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Patient experience and stroke care quality: a quality improvement initiative in Northeastern Ontario.

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 m…

Improving prostate MRI quality and its diagnostic impact: a prospective quality improvement initiative.

PURPOSE: High-quality imaging is critical for accurate prostate cancer assessment using MRI. This study describes a quality improvement (QI) initiative for prostate MRI and evaluates the impact of image quality on diagnostic performance. METHODS: In this prospective study, 1328 patients underwent prostate MRI between March 2023 and March 2024. The QI initiative focused on patient preparation, protocol standardization, technologist education, and quality control. Image quality was prospectively scored using the Prostate Imaging Quality (PI-QUAL) system. Diagnostic performance was assessed by c…

The Sequence of Improvement: A Structured Step-by-Step Approach to Quality Improvement in Healthcare.

Quality improvement in healthcare needs methods that balance rigor with usability, and the sequence of improvement offers a practical way for teams to work through complex issues. It moves from defining a problem to understanding it, shaping strategy, testing ideas, and embedding change, drawing on improvement science, Deming, systems thinking, and complexity theory while remaining accessible for everyday practice. More than 900 projects and thousands of staff have used it, creating a strong peer-reviewed evidence base. Applications include reducing pressure ulcers across an organization and i…

SQUIRE-EDU (Standards for QUality Improvement Reporting Excellence in Education): Publication Guidelines for Educational Improvement.

The SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence) guidelines were published in 2015 to increase the completeness, precision, and transparency of published reports about efforts to improve the safety, value, and quality of health care. The principles and methods applied in work to improve health care are often applied in educational improvement as well. In 2016, a group was convened to develop an extension to SQUIRE that would meet the needs of the education community. This article describes the development of the SQUIRE-EDU extension over a three-year period and its key c…

Hypertension improvement project: randomized trial of quality improvement for physicians and lifestyle modification for patients.

Despite widely publicized hypertension treatment guidelines for physicians and lifestyle recommendations for patients, blood pressure control rates remain low. In community-based primary care clinics, we performed a nested, 2 x 2 randomized, controlled trial of physician intervention versus control and/or patient intervention versus control. Physician intervention included internet-based training, self-monitoring, and quarterly feedback reports. Patient intervention included 20 weekly group sessions followed by 12 monthly telephone counseling contacts and focused on weight loss, Dietary Approa

Hospital Context and Strategies for Cesarean Delivery Quality Improvement.

OBJECTIVE: To compare hospitals with lower nulliparous, term, singleton, vertex (NTSV) cesarean delivery rates against those with higher rates, with a goal of identifying key organizational contextual factors and strategies for cesarean delivery quality improvement (QI) efforts. METHODS: We conducted a comparative multiple case study of hospitals participating in the Obstetrics Initiative, a statewide quality collaborative funded by Blue Cross Blue Shield of Michigan and Blue Care Network. Hospitals with more than 1,000 annual births were purposively selected from sites with low cesarean deli…

Hospital-acquired pressure injury prevention: a quality improvement project.

The prevention, management and monitoring of pressure injuries (PIs) have become an important quality indicator for healthcare. In an acute … prevention measures. The measured outcome was the HAPI incidence rate on the identified unit. This quality improvement project used Lewin's change theory as the framework. The PICOT clinical question was: 'How does implementing a PI prevention bundle and validating the knowledge, skills and attitudes of nurses on a medical surgical/step-down unit result in an improv …

Depression screening among Haitian immigrants: A quality-improvement project.

BACKGROUND: Haitians frequently encounter barriers during screening for depression. This quality-improvement project evaluated the effectiveness of depression screening tools specifically adapted for Haitian Creole-speaking populations. LOCAL PROBLEM: The English version of the Patient Health Questionnaire-9 (PHQ-9), widely used to screen for depressive symptoms, may not accurately assess depression due to cultural and linguistic nuances. METHODS: The plan-do-study-act method was used to evaluate the effectiveness of the culturally adapted Haitian Creole PHQ-9 and Zanmi Lasante Depression Sy

Assisted Peritoneal Dialysis: A Feasibility and Quality Improvement Project.

Despite often offering a better quality of life than in-center hemodialysis, peritoneal dialysis (PD) at home can be challenging for many. From May 2021 to October 2024, we offered PD assistance at 2 home dialysis clinics in Dialysis Clinic, Inc, a mid-size national dialysis provider. Eligible patients could be incident to or established on PD, with anticipated need for either permanent or temporary assistance. Over 3 years, 6 patients received assisted PD. Three established PD patients needed assistance when their care partners were unavailable. Three other patients required assistance to ini

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… The Tufts Health Sciences institutional review board determined this quality improvement project was not human subjects research. Cases Over 3 years, 6 patients received assisted PD ( Table 1 ). Patients (or surviving next of kin) consented to share their stories. …

Improving Pleural Fluid pH Accuracy: A Quality Improvement Initiative.

BACKGROUND: Fluid pH remains a standard test when evaluating pleural effusions. Studies recommend using a blood gas analyzer to measure fluid pH immediately after sample collection. Centralization of laboratory services at our institution led to migration of blood gas analysis to a single core laboratory with uncertain impacts on pH results. METHODS: Pleural fluid samples were obtained from 30 patients during routine clinical care, excluding those with frank purulence or blood. Fluid pH and pCO2 were measured on a blood gas analyzer. We compared samples collected in plastic screw-top vials fr

Structured Quality Improvement to Reduce Hospital-acquired Pressure Injuries.

OBJECTIVES: An Academic Medical Center in the United States faced a high rate of hospital-acquired pressure injuries (HAPIs), prompting a quality improvement (QI) project. HAPIs have not received the same level of attention for prevention as other significant hospital complications, such as central line-associated bloodstream infections (CLABSIs) and venous thromboembolism (VTE), but contribute to morbidity, increased costs, and negatively impact patient care. They can be reduced by applying core strategies for other hospital-acquired conditions (HACs). The goal was a 50% reduction in HAPIs ov…

Implementing active surveillance for tuberculosis: A quality improvement project.

BACKGROUND: South Africa is a high tuberculosis (TB)-burden country with the worst multidrug-resistant TB (MDRTB) epidemic in Sub-Saharan Af … ed to evaluate the implementation of active surveillance for TB in a CHW team. METHODS: This was a quality improvement project (QIP) focused on the implementation of TB screening in the community-based services at a primary care facility in the Nelson Mandela Bay Health District (NMBHD). RESULTS: The baseline audit revealed one team was available in the facility ev …

Nurse performed bladder ultrasound: a clinical quality improvement initiative.

Background: Bladder ultrasound (BUS) provides an accurate measurement of post-void residual (PVR) volume and bladder assessment. Access to BUS is dependent on practitioner availability with delays resulting in poor symptom management, delayed discharge and dissatisfaction. Developing nursing practice to perform BUS can address these patient's needs.Aims: Through a quality improvement initiative the aims were (1) to develop theoretical knowledge and practical competence of nurses to perform BUS, (2) to evaluate nursing activity in relation to BUS, (3) to evaluate stakeholders perceptions of the…

Personalizing Quality Improvement: Addressing Anticoagulation Gaps in Atrial Fibrillation.

INTRODUCTION: Risk of stroke is greater in patients with atrial fibrillation. Anticoagulation is effective at decreasing risk, yet 40-50% of eligible patients are not prescribed anticoagulation and seem to have a concerning gap in care quality. This quality improvement initiative implemented a pharmacist-led approach to identify, verify, and close apparent anticoagulation treatment gaps. METHODS: We included adult primary care patients with diagnosis of atrial fibrillation; congestive heart failure, hypertension, age ≥75 years (doubled), diabetes, stroke/transient ischemic attack (doubled), v…

Perioperative Quality Improvement in Children's Hospitals Neonatal Consortium NICUs.

Infants admitted to NICUs in children's hospitals represent a different population than those in a traditional birth hospital. The patients in a children's hospital NICU often have the most complex neonatal diagnoses and are cared for by various subspecialists. The Children's Hospitals Neonatal Consortium is a collaborative of more than 40 NICUs that collect data and perform quality improvement (QI) work across the United States and Canada. The collaborative's database provides an opportunity to benchmark clinical outcomes for this specialized population and to support the QI efforts. In this …

Quality Improvement Within a Mental Health Setting: Alcohol Detoxification.

Aims We describe a clinical audit on alcohol detoxification, using NICE guidelines as a comparable standard. NICE guidelines recommend compl … h, UK (POMH-UK). Two additional audit cycles were completed within the service to ensure continuous quality improvement and clinical effectiveness. Methods Retrospective chart reviews were performed for admissions within pre-defined 6-month periods. Inclusion criteria: ICD-10 F10 diagnosis; prescription of alcohol detoxification schedule. Results This mental health s …

Value-based Care and Quality Improvement in Perioperative Neuroscience.

Value-based care and quality improvement are related concepts used to measure and improve clinical care. Value-based care represents the relationship between the incremental gain in outcome for patients and cost efficiency. It is achieved by identifying outcomes that are important to patients, codesigning solutions using multidisciplinary teams, measuring both outcomes and costs to drive further improvements, and developing partnerships across the health system. Quality improvement is focused on process improvement and compliance with best practice, and often uses "Plan-Do-Study-Act" cycles to…

Quality improvement for neonatal resuscitation and delivery room care.

Quality improvement has become a foundation of neonatal care. Structured approaches to improvement can standardize practices, improve teamwork, engage families, and improve outcomes. The delivery room presents a unique environment for quality improvement; optimal delivery room care requires advanced preparation, adequately trained providers, and carefully coordinated team dynamics. In this article, we examine quality improvement for neonatal resuscitation. We review the published literature, focusing on reports targeting admission hypothermia, delayed cord clamping, and initial respiratory sup…

Regional anesthesia in trauma patients: a quality improvement study.

BACKGROUND: Traumatic injury is associated with severe pain that is often inadequately managed. Opioids remain the mainstay of pain manageme … extremity fractures and dislocations when introduced early. METHODS: This was a prospective cohort quality improvement study evaluating the use of earlier and more consistent regional anesthesia procedures in 28 consecutive trauma patients at a large Canadian trauma center. In this quasi-experimental before and after study, we identified all trauma patients with an …