Objectives Limited research has explored how demographic and social factors affect opioid use after lumbar fusion. This review quantifies how frequently patient-level factors are reported in the literature. It also summarises findings from observational studies that use these factors to analytically evaluate how patient-level factors influence opioid use after lumbar fusion.Methods Medline (via PubMed) was comprehensively searched to identify studies published between 1 January 2015 and 18 April 2025 that reported either opioid consumption or time to rescue analgesia after lumbar fusion. Randomised controlled trials, studies with paediatric patients and studies in which lumbar fusion was not disaggregated from other surgeries were excluded. From each eligible article, data regarding patient-level factors were extracted, and proportions of articles reporting and analysing each variable were calculated.Results 70 publications met all eligibility criteria. Age (98.6%) and sex (98.6%) were routinely reported, whereas psychiatric comorbidities (25.7%), race (24.3%), insurance status (21.4%), ethnicity (5.7%), urban versus rural residence (5.7%), employment status (1.4%) and education level (1.4%) were more rarely reported. Only 5.7% of studies analysed sex and age as predictors of pain management, 2.9% examined psychiatric comorbidities and 1.4% assessed race or insurance status; none evaluated ethnicity, urban versus rural residence, employment, education, area deprivation index, social vulnerability index, household income, English proficiency or immigration status.Discussion The publications analysed within this review found older age consistently predicted decreased opioid consumption, whereas findings related to sex were mixed. However, any interpretation regarding the impact of patient-level factors on opioid use after lumbar fusion is constrained by the scarcity of studies that have statistically analysed these associations and the strict inclusion criteria of the study, which required opioid consumption to be quantified in a standardised format, that is, morphine milligram equivalents.
Distress is common among patients with cancer and is associated with worse outcomes yet routine distress screening remains inconsistently implemented in outpatient oncology clinics, particularly for Veterans. We conducted a quality improvement project (QIP) in the surgical oncology clinic at a large Veterans Affairs medical centre to improve distress screening among Veterans with newly diagnosed cancer.A multidisciplinary team designed and implemented a comprehensive psychosocial distress screening programme using the validated NCCN Distress Thermometer. Key drivers of screening reliability were identified through stakeholder interviews and used to guide intervention design. The intervention incorporated standardised screening, evaluation of positive screens, predefined referral pathways, timely follow-up with embedded mental health services and structured electronic record documentation. The programme was iteratively refined through Plan–Do–Study–Act cycles.A total of 178 veterans were included over a 6-month baseline period and 12 months of intervention. During the baseline phase, only 5% of eligible veterans had documented distress screening. Following implementation, screening rates increased from 5% at baseline to 87% by the end of the intervention period. 27 of 117 veterans (23.1%) screened positive for distress during the intervention period. 18 accepted referrals to mental health services, four were already established with mental healthcare and five declined referral. Veterans requiring urgent evaluation were seen by mental health services the same day or the following day, while all remaining veterans accepting referral were scheduled within 2–3 weeks.This project demonstrates that systematic distress screening for veterans with cancer can be successfully embedded into routine outpatient oncology care. Pairing standardised workflows with integrated referral pathways, timely follow-up and electronic health record documentation provides a scalable and sustainable model for comprehensive psychosocial distress screening in veteran oncology care.
Background Clinical audit is fundamental to clinical governance and improving healthcare quality and safety. However, its potential for sustained quality improvement is often underutilised. This study explores how clinical audits act as catalysts for quality improvement in primary care using a strategic analytical approach.Methods The study involved a qualitative systematic review of peer-reviewed literature from January 2015 to March 2024. Structured database searches and predefined inclusion criteria were used to identify relevant studies, and thematic analysis was employed to synthesise data. The findings were mapped onto a SWOT (Strengths, Weaknesses, Opportunities, Threats) framework, followed by development of a TOWS matrix to convert insights into actionable strategies.Results 35 studies met the inclusion criteria, covering diverse primary care settings and study designs. Evidence consistently showed that clinical audits improved adherence to guidelines, interdisciplinary collaboration and patient care processes. Key strengths included better clinical practice, knowledge sharing and teamwork. Opportunities were found in integrating audit results into clinical systems, supporting policy development and optimising resources. Weaknesses identified were reduced clinical ownership, fear of blame or litigation, and health information system limitations. Threats included professional scepticism, institutional inertia and time constraints. The Threats, Opportunities, Weaknesses, and Strengths (TOWS) analysis underscored the importance of non-punitive audit environments, leadership engagement and transparent communication to enhance audit impact.Conclusions Clinical audit remains a vital tool for quality improvement in primary care. When supported by strong organisational structures, audits can evolve from compliance tasks to dynamic instruments for organisational learning and patient-centred care. The SWOT–TOWS analysis offers strategic guidance for strengthening audit processes and achieving lasting improvements in clinical practice.
