well documented in both arms (100% vs 95.8%, p=0.245), while psychological (58.1% vs 25%, p=0.009) and social (54.1% vs 29.2%, p=0.038) dimensions were more frequently documented in the intervention arm.

Step II quality criteria (low-risk patients) were met in 58.1% of intervention versus 4.2% of control records (p<0.001), and step III (medium-risk) in 55.4% versus 4.2% (p<0.001). No EPRs met step IV (high-risk) quality criteria.

The intervention arm more often documented psychosocial assessments, risk stratification, behavioural strategies and advice to stay active. Person-centredness (ie, goals, values, resources, expectations) was rarely documented (36.5% vs 0%, p<0.001).

Training in guideline-oriented biopsychosocial approach was associated with more frequent documentation of behaviours aligned with high-quality LBP management. However, overall quality varied, and person-centred aspects remained underreported. Complementary implementation strategies are required to ensure consistent delivery and documentation of biopsychosocial clinical practice in OHPC.

PubMed, Web of Science and Ichushi Web were searched for English or Japanese studies evaluating adult RRSs (January2010–April2025). We included 47 records (43 comparative and 4 systematic reviews); the national guideline was not included.

Mature RRSs were associated with a 35% relative reduction in unexpected in-hospital cardiac arrests and a 12% decrease in all-cause hospital mortality. However, the evidence is not uniformly positive—systematic reviews and multicentre analyses reported no significant mortality benefit—and outcome heterogeneity limits comparability. Effective programmes share three key features: (1) single-parameter activation criteria augmented by early-warning scores; (2) tiered response models for advanced practice nurses and (3) audit-feedback cycles with dashboards. Crew resource management, in situ simulation and mindfulness-based self-leadership approaches may be associated with reduced decision latency. Emerging tools like deep-learning prediction algorithms, continuous wearable monitoring and tele-support systems may expand coverage but require governance. Common barriers include limited night-time staffing, cultural reluctance to escalate care and medicolegal ambiguity; targeted education and registry-driven feedback mitigate challenges.

Well-structured RRSs improve outcomes beyond traditional code-blue models. Aligning activation thresholds, multidisciplinary competencies and data-driven quality improvement cycles with local resources may help new Japanese rapid response team members develop resilient, high-performing services.

Describe Hospital Outcome Prediction Equation V.7 (HOPE-7) methodology.

State of Victoria (Australia), population 6.8 million.

Multiphase process: (a) principal diagnoses aggregated into 406 clinical diagnosis groups (CDGs); (b) low case fatality rate (CFR<0.02%) CDGs set aside; (c) remaining CDGs ranked according to predicted risk; (d) final generalised linear model fitted to (75%) training dataset; (e) low-risk cases reinserted and allocated zero risk; (e) model performance in validation dataset assessed for calibration (Hosmer-Lemeshow goodness-of-fit (H₁₀), Brier score, calibration plot), discrimination (area under the receiver operator characteristic (AUCROC) and area under the precision recall (AUCPRC) curves) and classification (dispersion value (), SD random effect ()). Ideal model: Brier score~0, H₁₀ p value>0.05, AUCROC>0.80, AUCPRC>0.30, ~1 and ~0. Classification assessed by proportion of outlier CFR reclassified as inlier HSMR.

315 hospitals treated 12.97 million adult separations and 152 (48.3%) reported 63 806 in-hospital deaths, 0.49 (95% CI 0.48 to 0.50) per 100 separations. 10 722 principal diagnoses allocated to 198 non-significant CDGs, 45 low-risk CDGs (5.05 million cases) assigned zero risk and 163 significant CDGs aggregated to 20 risk ranks. Final model (development cohort 9.73 million) included demographic variables (age, birth sex, emergency, aged-care resident, hospital transfer, relationship status), one interaction term (emergency transfer) and 20 diagnosis-risk categories. Validation metrics (cohort 3.24 million): Brier score 0.015; H₁₀ p value 0.09; AUCROC 0.90 (95% CI 0.87 to 0.92); AUCPRC 0.28 (95% CI 0.25 to 0.31); =4.31 and =0.24. Study hospitals generated 2192 hospital quarters with 2053 (95.7%) outlier CFR values, of which 1975 (96.2%) reclassified as HSMR inliers.

HOPE-7 is a parsimonious and pragmatic HSMR model based on administrative data common to many jurisdictions that displayed satisfactory calibration, classification and discrimination metrics and addressed frequent HSMR limitations.

We conducted a rapid scoping review to develop questions and a standardised procedure for completing a BPMH, and to understand patient, caregiver, and healthcare professional preferences or perceptions regarding the BPMH interview.

We searched Medline, the Joanna Briggs Institute Evidence-Based Practice Database, the Evidence-Based Medicine Reviews database, and grey literature. We included peer-reviewed quantitative literature (randomised/non-randomised controlled trials, observational studies), qualitative studies, systematic reviews, and grey literature (including guidelines, quality improvement initiatives, patient experiences, health technology assessments). Following pilot testing to ensure inter-rater reliability, articles were screened and data extracted in duplicate using the Covidence platform. INPLASY registration protocol INPLASY2024110033.

Our search identified 5424 records, and after removing duplicates and screening, we extracted data from 95 articles. Identified studies provided additional questions and procedural steps for assessing adherence, use of non-prescription medications and substances (eg, alcohol, smoking, cannabis, recreational use), and integration of virtual care into the BPMH guide. Perceived facilitators and barriers to conducting a BPMH included clinical leadership support for trained healthcare professionals to perform a BPMH, virtual care, access to technology, and intact hearing for patients or interviewed caregivers.

This review identified additional questions and approaches for updating the ISMP Canada BPMH interview guide. Additional feedback from users of the existing interview guide, and patients and caregivers who have participated in a BPMH interview should be integrated through codesign into the new updated ISMP Canada BPMH guide.

INPLASY2024110033

This quality improvement study aimed to reduce nursing-initiated hospitalist requests by 25% across four pilot units by October 2023. From February to May 2023, 99 nurses completed 1 hour refresher training sessions to strengthen clinical decision-making, clarify scope within the IDT, and improve workflow efficiency. Pre-training and post-training surveys assessed nurses’ self-reported knowledge and comfort, and an implementation survey assessed perceived impacts on practice and collaboration. A retrospective electronic health record (EHR) chart review (September 2022–June 2024) evaluated total and declined hospitalist requests (outcome measures), focused nursing assessments (FNAs; process measures) and direct allied health requests (AHRs; balancing measures).

Pre-training and post-training surveys were completed by 69 and 72 nurses, respectively. Mean composite self-reported knowledge scores increased from 3.56 (SD 0.88) pre-training to 4.57 (SD 0.57) post-training (mean difference 1.02; 95% CI 0.77 to 1.26; p<0.001). Implementation surveys indicated improved clinical practice, enhanced IDT collaboration, and strong endorsement of the training. However, nursing-initiated hospitalist requests (monthly mean=339.4) and declined requests (monthly mean=30.6; 9% decline rate) showed no sustained reduction. Common reasons for declined requests included completed assessments (18.8%), duplicate requests (18.8%), and redirected AHRs (13.0%). FNAs (monthly mean=91.77) and AHRs (monthly mean=14.3) remained stable.

Targeted nursing education improved nurses’ self-reported knowledge and IDT perceived collaboration but did not reduce hospitalist requests. Sustained impact may require ongoing education, integrated onboarding, EHR workflow enhancements, and clearer role definitions.

In-depth one-to-one qualitative interviews, analysed using inductive and deductive methods to explore and then organise factors participants associated with healthcare-related harm and map these factors onto a socioecological framework (SEF).

People from minoritised groups in the United Kingdom (UK) self-reporting harm arising from the National Health Service (NHS), recruited from community groups, social media and a survey of the general public.

48 participants currently minoritised in the UK based on one or more of faith, ethnicity, disability, sexual orientation or gender modality who have experienced harm in the NHS.

Heterogeneous and interacting factors contribute to healthcare-related harms, spanning all five levels of the SEF: individual, interpersonal, community, organisational and societal. Multiple factors from powerlessness and low trust to unwelcoming NHS environments reinforce each other to increase risk of harm in minoritised populations. The SEF helped draw out less visible factors associated with the experience of unsafe care, including a health service designed around the needs of the majority population and societal attitudes to minoritised groups.

Multiple individual factors are already known drivers of disparities in safety among minoritised groups such as language barriers and cultural differences in beliefs. The SEF enabled an expanded view of contributory factors to harm in these groups, thereby providing a wider set of potential interventions to address safety inequities. A narrow focus on improving the quality of interpersonal, relational care is unlikely to have a significant impact on safety improvement in minoritised groups without addressing structural and institutionalised processes that drive discrimination and exclusion.

A systematic review and Meta-analysis of Observational Studies in Epidemiology was performed. Extracted data were pooled using a random-effects model and Grading of Recommendations, Assessment, Development and Evaluation approaches.

PubMed, CINAHL, Cochrane Library and Science Direct databases were searched on 29 May 2025 for eligible studies.

Peer-reviewed studies published after 2003 that reported technical error prevalence in any aspect of routine tissue collection and processing.

The search returned 30 articles (31 studies), including data from 2 794 987 surgical pathology cases. Pooled effect sizes were calculated for pre-analytic errors at 16.71 per 1000 cases (95% CI 6.42 to 31.67), actively identified errors in the laboratory at 40.17 per 1000 (95% CI 7.04 to 97.61) and reported surgical pathology specimen errors at 4.94 per 1000 (95% CI 1.33 to 10.80). Subgroup analysis showed an occult error prevalence of 2.54 per 1000 cases (95% CI 1.63 to 3.64), and surgical pathology case contamination was 62.23 per 1000 (95% CI 8.22 to 159.33).

The analysis suggests that tissue processing technical errors are more prevalent than reported. A lack of standardised methods for defining and detecting errors contributes to undocumented and unidentified errors, leaving the true error prevalence unknown. The majority of clinical decisions are based on laboratory results; however, without reliable detection and reporting, errors in vulnerable processes risk compromising patient diagnoses.

CRD42024600518.

Improve management of chronic pain by reducing chronic and high-dose opioid prescribing and increasing awareness and availability of biopsychosocial support.

Mobilising activity across the macro, meso and micro levels of the healthcare system in England, the initiative employed a novel 7 Phase Whole System Approach Framework (WSA7), enabling diverse stakeholders to coordinate improvement and learning activity to understand the local problems, coordinate change ideas and consider how to sustain improvement across the pathway of care.

Predefined national outcomes relating to opioid prescribing were achieved: There was a 5.13% decrease in the rate of chronic opioid prescribing vs baseline, equating to 56 403 fewer people prescribed chronic opioids than would have had the rate remained at baseline levels, preventing between 841 and 910 deaths. Decrease of 20.35% in rate of high-dose prescribing versus baseline, halving the risk of opioid-related death for 16 963 people. Increased availability and awareness of biopsychosocial support; at least 12 093 patients supported to self-manage their pain. 27 integrated care systems (ICSs) fully participated in the initiative, five partially. Successful implementation of the WSA7 (n=19 ICSs) achieved greater sustained improvement vs non-participating ICSs (n=10), ICSs with implementation failure (n=8) and partial implementation (n=5).

Employing the WSA7 created contextual conditions across ICSs that supported and sustained improvement in a complex problem that challenges health and care systems across England.

A cross-sectional study was conducted from May to June 2023 among 1784 healthcare professionals selected using systematic random sampling. Data were analysed using descriptive statistics, ² tests and analysis of variance.

A total of 629 responded (35% response rate): 68 doctors (10%), 435 nurses (69%) and 126 allied health professionals (20%). Incident reporting was highest among allied health professionals (65%), followed by nurses (39%) and doctors (27%). However, nurses reported the highest absolute number of incidents (n=170). Types of incidents most frequently reported included medication related (n=92), patient safety (n=69) and patient care (n=42). The most common barriers were personal, particularly fear of punitive action (66% of allied health professionals, 36% of nurses and 15% of doctors), identity tracking concerns (56%, 40% and 38%, respectively) and perceived lack of anonymity. Differences in perceived barriers across groups were statistically significant (p<0.05).

Individual-level barriers—especially fear of punitive action and lack of anonymity—continue to limit reporting despite established systems. Leadership must foster a non-punitive, confidential culture and improve feedback. While simplifying processes and expanding training may enhance participation, these strategies remain untested at our institution, serving instead as guidance for future quality improvement efforts.

This evaluation aimed to qualitatively explore the experiences of the service users and the social prescribing link workers.

Semistructured interviews of five service users and four social prescribing link workers were conducted online using Google Meet. Service users were sampled to reflect diversity in service branch, age and time since leaving the Armed Forces. Informed consent processes were carried out. Data were transcribed, checked, anonymised and inductively thematically analysed.

Service users had struggled to transition from a military to a civilian identity. Referrals were for mental health, social isolation, housing, finances, physical health and domestic abuse. Having a social prescribing link worker who was a veteran was a crucial component of establishing trust, without the need to explain military culture or experiences. This was instrumental in helping service users engage more fully with the service offered. Service users reported improvements in their living conditions and mental health, were more connected to other people and had a renewed sense of hope and optimism.

This is the first report of experiences of the AFC receiving bespoke social prescribing support. The findings highlight the crucial nature of designing the social prescribing service to resonate with military culture and the difficulties of transitioning to a civilian identity. Service users had improved well-being and were supported with a range of determinants of health. Further research needs to be carried out on other AFC members to confirm the findings.

Time-directed ERAS goals were developed, and a phased educational intervention was implemented through four Plan–Do–Study–Act cycles: (1) introductory teaching and baseline data collection, (2) development of a tool within the electronic patient record to promote real-time implementation of ERAS goals and enable continuous performance monitoring, (3) introduction of an e-learning module and (4) targeted educational interventions. Outcome measures included time to achieve ERAS goals and the proportion of postoperative patients clinically ready for discharge to the ward within 24 and 48 hours. Balancing measures included reintubation and ICU readmission rates.

Implementation of the phased educational intervention led to a sustained reduction in the time required to achieve ERAS goals. The proportion of patients clinically ready for discharge to the ward within 24 and 48 hours increased by 15.6% and 18.0%, respectively, exceeding the project’s 5% target. No increase in reintubation or ICU readmission rates was observed, indicating that improvements were achieved safely.

Implementing time-directed ERAS goals through a phased educational intervention increased the timeliness of post-operative recovery after cardiac surgery. This approach has the potential to improve patient flow, enhance ICU capacity and support wider efforts to address elective cardiac surgery backlogs across the NHS.

This retrospective cohort study used data from the Meir Medical Centre emergency department, 1 January 2021 to 31 May 2023. The study period included adding a fourth physician to the night shift staff in September 2021. Primary and secondary outcomes were time from patient entrance to doctor’s examination, time to decision about hospitalisation or discharge and rates of hospitalisation, 1 day hospitalisation and returning patients. Secondary analysis examined the mean and lowest seniority of the staff, and the mean number of patients examined by a physician during night shifts.

After increasing staff, hospitalisation rates decreased minimally from 44% to 42% (p=0.03), whereas 1 day hospitalisation rates increased from 26% to 28% (p=0.006). Paradoxically, time to disposition increased slightly from 4.5 to 4.7 hours (p<0.001). No significant changes were noted in return visit rates or time to first physician encounter.

The study did not result in significant impacts on key performance indicators after adding a physician to night shift staffing. Our findings suggest that increasing physician numbers did not significantly improve overall emergency department efficiency. The only benefit observed was a decrease in the number of patients per physician, potentially alleviating individual physician workload.

Adding a physician to the emergency department night shift staff did not result in significant improvements in work efficiency, as measured by the parameters assessed in this study.

Phase 1 expert group was formed and focused group discussions (FGDs) conducted to develop a Standard Operating Procedure (SOP) and the PREM Questionnaire tool. Phase 2 and phase 3, multiphasic study conducted in 15 hospitals, India with good geographical distribution using purposive sampling. Phase 2 consisted of a pilot study using the PREM tool with a sample size of 213 participants, and phase 3 consisted of a field study with 720 participants.

PREM tool developed with 21 questions based on SOP, findings of FGDs and patient feedback. The internal consistency of the PREM tool was excellent and indicated high reliability and showed that the expert group considered the questions essential. Concerning removing metallic devices before the scan, 100% of participants said yes in the pilot study and 99% in the main study. Lacunae identified in the study included screening using a metal detector, counselling about history of allergy, side effects of contrast agents and claustrophobia, and methods to contact the staff in case of any emergency during the MRI scan. These findings indicate that there is a need to improve safety practices based on feedback from patients using the MRI Safety PREM tool.

MRI Safety PREM tool was developed and validated as a zero-cost patient safety tool. Study participants accepted the PREM questionnaire as a vital tool for patients undergoing MRI to ensure patient safety and improved quality of care.

A few never events and near misses prompted our institution to create a surgical care safety bundle to improve perioperative patient safety. The surgical care bundle focused on improving the usage of surgical safety checklist (SSCL), surgical consents, surgical site marking (SSM) and sponge count in a phased manner. Baseline audits were conducted for each of the above components at different time points and measures were introduced to improve compliance.

The baseline usage of SSCL in 2010 was 65% that improved to 70% in 2014, 86% in 2016 and 97% in 2019. The availability of general surgical consents improved from 56% in 2010 to 70% in 2015. With the introduction of specialised surgical consents in 2019, the compliance improved significantly to 99%. SSM was added to the project in 2017, improved from baseline 74% to 95% in 2019 and continues to remain above 90%. Sponge count documentation has been below 80% in 2010 and was implemented as a part of the safe surgery protocol in 2019 after which compliance significantly improved and stayed above 90%. Good compliance with the usage of checklists and improved the safety culture was demonstrated by increased reporting of near miss events. Never events have not occurred after introduction of all components of surgical safety in 2019.

Phased implementation of surgical care safety bundles, audits and reaudits, repeated educational measures and a slow yet steady process of interventions has markedly improved the safety culture and surgical safety in a larger teaching hospital of a developing country.

Sixteen semi-structured interviews were conducted with clinicians from the vascular centres that participated in the PAD QIP and were analysed using framework analysis, based on the five broad domains within the Consolidated Framework for Implementation Research.

Five themes captured the main factors that affected the implementation of changes in the pathway of patients with chronic limb-threatening ischaemia: the programme, the benefit for patients, the role of the team, the resources and organisational processes, and the polarising effect of COVID-19. Regarding the programme, participants stated that the concrete timeframes, external performance monitoring, peer comparison and the programme’s national reach helped them obtain resources to implement changes. Learning from and sharing experiences with others was also useful. Accurate performance data were considered essential for leveraging resources, but data entry was onerous and required dedicated staff. The view that the programme was beneficial for patients, the support of a team of healthcare professionals and organisational support in the form of resources were important requirements for implementation, while the COVID-19 pandemic also played a crucial role as a contextual factor beyond the control of the participants. The main factors that differed between high-implementation and low-implementation centres were team beliefs, team structure, team compatibility, networks/communication, resources, implementation climate, relative priority and evidence strength.

This QI collaborative facilitated the implementation of changes according to participants, while team and organisational support was crucial.

A 2-year prospective evaluation was conducted in a 12-bed academic ICU in Milan, Italy. The Hospital Survey on Patient Safety Culture was administered to all ICU professionals (physicians, nurses, physiotherapists) in December 2022 and repeated in December 2024. Interventions included staff training, enhanced event reporting systems, regular morbidity and mortality conferences and a multidisciplinary safety team. Responses were analysed descriptively, including subgroup analysis by professional category and staff turnover.

A total of 86 staff completed the 2022 survey, and 66 completed the 2024 survey, with 56 participating in both. Over the 2 years, perceptions of teamwork (68%–81%), communication openness (47%–60%) and comfort in reporting errors (38%–55%) showed substantial improvement. The proportion of staff who perceived management support for safety increased from 70%–80%. Staff hired after 2022 reported more favourable safety perceptions than continuing staff, particularly in communication and reporting domains.

Structured, multidisciplinary interventions led to measurable improvements in ICU safety culture. However, persistent interprofessional differences and under-reporting of adverse events highlight the need for targeted strategies. Safety culture transformation requires sustained leadership, continuous onboarding and system-focused feedback mechanisms to ensure long-term impact.

To explore the motivations, experiences and attitudes of healthcare professionals who report incidents of perceived unprofessional behaviour through an organisational event reporting system.

A qualitative study was conducted involving semistructured interviews with 50 healthcare professionals who had submitted reports of unprofessional behaviour at the study site. Thematic analysis was used to identify recurring themes related to the reporters’ motivations, reservations, knowledge of the reporting process and considerations for direct communication.

Participants reported being motivated to report primarily by concerns about coworker mistreatment (52%) and patient safety (38%). While most participants (68%) expressed no reservations about reporting, some raised concerns about potential retaliation (32%). Most participants (82%) demonstrated an understanding of the reporting process, and over half (56%) indicated they had attempted to address the issue directly with the colleague involved before submitting a formal report.

Healthcare professionals are motivated to report unprofessional behaviour primarily out of concern for their colleagues and patient safety. Addressing fears of retaliation and promoting transparent reporting processes are essential for fostering a culture of safety and encouraging the reporting of unprofessional conduct. Findings suggest that organisations should continue to emphasise both formal reporting systems and training for direct communication to address unprofessional behaviour effectively.

PoC trial and evaluation.

Specialist children’s hospital.

101 families completed baseline measures; 26 families completed measures during the PoC trial, 18 parents and 11 ward-based staff participated in interviews, and four ward-based staff and four catering staff took part in focus groups.

Following adaptations to an existing web-based Food on Demand Delivery Service app, a PoC trial was undertaken on six inpatient wards during a 4-week period. Data were collected before and following implementation, using quantitative (surveys) and qualitative (focus groups and individual interviews) approaches.

The Food on Demand Delivery Service was positively evaluated by all stakeholder groups. Challenges were identified, particularly by catering staff in relation to communication and logistics, but overall findings supported upscaling to a hospital-wide roll-out.

The Food on Demand Delivery Service offers potential for addressing barriers to oral intake for hospitalised children. Challenges will need to be addressed prior to scaling up the project for a hospital-wide roll-out, and several recommendations came from the trial. However, the benefits for children, families and staff were evident and supported further work to enable the Food on Demand Delivery Service to be introduced across the hospital.

For 20 years, LA tried to be heard. She repeatedly told healthcare professionals that something specific was wrong, that her diagnosis did not fit her lived experience and that she needed different help. Instead, she was told she was not accepting her diagnosis. The consequences were devastating: 3 years in secure hospital settings costing the NHS thousands of pounds, suicide attempts requiring intensive care, friends being told to consider turning off her life support. "Had I been listened to 20 years earlier," she reflects, "I wouldn’t have had the last 20 years robbed from me. It almost cost me my life."

The breakthrough came through an unexpected route. While involved in People Participation at East London NHS Foundation Trust, LA attended an introductory quality improvement (QI) session. The basic tools—driver diagrams, baseline measurement and run charts—sparked a realisation: "If we...]]> 2026-01-22T04:46:59-08:00 info:doi/10.1136/bmjoq-2025-003812 hwp:master-id:bmjqir;bmjoq-2025-003812 British Medical Journal Publishing Group 2026-01-22 Commentary 15 1 e003812 e003812 http://bmjopenquality.bmj.com/cgi/content/short/15/1/e003291?rss=1 Introduction

Treatment of moderate to severe psoriasis typically requires the use of multiple systemic therapies over a patient’s lifetime. The efficacy and safety of systemic treatments are typically evaluated in clinical trials; however, patient registries are increasingly used to monitor long-term outcomes of systemic therapies for psoriasis in real-world settings. Psoriasis registries also generate important real-world evidence about psoriasis treatment that may facilitate a greater understanding of outcomes outside of a controlled clinical trial setting. This study thus characterises the design and measures used in real-world studies of psoriasis treatment from patient registries and assesses its use in informing clinical guidelines and reimbursement decisions.

A systematic literature review was conducted to identify real-world observational studies that used psoriasis registry data. PubMed and Embase were searched for English-language studies published between January 2018 and January 2023. To assess how real-world studies, clinical guidelines, and reimbursement and coverage reports have informed practice, treatment, and reimbursement guidelines, a narrative review of recommendations was conducted. All results were screened by two independent reviewers (LP and TAS) using prespecified inclusion and exclusion criteria. Outcomes of interest were extracted into Excel, with all conflicts resolved through discussion/consensus. Tables displayed outcomes and research topics first by year, then by registry.

CRD42023402431

The cross-sectional survey was distributed among PR attendees at the University Hospitals of Leicester (UHL) NHS Trust in the United Kingdom, between November 2023 and August 2024. Participants completed a 25-item survey exploring (i) relevant technology ownership and music-related behaviours, (ii) preferred music genres and songs and (iii) anticipated benefits/concerns of exercising to music. Quantitative data were analysed descriptively. Free-text data were analysed using qualitative counting.

We surveyed 109 people living with CRDs (51% male, 56% aged ≥70 year, 76% chronic obstructive pulmonary disease, 82% owned a smartphone). More than half had no prior experience of exercising to music (n=59, 54%). Despite this, almost half of participants listened to music at least once/day (n=54, 49%), primarily via the radio (n=83, 76%) and/or online music platforms (n=76, 70%). Pop (n=39, 36%) and Country (n=38, 35%) were the most popular music genres listened to, with the majority listening to music without headphones (n=64, 59%). The main concern about wearing headphones while exercising was that it might reduce their awareness of the surroundings (n=67, 61%). The perceived benefits of listening to music during exercise were to boost their mood (n=39, 36%) or help maintain their walking pace (n=19, 17%).

There is potential to use music as a tool to support exercise in PR. However, lack of prior experience exercising to music, diverse music preferences, safety considerations and the need to increase knowledge of the potential benefits of exercising to music are key challenges. These findings may help future PR services to implement music into their programmes and develop personalised music-based interventions to optimise exercise performance.

Baseline data were collected from all LT recipients between October 2018 and September 2020, the control group. An early extubation pathway was implemented in October 2020, and prospective data were collected from October 2020 to September 2022 and used as the intervention group. Primary outcome was extubation within 4 hours after LT. Secondary outcomes included the duration of mechanical ventilation, ICU length of stay (LOS) and hospital LOS.

During the study period, 342 LT procedures were performed, of which 339 patients were included in the study. Of LT recipients who met criteria for early extubation, the rate of extubation within 4 hours postoperatively increased from 23% (14/60) in the control group to 65% (62/96) in the intervention group (p<0.001). In adjusted models, the pathway was associated with an increased proportion of patients extubated within 4 hours (OR=6.74, 95% CI 3.04 to 14.92, p<0.001) and reduction in duration of mechanical ventilation (HR=1.95, 95% CI 1.37 to 2.79, p<0.001), ICU LOS (HR=1.42, 95% CI 1.02 to 1.99, p=0.04) and hospital LOS (HR=1.60, 95% CI 1.14 to 2.26, p=0.007).

An early extubation pathway for LT recipients reduced duration of mechanical ventilation, ICU LOS and hospital LOS.

A quality improvement study comprising three phases was planned in the NICU of a tertiary care hospital in western India to assess the impact of the central line care bundle. Baseline data were collected for 8 weeks to find the incidence of CLABSI. An aim statement was made and a team formed. A root cause analysis was conducted to identify the factors contributing to the high rate of CLABSI. Various changed ideas were tested in plan–do–study–act cycles and monitored with process indicators. Ideas were adopted or adapted based on their impact. Compliance with insertion and maintenance bundles was used as a process indicator, while the CLABSI rate served as an outcome indicator.

CLABSI rate reduced from 66/1000 catheter days (May 2023) to 18/1000 catheter days (95% CI 0.14 to 0.79; p value 0.012) during the study. Insertion bundle compliance increased to 85% during the intervention phase and 70% during the sustainability phase. Maintenance bundle compliance was 45% and 35% during the intervention and sustainability phases, respectively.

POCQI methods can help increase bundle care compliance in the NICU and reduce CLABSI rates in low- and middle-income country settings.

Preventing Preventable Strokes: Scalability used a triad of interventions to increase the number of eligible patients with AF receiving guideline-concordant anticoagulation, including (1) a best practice alert integrated with the electronic health record, (2) clinician education and (3) patient communication about the anticoagulation therapy that encouraged shared decision-making with clinicians. These interventions were conducted in primary care and cardiology outpatient clinics at (University of Florida Health). Patient-level data were collected during a 6-month intervention period and compared with a 6-month historical control period. Generalised estimating equations with a logistic link were used to estimate the odds of anticoagulant use, adjusting for demographic and clinical characteristics.

A total of 3274 individuals were included during the intervention period and 3200 during the preintervention period. The average anticoagulation rate increased from 75.7% to 79.2% across the two periods. In the fully adjusted model, patients in the intervention period had significantly higher odds of anticoagulant use compared with the preintervention period (adjusted OR (aOR) 1.13, 95% CI 1.05 to 1.21, p=0.0007). MyChart activation (aOR 1.38, 95% CI 1.19 to 1.61, p<0.0001) was also associated with increased anticoagulant use. Older age and higher CHA₂DS₂-VASc scores were associated with greater odds of anticoagulant use, while higher HAS-BLED scores and care in primary care (rather than cardiology) were associated with lower odds.

A triad of QI interventions at the practice, clinician and patient levels increased guideline-concordant anticoagulation use among patients with AF in half of the primary care and cardiology clinics in the University of Florida Health system.

The primary objective was to detail how two quality improvement (QI) projects leveraged predictive models to efficiently drive outcomes using the IHI Model for Improvement. Secondary objectives included describing how predictive modeling identifies high-risk patients and informs targeted interventions and demonstrating examples of both clinical and operational improvements achieved.

The two detailed quality improvement projects utilized the Institute for Healthcare Improvement (IHI) Model for Improvement. In both cases, predictive models were applied to identify and target high-risk patient populations.

· Clinical Improvement: One project targeted orthopedic trauma patients. Interventions included evidence based chemoprophylaxis (Lovenox) and early continuous daily physical and occupational therapy (PT/OT) (figure 1). Plan-Do-Study-Act (PDSA) cycles were used, specifically testing early PT/OT in all patients versus testing it only in high-risk patients (figure 2). The outcome measured was the rate of perioperative pulmonary embolism (PE) and deep venous thrombosis (DVT), also known as Patient Safety Indicator 12 (PSI 12).

· Operational Improvement: The second project focused on reducing same-day case cancellations for patients having elective ear, nose, throat (ENT) surgery. This improvement utilized a Preoperative Evaluation Triage System. This system incorporated a Machine-Learning American Society of Anesthesiologist (ASA) Score and Patient Questionnaire to determine if an Anesthesia televisit was indicated (figure 4).

The project targeting orthopedic trauma patients resulted in a 50% reduction in perioperative pulmonary embolism and deep venous thrombosis (PE/DVT). The rate, measured by PSI 12, was reduced from a baseline of 5.2 to 2.6 (figure 3). For the project focused on elective ENT surgery achieved a 13% reduction in same-day case cancellations. Furthermore, the preoperative evaluation triage system reduced unnecessary primary care physician (PCP) Preoperative Visits from 12% to 4% (figure 5), thereby increasing access for other patients.

Integrating predictive models with the IHI Model for Improvement is a successful strategy to efficiently drive outcomes. This approach demonstrates effectiveness in achieving both clinical improvements (PE/DVT reduction) and operational efficiencies (cancellation reduction). Crucially, by applying interventions only to those patients most likely to benefit, the integration of predictive modeling facilitates the conservation of resources.

Abstract 43 Figure 1

Intervention for high-risk patients

Abstract 43 Figure 2

Physical and occupational therapy run chart

Abstract 43 Figure 3

Outcome measure-PE/DVT rate

Abstract 43 Figure 4

Preoperative evaluation triage system

Abstract 43 Figure 5

Otorhinolaryngology (ORL) cancellation rate

This retrospective, quantitative, exploratory study evaluated the impact of early physical therapy (PT) initiation on return-to-work (RTW) times among employed adults with work-related acute LBP.

A total of 67 participants (table 1) were divided into two groups: Group 1 (n = 22) received PT within 24 hours of injury, while Group 2 (n = 45) experienced delayed PT initiation. RTW times were compared using ANOVA and Mann-Whitney U tests.

Although statistical significance was not achieved (p = 0.175), descriptive analysis revealed that Group 1 returned to work in a mean of 16.2 days (SD = 17.9; range: 1–73), compared to 20.1 days (SD = 17.1; range: 1–77) in Group 2—a difference of 3.9 days (table 2). Across age and gender subgroups, early PT was associated with a 2.7 to 10-day reduction in RTW time (table 3). The average number of PT sessions required to achieve pre-injury functional goals was similar between groups (4.29–4.86 sessions), with a median of 4 sessions in both (table 4).

While not statistically significant, early initiation of PT within 24 hours of work-related acute LBP may offer clinically meaningful reductions in disability duration and facilitate earlier RTW. These findings support the potential value of incorporating early PT into occupational health protocols to enhance workforce productivity and reduce healthcare costs.

Abstract 44 Table 1

Demographic variables for the respondents N = 67

Abstract 44 Table 2

Descriptive statistics for return-to-work time (days)

Abstract 44 Table 3

Return-to-work time (days) by age group and gender within physical therapy timing groups

Abstract 44 Table 4

Return-to-work time (days) by age group and gender within physical therapy timing groups

Recognizing the positive financial impact of high-quality care, patient safety, and exceptional patient experience is critical to sustaining hospital performance in this challenging environment.

To drive meaningful improvement despite limited resources, Riverside employed a focused, intentional, data-driven, and evidence-based approach. High-impact strategies were collaboratively implemented across multiple disciplines and departments. This system-wide methodology emphasized the interdependence of structure, people, processes, and technology to achieve integrated and sustainable outcomes.

Riverside has demonstrated sustained improvement across ten key performance indicators in acute care over several years (figure 1). These advancements have led to enhanced patient outcomes and improved performance in both pay-for-reporting and pay-for-performance programs administered by government and commercial payers (figure 2).

Strengthening quality outcomes and optimizing the capture of value-based reimbursement have a direct and substantial impact on hospital revenue. These efforts are essential in helping hospitals navigate and counteract ongoing financial headwinds.

Abstract 45 Figure 1

Key performance indicators (KPIs) for acute care

Abstract 45 Figure 2

Results of acute care KPIs

Using the Define, Measure, Analyze, Improve, Control (DMAIC) framework, the SSBB conducted front-line observations and interviews to validate ‘work as performed’ and collaborated with the team to map the process using the Suppliers, Inputs, Process steps, Outputs, and Customers (SIPOC), swim lane diagrams, and Value Stream Mapping (figure 1) that helped define workflows and gaps.

Statistical analysis progressed from two-variable testing to multivariate analysis (figure 2). Causes of antibiotic delays were visualized with a Fishbone diagram (figure 3).

To identify and quantify impact from potential disruptions, a Failure Modes and Effect Analysis - FMEA (figure 4) was facilitated with participation from dozens of ED staff, nurses, providers, and pharmacists. Identified disruptions—from patient arrival to inpatient transfer— were grouped by hazard scores and used to prioritize next steps and plan countermeasures.

Key Interventions (September 2023 Launch)

Abstract 46 Figure 1

Value stream mapping for sepsis present on admission patients (current state)

Abstract 46 Figure 2

Multi variable chart example for NEDOCS score + antibiotic administration + patient outcome

Abstract 46 Figure 3

Ishikawa diagram for delays in antibiotic administration for sepsis patients

Abstract 46 Figure 4

Partial section of the failure mode and effect analysis for sepsis- sepsis screening step

Abstract 46 Figure 5

Carilion Roanoke memorial hospital - sepsis recognition* in the emergency department

Abstract 46 Figure 6

Carilion Roanoke memorial hospital sepsis screening completion* in the emergency department

Abstract 46 Figure 7

Carilion Roanoke memorial hospital - antibiotics administration* for sepsis present on admission

Abstract 46 Figure 8

Carilion Roanoke memorial hospital sepsis orderset utilization* for sepsis present on admission

Abstract 46 Figure 9

To examine whether the IHI’s Organizational Assessment of Conditions to Foster Joy in Work can predict thriving.

1,395 participants completed the IHI’s assessment on autonomy, purpose, safety, teamwork, and equity (figure 1). Logistic regression tested whether these domains predicted thriving (figure 2).

Autonomy and purpose were the strongest predictors of thriving (p<0.05), increasing its likelihood by 37% and 47%, respectively. This pattern held among men, evening-shift workers and those aged 50 or older. In contrast, residents were 71% less likely to thrive than other staff (figure 3).

Baseline organizational assessments help to identify the drivers most predictive of improvement outcomes (figure 4), enabling teams to prioritize targeted change ideas (figure 5) to increase the likelihood of success.

Abstract 47 Figure 1

Results from baseline organizational assessment of conditions to foster joy in work

Abstract 47 Figure 2

Baseline thriving from work levels

Abstract 47 Figure 3

Baseline organizational and workforce characteristics predicting thriving from work

Abstract 47 Figure 4

Content theory

Abstract 47 Figure 5

High priority change ideas targeted to each key actor

To test the hypothesis that quality improvement (QI) efforts to reduce nCPAP in the DR would reduce pneumothorax rates.

We performed interventions to change nCPAP use in the DR to optimize nCPAP use with interdisciplinary DR team. We focused on reserving nCPAP for infants remaining hypoxemic on free flow oxygen rather than for signs of high work of breathing and/or the need for ANY supplemental oxygen in neonates born at 36 weeks of gestation or greater. We assessed continuous positive airway pressure (CPAP) use in the DR and pneumothorax events in deliveries between pneumothorax before and after the algorithm was implemented. We used statistical process control charts to assess improvement.

CPAP utilization in the delivery room for infants >36 weeks decreased from 3.4% to 1.0% (figure 1). Frequency of pneumothorax decreased (figure 2), with births between pneumothorax events increasing from 293 to 530 (figure 3).

A reduction in the use of CPAP in DR was associated with a decrease in the rate of pneumothorax with no increase in neonates with respiratory distress.

Abstract 37 Figure 1

Percent chart shows the process measure assessing utilization of CPAPs in the delivery room. The baseline was extended after August 17, and special cause was then detected twice related to interventions (see annotations) lowering the mean to 2.1% and then to 0.5%. Abbreviations: CPAP, continuous positive airway pressure; LCL, lower control limit; NRP, Neonatal Resuscitation Program; UCL, upper control limit

Abstract 37 Figure 2

Vermont Oxford network data highlighting an elevated rate of pneumothorax. Observed to expected pneumothorax and rate of pneumothorax among Neonatal Intensive Care Unite (NICU) admissions in term neonates > 37 weeks gestation. Pneumothorax rates as a function of NICU admissions decreased substantially from 2016 to 2019, while the observed – expected (0-E) rates decreased from approximately 8 in 2016 to approximately 2 in 2018 and then less than zero from 2019–2021

Abstract 37 Figure 3

Geometric chart assessing the outcome measure of births between pneumothorax events

The Caring Safely Tour, led by the Minnesota Alliance for Patient Safety (MAPS), aims to shift the safety narrative from failure analysis to understanding what enables success. Objectives include fostering cross-setting collaboration, amplifying patient and staff voices, strengthening safety culture through shared learning, and deepening understanding of human factors that shape safety outcomes.

This statewide initiative spans the continuum of care, engaging large systems, rural and community hospitals, long-term care, and patient partners in shared learning. Each tour stop features real-world site visits, structured debriefs, and facilitated discussions to explore system strengths and innovations. Participants co-identify ‘wise practices,’ which are synthesized and shared statewide through follow-up learning sessions.

Across five tour stops and more than 100 participants, the tour strengthened relationships, trust, and insight into the human and system factors that influence safety. Participants reported renewed motivation and resilience, applying new ideas within their own organizations. Host sites offered peer support and practical tools to extend learning beyond the tour. By learning from success and embracing complexity, the Caring Safely Tour demonstrates a transformative, story-based model that advances compassionate, connected safety culture across Minnesota.

ED boarding is often mislabeled an ‘ED issue’ but the root causes are systemic. Discharge delays, inefficient workflows, and fear of readmissions block efforts to improve throughput and care quality.

All hospital team members contribute to throughput. Our hospital-wide initiative improved ownership, streamlined discharges, and enhanced communication. This broke down barriers between ED and inpatient teams, creating a culture of innovation and safety.

As patient days decreased, satisfaction, safety, and engagement increased. Excess days reduced by 28%, boarding minutes fell 90%, and patient satisfaction increased 57%. Wait times, ED falls, and workplace violence all notably decreased as well. Readmission rates remain stable despite increasing patient volumes.

This session challenges assumptions around ED boarding, connects safety risks to throughput bottlenecks, and equips participants with practical strategies to drive innovation and sustainable change.

This initiative, part of a broader improvement strategy, aimed to implement a digital call bell system to provide more information regarding the request urgency.

The digital call bell was implemented for 3 months in two Childbirth units. Call bell response time data and pre/post qualitative survey data have been collected to evaluate the impact on experience.

Response time was reduced by 58.2% in Unit A and 44.7% in Unit D after the implementation of a digital call bell. 56% of the staff reported that additional information provided by the digital call bell increased efficiency.

Reducing response times improves patient safety and experience, and additional information from digital call bells allows nurses to prioritize and optimize care. Integration with existing call-bell systems may result in further improvements in the care experience.

Establish the causal pathway and evaluate the impact of Golden Hour on reducing infection-related complications using QEDs.

Segmented regression was applied to ITS data collected between November 2021 and July 2024. Between-group comparisons were performed using chi-square and Mann-Whitney U tests. Effect sizes were reported as absolute risk reduction (ARR) and number needed to treat (NNT).

For 10,442 fPHO reported events, the median TTA showed a significant monthly reduction (–8.5; p<0.001) from 70 (IQR: 40–150) to 41 minutes (IQR: 30–71) following the implementation of the Golden Hour. The intervention led to an immediate 5.8 percentage point reduction in sepsis incidence (95% CI: –9.9 to –1.6; p<0.05) (figure 1), which further decreased from 7.7% during the implementation phase to 4.3% in the sustainability phase (p<0.001). The ARR was 0.5%, 7.8%, and 0.7%, and the NNT was 189, 13, and 142 for mortality, sepsis, and ICU transfers, respectively (p<0.05)

QEDs offer a rigorous complement to run and SPC charts for establishing the causal pathway evidence of QI initiatives. Using QEDs, we demonstrated the Golden Hour effectiveness in improving and sustaining clinical outcomes at scale in real-world settings.

Abstract 48 Figure 1

Segmented regression on the impact of the golden hour on sepsis incidence

As above.

We established a tele-lung nodule clinic at a rural hospital, where a specialist could evaluate patients via telemedicine and then travel to UAB if they needed a procedure. We also simplified the referral process.

Post-intervention analysis revealed a decrease in the wait time for rural patients to be seen in the clinic from 29 to 8 days (figure 1). The mean distance traveled by rural patients for clinic visits also improved and is now comparable to that of local County residents, 13 miles vs 16 miles (table 1). The total number of patients seen from rural Counties also increased by more than double in 2020 compared to 2019.

This pilot project shows promising results for access to care for the rural population with suspected lung cancer when an innovative telemedicine approach and a simplified referral process were implemented.

Abstract 49 Figure 1

Time to clinic pre and post intervention

Abstract 49 Table 1

Distance traveled by rural patients vs. Jefferson country-post intervention

In 2023 SOPS, staff willingness to report errors increased by 69%, overall positive safety reports increased by 9% (figure 1). In 2025, overall safety reporting increased by 677% (figure 2), near miss reports increased by 240% (figure 3), sentinel safety events reduced 25% (0.102 to 0.074/1,000 patient days).

Culture change requires equal investment in leadership behavior and system design. Our peer-accountability model focuses on psychological safety rather than compliance. Sustainable transformation in health systems requires moving beyond checklist to human-centered safety.

Abstract 17 Figure 1

EHC patient safety culture survey

Abstract 17 Figure 2

Overall safety event reporting-EHC

Abstract 17 Figure 3

Near miss reporting-EHC

In June 2022, Connecticut Children’s BOD completed the IHI Governance of Quality Assessment (GQA). Survey results were used to guide our adoption and implementation of the IHI Framework.

Weekly BQIC planning meetings were established to ensure presentations aligned with IHI Framework domains. Progress was tracked via Connecticut Children’s House of Quality (figure 1) and reported annually to foster transparency and accountability.

Following a second GQA in June 2024, targeted improvements were made using iterative Plan-Do-Study-Act (PDSA) cycles. To further enhance these PDSAs, a Lean Black Belt project launched in September 2024 to redesign the BQIC workflow. A key outcome was a standardized presentation process, including early presenter engagement, structured preparation meetings, and tools such as a BQIC Presenter checklist (figure 2) and FAQ guide. The project enhanced strategic relevance and consistency of content delivered to the BQIC.

Between 2022 and 2024, Connecticut Children’s improved on 80% of the 30 IHI Framework elements within the GQA. Anecdotal feedback highlighted increased enthusiasm and ownership of quality outcomes among board members.

The IHI Framework is embedded not only in BQIC but across broader governance structures. Connecticut Children’s Performance Improvement Plan initiatives are explicitly linked to the IHI Framework. Additionally, the IHI Framework informs the curriculum of Connecticut Children’s Popik Family Quality and Patient Safety Fellowship, supporting future quality leaders.

Connecticut Children’s demonstrates how operationalizing the IHI Framework using a QI approach can enhance board engagement, improve information sharing to enhance strategic decision making, and better align decisions with quality goals. The approach is scalable and offers a replicable roadmap for other healthcare organizations aiming to elevate board engagement in quality and patient safety.

Abstract 21 Figure 1

Framework for effective board governance of health system quality at Connecticut children’s

Abstract 21 Figure 2

BQIC presenter checklist

The baseline data (March 2023 - February 2024) showed 17% (36% Site #1, 28% Site #2) of readmitted patients were identified as MVPs. Of those readmitted from Oct 2023-Sept 2024, the top drivers of utilization (DOUs) were: Inadequate plan for recurrent issue (46%); and Inadequate supports and services (28%).

DOU completion rate (10/5/24 - 3/31/25) was 34% (Site #1) and 34% (Site #2).

% Readmission from MVP (10/5/24 - 3/31/25) was 10% (Site #1) and 9% (Site #2) (table 1).

Abstract 4 Figure 1

Abstract 4 Table 1

We postulate the opportunities and effects of AI as a mediator of experience, defined as humans’ direct interactions with the world.

By considering the ways in which AI changes the interaction of caregivers and patients with environments built to provide care, we assess novel opportunities where AI can mediate exposure to situations that sap development of human faculties. We also identify situations where AI has potential to rob humans of valuable development.

Current AI systems can potentially correct the toxic experience of route, meaningless data entry that is prevalent throughout healthcare. The downside, habituated use of AI to replace healthy struggle – in cases such as writing – can stunt the development of human skill and replace excellence with mediocrity.

As a mediator of human interactions with the world, AI has the potential to help, or harm, our development as individuals and the insights we gain.

This session aims to present best practice recommendations for a standardized WPV data and measurement structure that enables better analysis, targeted action, and cross-organizational collaboration to reduce WPV incidents.

A comprehensive literature review, expert interviews, and guidance from a multidisciplinary expert panel and industry partners informed the development of a workplace violence data and measurement framework.

The resulting recommendations establish a foundational framework to guide organizations in collecting, analyzing, and applying WPV incident data. This structure supports proactive decision-making and fosters consistency across healthcare systems.

Attendees will gain actionable insights to strengthen their WPV data strategies. Implementing standardized measurement practices can accelerate efforts to predict, prevent, and respond to WPV—ultimately enhancing safety for the healthcare workforce.

Identify at-risk patients during wildfire events using clinical and environmental data. Deliver timely, tailored health education to prevent avoidable respiratory complications.

A multidisciplinary team developed an alert system based on electronic health and environmental data. Patients with COPD or asthma, living near wildfires and in high Air Quality Index (AQI) zones, received alerts via a secure portal. Messages included health tips, do it yourself (DIY) air filter guidance, and emergency readiness resources.

Since 2023, the system has triggered 356 wildfire poor air quality alerts. Patient feedback indicates greater awareness and preparedness.

This model demonstrates how health systems can leverage real-time data to protect vulnerable populations from environmental hazards, supporting better outcomes and system resilience in the face of climate change.

To present a blueprint to cultivate optimal professional wellbeing via systems, culture, policies, and behaviors characterized by kindness (Kindness is helping others do better.).

A literature review of 387 peer-reviewed articles regarding the interrelationships of kindness, occupational health, and leadership was performed.

54 occupational health determinants were identified and categorized into four domains:

Four practical, validated and evidence-based leader actions that improve occupational health were identified:

People Centered Kind Leader actions can substantially improve the mental, physical, spiritual, and social wellbeing of the healthcare professionals and the experience, quality, safety, and cost of the patients they have the privilege of serving.

We aim to improve the medicine unit 17.3% average readmission rate, by a relative 3% and improve the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHP) score by 5% by utilization of a ‘Discharge Planner’ by August 2025.

Hospitalists were surveyed, who indicated >50% of readmissions were felt to be due to a lack of transitions of care. A multidisciplinary team was founded who applied improvement methodology to find gaps in TOC. This was combined with the survey learning to make a ‘Discharge Planner’; A patient facing document that serves as a learning tool, and reference with the goal of improving this transition of care.

Readmissions on pilot units had a 9.4% reduced readmission rate (RRR) compared to other medicine units.

Patient involvement and understanding of discharge with a simple checklist and comprehension confirmation can improve readmissions. This is an area ripe for electronic medical record (EMR) automation and leveraging technology to reduce active review my medical professionals.

The enterprise-wide clinical variation reduction program resulted in significant impacts in the first two years such as: 19.2% relative mortality reduction and 0.03 LOS O/E reduction in ED boarding patients, reduced long-stay observation rates from 24.6% to 14.7%, eliminated 185,000 unnecessary daily labs, reduced 11,084 unnecessary antibiotic days, increased documented evidence-based albumin ordering rates from 10.1% to an average of 80.25%, and corresponding financial impacts across the portfolio of initiatives.

CVR in large systems is achievable through strategic partnerships and embedding proven methods into culture—driving better outcomes and lower costs. Attendees will leave with practical insights and tools to accelerate CVR in their own organizations.

The regional collaboratives aim to...

The HC2-IHI team implements a comprehensive set of networking and capacity-building activities. At the regional level, monthly collaborative calls and tri-annual in-person meetings focus on building relationships, strengthening governance of the coordination network, and assessing local assets and gaps to guide action. Representatives from 15–40 local organizations attend each meeting, depending on region size.

Statewide virtual activities facilitate sharing of best practices and deliver technical content on topics such as co-locating at clinical sites, billing and coding, and multi-sector case conferencing. Monthly statewide activities facilitated by HC2-IHI reach an average of 250 local leaders per month. A robust measurement and learning system ensures facilitation is targeted to participant needs, best practices from one region are scaled to others, and key learnings are escalated to DHCS.

Average Community Support services utilization among Medi-Cal members in participating counties increased sixfold, from 0.28% in Q1 2023 to 1.70% in Q1 2025. ECM utilization tripled over the same period, rising from 0.3% to 1.0%. Collaboratives are one of multiple supports provided by DHCS, so a direct causal link cannot be established, but as of September 2025, 81% of participants in HC2-IHI collaboratives report increased knowledge of services, 79% report confidence to implement ECM and Community Supports, and 72% are confident in their ability to sustain progress into 2026 and beyond.

As funding for collaboratives concludes in 2026, we are transferring facilitation strategies and resources to local leadership so that high-quality, coordinated services continue to benefit California Medi-Cal members into the future.

We conducted a three-cycle plan–do–study–act quality improvement project at Mansoura University Emergency Hospital between January 2021 and May 2023, including all children under 18 years with acute SCHFs. Cycle 1 (n=58) established baseline adherence. Cycle 2 (n=62) implemented educational workshops and a departmental protocol. Cycle 3 (n=58) introduced reinforcement training, regular case discussions, visual reminders and individualised audit feedback. The primary outcome was the proportion of cases managed ‘appropriately’ according to the AUC.

Among 178 patients, appropriate management increased from 62.1% at baseline to 75.8% after initial education and 87.9% after reinforcement interventions, representing a 25.8% absolute improvement. Rarely appropriate management decreased from 19.0% to 3.4%. The greatest improvements occurred in Gartland type II fractures. Key baseline barriers included the lack of AUC awareness (78% of surgeons unfamiliar), absence of standardised protocols and variable surgeon preferences. Following sustained educational interventions and audit feedback, AUC tool utilisation increased from 45% to 95%.

A phased quality improvement initiative combining education, protocolisation, reinforcement training and audit feedback significantly improved adherence to evidence-based guidelines for paediatric SCHFs. Sustained educational interventions with regular case-based discussions and individualised feedback are essential for long-term practice change. Organisational factors, particularly lack of awareness and inconsistent application of guidelines, represent the primary modifiable barriers to adherence.

This qualitative descriptive study explored the knowledge and attitudes of community pharmacists, dentists, general practitioners and practice nurses working in primary care in Ireland, toward planetary health and sustainable healthcare. Semistructured interviews were conducted between May and September 2024 and analysed using inductive qualitative content analysis.

Analysis of interviews (n=20) produced a broad range of insights which were consolidated into three higher order categories. Findings revealed that while HCPs recognised the importance of climate action, many felt unable to translate concern into practical change in primary care due to barriers such as a lack of knowledge, limited guidance and inadequate system-level supports. HCPs emphasised the need for targeted training, access to practical tools and clear leadership from the relevant stakeholders.

This study highlights the urgent need to shift from reliance on individual motivation to practice sustainably, to a coordinated public health response in Ireland. Achieving this requires educational and systemic changes, including supportive policy, incentivisation and practical sustainable interventions, to embed environmental sustainability into routine care.

The opioid RoH integrates four errors and four hazards hidden in the opioid medication-use process. Participants, working in pairs, were asked to prepare and administer an opioid to a fictitious patient. Two assessors recorded the number of errors detected and hazards avoided. During the debriefing, assessors reviewed and explained these items to the pair of trainees combined with a refresh on the 5R rule and the double-check process. Detection and avoidance rates were analysed using descriptive statistics. Participants assessed the training through a satisfaction questionnaire.

A total of 86 sessions were conducted, involving 172 participants including nurses, nurse assistants and physicians from a geriatric department. Participants detected errors such as wrong patient (60%), expired drugs (63%), incorrect strength or galenic form (55%) and documented allergy (55%), while most hazards were avoided, except for the correct device, which was used in only 65% of cases. Double-check performance was inefficient mainly focusing on the dose check. Satisfaction was high (9.2/10), and 73% of participants reported a knowledge gain.

The opioid RoH is an effective training to refresh and emphasise the rigorous application of the 5R rules and the double-check procedure to reduce MAEs. Additionally, this simulation showed persistent gaps such as patient identification and double-check failures, highlighting the need to strengthen safety practices through continuous training and institutional-level system improvements in medication administration safety.

Sponsored by the Ohio Department of Children and Youth, the Hemorrhage Quality Improvement Project (QIP) applies the Institute for Healthcare Improvement’s methodology to implement structured quality improvement (QI) activities to improve key measures and implement the Alliance for Innovation on Maternal Health’s Obstetric Hemorrhage Patient Safety Bundle. Hospitals provided patient data and completed surveys. Data from participating hospitals were used to calculate and monitor improvement in primary process measures (quantitative blood loss and haemorrhage risk assessment).

Across Ohio, 22 delivery hospitals spanning 13 health systems participated in the Hemorrhage QIP pilot. Participating hospitals achieved a statistically significant improvement in all process measures, including quantitative blood loss documentation (both overall and when limited to vaginal deliveries) and in the completion of haemorrhage risk assessment between admission and delivery.

The Hemorrhage QIP demonstrates feasibility of a statewide QI initiative to improve care for women who experience obstetrical haemorrhage. Delivery hospitals have clinical expertise to improve outcomes related to postpartum haemorrhage care. Providing opportunity for peer-to-peer learning, evidence-based resources and QI coaching within a replicable QI project creates an opportunity to reduce preventable morbidity and mortality caused by an obstetric haemorrhage.

Colorectal resections form a major component of elective surgical activity at our centre. During early 2024, local Model Health System dashboards showed readmission rates above regional medians for both colonic and rectal resections. These findings, together with governance discussions about potentially preventable readmissions, led to a quality improvement project. National benchmarking data from the Getting It Right First Time programme were used to contextualise performance. These benchmarks are now integrated within the NHS Model Health System, enabling ongoing data-driven monitoring across surgical specialties.

To evaluate 30-day readmission rates following elective colorectal resections, identify contributory factors, and propose targeted quality improvement measures.

A retrospective observational review was conducted at Whiston Hospital for patients undergoing elective colorectal resections between July and September 2024. Data included demographics, procedure type, comorbidities, length of stay and 30-day readmissions. Causes of readmission were analysed and compared with national data.

Among 28 patients (mean age 61±14 years; 61% male), the median length of stay was 6 days. The 30-day readmission rate was 14.2%, exceeding national benchmarks. Common causes included urinary retention, intra-abdominal collections, port-site hernia and gastrointestinal symptoms. Readmissions were associated with shorter stays and comorbidities. Model Health System data indicated early improvement in rectal resections but a modest rise in colonic cases.

Readmissions exceeded national averages, emphasising the need for enhanced recovery compliance, prehabilitation, improved discharge planning and early post-discharge follow-up. Continuous benchmarking supports sustainable improvement in outcomes.

The project was conducted at a tertiary centre between 2020 and 2022 with three data cycles: one baseline measurement and two Plan-Do-Study-Act (PDSA) cycles. PDSA cycle 1 involved regular screening of inpatients using the SPICT to trigger SPC referral. PDSA cycle 2 also involved screening using the SPICT, but instead to prompt multidisciplinary meeting (MDM) discussion between hepatology and SPC teams. Outcome measures reflecting holistic aspects of PC were assessed across all cycles.

PDSA cycle 1 demonstrated a significant reduction in patients receiving no PC measures (67% to 26%, p: <0.001) and increased SPC input (32% to 52%, p: 0.04). Community PC referrals also rose significantly (13% to 39%, p: 0.01).

PDSA cycle 2 failed to improve measures compared to baseline. Only 42% of eligible patients were discussed in the MDM. Most agreed plans were implemented, but only a minority included SPC review, community PC referral or advanced care planning.

Patients with ESLD continued to have unmet PC needs despite implementing an intervention based on expert guidance. PDSA cycle 1 demonstrated some significant, positive impacts, supporting the clinical utility of the SPICT, but within the context of a small, single-centre QI project with methodological limitations.

Interventions included the development and dissemination of infographic booklets, the establishment of CAPES Buddy for incident reporting and faculty training in psychological support skills. A total of 811 nursing students commenced training under the CAPES initiative between January 2023 and April 2024. Of these, 542 completed both baseline and follow-up surveys, which measured understanding of workplace harassment and confidence in responding. Additionally, 54 faculty members underwent psychological support training to strengthen their ability to support students in crisis.

Following the interventions, nursing students demonstrated a 13.7% increase in their ability to identify harassment and an 18.7% increase in confidence to respond appropriately. Overall, 98% of students demonstrated comprehension of harassment-related issues. These improvements were accompanied by increased reporting and more appropriate triage of harassment cases, with students using CAPES Buddy for complex incidents while clinical instructors managed less severe cases as first-line support. Faculty members also reported enhanced competence in supporting students, contributing to a safer learning environment.

CAPES strengthened students’ awareness of workplace harassment and improved their confidence in responding and reporting incidents. While most students found the training relevant and beneficial, delayed reporting remains a challenge. Future work should explore factors contributing to reporting delay such as fear of retaliation or lack of trust in reporting systems and evaluate targeted strategies to address them.

A QI initiative was developed to create an SOP based on retrospective surveys from past leaders, identifying key organisational challenges. Post implementation surveys assessed the SOP’s impact on onboarding effectiveness, role clarity and preparedness. The project followed a Plan-Do-Study-Act cycle to guide the intervention and evaluate outcomes.

The SOP improved new leader onboarding by reducing reliance on board members, increasing clarity of training materials and enhancing preparedness to lead from day 1. Leaders trained with the SOP reported fewer unanswered questions and greater self-reliance. Survey results indicated significant improvements in clarity and role understanding, with new leaders preferring to reference the SOP over informal knowledge transfer.

The findings suggest that SOPs are an effective tool for improving operational efficiency and leadership transitions in student-led healthcare organisations. This intervention also integrated QI education, fostering leadership skills and systems-based thinking. The study highlights the applicability of this model to other healthcare settings. The implementation of an SOP at SMD successfully addressed long-standing onboarding inefficiencies, providing a scalable solution to improve leadership transitions. This model can be applied to other student-run clinics and healthcare organisations, enhancing both organisational efficiency and medical education.

An integrated knowledge translation approach was used to design, implement and analyse a survey for primary care practitioners in the provincial context of British Columbia. The survey was divided into the four main sections: Demographic Information, Knowledge Assessment, Training Needs and Perception of Barriers. It was distributed through advertisement in e-newsletters for family physicians and nurse practitioners. It is aimed to evaluate and understand PCPs’ perceptions of tobacco use disorder and smoking cessation treatment; confidence when providing tobacco use disorder and smoking cessation support and treatment; educational needs and desired supports and barriers to providing and accessing smoking cessation supports and resources.

The survey garnered 198 complete responses from 154 family physicians and 44 nurse practitioners. Findings highlight a need for increased training and resources while exploring desired training content and methods of delivery. Time constraints were identified as the primary barrier to providing smoking cessation intervention, alongside lacking referral pathways, clinical services and support, and compensation. Respondents expressed a desire for ‘cheat sheets’ with information on smoking cessation resources and best practices, training and education on counselling techniques and vaping cessation guidance, and integrated clinical workflows.

This project emphasises the need for an interdisciplinary approach to smoking cessation centred around integration of resources, training and policies into current workflows (such as electronic medical records or a centralised platform for information). Important gaps have been illuminated in the processes that support smoking cessation in primary care in British Columbia.

Four simulation sessions, two in Japan and another two in the UK, were filmed with eye-trackers worn by a clinician and a nurse. In each site, one session was conducted with an experienced pair (UK_Ex and JP_Ex) and the other with a less experienced pair (UK_LessEx and JP_LessEx). The scenarios were a difficult intubation in Japan and a urine infection, with a family member present, in the UK. The numbers of occurrences and the time lengths of joint attention and individuals’ speeches in the four data sets were compared in total and in 15 s time ranges to see the correlations.

The Ex pairs in both contexts paid joint visual attention more frequently and longer and spoke more than the LessEx pairs. In the JP_Ex, the positive correlation was found between the numbers of joint attention and the total speech durations (r=0.81). That indicates the team members verbally coordinated each other’s attentional objects, which is termed coregulative attentional engagement. In contrast, in the UK_Ex, the correlation was negative (r=–0.70), where they visually monitored each other’s actions while talking to the patient’s family, which we call coinfluential attentional engagement. These tendencies were weak in the LessEx pairs.

Although the accuracy of automatic annotation (approximately. 40%–60%) should be improved before applying it to medical training, the research method could provide preliminary insight into elements of good team performance.

A comprehensive search was conducted in MEDLINE/PubMed, Google Scholar, Scopus, Cochrane Review and Web of Science for studies published up to January 2025. Eligible studies evaluated AI-generated text to video for medical or patient education, reporting both quantitative and qualitative outcomes. Two reviewers screened and extracted data. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Out of 103 identified studies, five studies met the inclusion criteria: four evaluated patient education and one evaluated physician training. Clinical areas were ophthalmology (2/5), plastic surgery (1/5), dysphagia rehabilitation (1/5) and neurosurgical training (1/5). In ophthalmology, control materials outperformed AI-generated videos on image/script accuracy (p<0.005), with similar script-image alignment. In dysphagia rehabilitation, a randomised trial reported improvements in swallowing function and related outcomes with an AI-assisted video game intervention (p<0.001). A plastic surgery study reported greater user preference for a video avatar tool compared with a text chatbot (63.5% vs 28.1%). Across the reviewed studies, samples were small and CIs were rarely reported. Outcome measures were heterogeneous, and meta-analysis was not feasible.

AI-generated videos can enhance engagement or selected outcomes in certain contexts, yet concerns about accuracy and inconsistent measurement persist. Current evidence is sparse and mixed. Currently, these tools can complement, rather than replace, standard resources until non-inferiority is demonstrated for the prespecified primary outcomes.

CRD42025640042.

A SmartLink was developed in the EpicCare electronic health record that populates a list of pending labs and pathology studies and was added to the standard discharge summary template for hospitalists and resident physicians. A 2-month pre-post review of randomly selected discharge encounters was conducted to assess the frequencies of discharge summaries reporting pending labs, discharges with pending labs, discharges with eventually abnormal pending labs and discharges with results reported in follow-up notes.

Of the 291 pre-intervention encounters reviewed, 130 (44.7%) had one or more labs pending, compared with 115 (40.6%) of 283 post-intervention encounters. 35 (26.9%) of the pre-intervention discharge summaries mentioned all pending labs, compared with 104 (90.4%) post-intervention, p value <0.01. There was no difference in the frequency of discharge encounters with results reported in follow-up notes; however, a trend towards significance was observed for those with abnormal results.

Implementing an automated link that pulls pending studies into discharge summary templates drastically improved documentation of pending labs. However, given the complexity of post-acute care transitions, more work is needed to ensure receipt and follow-up of this crucial communication.

An exploratory mixed methods co-design constructionist epistemological framework was used to identify recommendations. Participants comprised young people (15–25 years of age) with experience accessing healthcare for acute or chronic concerns, carers and professionals. Focus groups and a statewide survey were conducted concurrently.

Eighty-one individuals varying in location and fields across Queensland participated in nine focus groups. Themes and subthemes were successfully identified through the thematic analysis of the focus groups. Within the context of barriers and enablers, participants identified gaps and proposed recommendations to optimise care. Across the nine focus groups, consistent themes emerged, demonstrating sufficient data collection and saturation of responses. Additionally, 107 responses were collected, scored and ranked through the statewide survey prioritising predetermined recommendations to optimise AYA care, based on scoping work completed in 2020. Of the 57 recommendations presented to survey participants, 41 (71.9%) of these were classified as ‘needed’ and ‘very important’ to optimise AYA healthcare. Collective thematic analysis resulted in a list of prioritised recommendations to improve healthcare services for AYAs.

The research highlighted two central priorities: overcoming systemic challenges within AYA healthcare and establishing a clear, consistent definition and model of quality care in Queensland. The combined findings strongly support the urgent need to embed standardised principles, approaches and practices across the health system to ensure equitable and effective care for all young people.

A descriptive phenomenological qualitative study was conducted between March and June 2021 in five health facilities in Lilongwe, Malawi. Semistructured in-depth interviews were conducted with 30 purposively selected HCWs (4–8 per facility) involved in delivering Option B+ services. Thematic analysis was used, with data coded deductively and inductively. The Consolidated Framework for Implementation Research was applied to map the identified themes into relevant domains and constructs.

QI practices among HCWs were hindered by resource constraints, lack of incentives/reimbursement for QI activities conducted beyond working hours, poor communication between QI teams and implementers and resistance or negative attitudes towards QI. Opportunities to enhance QI included increasing meeting frequency, providing mentorship, peer-to-peer learning through exchange visits and securing funding from development partners.

Improving QI utilisation in Option B+ requires mobilising resources and having a structured feedback and mentorship mechanisms. Targeted incentives/reimbursements for HCWs and peer-to-peer learning through exchange visits between facilities can further enhance QI. Therefore, a blended QI approach incorporating these recommendations is needed to better support HCWs in delivering evidence-based interventions, strengthen the health system and may improve engagement outcomes.

We aimed to increase the rates of CRC screening in a primary care clinic associated with the internal medicine residency programme of a large healthcare system. In October 2021, the clinic had a CRC screening rate of 55.40%.

This prospective quality improvement study was implemented from July 2022 to January 2025 at the resident-run clinic. Data on CRC screening completion were analysed monthly.

Six Plan–Do–Study–Act cycles were implemented over the course of the project. These interventions were developed from results of root-cause analyses as well as feedback from patients and providers.

CRC screening rates rose from 55.40% to 65.79% over the period of interest with the implementation of sequential targeted interventions.

Underserved patients are at higher risk of CRC screening incompletion. Multifaceted interventions and multidisciplinary collaboration are essential for increasing CRC screening in this vulnerable population.

This quality improvement project was conducted in two tertiary and one district general hospitals in the UK in patients who had been prescribed SGLT2-inhibitors for either diabetes or heart failure. Initially, 100 patients were surveyed on their understanding of SGLT2-inhibitor use, including awareness of indications and side-effects. A patient information leaflet was developed in collaboration with the community pharmacy team and distributed to patients. Six months later, a follow-up survey of 54 patients evaluated their confidence in medication use and knowledge of adverse effects.

The initial survey revealed: 70% were unaware of their medication, 12% had read the manufacturer’s information, 5% were aware of sick-day rules and 12% recognised the risk of UTIs. Diabetic patients demonstrated low awareness of the risk of euglycaemic ketoacidosis (11%) and foot complications (5.6%). Diabetic patients also had higher hospitalisation rates due to drug-related adverse effects. 98% of patients agreed that receiving information about side effects was important. Postintervention, 100% of surveyed patients reported confidence in using SGLT2-inhibitors and knowing when to seek medical advice.

This initiative demonstrates that patients generally lack knowledge regarding the use of SGLT2-inhibitors. Patient education is crucial in improving understanding and medication compliance. Implementing accessible supplemental resources can enhance continued compliance and safety.

Improving the quality of child and adolescent mental healthcare across the WHO European Region is a priority. Despite advances in quality of care for mental health, many challenges remain, including the lack of a standardised approach to quality improvement.

Papers that outline methods used to develop quality standards or indicators for mental healthcare, published since the year 2000 in English and for use in the WHO European Region, Australia, Canada or the USA, were included.

Methods were based on guidance from the Joanna Briggs Institute and WHO. Searches were conducted across PubMed, Scopus, PsycInfo and Google Scholar from 16 January to 30 January 2024. The titles/abstracts and full-text articles were screened by two reviewers independently, and the inclusion/exclusion criteria were applied. A template based on five steps proposed to develop health indicators was used to extract relevant data by one reviewer and verified by another.

21 studies were included in the review. All papers originated from high-income countries, with dominance from the USA, Canada and the UK. Most papers described four or five of the five proposed steps; however, there was variation in the extent to which these steps were described and how they were implemented.

The results suggest that no consistent approach has been used to develop quality standards/indicators for mental healthcare. There is a need for more participation from people with lived experience and for more research across a wider geographic area.

CRD42024496509.

To implement a locally developed guideline and educational intervention to improve adherence to best practice in the management of paediatric foreign body ingestion.

We conducted a quality improvement project in a single tertiary ED over 5 months, using three plan–do–study–act (PDSA) cycles. Interventions included guideline development, dissemination at NCHD induction and departmental teaching and case-based discussions. The SMART aim was to improve correct management from 55% to >80% within 5 months. The primary outcome measure was the proportion of cases managed correctly according to the guideline. Process measures were unnecessary imaging and inappropriate specialist referrals; return visits were tracked as a balancing measure. Data were analysed descriptively and displayed using a p-chart. Educational impact was explored with case vignettes.

27 consecutive patients were included in the intervention period. Correct management increased from 55% at baseline to 87%–100% across PDSA cycles, exceeding the SMART aim. Process measures improved: unnecessary imaging decreased from 16% to 12% and inappropriate referrals from 3% to 0%. Avoidable return visits fell from 4% to 0%, without evidence of harm. Case vignette scores improved modestly (54%–63%), with variation across individual cases.

Introduction of a locally developed guideline significantly improved adherence to best practice in paediatric foreign body ingestion. Improvements extended to process and balancing measures, demonstrating a true test of change. Embedding the guideline in induction, teaching and the hospital intranet is expected to support sustainability.

This qualitative case study compares the roles played by managers (health network directors, division managers and local service network and family medicine group directors) within four regional health networks that participated in COMPAS+ from 2016 to 2019. Deductive and inductive thematic analysis of workshop reports, action plans and interviews with 24 key actors was performed, informed by a recent scoping review of decision-makers’ roles in quality improvement projects and project management literature.

The study revealed variability in project management across cases, particularly in the distribution of responsibility among upper, middle and lower management. Upper management provided strategic direction, middle management oversaw project execution and bridged organisational tiers, while lower management coordinated local change efforts. Middle managers were tasked with project management but often lacked role clarity and training. A significant gap was found in methodological guidance, typically provided by a quality improvement facilitator. This gap hindered projects’ potential and, in some cases, led to deviations from the intended quality improvement model.

Effective quality improvement project management requires well-defined managerial roles, training and communication between management levels. Our findings highlight the importance of integrating a facilitator role to provide methodological expertise and ensure adherence to quality improvement processes. Contextual expertise and local change leadership may be complemented by external quality improvement expertise. These insights lay the groundwork for future research on evidence-based strategies for effective project management.

We performed a literature search using four databases (MEDLINE through PubMed, Cumulative Index of Nursing and Allied Health Literature, Web of Science and Embase) to identify ERAC studies. Studies were considered if they compared an ‘enhanced’ or ‘fast track’ protocol to a control group and evaluated more than one system or outcome. The adopted QI methodology was evaluated through a standardised questionnaire developed by the authors which was sent to the authors of included studies.

We identified 29 studies. A standardised questionnaire was applied to all included papers to evaluate the presence and type of QI methodology, and 24 authors were approached to complete the survey. We received results from 15 authors, yielding a response rate of 63%. 40% of authors reported use of defined QI methodology, the majority using the Model for Improvement. The QI components most used by those not reporting use of a defined methodology were engagement with multidisciplinary key stakeholders (80%), use of key drivers (87%) and process mapping (60%). Most authors reported use of traditional statistical methodology when analysing results (73%), and 60% reported use of Standards for Quality Improvement Reporting Excellence guidelines. The mean duration of baseline data collection by non-randomised controlled trial studies was 11 months and 9.9 months after implementation.

There is a large variation in the QI practices used in protocol implementation and publication of ERAC studies. The minority of authors report the use of a defined QI methodology and very few report the use of standardised tools in their published works.

CRD42023399418.

This project, conducted in a level III NICU at the University of Illinois Hospital in Chicago began planning in May 2023. Baseline data were collected (November 2023–February 2024) via caregiver surveys and chart reviews. Plan-Do-Study-Act (PDSA) cycles (March–November 2024) introduced interventions like the ‘Alone-Back-Crib’ (ABC) Safe Sleep handouts on SUID disparities, staff education, and short videos. Compliance was assessed postdischarge through surveys and clinic questionnaires, with preintervention and postintervention data analysed using ² and t-tests. A control chart (p-chart) tracked process changes.

Among 248 infants (70 baseline, 178 intervention), mean safe sleep compliance increased from 96% to 97% (p=0.26). Reports of infants ‘never’ sleeping alone in a crib declined from 11.4% to 3.9% (p=0.01). Caregivers valued enhanced messaging on SUID disparities.

Despite high baseline compliance, culturally tailored education reinforced safe sleep practices. While overall adherence changed minimally, increased awareness and behavioural shifts highlight the need for sustained interventions, community engagement, implicit bias training and systemic strategies to reduce racial disparities in SUID.

A review of a convenience sample of ED attendances to University Hospital Kerry (UHK) found that 50% were inappropriate. A SMART aim in a quality improvement project (QIP) is an aim which is Specific, Measurable, Achievable, Relevant and Time based. The SMART aim of this QIP was to reduce the number of persons residing in RCFs, being inappropriately referred to UHK, from 50% to 30% from March 2024 to May 2025.

Quality improvement (QI) measures included the standardisation of terminology through the workings of the palliative frailty multidisciplinary team, development of a communication document on resuscitation status and treatment escalation preferences, and the implementation of an advanced nurse practitioner (ANP) palliative care service for RCFs supported by a palliative medicine physician. Education was integral in this QIP.

QI measures resulted in a reduction in monthly ED attendances of RCF residents from a median of 82 to 50. Inappropriate attendances reduced from 50% to 31%. Stakeholders’ feedback on the new service was overwhelmingly positive. The project resulted in financial savings for the health service.

Integration of the geriatric and palliative medicine services with staff of RCFs allowed for sharing of knowledge, standardisation of terminology and development of alternative models of care and pathways to access specialties. The introduction of a designated ANP palliative care service for RCFs has been essential in helping residents to receive the right care, in the right place, at the right time.

A scoping review was conducted which was prospectively registered on the Open Science Framework and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Four databases (MEDLINE, PubMed, Embase and CINAHL) were searched without date or language limits. We included comparative studies assessing professional medical interpreting services for adult patients with LEP in secondary or tertiary care using objective outcome measures related to clinical outcomes and/or healthcare utilisation. Data extraction included study design, interpreter modalities, outcome measures and adjustments for confounders.

Eleven studies met the inclusion criteria. Most were cohort or cross-sectional studies, predominantly conducted in the USA. The most common outcome measures were clinical, including length of stay (n=8), readmission (n=5) and return emergency visits (n=3). Four studies assessed healthcare utilisation, including outpatient appointment adherence. Results varied: some studies showed reduced length of stay and readmissions with interpreter use, while others found longer stays or no effect. Disease-specific outcomes (e.g., stroke care quality and obstetric indicators) consistently favoured interpreter or health advocate use. Adjustment for confounders was inconsistent with few studies accounting for illness severity.

This review highlights the heterogeneity and limitations in existing outcome measures for evaluating interpreter services. Length of stay and readmission are commonly used but prone to confounding. Disease-specific outcomes may offer greater sensitivity and relevance, especially when adjusted for clinical severity. Future research should prioritise the development of validated, standardised outcome sets that reflect both patient priorities and clinical relevance. These are essential for guiding service improvement and equitable healthcare delivery for LEP populations.

Using a recent data collection effort related to firearm injury as a case study, the purpose of the current methodology paper is to highlight concerns and challenges with online qualitative data collection and provide strategies for preventing, detecting and removing fraudulent participants in qualitative injury and violence prevention research.

Various predata collection activities can promote a study design that deters fraudulent participants, and additional ‘in-the-moment’ data collection activities can flag potential suspicious participants. Strategies include prescreening participants, requiring video and answers to basic questions relevant to the study topic and confirming certain pieces of information.

Online primary data collection can increase accessibility and support the safety of participants in injury and violence research, and there are considerations around detecting and removing fraudulent participants that researchers should note. Like all methods, a balance exists between study access, aims and resources. Researchers new to online qualitative data collection can use the strategies outlined here.

We examined diagnostic-error reports from 1631 hospitals in the Japan Council for Quality Healthcare database (2010–2023). Cases were identified using predefined keywords, and two independent physicians assessed them using the Revised Safer Dx Instrument and Diagnostic Error Evaluation and Research (DEER) taxonomy. Contributing factors were analysed, and statistical methods explored error patterns and stakeholder comparisons.

Among 147 654 event reports, 445 cases involved diagnostic errors. The most common errors occurred in diagnostic testing, assessment and follow-up, particularly misinterpretation of pathological or radiological reports on new injuries during hospitalisation. Physicians were the primary responsible providers (79.3%), while nurses were involved in 19.3% of cases. DEER taxonomy analysis revealed that nurses were more associated with errors in presentation, history-taking and physical examination (p<0.001). Additionally, patient-related factors, observation, reporting and training played a significantly greater role in errors involving nurses than physicians (p<0.001).

By leveraging expert-assessed unstructured data, this study provides a broader perspective on diagnostic safety. Findings highlight the critical role of AHPs in diagnostic errors. Our study underscores the need for targeted, profession-specific interventions embedded within broader interprofessional initiatives to effectively reduce diagnostic errors and enhance patient safety.

To explore the impact of ICU survivor stories on the interdisciplinary ICU team’s perceptions of their role in survivorship, resilience, burnout and sense of belonging at work.

This qualitative study used a cross-sectional survey and focus group design at a large academic hospital. Participants included 39 members of the ICU interdisciplinary team who reviewed ICU survivor profiles and completed a survey. A subset of participants engaged in focus groups.

Survey data were analysed using descriptive statistics. Open-ended survey responses and focus group transcripts underwent thematic analysis using descriptive and in vivo coding, followed by consensus-based theme development.

All survey items had mean scores above 3.0, indicating overall agreement with the positive impact of the survivor profiles. Six key themes emerged from qualitative analysis: validation and closure, learning and growth, gratitude, team building and collaboration, burnout and sense of belonging. Participants reported that the profiles provided emotional closure, reinforced the value of their work and fostered interdisciplinary appreciation. Some participants noted disparities in recognition across disciplines, highlighting opportunities for more inclusive team-building strategies.

ICU survivor stories may serve as a meaningful intervention to support emotional well-being, reduce burnout and enhance team cohesion among critical care providers. These narratives offer a humanising perspective on patient recovery and may help staff reconnect with the purpose behind their work. Future research should explore the long-term impact of such interventions and their potential to improve both provider well-being and patient care outcomes.

Complex intervention including a SMOR embedded within primary care electronic patient records alongside clinical decision support tools.

Doubly robust difference-in-difference analysis using linked electronic health records, comparing changes in prescribing and bleeding admissions in patients undergoing SMOR with those in patients not reviewed.

Sefton (intervention area) and Liverpool (comparator area) in the Northwest of England.

All patients with AF prescribed a DOAC in 2022.

Proportion of patients prescribed apixaban, proportion of patients prescribed edoxaban and rate of emergency hospital admissions for bleeding-related events.

The proportion of patients in Sefton prescribed edoxaban increased from 19% to 35%; 13% (95% CI 11% to 14%) of the increase was associated with the SMOR. There was an 11-percentage point decrease in patients prescribed apixaban (95% CI –12% to –10%). Undergoing review was associated with a non-significant reduction in the risk of bleeding admissions (eight fewer admissions per 1000 people reviewed per year; 95% CI –22 to 6).

SMORs can be delivered at scale and used to switch medications for a large proportion of people. There was no evidence of an increased risk of admissions for bleeding complications in AF patients following a large-scale switch from apixaban to edoxaban supported by SMORs. Such reviews could improve prescribing quality and patient safety by ensuring patients are on the most appropriate dose and choice of DOAC and lead to cost savings to health services (by facilitating a switch to a better value product) while not increasing risks for patients.

A case-study approach was employed to investigate the implementation of SCAs, incorporating mixed methods to provide a comprehensive understanding. Data triangulation included document analysis of policies, cross-sectional review of medication monitoring and prescribing practices across 37 GP practices, and key informant interviews with stakeholders. Logic and dark logic models were iteratively developed to map the intended and unintended outcomes of SCAs.

The monitoring and prescribing review revealed 32.3% of prescribed medications under SCAs lacked up-to-date monitoring data, with attention-deficit/hyperactivity disorder medications showing the highest rates of non-compliance. Interviews highlighted systemic challenges, including unclear responsibilities, inadequate patient involvement, fragmented communication between primary and secondary care, and insufficient integration of digital systems. These gaps contribute to patient safety risks, particularly for high-risk medications requiring stringent monitoring.

SCAs hold potential for improving care continuity but face significant operational and systemic barriers that undermine their safety and effectiveness. Findings evidence the need for clearer role delineation, robust communication frameworks, enhanced patient engagement and integrated digital solutions. Policy-makers and healthcare leaders must address these challenges to ensure SCAs deliver on their promise of seamless, safe and sustainable care. Future research should focus on incorporating the perspectives of secondary care providers and pharmacists to develop more inclusive solutions.

To explore how physicians conceptualise, experience and manage care left undone.

A qualitative study was conducted using semi-structured interviews with 12 physicians active in a tertiary teaching hospital. Thematic analysis was guided by existing literature on missed care but allowed inductive insights to emerge from the data.

Physicians were generally unfamiliar with the term ‘care left undone’, yet readily identified with the phenomenon when described, conceptualising it as a routine aspect of clinical practice shaped by time scarcity, competing demands and professional judgement. High workload, understaffing and a multitude of responsibilities were identified as main antecedents of care left undone. Omissions most frequently involved administrative tasks, psychosocial support and communication, which were deprioritised relative to diagnostic and therapeutic tasks to mitigate any negative effects on patient outcomes. Strategies to navigate care left undone included implicit triage and task delegation, often framed as expressions of clinical expertise rather than deficiencies. Reported consequences included compromised patient safety, disrupted continuity of care and adverse emotional and professional impacts on physicians, such as moral distress and burnout. Proposed solutions were identified at the organisational (eg, staffing, workload reduction, supportive environment), interpersonal (eg, enhanced collaboration) and patient levels (eg, health literacy and engagement). A cross-cutting meta-theme of professional identity and role boundaries shaped how physicians perceived, rationalised and responded to care left undone, highlighting the need for interdisciplinary, context-sensitive interventions.

Care left undone is a relevant yet underexplored phenomenon among physicians active in acute care hospitals. Addressing care left undone requires profession-sensitive approaches that account for differences in role structure, decision-making autonomy and identity. Quality improvement initiatives should include physicians in the co-design of interventions to ensure they reflect clinical realities and foster engagement.

To identify and compare physician and patient perspectives on priorities, barriers and preferences for PROM implementation to inform a quality improvement initiative.

We conducted a mixed-methods evaluation (October 2024–December 2024) in two outpatient clinics. Data included quantitative surveys assessing priorities and challenges from physicians (N=8) and patients (N=35), and qualitative data from physician meeting field notes, patient interaction field notes and open-ended survey responses. Quantitative data were analysed descriptively; qualitative data underwent thematic analysis. Findings were integrated using triangulation.

Physicians and patients aligned on prioritising pain interference and physical function. However, patients prioritised pain severity and personal goals more highly than physicians. While 70% of patients found PROMs useful, only 24% reported discussing PROM findings with providers, and 75% of clinicians responded ‘not at all confident’ to a question about score interpretation. Implementation challenges diverged significantly: physicians universally (100%) cited perceived patient time burden as a barrier, but this concern was infrequently shared by patients (11.4%). Physicians also cited workflow integration as a barrier (87.5%), while patients primarily prioritised PROM format/design (37.1%) and relevance (28.6%). Five qualitative themes emerged across patients and physicians: (1) critiques of PROM content/fidelity; (2) disconnect between data collection and clinical integration; (3) prioritising function and patient-centred goals; (4) need for flexibility, customisation and communication and (5) system-level barriers influencing implementation.

Gaps exist between PROM collection and meaningful clinical use in this setting, driven by content limitations, workflow barriers, system issues and divergent stakeholder perspectives. Improving PROM implementation requires a multistakeholder approach prioritising function-focused, relevant measures integrated effectively into clinical workflows and support by system-level changes.

The Physician Quality Committee at our academic tertiary care hospital implemented a series of interventions, including a peer-to-peer feedback mechanism, longitudinal education and coaching, standardised QI project templates and efforts to facilitate culture change. The QIPs from 13 clinical departments were reviewed for the years before (2018–2019) and after the interventions (2022–2023) and scored according to a structured rubric, created by consensus among physician quality leads. Data are reported as means and medians (IQR). A Wilcoxon signed-rank test was used to evaluate for statistical significance. A Likert-scale survey was used to assess physician QI leads’ perception of the impact of the initiatives.

The mean score on the structured rubric was 4.4/12 for the QIPs from 2018 to 2019 and 8.0/12 for the QIPs from 2022 to 2023 (Z=3.06, p=0.0005). The median score (25th, 75th percentile) in 2018–2019 was 4.5 (3.5, 5.13), which increased to 8.5 (7.0, 9.0) in 2022–2023. The survey response for physician QI leads was 10/13 (76.9%). The most positive response was the QI lead’s knowledge and understanding of how to structure a QI project (mean score of 4.4/5); the least positive response was related to departmental focus and clarity regarding QI priorities (mean score of 3.9/5).

Multifaceted physician-led interventions resulted in improvements in the quality and content of clinical department QIPs, improved physician knowledge of QI methodology, enhanced focus and clarity around departmental QI priorities, and improved awareness of hospital-wide improvement efforts.

We applied the Model for Improvement framework while using Plan-Do-Study-Act cycles to test and refine interventions. The traditional Kanban system was redesigned by introducing replenishment triggers, adopting bin systems, implementing Kanban boards, and standardizing Kanban quantities based on the frequency of consumable use. Impact was assessed using statistical process control charts generated with QI Macros software. Outcome measures included total weekly consumable costs; process measures assessed staff compliance with the Kanban system; and balance measures tracked out-stocking rates and staff satisfaction.

Over three years, the modified Kanban system reduced weekly costs by 40–50%, from QAR 31 000 (US$8500) to QAR 19 000 (US$5100) during testing and stabilised at QAR 16 000 (US$4300) post-implementation. Staff satisfaction increased from 79% to 90%, driven by improved workflow and inventory tracking. Out-stocking rates declined from 0.04 to 0.02 per 1000 inpatient days during testing, ultimately reaching near zero after implementation. Compliance improved from 76% to 95%, directly contributing to both cost savings and operational efficiency.

The modified Kanban system effectively reduces costs, enhances staff satisfaction and improves operational efficiency by minimising stockouts. This study underscores the value of quality improvement and lean methodologies, such as Kanban, in optimising healthcare supply chains and reducing waste.

We started off with a driver diagram to identify what the primary and secondary drivers are for improving the quality of care for patients with sensory impairment. Of the drivers discussed, we believed that we could have a meaningful impact on improving sensory impairment awareness among the multidisciplinary team (MDT) on the ward. We then went through our Plan, Do, Study, Act (PDSA) cycles, which were as follows: PDSA cycle 1, where I and my two colleagues educated the MDT on how to use the electronic patient records property form checklist, which was being underused. This form tracks whether patients require sensory aids. We did three teaching sessions during board rounds and audited the use of this form over time. PDSA cycle 2 used a laminated bedside checklist that is filled in by the MDT and is used as a visual reminder of the patient’s sensory impairment status.

The EPR form completion rate increased by 14% over a period of 4 weeks, although this was not statistically significant. 18% of the bedside checklists were filled in, which was statistically significant. Both interventions in combination led to a statistically significant increase in sensory impairment awareness, with a 32% decrease in sensory aid unknown rates, a 40% decrease in dementia unknown rates and a 56% decrease in both sensory and dementia unknown rates. Delirium status was not formally assessed in this QIP due to documentation inconsistencies; however, its relevance remains acknowledged.

We conducted a nonrandomized, interrupted time-series Quality Improvement Project (QIP) using the Model for Improvement. Interventions included technologist-led prospective screening of pRBC orders, policy updates, and educational campaigns. Outcome measures were rates of inappropriate transfusions based on hemoglobin and single-unit criteria; balancing measures included transfusion-related adverse events. Sustainability was assessed using Statistical Process Control charts. Cost analysis estimated savings using an activity-based cost of $C1500 per pRBC unit.

Initial implementation improved compliance to 90% (pre-transfusion hemoglobin) and 71% (single-unit) within three months. Extended analysis (2021–2024) demonstrated sustained rates of 90% and 77%, respectively. At the St. Catharines Site, monthly median transfusions decreased from 273 to 173 units, yielding a 56% reduction in RBC utilization and 44% cost savings amounting to $C5052000.

Technologist-led screening achieved sustained improvements in transfusion appropriateness, leading to substantial cost savings. Variability across sites underscores the need for further research on contextual factors influencing future QIP success.

The study had a mixed-methods design, combining quantitative and qualitative methods, and was done at the PICU of Sophia Children’s Hospital (Rotterdam, The Netherlands). The Safety Attitudes Questionnaire (SAQ) was used to measure patient safety culture, with surveys administered in 2009, 2012, 2014, 2017, 2019 and 2023. Trends in patient safety culture over time were analysed. Additionally, staff members provided recommendations to improve patient safety, which were subsequently categorised into overarching themes. An expert panel was convened and interviews with staff members were conducted to further evaluate the most frequently mentioned recommendations and assess their relevance and feasibility for implementation.

From 2009 to 2023, patient safety culture demonstrated overall improvement. However, specific domains, including stress recognition, perceptions of management and working conditions, still show room for further improvement. Most recommendations identified through the SAQ fell within the themes of interprofessional communication, medical equipment and hospital working environment, and staffing. Concrete suggestions included appointing a dedicated contact person to improve communication with parents and establishing clear agreements to strengthen communication and teamwork within the PICU.

The patient safety culture at the PICU of Sophia Children’s Hospital improved over the years, although areas for improvement remain. Sustained improvements in patient safety culture require continuous investment in interprofessional communication, workplace conditions and staffing. This study not only highlights long-term trends but also presents actionable strategies proposed by staff to address persistent challenges. Effective implementation and ongoing evaluation of these interventions are essential to strengthen safety culture, enhance staff well-being and ultimately improve patient outcomes.

206 consecutive paediatric patients who underwent arthrocentesis for the diagnosis of septic arthritis were identified. Midway through the collection period, the QI intervention (stat card) was implemented. We collected the date and time of arthrocentesis and sample verification (TAT) and calculated the proportion of TAT <1 hour preintervention and postintervention. We collected variables related to the affected joint and whether the stat card was used. Operative time was calculated for those samples collected in the Operating Room (OR).

The final study population included 109 patients preintervention and 88 patients postintervention. Postintervention, the stat card was used in only 44% (20/45) of eligible cases. Compliance was highest in aspirations of the hip (75%). After adjusting for the affected joint, the odds of TAT <1 hour were higher in the postintervention stat card group compared with the postintervention no stat card group (odds ratio 7.10, p=0.0147) and to the preintervention group (odds ratio 3.63, p=0.0810). There was no difference between the postintervention no stat card versus the preintervention groups (odds ratio 0.51, p=0.2524). TAT was significantly decreased when the stat card was used (42 min) compared with when it was not used (84 min) (mean difference –39.5%, p=0.0178). After adjusting for the affected joint, there was no difference in operative time across the three groups (p=0.2531).

A multidisciplinary QI initiative for the intraoperative diagnosis of septic arthritis was effective in reducing cell count TAT but demonstrated poor compliance and failed to reduce operative time.

This QIP was conducted at Royal Derby Hospital using a multidisciplinary, systematic approach based on Plan-Do-Study-Act cycles. Baseline data were collected from 100 randomly selected patients (November 2021–May 2022) and compared with outcomes during a 52-week intervention period (September 2023–August 2024). Interventions included educational sessions, quick reference materials and enhanced prescribing tools. Data were analysed for compliance with RCEM standards, adverse events (liver function derangement and anaphylactoid reactions) and system-level measures, such as length of inpatient stay and timing of paracetamol plasma levels.

A total of 214 patients were included. Compliance with RCEM standard 1 improved from 36% to 43%. No change was noted for standards 2 and 3. Median inpatient stay decreased from 35 hours to 30.5 hours. No significant differences were found in adverse events. Special cause variation was identified in paracetamol plasma level timing, attributed to early sampling in some cases.

This QIP addressed problems of delayed or inconsistent NAC administration in the ED by improving compliance with RCEM standard 1 and reducing inpatient stay while maintaining patient safety. Although standards 2 and 3 did not improve, the interventions proved cost-effective, feasible and scalable. Future work should focus on sustaining improvements and exploring patient-centred outcomes across diverse healthcare settings.

The data consist of 22 semistructured individual interviews with regular and temporary healthcare workers involved in the intensive care of COVID-19 patients, including nurse assistants, registered nurses, critical care nurses and consultant and junior physicians. Thematic analysis was used to analyse the data.

The overarching theme that emerged was trying to create order in chaos.

The theme encompassed four categories: adaptation with consequences, learning and growing while sacrificing my health, supporting and balancing staff resources without having enough, and challenging ICU values and standards. Each category comprised multiple subcategories.

Our study demonstrates challenges and identifies workarounds, support strategies and personnel learning experienced by COVID-19 intensive care teams in delivering patient care, ensuring patient safety and managing staff resilience. The findings can be used to better prepare for future crises.

To describe the roles and responsibilities of RNs in early recognition and management of sepsis in acute hospital settings, applying the Action, Actor, Context, Target and Time (AACTT) Implementation Science Framework to specify nursing behaviours across domains, and identify evidence gaps to inform future research and practice.

The review was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. We searched Medline, EMBASE, CINAHL and PubMed for studies discussing the contribution of RNs in acute hospital-based sepsis care. Data were extracted and mapped to the AACTT framework domains.

27 (90%) of 30 included studies described RNs as the actor responsible for the action of sepsis screening. 26 studies (87%) described RN actions relating to timely care escalation and sepsis management. A broader range of actions was identified in resource-restricted contexts, with three (10%) studies reporting RN-initiated blood tests, chest X-rays, intravenous fluids and antimicrobials.

Across 16 studies (53%), eight roles with dedicated focus on sepsis identification and management were identified; only one study outlined formal training requirements. Nurse practitioners were excluded here given their credentialed role and scope.

Nurses perform essential actions in early sepsis recognition and management, with several RN roles focused on sepsis care identified. A broader scope of nurse-initiated actions was identified in resource-restricted contexts to meet clinical demand. There is potential for a greater scope of nursing actions in sepsis care for the benefit of patients and health services, but to achieve this, standardised training requirements need to be developed, and scope of practice defined.

The Rating of Integrated Health Services (RIHS) survey was developed based on the YIP framework to assess levels of youth mental health service integration in New South Wales (NSW) local health districts (LHDs). Managers of specialist services/programmes across 18 LHDs in NSW were invited to complete the RIHS survey. Responses were coded into indicators of levels of integrated care and aggregated into an overall assessment of service integration.

Validity of the RIHS scales was indicated by positive correlations with independent items of service integration. In relation to integration levels, 41/56 services/programmes had minimal-to-basic levels of integration with headspace centres. The results were consistent across programmes and regions. Three structural areas of interagency collaboration were identified for improving service integration: (i) information systems, communication, products and technology; (ii) financing; and (iii) leadership, governance, policy and values.

The results provide evidence of the significantly fragmented youth mental healthcare system in Australia. There is a need to address structural aspects of service integration to improve integration between headspace and LHD services for young people.

We developed a multifaceted improvement initiative targeting TI at four academic primary care practices, aiming to increase rates of SGLT-2i and GLP-1RA use for patients with type 2 diabetes (T2DM). Prescribing trends for GLP-1RAs, SGLT-2is, sulfonylureas and insulin were compiled quarterly over a 12-month baseline period and 12-month intervention period and analysed using interrupted time series analyses. Providers completed a brief questionnaire assessing project feasibility and acceptability.

GLP-1RA prescribing showed an upward trend during both the baseline and intervention periods (+0.70% vs +0.87% per quarter; p=0.14 for difference) and increased significantly in the first intervention quarter (+1.73%; p=0.003). SGLT-2i prescribing was static during the baseline period, showed an upward trend during the intervention (0.0% vs +0.43% per quarter; p=0.05 for difference) and increased significantly in the first intervention quarter (+1.0%; p=0.03). In those prescribed a GLP-1RA or an SGLT-2i, sulfonylurea prescribing dropped significantly after intervention (–2.0% per quarter; p=0.02). Insulin prescribing rates did not change throughout the study period. There was no significant change in haemoglobin A1c among patients newly prescribed a GLP-1RA and/or an SGLT-2i during the intervention period (7.3% ±1.5% baseline vs 7.2% ±1.4% intervention period, p=0.23). Most providers indicated that they had prescribed (90%) and were more likely to prescribe (81%) GLP-1RAs and/or SGLT-2is in the future because of their participation.

A quality improvement initiative targeting drivers of TI was associated with increased rates of guideline-based medication prescribing for primary care patients with diabetes and may be applied to other conditions in which TI limits care optimisation or guideline adherence.

A mixed-methods study was conducted. Quantitative data collected from health records from December 2020 to March 2023 were used to evaluate adherence, and differences were analysed with generalised mixed models. Surveys and semistructured interviews with healthcare providers (HCPs) were used to identify barriers and facilitators, using the extended normalisation theory.

The study included 299 patients. Documentation of repeated screening for infectious diseases when prior tests exceeded 1 year decreased (p<0.001). Adherence to ordering blood tests as advised increased (p<0.001). For patients experiencing a flare, a small but significant increase was observed in the use of validated questionnaires for scoring disease activity (p=0.004). Adherence improved in registering smoking status (p=0.003), side effects (p<0.001), medication adherence (p<0.001) and ordering advised blood tests as recommended (p<0.001). Weight registration decreased (p=0.002).

From 85 surveys, 42 were completed, with 11 interviews conducted. Facilitators were improving collaboration and the potential to standardise care. Barriers were the complexity of the implementation in health records, the difficulty for providers to change routines and IBD heterogeneity.

Adherence to the CP appears to be challenging, due to the difficulty HCPs experience in changing routines. Discrepancies between performed and documented tasks may affect adherence rates. The gradual improvement suggests increased familiarity with the CP may enhance adoption.

MEC-2020-075.

A multidisciplinary QI team used the fishbone diagram to identify the root causes of low VL testing coverage. The nationally adopted model for improvement was employed using the plan–do–study–act (PDSA) cycles. Baseline data were taken from January to March 2024. The QI project was implemented from 1 April to 30 September 2024, for 6 months. A run chart was used to track the progress of the QI project and enforce evidence-based decision-making.

The QI team tailored five well-worked interventions tested in three PDSA cycles, including appointment date reminders for OVC caregivers, on-the-job capacity building and targeted supportive supervision for staff, conducting caregiver awareness sessions, weekly VL result tracking and feedback mechanism and enhancing community–facility linkages.

The run chart demonstrated a 7% increment in OVC VL testing coverage, evidenced by six consecutive data points above the median line, indicating a statistically significant association between the identified QI gap and the implemented interventions.

The QI project effectively improved the OVC VL testing coverage in Jinka town. This collaboration not only improves the VL testing coverage but also provides a comprehensive supportive environment for caregivers and families affected by HIV in the area.

Chart review at a level IV neonatal intensive care unit (NICU 1) noted a low rate of documentation that the RRE was completed prior to discharge for eligible patients and suboptimal rates at three other NICUs of varying acuities and operational structures (NICUs 2, 3, 4). This prompted the initiation of a quality improvement initiative to improve RRE completion before discharge.

A driver diagram was generated to guide testing and implementation of interventions including ophthalmoscope placement, clinician education and electronic health record (EHR) reminders over eight plan-do-study-act cycles at NICU 1. Using the knowledge gained from NICU 1, two impactful tests of change were utilised to perform a 22 factorial planned experiment (PE) at NICUs 2, 3 and 4.

This initiative led to sustained improvement in completion of the RRE from baseline 66.8% (13-month period) to 100% (22-month intervention period with special cause noted) at NICU 1 with two abnormal RREs detected. The PE using established factors from NICU 1 at NICUs 2, 3 and 4 demonstrated that the combination of ophthalmoscope placement optimisation plus EHR RRE trigger led to 100% RRE compliance at all sites.

This initiative led to a sustained improvement in RRE completion at NICU 1. PE at three other NICUs of varying types and staffing structures identified a synergistic set of change factors, which may yield the greatest improvement across the spectrum of NICUs.

Prior to our intervention, median time to ECG in the emergency department (ED) was 16.7 min, with peak times reaching 20.7 min in January 2024, exceeding American College of Cardiology/American Heart Association guidelines recommending an ECG within 10 min of arrival. Contributing factors included workflow inefficiencies, inadequate staffing and process inconsistency.

A quality improvement initiative was implemented from February 2024 to February 2025 aimed at reducing time to ECG and time to ECG interpretation. Key interventions included nursing education, process standardisation, stamps to standardise documentation, ECG responsibility reallocation (triage ECGs done by nurses, floor ECGs done by techs) and the creation of a designated ECG space in triage.

There were 3510 eligible ECGs conducted across the 12-month intervention period with 1522 ECGs (43.4%) meeting the <10 min goal. The initiative led to a reduction in time to ECG by 4.68 min (95% CI –7.74 to –1.62), a 10.8% reduction in median door-to-ECG time from 1 year prior to the intervention (12.9 min to 11.4 min), and a 32% reduction in median door-to-ECG time (16.7 min to 11.4 min) from 6 months prior to the intervention. There was a 74% reduction in median ECG interpretation time (101 min to 26.5 min) over 12 months.

Process standardisation, role delegation and education effectively reduced ECG times in the ED. Changes in staff who complete ECGs and standardisation of documentation may aid in improving performance metrics in ED settings.

Monocentric retrospective cohort study of a failed quality improvement project using prospectively collected data including 1276 live-born very preterm infants between 2010 and 2023. Primary outcome measures were IVH, severe IVH and death or severe IVH. Statistical analysis included propensity score matching.

IBIS, an ongoing IVH prevention bundle based on a systematic literature search starting in October 2016.

Comparing pre-IBIS patients (2010–September 2016) to IBIS patients (October 2016–2023) revealed no reduction in IVH (25.1% vs 25.1%) or severe IVH (9.6% vs 9.1%). Instead, mortality (24.8% vs 13%) and delivery room mortality (9% vs 5%) were almost halved and fewer infants died after primary palliative care (8.5% vs 4.7%) or after redirection from intensive to palliative care (15.1% vs 7.9%). Longitudinal analysis revealed no trends for IVH or severe IVH over the entire period. Limiting the analysis to the IBIS period reveals a significant trend for fewer IVH (p=0.001). Propensity score matching revealed significant reduction for severe IVH (OR 0.62, 95% CI 0.39 to 0.99) and death or severe IVH (OR 0.42, 95% CI: 0.3 to 0.59) but not for IVH.

The IBIS SMART Aim to reduce IVH failed. Simultaneously, survival was significantly increased by the increased provision of life-sustaining intensive care at lower GAs, which possibly led to an increased risk for acquiring IVH. Our results highlight the need for a better understanding of the effects of extending perinatal interventional activity to lower GAs on adverse outcome monitoring.

Following the International Society for Pharmacoeconomics and Outcomes Research guidelines, the FaCE and FDI scales were translated and culturally adapted for Chinese use (including forward and back translation). From January to August 2024, 150 Chinese PFP patients and 50 age/gender-matched healthy controls in Sichuan Province were enrolled to evaluate psychometric properties. Statistical analyses included Cronbach’s α (internal consistency), two-way random-effects intraclass correlation coefficient (test-retest reliability, 2-week follow-up), exploratory factor analysis (EFA, principal component analysis/varimax rotation, Kaiser-Meyer-Olkin/Bartlett’s test; construct validity), Content Validity Index (CVI), Pearson correlations (convergent/discriminant validity VS 36-Item Short Form Health Survey (SF-36)), Mann-Whitney U test (group differences) and standardised response means (SRM)/Cohen’s d (responsiveness).

The Cronbach’s α for the FaCE scale was 0.835, and for the FDI scale, it was 0.895, indicating good internal consistency. Factor analysis revealed six dimensions for the FaCE scale, while the FDI scale was confirmed to have a two-dimensional structure. Additionally, significant correlations were found between the relevant dimensions of the FaCE and FDI scales and the SF-36, supporting their convergent validity. The Mann-Whitney U test indicated significant differences in initial questionnaire responses between the experimental and control groups (p<0.01). Responsiveness analysis demonstrated that the FaCE scale effectively captured changes in patient status.

This study validates the effectiveness and reliability of the Chinese-version FaCE and FDI in patients with PFP, providing robust evidence for their use as assessment tools for QoL in this population.

We used a framework based on UK National Health Service primary care documents to structure the review. Separate literature searches were performed in four databases to identify relevant reviews and primary studies. Studies were included if (1) the main focus was a metric or indicator that fell within the review framework or (2) they reported an OD or QI initiative or intervention in UK primary care that used one or more of the previously identified metrics or indicators. We mapped studies in group 1 against our framework domains. We performed a narrative synthesis of studies in group 2, again organised by the overall framework.

We included 28 studies, 24 (11 reviews and 13 international primary studies) for metrics or indicators and 4 for initiatives or interventions. The number of individual indicators or groups of indicators in group 1 studies ranged from 1 to 773. Three of the four UK QI/OD studies focused on initial access to general practice services; the other dealt with a programme to encourage self-care for long-term conditions. Mapping of the group 1 studies identified potentially relevant indicators across all domains but the process was methodologically challenging.

Although numerous potential indicators exist, they tend to be poorly defined and lack examples of their use in practice. Further work is needed to identify and evaluate candidate indicators.

A team-based approach was implemented, including junior doctors, nurses, pharmacists and the hospital’s information technology team. The plan-do-study-act (PDSA) methodology was used to design, test and implement interventions. Key interventions included educational sessions for junior doctors, integration of pharmacy systems for easy access, daily reminders via a WhatsApp group, and reinforcement of the process by senior residents. Data collection was standardised, tracking patient demographics, reconciliation times and team responsibilities. Compliance was monitored over a 4-month intervention period.

At the start of the intervention, medication reconciliation compliance was at 4%. Initial progress was slow, requiring frequent reminders and educational sessions. However, by the end of the first month, compliance had reached 77%, and by the end of the 4-month period, it improved to 96%, surpassing the target of 90%. This improvement was sustained with a compliance rate above 90% for 6 months following the intervention.

The use of the PDSA methodology significantly improved medication reconciliation compliance, achieving a 96% adherence rate. Engaging healthcare staff through education, clear communication and a team-based approach was key to overcoming barriers and ensuring sustainable improvements. This model can be applied to other QI projects aimed at enhancing patient safety and reducing preventable harm.

Using an iterative plan-do-study-act model, interventions were implemented from January to September 2024 among average-risk patients aged 45–75 years who presented to primary care visits. Interventions focused on (1) biweekly, small-group provider education sessions with daily reminders, (2) bilingual patient-facing educational materials, posters and instructional videos and (3) electronic medical record portal outreach. The primary outcome was Cologuard completion rate among CRC-screening eligible patients. Process measures were Cologuard order rates and kit return rates, and the secondary outcome was the overall CRC screening completion rates.

A total of 2171 CRC-screening eligible patients visited during the intervention period, and a total of 399 Cologuard orders were placed, with 235 completed kits returned. Cologuard completion rates improved from a preintervention median of 7.38%–10.00%. Median order rates rose from 14.59% to 18.71%, and overall CRC screening rates increased from 68.6% to 72.2%. Direct patient messaging had the most immediate impact, with 7.2% responses by recipients, resulting in 16 screenings and a transient peak of 20.71% in monthly Cologuard completion.

This project demonstrates that practical, multifaceted, low-cost strategies of provider-focused education and patient-directed digital outreach can significantly improve Cologuard usage, ultimately leading to an increase in CRC screening completion rates. Sustained reinforcement and improvement in kit return will be a key to future improvements.

A cross-sectional survey study was conducted among adult patients scheduled for a tertiary outpatient surgery clinic visit from September 2020 to September 2021. The cost of a surgical visit was assessed using a study-specific questionnaire. Visit costs between subspecialties and visit modalities were compared with generalised linear modelling.

Of the 961 included surgical patients (866 in-person and 95 video visits), those who received a video visit experienced a substantial halving of visit-related costs (67 vs 172; β=–103.65, p<0.001) and reduction in costs with increasing age (β=–1.52, p=<0.001), attributable to decreased absenteeism from work for patients and companions, and the absence of travel expenses.

Direct and indirect costs among patients and relatives for a visit to a tertiary surgical outpatient clinic are high. Reporting previously neglected, yet significant costs, including those borne by companions, could enhance awareness among clinicians and policymakers regarding the financial and societal impact of offering certain visit modalities and may influence the shared decision-making process.

A needs assessment using a three-round Delphi process was completed among leaders in anaesthesiologists across medical colleges in our country. The responders were mostly alumni of our institution and their colleagues. Delphi round 1 identified technical and non-technical skills after brainstorming sessions with experts in the field. Round 2 involved collecting data through questionnaires about the technical skills best suited for simulation-based training and topics of importance using Copenhagen Academy for Medical Education and Simulation-Needs Assessment Formula (CAMES NAF) score. Round 3 included final elimination and reprioritisation. The topics were narrowed down by steering research members based on data saturation in the open-ended questions (qualitative), as well as statistical data (CAMES-NAF) for the quantitative questions.

In Delphi round 1, we identified 22 technical skills, 10 non-technical skills and 21 scenarios. Response rates in the Delphi round 2 averaged to 85.5% and responses were prioritised using CAMES NAF score. Open-ended questions reached data saturation for non-technical skills and scenarios. In round 3, we were able to narrow it down to 10 technical skills, 5 non-technical skills and 8 scenarios after elimination and reprioritisation.

We identified and prioritised 8 scenarios, 10 technical skills and 5 non-technical skills in anaesthesiology that are suitable for simulation and may be used as a guide for developing simulation-based curriculum in anaesthesiology.

We implemented a continuity clinic note template with a specific SDM ‘dot phrase’ to improve the documentation and execution of SDM conversations. Our primary aim was to increase SDM documentation for prostate cancer screening, with a secondary aim to improve follow-up on abnormal PSA values. The intervention included men aged 55–69 years. Preintervention, residents were educated on SDM and PSA screening. Postintervention, patient charts were reviewed for documentation rates and screening outcomes. Feedback was collected during dedicated sessions. Finally, comparative statistics were conducted between baseline preintervention and eligible postintervention cohorts.

SDM documentation improved significantly from 7.1% preintervention to 37.2% postintervention (p<0.001). PSA screening rates increased from 31.5% to 37.8% (p=0.155), though not significantly. Notably, 49.3% of patients declined PSA testing post-SDM, and 68.5% of previously screened patients were up to date with PSA testing. Residents reported challenges with SDM implementation, including time constraints and patient acuity.

Templated notes and dot phrases significantly improved SDM documentation, both compared with our clinic baseline rates and compared with recent reported national rates, overall enhancing standardised preventive care in primary care. Although PSA screening rates improved, challenges such as time limitations and patient no-shows impacted the intervention’s effectiveness. Future cycles will address these barriers to improve outcomes further.

We assessed the reliability, factor structure and validity of the Sinclair Compassion Questionnaire-Short Form (SCQ-SF).

The SCQ-SF was embedded in a large administration survey (N=2236) aimed at assessing Canadians in facility-based continuing care contexts. Reliability analysis and confirmatory factor analysis (CFA) were conducted on the SCQ-SF data.

Data from 2236 residents were analysed. Cronbach’s alpha (α =0.91) indicated that the SCQ-Short had excellent reliability. CFA indicated a well-fitting unidimensional model of compassion. The standardised factor loadings for the 5-items ranged between 0.76 and 0.87. Global indicators of fit were largely excellent (root-mean-squared residuals = 0.06, comparative fit index <0.99, standardised root-mean squared residual = 0.01, 2 =35.66, p<0.001).

The SCQ-SF is a short psychometric tool, with excellent internal consistency, strong factor loadings and good fit. The SCQ-SF is suitable for use by clinicians, researchers and health system analysts.

We measured enjoyment levels by distributing an anonymous questionnaire weekly at team meetings, scoring enjoyment levels on a scale 1–10 and collecting qualitative feedback. We also calculated monthly staffing levels. The team developed a driver diagram and interventions were introduced from this including reflective practice sessions, monthly teaching sessions, staff social events and a cross-cover/duty policy with guidance on flexible working.

After the interventions were implemented, the median staff enjoyment score increased slightly from 6.75/10 to 7/10 and the median staffing levels increased from 61% to 89% over a period of 18 months. We found that staffing levels and enjoyment levels correlated with each other. From analysis of the qualitative feedback over the duration of the project, the number of negative comments received did reduce. It should be noted that the number of comments around the intensity of workload remained the same when comparing the baseline period to the final weeks of the project.

There was little change in staff enjoyment levels at work. This may be reflective of the general state of the National Health Service with poor levels of morale nationally but may also be linked to ongoing concerns in the qualitative feedback from the team about high workloads. Despite this, we made positive changes and the project helped bring the team together. The project further emphasises the link between staffing levels and enjoyment levels. Overall, our project helped to increase staffing levels and highlight the importance of well-being in the workplace.

The study had three discrete phases: a systematic review to identify cost variables used globally to calculate the cost of medication errors (published), followed by a Delphi study with 18 experts to assess appropriateness, accuracy, accessibility and measurability of identified cost variables. Finally, a hospital bill analysis was done to assess accessibility and measurability of cost variables.

In Delphi round 1, out of 13 cost variables, nine were retained as appropriate for calculating medication error costs. None were rated as accessible or measurable in the healthcare settings in Sri Lanka. Experts highlighted the need for a guideline to use the cost variables, which was then developed and shared among experts in Delphi round 2. The SLCV, including eight variables, was retained as appropriate for calculating medication error cost after Delphi round 2. Thirty-one bills confirmed the accessibility and measurability of most variables in SLCV.

A standard list comprising eight appropriate cost variables to calculate the cost of medication errors, and a guideline was developed for Sri Lanka. The accessibility of these variables was affirmed through a bill audit.

Reporting incidents allows healthcare providers to identify safety issues and implement improvements. However, variations in reporting practices, particularly in maternity care, have been found across different healthcare settings. Despite the growing use of electronic systems, challenges such as under-reporting, lack of feedback and insufficient organisational learning persist.

This review explores how patient safety incidents are reported in maternity care, identifies the systems used globally, examines potential barriers and enablers to reporting, and highlights gaps in existing research and practice.

A systematic review was conducted, analysing studies that focused on incident reporting practices in maternity care. An artificial intelligence text analysis tool (Caplena) was used to aid the synthesis of the study data. Methodologies included quantitative surveys, qualitative interviews and mixed methods approaches.

A total of 15 studies from seven different countries were analysed. Reporting systems ranged from traditional paper-based methods to electronic platforms. Barriers included organisational culture, time pressures and inadequate reporting platforms. Enablers involved supportive leadership, training and user-friendly reporting systems. Substantial gaps included the under-reporting of near misses, lack of feedback mechanisms and insufficient attention to staff experiences.

The findings highlight the need for consistent, user-friendly reporting systems and fostering a supportive, non-punitive culture. Strengthening and improving feedback mechanisms is also critical to enhance reporting practices. Recommendations are provided for designing future reporting systems.

Improving patient safety incident reporting in maternity care requires system improvements, cultural changes and further research to address identified gaps and optimise incident management systems.

A three-phase study was implemented: (1) baseline data were collected from preintervention referrals by noting the reason for consultation and if certain information, deemed relevant for an appropriate referral, was included; (2) a referral guideline, outlining when and how to refer, was distributed to family physicians in the region; and (3) postintervention referrals were collected and analysed as in phase I.

A total of 404 referrals were collected (161 pre-intervention and 243 post-intervention). A 36% increase in patients who were deemed appropriate surgical candidates was reported post-intervention (p=0.044), with an escalation in the proportion of patients requiring neurosurgeon assessment observed over time. Limited improvements were appreciated in the presence of the criteria indicated for inclusion in a referral document.

While challenges remain when attempting to modify the referring behaviours of primary care physicians, this research has demonstrated that guidelines aimed at enhancing specialist directed referrals can lead to improvements in their performance. Nonetheless, translating guidelines into practice is a recognised issue, often requiring time and multiple exposures. Active forms of medical education and multifaceted interventions have been demonstrated to be the most effective means of implementing guidelines into practice, an approach that could further address referral inadequacies in the future.

The study evaluated system gaps using WHO Quality Assessment/Quality Improvement Tool for Maternal and Newborn Care (WHO QA/QI MN) and implemented Point of Care Quality Improvement (POCQI) methodology to improve and sustain the composite outcome of mortality and/or major morbidities, including bronchopulmonary dysplasia, necrotising enterocolitis stage 3, late-onset sepsis and intraventricular haemorrhage grade ≥3.

The study was conducted over 14 months. The adapted WHO QA/QI MN tool and POCQI methodology were used to focus on key clinical practices, namely, kangaroo mother care (KMC), use of mother’s own milk (MoM) and antibiotic usage, utilising multiple plan-do-study-act cycles.

Among 961 preterm neonates enrolled, KMC rates increased from 70.25% to 85.58%, and exclusive MoM use by day 7 increased from 59.24% to 70.2%. Antibiotic use declined from 25.5% to 20.67%. While process improvements were noted, the composite outcome of mortality and major morbidities did not show statistically significant reduction; however, a decreasing trend was observed post-intervention.

This study demonstrates the feasibility of using the WHO tool by trained personnel for gap analysis. POCQI is an important approach to enhance evidence-based care practices and sustain good outcomes for preterm neonates in resource-limited settings. A longer follow-up may be needed to observe significant improvements in clinical outcomes.

A retrospective cross-sectional study was conducted at the University Hospitals of Leicester between September 2020 and December 2020, including 2862 singleton pregnancies at booking and 2407 deliveries. Data from the maternity server covered demographics and key performance indicators (KPIs), such as gestational age at booking, uptake of first trimester screening test (FTST), perinatal outcome, third- and fourth-degree perineal tears and post-partum haemorrhage (PPH). The NHS perinatal surveillance dashboard categorised these KPIs by ethnicity and EP.

The booking cohort comprised 62% White, 26% Asian, 3% Black, 2% mixed race and 2.5% any other ethnic group. Late antenatal booking was highest in the mixed-race cohort (15%). Women who do not speak English as their first language (NEPL) were the largest undecided group with the FTST uptake (10%). Among the delivery group, mixed-race women had a higher stillbirth rate (21.28 per 1000 live births) and preterm births (10%). Third- and fourth-degree tear rates were highest among ethnic minority-NEPL cohorts (4.36%), although they were not statistically significant. No significant differences were observed in PPH rates.

This study highlights perinatal disparities among diverse ethnic groups and non-English-speaking women, necessitating targeted interventions to address these inequities for better perinatal outcomes for diverse populations. Including ethnicity and EP in perinatal dashboards reveals these disparities and aids in developing quality assurance systems to monitor and address them.

We collected baseline retrospective data on a historical cohort of patients undergoing pancreaticoduodenectomy or total pancreatectomy from 1 January 2022 to 31 December 2022. We then launched our QI project on 1 January 2023, consisting of a multidisciplinary team creation and numerous outreach activities. The project had two Plan, Do, Study, Act (PDSA) cycles and ran until April 2024. The Standards for Quality Improvement Reporting Excellence guidelines were used to report results.

Baseline cohort data included 64 patients, with 32% receiving pip–tazo and 39% developing an SSI. During phase one of our QI project (1 January 2023–31 August 2023), 54 patients underwent surgery, 90.7% received pip–tazo and 27.8% developed an SSI. Those who had undergone preoperative biliary stenting had a higher SSI rate (46.9% vs 4.4%). We thus added a second SSI reduction measure to patients with biliary stents: the ringed wound protector. During the second phase of our QI project (1 September 2023–1 April 2024), 51 patients underwent surgery, 98.0% received pip–tazo and 65.0% had a wound protector placed. SSI rates in this group were 9.8%.

We describe a QI project whereby we increased the rates of correct antibiotic dosing in patients undergoing pancreatectomy to 98.0%. Although pip–tazo reduced SSI rates, the addition of a ringed wound protector in patients at high risk further reduced rates of SSI. We thus suggest the use of pip–tazo and ringed wound protectors as an effective strategy to reduce SSI rates in patients undergoing pancreatectomy.

We conducted a nationwide survey to examine how medication prescribing alert systems are managed in Japanese hospitals. Hospitals recognised for maintaining high standards in patient safety were selected to provide insights into current alert management practices. Survey invitation letters were sent to the healthcare information systems departments of the eligible hospitals. Participants were asked to complete the survey through a web-based form (Google Forms) or by mail. Data collection took place between December 2021 and January 2022.

Questionnaires were sent to 1055 hospitals, with responses received from 259 (response rate of 24.5%). A total of 110 (42.6%) hospitals reported being unaware of all types of medication prescribing alerts. Many hospitals reported an inability to measure alert data. Only 42 (16.3%) hospitals had established policies and procedures for adding new alerts.

Only a few hospitals have a system for the quantitative evaluation and comprehensive control of medication prescribing alerts. Each hospital should implement a policy and procedure for alert management and develop an alert data measuring system.

A pre-scoping exercise audit at a single musculoskeletal service in GM conducted from May 2021 to June 2023 highlighted that clinician compliance rates for these referrals were 15% below the service provider’s internal national average and 25% below the service provider’s internal national target, demonstrating the need for a quality improvement project.

The Model for Improvement was implemented using four Plan–Do–Study–Act (PDSA) cycles. These cycles were executed over 14 weeks and aimed to improve compliance through educational sessions, clinical resources, interactive learning and practical tools.

The project comprised four PDSA cycles: PDSA 1 introduced educational sessions and case discussions, PDSA 2 implemented a clinical flowchart to guide decision-making, PDSA 3 included a knowledge retention quiz and PDSA 4 involved a repeat quiz and further discussions to consolidate learning. The target was to increase compliance rates from 70% to 85% or more.

The project successfully improved compliance rates by 30%, with the final compliance rate reaching 100%, surpassing the service provider’s internal national average and target, respectively. 100% compliance was achieved and sustained during PDSA 4 until the end of the project. Clinician confidence and quiz scores also increased during the intervention.

Educational initiatives, combined with practical tools like clinical flowcharts and quizzes, significantly improved compliance rates. The project provides a scalable model that can be adapted by other community healthcare services to enhance compliance with orthopaedic referrals.

This study aimed to enhance the person-centredness of occupational therapy care plans by implementing the GDCP framework, with a target of improving OT contributions from 27.44% to 70% by October 2024.

A quality improvement approach using multiple plan-do-study-act cycles was employed to embed the GDCP framework into three inpatient wards. Key interventions included standardising OT care-plan input, providing in-house training on care-plan audits, and ensuring timely documentation of patient goals and interventions. Monthly audits were conducted to assess progress and identify areas for further improvement.

Across the board, OT input into care plans significantly improved from 27.44% (June–October 2023) to 53.25% (November 2023–October 2024). Ward-specific improvements were observed, with Ward T increasing from 24.42% to 43.32%, Ward M from 37% to 67.03% and Ward P from 21.09% to 44.34%. Key areas of improvement included clearer goal-action links and increased involvement of patients in care planning.

Implementing the GDCP framework enhanced the quality and consistency of OT contributions to care plans, fostering a more structured and outcome-driven approach. However, ongoing challenges such as workforce shortages and OTs being allocated to non-specialist roles in safer staffing need to be addressed to sustain improvements in person-centred care planning.