 Subjects -> OCCUPATIONS AND CAREERS (Total: 33 journals)
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- Navigating the complex terrain of patient safety: challenges, strategies,
and the importance of ongoing evaluation and knowledge sharing-
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First page: mzae074
PubDate: Mon, 29 Jul 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae074
Issue No: Vol. 36, No. 3 (2024)
- Virtue ethics, the next step in quality improvement'
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First page: mzae072
PubDate: Mon, 29 Jul 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae072
Issue No: Vol. 36, No. 3 (2024)
- Embracing the use of artificial intelligence in scientific publishing
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First page: mzae071
PubDate: Wed, 24 Jul 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae071
Issue No: Vol. 36, No. 3 (2024)
- Control charts in healthcare quality monitoring: a systematic review and
bibliometric analysis-
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First page: mzae060
Abstract: AbstractControl charts, used in healthcare operations to monitor process stability and quality, are essential for ensuring patient safety and improving clinical outcomes. This comprehensive research study aims to provide a thorough understanding of the role of control charts in healthcare quality monitoring and future perspectives by utilizing a dual methodology approach involving a systematic review and a pioneering bibliometric analysis. A systematic review of 73 out of 223 articles was conducted, synthesizing existing literature (1995–2023) and revealing insights into key trends, methodological approaches, and emerging themes of control charts in healthcare. In parallel, a bibliometric analysis (1990–2023) on 184 articles gathered from Web of Science and Scopus was performed, quantitatively assessing the scholarly landscape encompassing control charts in healthcare. Among 25 countries, the USA is the foremost user of control charts, accounting for 33% of all applications, whereas among 14 health departments, epidemiology leads with 28% of applications. The practice of control charts in health monitoring has increased by more than one-third during the last 3 years. Globally, exponentially weighted moving average charts are the most popular, but interestingly the USA remained the top user of Shewhart charts. The study also uncovers a dynamic landscape in healthcare quality monitoring, with key contributors, research networks, research hotspot tendencies, and leading countries. Influential authors, such as J.C. Benneyan, W.H. Woodall, and M.A. Mohammed played a leading role in this field. In-countries networking, USA–UK leads the largest cluster, while other clusters include Denmark–Norway–Sweden, China–Singapore, and Canada–South Africa. From 1990 to 2023, healthcare monitoring evolved from studying efficiency to focusing on conditional monitoring and flowcharting, with human health, patient safety, and health surveys dominating 2011–2020, and recent years emphasizing epidemic control, COronaVIrus Disease of 2019 (COVID-19) statistical process control, hospitals, and human health monitoring using control charts. It identifies a transition from conventional to artificial intelligence approaches, with increasing contributions from machine learning and deep learning in the context of Industry 4.0. New researchers and journals are emerging, reshaping the academic context of control charts in healthcare. Our research reveals the evolving landscape of healthcare quality monitoring, surpassing traditional reviews. We uncover emerging trends, research gaps, and a transition in leadership from established contributors to newcomers amidst technological advancements. This study deepens the importance of control charts, offering insights for healthcare professionals, researchers, and policymakers to enhance healthcare quality. Future challenges and research directions are also provided.
PubDate: Wed, 17 Jul 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae060
Issue No: Vol. 36, No. 3 (2024)
- People-centered primary care measures in health equity: a perspective of
urban–rural comparison in Beijing, China-
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First page: mzae067
Abstract: AbstractPerson-centered primary care measures (PCPCM) facilitate high-quality and culturally appropriate primary care. Access to PCPCM remains unequal between rural and urban areas, and the available evidence on rural PCPCM is still lacking. A cross-sectional survey was conducted with stratified sampling by regions, and four districts (Xicheng, Fengtai, Huairou, and Daxing) in Beijing were selected to test the performance of PCPCM in both urban and rural areas. Descriptive statistical methods were used to compare the urban–rural differences in the demographic characteristics of PCPCM. Correlation and regression analyses were performed to determine the associations between PCPCM in demographics and utilization of primary care. The PCPCM showed good reliability and validity in both urban and rural areas (P < .001), slightly lower in rural areas, but scores of rural PCPCM (R-PCPCM) in all items were lower than urban PCPCM (U-PCPCM). Patients in either the preferred urban or rural health centers all showed the highest PCPCM scores, with U-PCPCM= 3.31 for CHCs and R-PCPCM= 3.10 for RHCs, respectively. Patients in urban areas were more likely to receive higher-quality primary care than in rural areas (P < .001). Patients who preferred hospitals (β = 2.61, P < .001) or CHCs (β = 0.71, P = .003) as providers was a significant positive predictor of U-PCPCM but it was the preference for hospitals (β = 2.95, P < .001) for R-PCPCM. Urban–rural differences existed in the performance of PCPCM, with rural areas typically more difficult to access better PCPCM. To promote health equity in rural areas, healthcare providers should strive to minimize urban–rural differences in the quality and utilization of primary care services as much as feasible.
PubDate: Mon, 15 Jul 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae067
Issue No: Vol. 36, No. 3 (2024)
- What does the future of quality improvement look like'
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First page: mzae070
PubDate: Sat, 13 Jul 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae070
Issue No: Vol. 36, No. 3 (2024)
- Formal and informal hospital emergency management practices: managing for
safety and performance amid crisis-
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First page: mzae069
Abstract: AbstractAlthough formal preparedness for unexpected crises has long been a concern of health care policy and delivery, many hospitals struggled to manage staff and equipment shortages, precarious finances, and supply chain disruptions among other difficulties during the Coronavirus disease pandemic. Our purpose was to analyze how hospitals used formal and informal emergency management practices to maintain safe and high-quality care while responding to crisis. We conducted a qualitative study based on 26 interviews with hospital leaders and emergency managers from 12 US hospitals, purposively sampled to vary along geographic location, urban/rural delineation, size, resource availability, system membership, teaching status, and performance levels among other characteristics. In order to manage staff, space, supplies, and system- related challenges, hospitals engaged formal and informal practices around planning, teaming, and exchanging resources and information. Relying solely only on formal or informal practices proved inadequate, especially when prespecified plans, the incident command structure, and existing contracts and communication platforms failed to support resilient response. We identified emergent capabilities—imaginative planning, recombinant teaming, and transformational exchange—through which hospitals achieved harmonious interplay between the formal and informal practices of emergency management that supported safe care and resilience amid crisis. Managing emergent challenges for and amid crisis calls for health care delivery organizations to engage creative planning processes, enable motivated workers with diverse skill sets to team up, and establish rich inter- and intra-organizational partnerships that support vital exchange.
PubDate: Thu, 11 Jul 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae069
Issue No: Vol. 36, No. 3 (2024)
- A study of prehospital EMS response time and influencing factors in the
main urban area of Chongqing, China-
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First page: mzae065
Abstract: AbstractShortening the prehospital emergency medical service (EMS) response time is crucial for saving lives and lowering mortality and disability rates in patients with sudden illnesses. Descriptive analyses of prehospital EMS response time and each component were conducted separately using ambulance trip data from the 120 Dispatch Command Centre in the main urban area of Chongqing in 2021, and then, logistic regression analyses were used to explore the influencing factors. The median prehospital EMS response time in the main urban area of Chongqing was 14.52 min and the mean was 16.14 min. A 44.89% of prehospital EMS response time exceeded 15 min. Response time was more likely to surpass this threshold during peak hours and in high population density areas. Conversely, lower probabilities exceeding 15 min were observed during the night shift, summer, and autumn seasons, and areas with a high density of emergency station. 33.28% of preparation time was >3 min, with the night shift and high population density areas more likely to be >3 min, while for the summer and autumn seasons, high Gross National Product (GDP) per capita areas had a lower likelihood of having preparation time >3 min. 45.52% of travel time was >11 min, with peak hours, summer and autumn, and high GDP per capita areas more likely to have had a travel time >11 min, while night shift and high emergency station density areas had a lower likelihood of travel time >11 min. The primary factors influencing prehospital EMS response time were shifts, traffic scenarios, seasons, GDP per capita, emergency station density, and population density. Relevant departments can devise effective interventions to reduce response time through resource allocation and department coordination, staff training and work arrangement optimisation, as well as public participation and education, thereby enhancing the efficiency of prehospital emergency medical services.
PubDate: Thu, 11 Jul 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae065
Issue No: Vol. 36, No. 3 (2024)
- The utility of website-based quality improvement tools for health
professionals: a systematic review-
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First page: mzae068
Abstract: AbstractAs technology continues to advance, it is important to understand how website-based tools can support quality improvement. Website-based tools refer to resources such as toolkits that users can access and use autonomously through a dedicated website. This review examined how website-based tools can support healthcare professionals with quality improvement, including the optimal processes used to develop tools and the elements of an effective tool. A systematic search of seven databases was conducted to include articles published between January 2012 and January 2024. Articles were included if they were peer reviewed, written in English, based in health settings, and reported the development or evaluation of a quality improvement website-based tool for professionals. A narrative synthesis was conducted using NVivo. Risk of bias was assessed using the Mixed Methods Appraisal Tool. All papers were independently screened and coded by two authors using a six-phase conceptual framework by Braun and Clarke. Eighteen studies met the inclusion criteria. Themes identified were tool development processes, quality improvement mechanisms and barriers and facilitators to tool usage. Digitalizing existing quality improvement processes (n = 7), identifying gaps in practice (n = 6), and contributing to professional development (n = 3) were common quality improvement aims. Tools were associated with the reported enhancement of accuracy and efficiency in clinical tasks, improvement in adherence to guidelines, facilitation of reflective practice, and provision of tailored feedback for continuous quality improvement. Common features were educational resources (n = 7) and assisting the user to assess current practices against standards/recommendations (n = 6), which supported professionals in achieving better clinical outcomes, increased professional satisfaction and streamlined workflow in various settings. Studies reported facilitators to tool usage including relevance to practice, accessibility, and facilitating multidisciplinary action, making these tools practical and time-efficient for healthcare. However, barriers such as being time consuming, irrelevant to practice, difficult to use, and lack of organizational engagement were reported. Almost all tools were co-developed with stakeholders. The co-design approaches varied, reflecting different levels of stakeholder engagement and adoption of co-design methodologies. It is noted that the quality of included studies was low. These findings offer valuable insights for future development of quality improvement website-based tools in healthcare. Recommendations include ensuring tools are co-developed with healthcare professionals, focusing on practical usability and addressing common barriers to enhance engagement and effectiveness in improving healthcare quality. Randomized controlled trials are warranted to provide objective evidence of tool efficacy.
PubDate: Wed, 10 Jul 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae068
Issue No: Vol. 36, No. 3 (2024)
- Sharps injuries among healthcare workers in Liberia and Ghana: a
cross-sectional survey-
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First page: mzae066
Abstract: AbstractThere are little data on sharps injuries among healthcare workers in West Africa despite the region’s high rate of hepatitis B and human immunodeficiency virus. The purpose of this study is to investigate healthcare workers’ history of sharps injuries in Liberia and Ghana. An electronic cross-sectional survey was conducted among healthcare workers in Liberia and Ghana from February to June 2022. A link to the survey was texted to participants through professional association membership lists, including nursing, midwifery, and physician assistant organizations in both Liberia and Ghana and a physician organization in Ghana only. Five hundred and nine participants reported an average of 1.8 injuries per year in Liberia and 1.1 in Ghana (P ≤ .01); 15.1% of healthcare workers reported three or more injuries in the past year. Liberia had a higher proportion of frequently injured workers (P = .01). Frequently injured workers were evenly distributed across worker types. Workers in this region are vulnerable to sharps injuries. A frequently injured subset of workers likely has distinctive risk factors and would benefit from further investigation and intervention.
PubDate: Mon, 08 Jul 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae066
Issue No: Vol. 36, No. 3 (2024)
- Measuring the overall development of patient safety in a new hospital
using trigger tools-
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First page: mzae064
Abstract: AbstractThe new building of the Hospital in Lichtenfels (Germany) was put into operation in mid-July 2018. Neither the medical personnel nor medical departments have been changed. We want to evaluate how ‘safe’ or ‘insecure’ the new hospital or department in the beginning might have been. Our objective is to investigate if safety decreases at the beginning in a new hospital, despite modern environments and conditions. Adverse events (AEs) associated with treatment were included to evaluate the total number of AEs resulting from medical care and medications. Patients’ records had to be closed and completed, the length of stay had to be at least 24 h, and the patient had to have been formally admitted to the hospital [Institute for Healthcare Improvement (IHI) ‘Global Trigger Tool’ (GTT) recommendation]. The identified AEs were grouped into 27 categories of the IHI ‘GTT’. We randomly reviewed 40 patient records per month 6 months before and 6 months after moving to the new hospital. Statistical analysis showed that there was no significant difference in individual AEs. The sum of AEs was statistically higher after moving into a new hospital. A complete number of harms did reach statistical significance (χ2 = 6.62; df = 1; P < .05; Cramer’s V = 0.12), indicating that new environments ‘trigger’ significantly more potential errors (50%) in comparison to the old environments (38.33%). According to our findings, the new hospital appears to be slightly insecure in the first 6 months after opening.
PubDate: Mon, 08 Jul 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae064
Issue No: Vol. 36, No. 3 (2024)
- Use of the DMAIC Lean Six Sigma quality improvement framework to improve
beta-lactam antibiotic adequacy in the critically ill-
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First page: mzae062
Abstract: AbstractBeta-lactam antibiotics are widely used in the intensive care unit due to their favorable effectiveness and safety profiles. Beta-lactams given to patients with sepsis must be delivered as soon as possible after infection recognition (early), treat the suspected organism (appropriate), and be administered at a dose that eradicates the infection (adequate). Early and appropriate antibiotic delivery occurs in >90% of patients, but less than half of patients with sepsis achieve adequate antibiotic exposure. This project aimed to address this quality gap and improve beta-lactam adequacy using the Define, Measure, Analyze, Improve, and Control Lean Six Sigma quality improvement framework. A multidisciplinary steering committee was formed, which completed a stakeholder analysis to define the gap in practice. An Ishikawa cause and effect (Fishbone) diagram was used to identify the root causes and an impact/effort grid facilitated prioritization of interventions. An intervention that included bundled education with the use of therapeutic drug monitoring (TDM; i.e. drug-level testing) was projected to have the highest impact relative to the amount of effort and selected to address beta-lactam inadequacy in the critically ill. The education and TDM intervention were deployed through a Plan, Do, Study, Act cycle. In the 3 months after “go-live,” 54 episodes of beta-lactam TDM occurred in 41 unique intensive care unit patients. The primary quality metric of beta-lactam adequacy was achieved in 94% of individuals after the intervention. Ninety-four percent of clinicians gauged the education provided as sufficient. The primary counterbalance of antimicrobial days of therapy, a core antimicrobial stewardship metric, was unchanged over time (favorable result; P = .73). Application of the Define, Measure, Analyze, Improve, and Control Lean Six Sigma quality improvement framework effectively improved beta-lactam adequacy in critically ill patients. The approach taken in this quality improvement project is widely generalizable to other drugs, drug classes, or settings to increase the adequacy of drug exposure.
PubDate: Tue, 02 Jul 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae062
Issue No: Vol. 36, No. 3 (2024)
- Giving meaning to quality of healthcare in Malaysia
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First page: mzae063
Abstract: AbstractEnsuring quality in healthcare calls for a coordinated, systematic, congruous, and sustained approach. Nevertheless, it demands defining what the quality of healthcare means in the local context. Presently, the Malaysian healthcare system utilizes various definitions of quality of healthcare across the different initiatives and levels of healthcare, which can lead to fragmented or ineffective quality improvement. The study aims to describe the process undertaken in developing an explicit definition of the quality of healthcare tailored to the Malaysian context, which is currently lacking. A pluralistic method was used to explore the different perspectives. Three distinct approaches were used to understand how quality is defined among the different stakeholder groups: (i) interactive policy-makers engagement sessions, (ii) a review of local quality-related documents, and (iii) an online survey engaging the public. The domains depicting quality of healthcare that emerged through these three approaches were mapped against a framework and synthesized to form the local definition of quality. A national quality-related technical working group convened on several sessions to achieve consensus and finalize the definition of quality of healthcare. Quality healthcare in Malaysia is defined as providing high-quality healthcare that is safe, timely, effective, equitable, efficient, people-centred, and accessible [STEEEPA] which is innovative and responsive to the needs of the people, and is delivered as a team, in a caring and professional manner in order to improve health outcomes and client experience. The consensus-driven local definition of healthcare quality will guide policies and ensure standardization in measuring quality, thereby steering efforts to improve the quality of healthcare services delivered in Malaysia.
PubDate: Sat, 29 Jun 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae063
Issue No: Vol. 36, No. 3 (2024)
- Addressing the challenge of reducing low-value care
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First page: mzae061
PubDate: Sat, 29 Jun 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae061
Issue No: Vol. 36, No. 3 (2024)
- The ‘Silent Threat’ in medical, surgical, and intensive care unit
wards: a daytime and nighttime study-
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First page: mzae059
PubDate: Wed, 26 Jun 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae059
Issue No: Vol. 36, No. 3 (2024)
- Seeking systems-based facilitators of safety and healthcare resilience: a
thematic review of incident reports-
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First page: mzae057
Abstract: AbstractPatient safety incident reports are a key source of safety intelligence. This study aimed to explore whether information contained in such reports can elicit facilitators of safety, including responding, anticipating, monitoring, learning, and other mechanisms by which safety is maintained. The review further explored whether, if found, this information could be used to inform safety interventions. Anonymized incident reports submitted between August and October 2020 were obtained from two large teaching hospitals. The Systems Engineering Initiative for Patient Safety (SEIPS) tool and the resilience potentials (responding, anticipating, monitoring, and learning) frameworks guided thematic analysis. SEIPS was used to explore the components of people, tools, tasks, and environments, as well as the interactions between them, which contribute to safety. The resilience potentials provided insight into healthcare resilience at individual, team, and organizational levels. Sixty incident reports were analysed. These included descriptions of all the SEIPS framework components. People used tools such as electronic prescribing systems to perform tasks within different healthcare environments that facilitated safety. All four resilient capacities were identified, with mostly individuals and teams responding to events; however, monitoring, anticipation, and learning were described for individuals, teams, and organizations. Incident reports contain information about safety practices, much of which is not identified by traditional approaches such as root cause analysis. This information can be used to enhance safety enablers and encourage greater proactive anticipation and system-level learning.
PubDate: Tue, 25 Jun 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae057
Issue No: Vol. 36, No. 3 (2024)
- Attitude toward perioperative safety among operation room clinicians at
Ethiopian University Hospital-
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First page: mzae051
Abstract: AbstractPatient safety is a fundamental of good quality and also a high priority for the health-care system. Maintaining patient safety reduces errors and harm that patients can suffer during health care. The operating room clinicians have a vital role in ensuring patient safety. The general objective of this study was to assess attitudes towards perioperative safety and associated factors among the operation room clinicians at the University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia, 2022. A cross-sectional study was conducted on operation room clinicians at UoGCSH. The data were collected by using a self-administered structured questionnaire that included the Safety Attitude Questionnaire (SAQ). Binary logistic regression analysis was employed, and the strength of association was described in adjusted odds ratios with a 95% confidence interval (CI). A total of 260 (76% response rate) operation room clinicians have participated in this study. The mean ± SD of attitude toward perioperative safety was 57.8 ± 0.9. Only 32 (12.3%) operation room clinicians have shown a favorable attitude toward perioperative safety. Most of the clinicians were found to have unfavorable attitudes toward all domains of SAQ except the stress recognition domain. Age >30 years [adjusted odds ratios (AOR): 3.1, CI: 1.1, 8.7, P = .035], working for ≥40 h/week (AOR: 3.9, CI: 1.4, 11.1, P = .01), working in ophthalmologic (AOR: 12.0, CI: 3.8, 38.8, P < .001) and gynecologic (AOR: 3.6, CI: 1.1, 12.7, P = .04) operation rooms, and having training on perioperative safety (AOR: 2.6, CI: 1.1, 6.5, P < .03) were found associated with having favorable attitude toward perioperative safety. Most operation room clinicians had an unfavorable attitude toward perioperative safety and all the domains of SAQ except the stress recognition domain. Older age ≥ 30 years, working for ≥40 h/week, having safety-related training, and working in ophthalmologic and gynecologic operation rooms were found associated with having a favorable attitude toward perioperative safety.
PubDate: Tue, 11 Jun 2024 00:00:00 GMT
DOI: 10.1093/intqhc/mzae051
Issue No: Vol. 36, No. 3 (2024)
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