Hospital-acquired pressure injuries (HAPIs) are localised damage to the skin resulting from pressure either alone or in combination with shear and microclimate. These injuries have a significant impact on patients’ well-being and healthcare systems. Prolonged surgery significantly increases the risk of developing HAPIs. The adoption of preventive measures in the operating theatre (OT) can reduce the incidence of HAPIs in this context. This report presents the maintenance of a quality improvement project for HAPI prevention in the OT from 2019 to 2023 and evaluates the impact of the preventive measures on reducing HAPI and overall skin integrity incidents. A retrospective data analysis (from 2016–2017) was conducted to gather baseline information on all skin injuries particularly HAPIs reported in the OT. Upon completion of a needs analysis, a phased improvement project was implemented in 2018 and maintained until 2023. Comparative data from 2016 to Q1 2018 (preimplementation) and Q2 2018 to Q4 2023 (postimplementation) were analysed. A reduction in HAPI and skin integrity incident rate was observed over time (from 1.58 in 2016 to 0.13 in 2023). No pressure injury incidences were reported in 2021 and 2022. Other skin integrity events showed a significant reduction of 38.5%, following the start of this initiative, with steady numbers until 2019 (39 other skin integrity events in 2016 reduced to 24 events in 2018). A major reduction of 82.6% was observed in 2020, with a reduction from 23 other skin integrity events in 2019 to four in 2020, which was sustained as minimal incidents until 2023. The quality improvement project was effective in reducing HAPI in the OT, which was sustained in the following years, resulting in a reduction of global skin integrity issues due to staff awareness, continuous evaluation and implementation of corrective actions.
Background Effective medical record management is crucial for timely access to patient information and quality care. Issues like loss, misplacement and delays in retrieval lead to longer wait times and reduced staff efficiency yet these operational challenges are often neglected in healthcare improvement efforts.Aim of the project This project seeks to improve medical record management at Wallaga University Comprehensive Specialized Hospital, increasing the baseline from 35% to 90% between 15 September and 10 December 2025.Methods A quality improvement approach was implemented using sequential plan-do-study-act (PDSA cycles. Key interventions included staff training on filing and tracking, numerical reorganisation of folders, separation of active/inactive files, a digital tracking system, assignment of folder responsibilities, privacy measures and routine audits with feedback. Effectiveness was evaluated using quantitative indicators (retrieval rates, lost folder rates, waiting times, satisfaction surveys) and qualitative feedback from stakeholders.Results Performance improved significantly from 41% to 95% over seven PDSA cycles. Lost folders decreased from 13% to 2%, delayed retrieval dropped from 25% to 3% and timely folder provision rose from 72% to 95%. Patient satisfaction increased from 40% to 90%, while healthcare provider satisfaction grew from 60% to 85%. Qualitative feedback highlighted reduced conflicts, improved workflow, enhanced accountability and fewer duplicate records.Conclusion The structured quality improvement intervention effectively enhanced medical record management, showcasing the efficacy of PDSA cycles combined with practical interventions. Sustained improvements are anticipated with ongoing monitoring and staff engagement. This model can be adapted by other hospitals facing similar challenges, contributing to more efficient, patient-centred healthcare delivery.
Introduction Insulin is fundamental for the management of diabetes. In Peru, limited training among healthcare professionals is an important barrier to insulin prescription and usage. Given the advantages of e-learning such as time flexibility, low cost and penetration, the Peruvian government launched an e-learning training on diabetes and insulin usage for healthcare professionals working in public facilities in December 2021. This study aims to assess the feasibility and acceptability of this initiative. Methods We conducted a mixed-methods study with a sequential explanatory design to assess feasibility and acceptability of the e-learning training. We included all enrolled participants regardless of whether they completed the course. First, quantitative data were collected through online surveys. Then, qualitative data were collected through in-depth interviews. The data were analysed separately, but the results were interpreted together to triangulate findings. Results This course reached 536 healthcare professionals at the national level, from which 338 (63.1%) completed the course. 304 (56.7%) of the participants lived outside Lima, the capital of Peru, and 285 (53.2%) worked in a primary care facility. Participants manifested high satisfaction with the course content and its applicability. However, some barriers to participation were found. Chiefly, family burden, workload, poor internet connection and the lack of protected training hours. Conclusion The study highlights the feasibility of using e-learning to train healthcare professionals, particularly in underserved areas, offering flexibility and broad access. Some barriers need to be considered for future interventions that prevent dropouts.
Our quality improvement (QI) project aimed to reduce reliance on external temporary staff used for 1:1 observation and support within a recently merged acute, community and mental health National Health Service (NHS) Trust. Temporary staffing costs reached £2.7 million in the previous financial year. Between February 2022 and June 2024, we aimed to establish a more efficient and consistent approach, particularly within acute physical healthcare settings. The project focused on four main patient cohorts and the goal was to reduce temporary staffing costs by 25%. A multidisciplinary team, guided by the 7 Steps to QI methodology, developed and tested two key tools to standardise decision-making and reduce the need for temporary staff. The project was implemented in nine pilot areas across the Trust, leading to a reduction in staffing costs by £600,000 in the first year, with a further £1.2 million in the second year. Additionally, patient falls with harm decreased by 8%. Challenges arose due to communication barriers and the need for cultural change. By empowering local teams to make more informed decisions, the project demonstrated the value of standardised tools and staff training in enhancing both patient care and organisational sustainability.
INTRODUCTION:Between 2005 and 2010, reductions in newborn mortality fell behind those for maternal and under-five child mortality in Cambodia. To improve newborn outcomes, we developed and scaled-up early essential newborn care (EENC) nationally using a new clinical coaching and data-based quality improvement approach. This study aimed to determine EENC's contribution to Cambodia's observed neonatal mortality decline between 2010 and 2022. METHODS:Standard indicators in the EENC monitoring and evaluation framework were calculated from programme records, nationally representative population-based surveys and facility-based assessments using standardised methods. The Lives Saved Tool (LiST) was used to model newborn lives saved 2010-2022 using facility estimates of care quality. RESULTS:Newborn mortality declined from 27 to 8/1000 live births (70.4%) comparing 2010 and 2022. The average annual rate of newborn mortality decline accelerated by 33% after EENC introduction in 2012 compared with the previous 10 years, with greatest declines among high-risk groups (poorest, rural, uneducated and with low birth interval). Between 2010 and 2022, EENC was integrated into national and subnational policies, standards and implementation plans and introduced to 87.6% of birth facilities. The average birth practice score rose to 72.9% (95% CI 59.0% to 83.4%) in 2022, from 6% (95% CI 1.7% to 20.1%) in 2011. Significant improvements were seen in application of clean birth environments, immediate drying and stimulation, thermal protection (immediate and prolonged skin to skin contact), delayed cord clamping and clean cord care. LiST modelling estimated that EENC interventions averted 21 704 Cambodian newborn deaths (range 17 694-26 450) during 2010-2022 and were responsible for 75.3% (range 69.5%-80.5%) of the observed national mortality reduction. CONCLUSION:A new approach to EENC programme implementation led to sustained country-wide improvements in evidence-based practices around birth. Improved care quality was associated with 69.5-80.5% of the observed neonatal mortality decline in Cambodia between 2010 and 2022.
Background Annual screening for diabetic kidney disease (DKD) with serum creatinine and albuminuria is recommended by multiple clinical guidelines but screening rates remain low nationwide (<50%). The Veterans Health Administration has implemented quality improvement (QI) interventions that resulted in a significantly higher national DKD screening rate of 63%. However, the rate in the resident primary care clinic at the Iowa City Veterans Affairs (ICVA) was only 41%, suggesting that these interventions may not be as effective in resident clinics. Residents have unique schedules and time demands, thus QI initiatives targeting this transient physician population need to be appropriately tailored.Methods An interprofessional working group aimed to increase the screening rate for DKD in the resident clinic from 41% to 65% over 8 months using Lean methodology. This non-randomised, prospective QI project was conducted at the resident primary care clinic at the ICVA, which serves approximately 3000 Veterans (including 750 with diabetes). Two sequential interventions were implemented: (1) a national electronic health record reminder and (2) a tailored, resident-specific, multifaceted approach involving incentives, gamification, workflow improvements, audit and feedback, and benchmarking. The primary outcome was monthly percentage of Veterans with both a urine albumin-to-creatinine ratio and serum creatinine tested in the past year. The process measure was weekly percentage of eligible Veterans tested for albuminuria within 1 day before or 7 days after a primary care appointment.Results The percentage of compliant Veterans in the resident primary care clinic increased from 41% (239/590) in June 2023 to 66% (395/603) by March 2024. Weekly screening rates of eligible Veterans rose from 16% to 48%. The biggest improvement was seen after the resident-specific interventions.Conclusions This project demonstrates the need for and effectiveness of tailored, resident-specific implementation strategies to achieve QI aims among these physicians.
Discharge summaries (DS) are essential for ensuring safe and effective transitions from inpatient to outpatient care, yet completion rates are often suboptimal in low-resource settings. This quality improvement project (QIP) was undertaken in the General Surgery and Neurosurgery units of the Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Nigeria, to increase DS completion to at least 50% within 12 weeks. Using the Plan–Do–Study–Act (PDSA) model, baseline performance was established via a 3-month retrospective audit, revealing DS completion rates of 0% (0/56) in General Surgery and 33% (7/21) in Neurosurgery, with an overall rate of 9% (7/77). A survey of surgical trainees and house officers identified poor knowledge of DS practice and the absence of a standardised template as key barriers.Interventions included DS training at induction, dissemination of prestructured templates, deployment of visual management tools and appointment of unit-based DS champions. Change ideas were tested in 1-week to 2-week PDSA cycles with continuous monitoring of process and outcome measures. Data were analysed using IBM SPSS Statistics V.25, and significance was assessed via χ2 testing.Following implementation, DS completion rates improved to 82% (68/83), consistently surpassing the target and reaching 100% during some cycles (χ2=85.35, p<0.0001). Median daily discharges were 2.0 in General Surgery and 1.5 in Neurosurgery, with median completion rates of 93.4% and 100%, respectively. These improvements reflected the effectiveness of targeted training, standardised documentation and role designation in addressing systemic and behavioural barriers.This QIP demonstrates that structured, context-appropriate interventions can substantially and sustainably increase DS completion rates in resource-limited settings, thereby strengthening continuity of care. Future directions include scaling these strategies to other departments, integrating electronic DS systems and embedding routine audits to sustain compliance.
Background Perioperative anaphylaxis is a rare but complex clinical crisis, with outcomes heavily dependent on prompt and effective management by anaesthesiologists. However, evidence supporting the efficacy of scenario-based simulation (SBS) training in perioperative anaphylaxis management remains limited. This study aimed to evaluate the impact of SBS versus video-based training (VBT) on learning outcomes and satisfaction among undergraduate anaesthesia students. Methods In this prospective randomised study, 84 fourth-year anaesthesia undergraduate students from Anhui Medical University were assigned to either SBS or VBT for perioperative anaphylaxis education. Knowledge assessments were conducted before (pretest) and after (post-test) training. Outcomes included post-test scores, student satisfaction (assessed via a 5-point Likert scale) and performance in a simulated clinical scenario 1 week later. Scenario performance was evaluated using a technical checklist and the Anesthesiologists’ Non-Technical Skills scoring system. Results Baseline characteristics (age, sex and pretest scores) were comparable between groups. The post-test scores were higher in the SBS group than those of the VBT group (80.0 (73.7 – 85.0) vs 70.0 (65.0 – 75.0), respectively, p<0.001). Both groups improved in post-test scores after training. The SBS group’s post-test score increased significantly more than that of the VBT group (39.2% (30.7% – 44.6%) vs 16.6% (8.3% – 20.0%), respectively, p<0.001). In the simulation scenario test, the SBS group outperformed the VBT group in both technical (33.5 (31.0–36.0) vs 28.0 (26.0–30.0), p<0.001) and non-technical skills (47.5 (44.0–51.0) vs 43.0 (42.0–48.0), p=0.002). Conclusions SBS demonstrates greater efficacy than VBT in improving anaesthesia students’ learning outcomes, including technical and non-technical skills in managing perioperative anaphylaxis, with higher student satisfaction.
Background Adults discharged from the hospital with poorly controlled diabetes face elevated readmission risk, yet health systems lack practical models for integrating remote glucose monitoring into post-discharge care. Existing approaches often exclude patients at the highest risk who have limited English proficiency, adverse social determinants of health or limited smartphone access.Local problem At a 292-bed community hospital in White Plains New York, patients discharged with haemoglobin A1c ≥8% showed higher rates of hospital utilisation. Local mortality data revealed disparities affecting Black/African American and Hispanic/Latino residents, prompting a programme design with equity as a core objective.Methods We integrated remote patient monitoring (RPM) into our nurse-led transitional care programme through five Plan-Do-Study-Act (PDSA) cycles from April 2024- to January 2025. Patients received RPM services and care coordination for 90 days. Enrolment, appointment attendance, A1c completion and demographic representation were evaluated through each cycle.Results Among 442 screened patients, 46 were enrolled (enrolment grew from 10.5% to 39.7%, p<0.001). Enrolled patients closely matched the eligible population across targeted demographic groups. Follow-up appointment attendance reached 78.3% for primary care and 69.6% for endocrinology. A1c testing completion improved to 48% in the final cycle. The most substantial gains in feasibility occurred after redistributing monitoring to a team-based model.Conclusions Iterative PDSA cycles enabled the development of an equitable RPM-enabled transitional care pathway for diabetes, achieving proportional enrolment across all targeted demographic groups. Key implementation insights included workforce capacity as the primary constraint to enrolment, workflow simplification through continuous glucose monitoring standardisation and the importance of pre-arranged ambulatory follow-up. Health systems implementing RPM for transitional care should prioritise adequate monitoring workforce, streamline device protocols and coordinate ambulatory integration from programme inception to enable scalable, equitable implementation.
Background Older patients with Clostridioides difficile infection (CDI) are often frail and multimorbid, with reported 90-day mortality rates of 28%–36%. Despite this, treatment often fails to align with infection severity, and care coordination remains complex. This study describes the development and iterative refinement of a clinical checklist to support structured treatment and care planning in this high-risk group.Methods We conducted a two-phase model development study to identify key management factors. Checklist development followed an iterative quality improvement framework using Plan-Do-Study-Act cycles and driver diagrams. In phase I, older patients with CDI were followed to identify key treatment and care priorities, informing the initial checklist version. In phase II, the checklist was used in a pragmatic, randomised trial investigating Comprehensive Geriatric Assessment (CGA) in older patients with CDI. The checklist was iteratively revised based on clinical use and feedback.Results In phase I, treatment courses of 10 older patients with CDI were reviewed, identifying three key priorities for the initial checklist: (1) CDI treatment planning with frailty assessment, (2) medication review and (3) attention to rehydration and nutrition. In phase II, the CDI checklist was applied in 108 patients allocated to CGA. Standardised treatment planning was ensured, including assessment of faecal microbiota transplantation (FMT) eligibility. Among those treated with non-CDI related antibiotics or proton-pump inhibitors, 52% (26/50) and 70% (39/56), respectively, had treatment discontinued. Nutritional and rehydration support was provided in 64 (59%) and 61 (56%) patients. The CDI checklist was subsequently expanded based on clinical use to include new elements, such as post-FMT laxative treatment and cross-specialty coordination.Conclusion A clinical checklist can support structured and holistic care planning in older adults with CDI. Core components include CDI treatment planning, assessment of FMT eligibility, frailty evaluation, medication review and supportive therapies such as nutrition and rehydration.
A structured, system-level quality improvement (QI) initiative at Singapore General Hospital was undertaken to reduce postoperative length of stay (LOS) after uncomplicated lower segment caesarean section (LSCS) and improve performance on the national Value-Driven Care clinical quality index. This project specifically targeted an increase in postoperative day 3 (POD3) discharge rates towards the 88% internal benchmark without compromising safety or increasing readmissions.Uncomplicated LSCS cases between October 2023 and September 2025 were included, with complicated caesarean sections and severe neonatal morbidity excluded. A single-centre pre–post design was used, with October 2023–September 2024 as the baseline period and October 2024–September 2025 as the intervention period. Root causes of delayed discharge were identified using a fishbone (Ishikawa) analysis, informing a three-phase, system-level intervention: department-wide performance sharing, a bundled intervention (standardised patient education, multidisciplinary discharge coordination via Microsoft Teams and coding support) and clinician-specific feedback.Baseline POD3 discharge performance was 80.0% (n=352) after correction of coding inaccuracies. Following phased implementation, the postoperative LOS ≤3 days rate increased to 84.5% (n=241) overall, with a more marked improvement from 83.3% to 92.5% after introduction of the bundled system-level intervention. Run charts showed an upward shift and reduced monthly variation in POD3 discharge rates, indicating more consistent practice. There was no clinically significant increase in 30-day readmissions, emergency attendances or postoperative complications, and a simple cost analysis estimated savings of SGD 70 884 from reduced LOS.This multidisciplinary, enhanced recovery after surgery-aligned QI project successfully shortened postoperative LOS for uncomplicated LSCS without evidence of harm. Core components—clear discharge expectations, coordinated mother–baby discharge planning, accurate coding and non-punitive clinician feedback—are conceptually transferable to similar obstetric units seeking to optimise postcaesarean LOS within value-based care frameworks.
Background Patient-reported experience measures (PREM) are key indicators of healthcare quality linked to improved outcomes. The Canadian Stroke Best Practice Recommendations emphasise the importance of capturing patient perceptions of health services to enhance clinical outcomes in stroke care. Building on our previously established stroke-specific PREM, this quality improvement (QI) observational project aimed to gather stroke patient experience data to identify strengths and opportunities for improvement.Methods This QI initiative was implemented in an acute stroke unit as part of the mobile transient ischaemic attack (TIA) and stroke with adaptive workflow project funded by Ontario’s Ministry of Health. An interdisciplinary team of healthcare professionals and leadership members developed a survey focusing on patient journey themes. The survey was reviewed for readability and comprehension by two patients to ensure its appropriateness and relevance. The Institute for Healthcare Improvement model guided the initiative, with a project lead identifying eligible patients and a reactivation worker administering the surveys.Results A total of 110 patients with stroke or TIA completed the survey over a 12-month observational period. Positive experience rates ranged from 90.0% to 99.1% across all seven domains, and no respondent selected disagree or strongly disagree on any item. Discharge readiness was the lowest-rated domain (90%), whereas a coordinated transition to the stroke unit achieved the highest ratings (99.1%). Inductive thematic analysis of open-ended responses identified three themes: (1) overall satisfaction, gratitude and quality of care; (2) patient-centred communication and emotional support and (3) isolated concerns.Conclusion This QI initiative, building on previous work, showed positive patient experiences across all seven domains, with discharge readiness as a priority for improvement. The mixed-methods approach, which integrates quantitative Likert data with thematic analysis, offers a replicable model for patient-centred quality monitoring of stroke care.
Background Black and Latina women experience persistent breast cancer screening disparities. Patient navigation has demonstrated effectiveness in clinic-based populations, but evidence regarding navigation for women engaged through community outreach remains limited.Local problem In Northern New Jersey, late-stage breast cancer diagnosis rates among black women range from 38% to 44% compared with 27% among all women. Our institution lacked a systematic community-based outreach-to-screening navigation pathway.Methods This quality improvement initiative, conducted from December 2023 through December 2025 within a large integrated health system, leveraged existing Community Outreach and Engagement infrastructure across 230 community events, tracking a navigation process cascade from engagement through screening completion. Eligibility: women aged 40+ years without a mammogram in the past 12 months (United States Preventive Services Task Force/American Cancer Society).Interventions The programme included community outreach, eligibility screening, navigation enrolment, navigator follow-up (4–6 contact attempts over 4–6 weeks), scheduling support and social needs screening.Results The programme engaged 1318 women; among 277 with demographic data, 80.9% identified as black or Latina and 78.8% were uninsured. Of 564 screened for eligibility, 333 (59.0%) enrolled in navigation. Contact success was 73% (210/288 with documented contact attempts in 2024). A critical gap emerged at scheduling: only 5 women (1.5% of enrolled) had mammography scheduled. Post-hoc analysis revealed navigators lacked operational authority to schedule appointments directly. Among 400 women completing social needs screening, 96.0% reported food insecurity.Conclusions This initiative identified an immediately actionable infrastructure gap: navigators lacked direct scheduling authority, appearing to be a critical barrier to translating engagement into completed care. The 96% food insecurity prevalence characterises a population facing compounding structural barriers, suggesting self-scheduling may be a structurally inequitable expectation. We propose that direct scheduling authority is a potentially necessary condition for effective community-based navigation—a hypothesis warranting prospective testing.
Objective This study aimed to identify the barriers and facilitators for quality improvement (QI) in emergency units (EUs) in low- or middle-income countries (LMICs) and to understand the prioritisation of care quality domains to inform the development of EU-specific guidance for QI across all World Health Organisation (WHO quality domains for LMICs.Methods We conducted in-depth interviews (IDIs) with specialist emergency physicians from LMICs and convened a workshop with global technical experts in emergency care. A structured topic guide was used for the IDIs. Interviews were conducted virtually, transcribed and thematically analysed using the WHO quality domains and the WHO Health Systems Framework. Data collection and analysis continued until saturation was reached. The 2-day workshop included presentations, discussions and interactive ranking exercises to assess measurements for QI and prioritise WHO quality domains for guidance development. Findings from both components were synthesised to generate key insights.Findings Eleven IDIs were conducted and 26 experts participated at the workshop. QI efforts in LMIC EUs primarily focused on quality domains of effectiveness, timeliness, safety and occasionally patient-centredness. Key barriers to QI included high patient turnover, a lack of skilled staff, limited funds and resources and prioritising patient care quantity over quality. Facilitators included the availability of QI guidance, training, initiating small-scale projects, enhancing documentation and communication and supportive hospital management. Safety and effectiveness were considered the most feasible domains for QI, although all domains were considered important. Variability in how participants defined these domains highlighted the need for clear guidance on definitions, their relative importance and appropriate measures for each.Conclusions EUs are complex, high-pressure environments managing time-critical health conditions and require development of specific tools and guidance for QI. Addressing the barriers and leveraging facilitators identified in this study can inform the development of effective QI strategies for LMIC EUs.
Background Healthcare systems internationally face persistent workforce shortages, rising burnout and increasing concerns regarding patient safety. While these challenges are often addressed through staffing, resilience or wellbeing initiatives, less attention has been paid to the temporal architecture through which healthcare work is organised. This paper argues that fatigue represents a systems-level signal of maladaptive temporal design rather than an inevitable consequence of clinical work and proposes temporal governance as a novel framework for redesigning healthcare work. Methods An integrative review was undertaken combining evidence from empirical studies, policy evaluations, organisational pilots and systems theory. International working-time reduction initiatives published between 2015 and 2025 were identified through targeted searches of academic databases, government reports and grey literature. Cases were analysed comparatively to identify recurring mechanisms linking temporal redesign with workforce and organisational outcomes. Results Across heterogeneous international settings, reductions in working time were consistently associated with improvements in workforce wellbeing, lower burnout, reduced sickness absence, improved retention and preservation or enhancement of organisational performance. Four convergent mechanisms emerged across studies: physiological recovery, cognitive clarity, temporal autonomy and organisational focus. These mechanisms provide a plausible systems-level explanation for how redesigning working time can simultaneously improve human sustainability and organisational effectiveness. Drawing upon complexity science, the paper proposes a mechanism-based theory of change in which temporal redesign stabilises reinforcing fatigue loops and strengthens adaptive capacity within healthcare systems. Conclusions Fatigue should be understood not solely as an occupational health issue but as an indicator of systemic temporal imbalance. Working-time redesign offers a promising governance intervention capable of improving workforce sustainability while maintaining organisational performance. Rather than framing shorter working hours as a workforce benefit alone, healthcare organisations should recognise time as critical infrastructure that can be intentionally designed, governed and evaluated as a core patient safety variable. Future research should determine the optimal temporal architectures for different healthcare contexts and establish time as a measurable dimension of healthcare quality and safety.
Background General adult psychiatry in Sweden faces significant challenges with rising patient volumes and limited therapeutic capacity, leading to prolonged waiting times and restricted access to care. Feedback-informed treatment (FIT) has shown promise in improving access to mental health services by enhancing treatment efficiency and patient outcomes. Aim This study aimed to evaluate whether the implementation of FIT in an adult psychiatric outpatient clinic in Region Skåne, Sweden, was associated with changes in therapy duration and waiting times compared with a control clinic without FIT. Methods A retrospective, observational design was employed to compare therapy length and waiting times between a clinic implementing FIT (n=139) and a control clinic (n=74) from 2022 to 2024. Data were extracted from patient records, including demographics and patient-reported outcomes (Outcome Rating Scale scores). Linear regression analyses were conducted to assess trends over time, and the steady-state assumption was evaluated to ensure the validity of the findings. Results The FIT clinic exhibited a significant reduction in therapy duration over time (B=–0.019, p<0.001), while no significant trend was observed in the control clinic. Waiting times remained stable at the FIT clinic but increased non-significantly at the control clinic. The interaction effect for waiting times was significant (B=0.120, p=0.028), indicating a more favourable trajectory at the FIT clinic. Patient-reported outcomes did not differ significantly between the two periods (2021–2022 vs 2023–2024). Conclusions The implementation of FIT in adult psychiatric outpatient care was associated with shorter therapy durations and more favourable waiting time trajectories, without deteriorating patient-reported outcomes, although these data were descriptive and not available for the control clinic. Given the observational, non-randomised design and modest effects, the findings should be interpreted as exploratory evidence that feedback-informed practice may be relevant to efforts to improve access and resource use in routine psychiatric care.
Background Caffeinated hot drinks are routinely offered as the default in hospitals despite guidance recommending caffeine reduction for urinary urgency. Caffeine may increase urinary frequency, disrupt sleep and contribute to toileting-related falls, particularly among older adults living with frailty. Local problem Routinely collected incident reporting data at an National Health Service (NHS) Foundation Trust identified that around one quarter of inpatient falls were toileting-related. Staff recognised caffeine as a potential contributor but reported limited ability to influence drink provision within existing ward routines. Methods A registered quality improvement initiative used two sequential Plan–Do–Study–Act cycles to implement a ‘decaf by default’ approach across acute and community wards, an emergency department and a care home, followed by evaluation after organisation-wide rollout. Routine incident reporting monitored toileting-related falls, while staff and manager experience was assessed using structured questionnaires. Intervention Decaffeinated hot drinks were offered as the default, with caffeinated drinks available on request. Implementation was supported by staff education, shared decision-making materials, face-to-face clinical support and a patient-facing ‘Taste the Difference’ activity. Results Across pilot sites, toileting-related falls as a proportion of all inpatient falls reduced from 19%–21% to 11%–15%. Toileting-related falls reduced by approximately 11% in Cycle 1 and 20% in Cycle 2, with seven wards achieving reductions greater than 50%. Following organisation-wide rollout, the proportion of inpatient falls that were toileting-related reduced from 33.2% to 25.9%. Managers reported calmer ward environments, improved sleep, reduced agitation and fewer urgency-driven toileting attempts. Patient and relative feedback was predominantly positive or neutral. Conclusions Changing default drink provision to decaffeinated options is a feasible, low-cost intervention associated with fewer toileting-related falls and improved ward environments while preserving patient choice. Sustained improvements following organisation-wide rollout suggest the approach is scalable using existing clinical infrastructure.
Background Patient experience and safety are central to healthcare quality, yet their relationship remains underexplored. While earlier evidence suggests a positive association, policy and practice are continually developing around the world. This review systematically examines the literature to better understand how patient experience and safety are linked. Methods Searches were conducted via PubMed (2000–2023) using predefined terms on patient experience and safety. Articles were uploaded to Rayyan, duplicates removed and titles and abstracts screened for relevance. Full articles were reviewed and 30 eligible studies were included. A narrative synthesis was performed, with quality and evidence strength assessed using the Mixed Methods Appraisal Tool and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. Results Evidence regarding the relationship between patient experience and safety was heterogeneous. Seven studies demonstrated consistent positive associations, 6 reported no association and 17 yielded mixed findings across different safety metrics. Among these 17 studies, 7 tended to support a positive association, 5 suggested no association and 5 reported results that varied according to the analytical approach. Discussion This review found mixed evidence on the relationship between patient experience and safety, and causality remains unknown. While some research identified clear associations, others showed considerable variation, often influenced by the specific measures used. Studies focused on secondary care, leaving gaps in primary and mental health settings. Notably, no research examined links between safety and the Picker Principles of ‘fast access to healthcare advice’ or ‘family and carer involvement’—domains considered vital to safety. The review suggests that future research should explore domain-specific links and include experimental designs to strengthen causal understanding of the granular elements of safety and experience. Further investigation across care settings and population subgroups would help to fully understand how patient experience influences safety and vice versa. Overall, this review provides evidence that patient experience and safety are related but distinct concepts that should be addressed together in quality improvement efforts.
Medical equipment downtime is a major challenge in healthcare facilities, often driven by mechanical and electrical failures, delayed fault reporting and the absence of structured preventive maintenance. At Suhul Hospital, Shire, these issues were compounded by human error, outdated maintenance practices, limited standards and shortages of spare parts, leading to prolonged equipment unavailability and disrupted patient care. This project applied a Lean Six Sigma (LSS) approach to address these inefficiencies. Key tools included 5S practices, detailed process mapping, corrective maintenance standardisation and a structured preventive maintenance plan. A mixed-methods design was used, combining document review with semi-structured interviews involving 18 purposively selected professionals with at least a diploma and 4 years of relevant experience. Quantitative measures focused on downtime, defects and process capability, while qualitative data explored root causes and waste within the maintenance workflow. Implementation of Lean Six Sigma produced substantial improvements in medical equipment maintenance performance. Total equipment downtime decreased from 89,735 minutes to 292 minutes, while recorded defects decreased from 842 to 43. Overall, downtime decreased by 99.67%, defects by 94.89% and the Sigma level improved from 2.74 to 3.62, indicating a shift from low to moderate process reliability. These findings demonstrate that structured quality improvement methods can significantly enhance the efficiency and reliability of medical equipment maintenance in resource-constrained settings. While the intervention was successful, the project was limited to a single hospital, and further multi-site studies are recommended to strengthen generalisability.
Background Clinical practice guidelines (CPGs) are key to standardised, evidence-based and equitable healthcare, and the inclusion of sex and gender considerations in CPGs is increasingly recognised as essential for quality care and health equity. This umbrella review synthesised evidence from reviews examining the extent and quality of sex and gender considerations in CPGs and identified barriers and best practice strategies to support their inclusion. Methods Literature searches were conducted across eight databases, identifying systematic reviews and other reviews published between 2000 and 2025 that focused on sex and gender considerations in CPGs. Data extraction and quality appraisal followed Joanna Briggs Institute guidelines. After descriptively summarising the reviews, narrative synthesis was used to summarise how sex and gender considerations were integrated across the included reviews, identifying common issues and recommendations for improving their incorporation into CPGs. Results Analysis of the seven included reviews (appraising a total of 784 CPGs) found that despite mention of sex or gender in 69% of CPGs, only 15% incorporated these factors into diagnostic or management recommendations, reflecting inconsistent, conceptually unclear and often superficial application. Major barriers included under-representation of women, limited sex and gender expertise on guideline committees, incomplete translation of sex-specific and gender-specific evidence into recommendations, inconsistent terminology and methodological limitations in guideline development. To address these gaps, the included reviews identified several strategies that could be implemented before, during and after the guideline development process. Conclusion Sex and gender inclusion in CPGs remains inconsistent and superficial, with significant implications for health equity. Addressing this requires strengthening sex-informed and gender-informed evidence, ensuring diverse and expert representation in guideline development and adopting systematic approaches that translate evidence into equitable, population-responsive recommendations.
