Search Results (43)

Background/Objectives: Falls-prevention advice in primary care does not always lead to a practical next step. We evaluated a brief, non-clinical Falls Conversation package at one urban NHS general practice. Methods: During a 12-week quality improvement/service evaluation, patients aged 65 years or older were offered a baseline reflection survey, written information, a home-safety checklist and, in later Plan-Do-Study-Act (PDSA) cycles, a one-action prompt. The package did not include clinical assessment, treatment, referral or medication review. Matched pre-post outcomes were analysed, with actions and balancing outcomes recorded at four to six weeks. Results: Of 510 eligible patients, 442 were approached, 334 engaged, 295 provided matched pre-post data and 256 completed follow-up. The mean project-specific knowledge score was 1.83 (SD 1.02) before and 2.60 (SD 0.95) immediately after the package, a paired difference of 0.77 out of 4 (95% CI 0.65 to 0.88; Cohen’s d_z = 0.79; p < 0.001). Worry changed by −0.07 out of 5 (95% CI −0.13 to −0.01; d_z = −0.13), and activity avoidance by −3.4 percentage points (95% CI −7.5 to 0.7; p = 0.144). At follow-up, 157/256 participants reported at least one action (61.3%, 95% CI 55.2% to 67.1%); actions were heterogeneous and unverified. Action selection and completion rose descriptively across non-randomised PDSA cohorts. Conclusions: The package appeared feasible to embed in one practice and was associated with higher immediate knowledge scores and patient-reported action. It did not demonstrate reduced falls or clinically meaningful change in fear-related outcomes. Controlled studies using validated measures, objective outcomes and longer follow-up are required. Full article

Background: High-quality trauma data are essential for data-informed decision-making. However, completeness and accuracy of trauma registries remain challenging in low- and middle-income countries. This study aimed to assess trauma registry data quality in Rwanda and describe a coordinated implementation package used to support improvements in registry completeness and accuracy. Methods: We conducted a prospective, longitudinal quasi-experimental quality-improvement study with repeated monthly measurements across eight hospitals in Rwanda from October 2023 to September 2025. Trauma registry data quality indicators—case missingness, variable missingness, and variable accuracy—were assessed monthly using a predefined Rwanda Trauma Registry data quality assessment and reporting protocol. Results: A total of 26,268 trauma cases were recorded across the eight hospitals. Linear mixed-effects models showed significant temporal improvements in trauma registry data quality. Case missingness decreased by 0.72 percentage points per month (β = −0.721; 95% CI −0.955 to −0.487; p < 0.001), and variable missingness declined by 0.33 percentage points per month (β = −0.331; 95% CI −0.435 to −0.228; p < 0.001). Variable accuracy increased by 0.25 percentage points per month (β = 0.253; 95% CI 0.198 to 0.307; p < 0.001). Conclusions: The findings show substantial improvements in registry completeness and accuracy during a coordinated, bundled, PDSA-guided quality-improvement implementation process in Rwanda. Because the study was uncontrolled and the activities were implemented together, the results should be interpreted as associations over time rather than causal effects of any individual intervention component. Full article

Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related mortality worldwide. Despite established guidelines recommending semiannual surveillance for high-risk patients, real-world adherence remains inconsistent. Gaps in healthcare personnel knowledge and care coordination are recognized contributors to this implementation failure. Methods: Under IRB review, a quality improvement project using the Plan-Do-Study-Act (PDSA) framework was conducted in an ambulatory liver clinic in the southwestern United States. One PDSA cycle was completed. Retrospective and prospective chart reviews (n = 50 charts each) were conducted to assess HCC surveillance ordering and scheduling rates. Thirty healthcare personnel completed investigator-developed pre- and postintervention surveys measuring knowledge and perceptions. Intervention: A structured educational session grounded in current American Association for the Study of Liver Diseases (AASLD) surveillance guidelines was delivered to the full interdisciplinary clinic team, incorporating clinic-specific compliance data and role-specific coordination responsibilities. Results: Knowledge scores improved significantly from a mean of 41.67% to 95.33% (t [29] = −20.27, p < 0.001, d = 3.70). Perception scores improved (Wilcoxon z = −4.30, p < 0.001). Surveillance ordering increased from 88% to 94% and scheduling from 60% to 80%. Conclusions: A single structured educational PDSA cycle was associated with significant improvements in healthcare personnel knowledge and perceptions and with improved ordering and scheduling of HCC surveillance imaging. Postintervention imaging completion and result review rates were not assessed within the available follow-up period. Run chart monitoring of surveillance metrics across subsequent PDSA cycles is planned to evaluate sustainment and guide iterative improvement. Full article

In this work, high-resolution sparse channel estimation in multiple-input multiple-output orthogonal frequency division multiplexing (MIMO-OFDM) systems is addressed. Firstly, a block-structured compressed channel sensing (CCS) model with high spectral efficiency and high delay resolution is constructed. Then, by fully exploiting the temporal correlation and joint sparsity of the channels, a novel two-stage prior delay support-aided delay tracking and block residual norm minimization (PDSA-DT-BRNM) algorithm is proposed. In the first stage, with a limited number of pilots for each antenna and the delay grids within the prior delay support, an efficient delay tracking and block norm minimization algorithm is put forward to choose the common delay grids and estimate each block gain iteratively. In the second stage, by comprehensively utilizing the intermediate channel estimation results of the first stage and the prior delay support, an optimized channel estimation strategy is developed based on the block residual norm minimization (BRNM) criterion. Simulation results and theoretical analysis show the effectiveness of the proposed channel estimation scheme in terms of channel estimation performance, spectral efficiency and computational complexity. Full article

Background: Central line-associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) pose a significant risk, especially for very low birth weight infants due to their immature immune systems and the need for invasive procedures. The implementation of evidence-based bundles, as recommended by international guidelines, has proven effective in significantly reducing CLABSI rates, improving clinical outcomes, and lowering hospital costs. However, evidence from long-term, real-world quality-improvement programs in European NICUs—especially those using repeated PDSA cycles and detailed monitoring across multiple periods—remains limited. Methods: This quality improvement prospective study, conducted in the NICU of “V. Buzzi” Children’s Hospital, aimed to reduce high CLABSI rates using a plan-do-study-act (PDSA) framework. A multidisciplinary team developed and implemented a new evidence-based central line bundle in 2021, focusing on standardized practices, enhanced training, and monitoring. The study analyzed 594 CVCs placed in 348 neonates across a total 4-years period (P1–P12). Results: Implementation of a central line bundle significantly reduced CLABSI rates from 29.1 to 2.2 per 1000 CVC days (p-value 0.002), with notable variations during intermediate periods. Birth weight and study period progression were the only variables significantly associated with CLABSI reduction. Conclusions: Infection rates dropped significantly post-intervention, achieving zero in one of the latest periods: continuous monitoring, staff training, and targeted interventions were pivotal. Future efforts will focus on refining practices, increasing tunneled centrally inserted central catheter (CICC) use, and sustaining prevention measures. Full article

Background: Herpes zoster (HZ) poses significant risks to immunocompromised individuals, particularly cancer patients receiving systemic therapies. The recombinant zoster vaccine (RZV, Shingrix^®) provides strong and durable protection against HZ and its complications. Nevertheless, vaccination coverage remains low, mainly due to limited awareness among patients and healthcare providers and logistical barriers to vaccine access and delivery. Materials and Methods: We conducted a single-center quality improvement (QI) project to enhance RZV uptake among oncology outpatients receiving systemic therapy. Following the Plan–Do–Study–Act (PDSA) model, baseline HZ vaccination coverage was assessed, and an in-house vaccination campaign was implemented. Vaccination rates were monitored every two months over a 14-month period. Results: At baseline, only 5.4% (24/446) of patients had received RZV. After 14 months, 365 patients were evaluated for vaccination: 200 (55%) were vaccinated, 134 (37%) were ineligible, and 31 (8%) refused RZV. The overall vaccination rate increased from 5.4% to 44%. Reported adverse events were mild and primarily local reactions, confirming the vaccine’s favorable safety profile in this population. Conclusions: This real-world QI initiative demonstrates that an in-house vaccination strategy embedded within oncology services can substantially improve RZV coverage and patient engagement. The approach highlights the key role of oncology teams in leading preventive interventions for immunocompromised patients. By integrating vaccination into routine cancer care, institutions can overcome traditional organizational barriers and align with current ASCO and ESMO recommendations for comprehensive patient protection. Full article

Objective: To implement a neonatal iron deficiency (ID) guideline as part of a neuroprotective strategy using reticulocyte hemoglobin content (RET-He) for neonates born <33 weeks postmenstrual age (PMA) and small for gestational age (SGA) neonates ≥33 weeks PMA, to achieve ≥80% screening rate by June 2024. Methods: An interdisciplinary team conducted a quality improvement initiative in a level III neonatal intensive care unit (NICU) from April 2022 to August 2024. RET-He is a validated, sensitive marker of early iron deficiency reflecting recent iron supply for erythropoiesis and providing a more reliable measure than ferritin. The primary outcome was RET-He screening at 30 ± 7 days for neonates <33 weeks PMA or pre-discharge for SGA neonates ≥33 weeks PMA. Exclusion criteria were death or transfer before eligibility. Process measures included ID screening failure rate (RET-He level < 29 pg). Results: Of 345 eligible neonates, P-chart analysis showed screening rates for premature neonates <33 weeks PMA declined during PDSA 1–2, before improving to 85.9% in PDSA 3. ID screening failure was 12.6% at one month, increasing to 32.1% at two months. For SGA neonates ≥33 weeks PMA, screening rates remained low, peaking at 36% in PDSA 3, with a 2.2% failure rate. Conclusions: Implementation of a RET-He based ID guideline improved screening rates for premature neonates but was less effective for SGA neonates. Despite improved guideline adherence, ID prevalence remained high at NICU discharge, indicating a further need to improve nutritional prevention and treatment strategies. Full article

Large Language Models (LLMs) encounter significant challenges when applied in specialized domains that require precise and localized information. This problem is particularly critical in regulatory sectors, such as the animal health sector in Brazil, where professionals depend on complex and constantly updated legal norms to perform their work. The generic knowledge encapsulated in traditional LLMs is often insufficient to provide reliable support in these contexts, which can lead to inaccurate or outdated responses. To address this gap, this work presents a practical implementation of a Retrieval-Augmented Generation (RAG) system. We detail the integration of this system with the Plataforma de Defesa Sanitária Animal do Rio Grande do Sul (PDSA-RS), a real platform used for animal production certification. Our solution connects an LLM to an external knowledge base containing specific Brazilian legislation, allowing the model to retrieve relevant legal texts in real time to generate its responses. The principal objective is to demonstrate how this approach can produce accurate and contextually grounded answers for professionals in the veterinary field, assisting in decision-making processes for sanitary certification. Full article

Background/Objectives: There is growing evidence to support ambient artificial intelligence (AI) scribes in healthcare to improve medical documentation by generating timely and comprehensive notes. Using the Plan–Do–Study–Act (PDSA) methodology, this study evaluated the utility and potential time savings of an ambient AI scribe, Scribeberry, (V2), in a palliative medicine outpatient setting, comparing it to the standard practice of dictation. Methods: This prospective quality improvement study was conducted at an academic medical center by two palliative medicine resident physicians. Residents documented patient visits using a freely available ambient AI scribe software program, Scribeberry, as well as using standard dictation software. Primary outcome measures included the editing time for the AI scribe and the dictating and editing times for a dictated manuscript, as well as subjective assessments of the accuracy, organization, and overall usefulness of the AI-generated clinical letters. Results: A heterogenous response was seen with the implementation of an AI scribe. One resident saw a statistically significant reduction (p < 0.025) in the time spent on clinical documentation, while a second resident saw essentially no improvement. The resident who experienced time savings with the ambient AI scribe also demonstrated a significant improvement in the graded organization and usefulness of the AI outputs over time, while the other resident did not demonstrate significant improvements in any of the metrics assessed over the course of this project. Conclusions: This pilot study describes the use of an ambient AI scribe software program, Scribeberry, in the community palliative medicine context. Our results showed a mixed response with respect to time savings and improvements in the organization, accuracy, and overall clinical usefulness of the AI-generated notes over time. Given the small sample size and short study duration, this study is insufficiently powered to draw conclusions with respect to AI scribe benefits in real-world contexts. Full article

Background: It is generally well-known that narration of care is critically important to high-quality nursing care. Narration of care is loosely defined as a nurse’s ability to describe to patients and families the clinical purpose behind nursing practice, what is hoped to be achieved, and the “why” (or clinical rationale) behind nursing activities. Despite the importance of narration of care, there is little practical guidance given to nurses about how to narrate care—what makes for effective or ineffective narration of care. Objective: Our aim was to develop a framework for teaching nurses and patient care assistants (PCAs) on how to effectively narrate care. In this article, we provide a practical framework for teaching nurses and PCAs how to narrate care. We describe the process of developing the framework as part of quality improvement efforts and implementing a course for eight hospitals based on the framework. Methods: Consistent with a Plan-Do-Study Act (PDSA) quality improvement approach, we developed the framework by first conducting a data and literature review, then convening a taskforce, discussing with patients on our existing committees, and finally formulating a framework. We then drafted supplementary cases and course material and implemented a course to teach nurses and PCAs how to narrate care. Results: The narration of care framework (NOC) that we developed and implemented consisted of the following five principles, which can be called RECAP as an acronym: 1. The “R” in RECAP stands for removing uncertainty. 2. The “E” in RECAP stands for explaining the environment. 3. The “C” in RECAP stands for being calm and sincere. 4. The “A” in RECAP stands for assume nothing. 5. The “P” in RECAP stands for personal connection. As for the course developed based on the RECAP principles, there was a total of 276 course offerings conducted by 30 facilitators, and 7341 nurses and PCAs completed the course. The evaluations reflected that 99% of learners believed their learning was improved by the course. Discussion: There are several multifaceted benefits to NOC: nurses’ and PCAs’ capability to narrate care well shows empathy and compassion to patients; it strengthens patient understanding and education that can lead to improved patient outcomes; and it helps allay patients’ uncertainties and anxieties. In essence, narrating care in an effective manner cultivates a strong nurse–patient therapeutic relationship. Yet, in the absence of any practical guidance, nurses and PCAs are left to develop narration skills on their own, learning by trial and error, and, in doing so, perhaps failing to meet patients’ needs and failing to fully derive the many benefits that the NOC is designed to achieve. Our hope is that, if hospital systems adopt our work, nurses and PCAs can comfortably and confidently enter the profession knowing the purpose or narrating care, its many benefits, and how to practically conduct sufficient narration, and what would constitute insufficient narration. Hospitals, in turn, can specify and clearly articulate their expectations for nurses and PCAs narrating with patients—what would make for a strong, compassionate process and what would be inadequate. For more experienced nurses, they can use the RECAP framework to reflect on their own practices and perhaps strengthen or refreshen existing skills. Conclusions: NOC is acknowledged, somewhat implicitly, as being critical to nursing and PCA practice, yet practical instruction and specified principles are lacking. We aimed to fill this gap by developing, implementing, and teaching a practical framework, armed with many tools nurses can use. Full article

Background/Objectives: Necrotizing enterocolitis (NEC) is one of the most devastating gastrointestinal emergencies in preterm infants. This quality improvement (QI) project aimed to increase the utilization of accepted evidence-based practices in our neonatal intensive care unit (NICU) to ultimately decrease the incidence of NEC in our level III NICU. Methods: Our QI team implemented a bundle of nine of these evidenced-based practices for NEC prevention and disseminated information among the NICU team. Items in the bundle included delayed cord clamping, parental education on the importance of breast milk, obtaining early consent for donor breast milk, adherence to the unit’s feeding protocol, avoiding routine gastric residual checks, the discontinuation of antibiotics at 48 h once blood cultures were negative, restricting the use of antacids, nasogastric tube (NGT) replacement every 72 h and the removal of central lines once a feeding volume of 100 mL/kg/day was attained. The baseline incidence of clinically proven NEC was found to be 7% at the start of the intervention. We conducted two Plan-Do-Study-Act (PDSA) cycles over a 2-year period from 1 January 2021 to 31 December 2022. Results: There were 74 infants who met the inclusion criteria of being <1500 g and/or at <32 weeks of gestation. The adherence to our process measures improved over the course of our two PDSA cycles from 78% adherence to 91.6%, p < 0.05. The incidence of NEC decreased from 7% to 5.3% following the first PDSA cycle, a 24% reduction. Following the second PDSA cycle, the incidence decreased even further from 5.3% to 2.8%, a 60% reduction from baseline, although this was not statistically significant due to the small sample size. Conclusions: In this QI initiative, we achieved improved adherence to several evidence-based interventions over a two-year period with the aim of reducing the incidence of NEC at our institution. Full article

Background: Epidermal cysts are common benign lesions encountered in primary care, especially in minor surgery clinics. The management of large epidermal cysts (>5 cm in diameter) poses significant challenges, including surgical intervention requirements, potential for complications, and impacts on patient care and clinic workflow. The prevalence of these cysts underlines the need for optimised management strategies that are essential for enhancing patient outcomes and clinic efficiency. This quality improvement initiative sought to better manage large epidermal cysts in primary care settings. Patients and methods: The initiative utilised the Plan-Do-Study-Act (PDSA) cycle over three distinct phases, with an emphasis on improving surgical techniques and postoperative care, optimising clinic workflow, and enhancing patient education and involvement. Over the course of this eighteen-month study, 100 patients who required surgical excision of large epidermal cysts were included. The interventions focused on standardising surgical protocols, implementing a new scheduling system, and developing comprehensive educational materials for patients. Results: The programme contributed to major efficiency gains for surgeries: the average operative time was reduced from 45 min to 30. The postoperative complication rate decreased dramatically while patient and clinician satisfaction went up, as did clinic throughput. With patient education enhancements, follow-up adherence rose to 92% while the postoperative complication rate declined from 18% to 9% with the overall approach to patient engagement. Conclusions: The successful application of the PDSA cycles in this work demonstrates that quality improvement methodologies have a potential role in optimising management for large epidermal cysts in primary care settings. Developed interventions can therefore be put into routine care that will indeed improve patient outcome, clinician experience, and operational efficiency in minor surgery clinics. Full article

Texas Medicaid improved infant well-child visit rates by participating in a national learning collaborative. The two-year program encouraged creativity and innovation in care for Medicaid recipients through partnerships with managed care organizations (MCOs). The MCO projects discovered valuable practices in member outreach and were disseminated in shared learning experiences. At the completion of the learning collaborative, Texas Medicaid surveyed the MCO participants to assess the impact of their projects on Medicaid beneficiaries in Texas as well as the quality improvement project format. Collectively, the MCOs raised the infant well-child visit rate year-over-year. All of the partner MCOs stated they plan to continue focused work on improving infant well-child visit rates after the learning collaborative. Full article

Background: There are many nonpharmacological pain management services available to hospitalized youth; however, not all youth are offered these services. Lack of knowledge about resources, difficulty with the referral process, and lack of understanding about nonpharmacological pain management services and when to refer patients are among the main reasons for lack of utilization. Quality improvement (QI) initiatives have grown within hospital settings and can serve to create change in fast-paced environments. Methods: The current QI project aimed to pilot an educational program to increase the use of nonpharmacological pain management interventions. Staff located on one floor of a pediatric hospital on the East Coast were selected because of the wide range of patient presentations and likelihood that these youth may present with pain during the hospitalization. Following several incremental changes and multiple PDSA cycles, utilization of nonpharmacological pain management services was assessed. Results: Education only did not result in increases in nonpharmacological pain management services ordered. A best practice alert for nursing staff, implemented within the electronic medical record, led to a 50% increase in services ordered. Conclusions: These results suggest that to improve use of nonpharmacological pain management strategies, hospital systems may need to consider more than education. Full article

Background: Mental health (MH) polypharmacy, defined as prescribing multiple mental health medications for the same condition, presents significant challenges in clinical practice. With varying prevalence rates and an increasing trend, particularly in the UK, this deprescribing prospective quality improvement project aimed to address the complexities and risks associated with MH polypharmacy. Patients and Methods: A large primary care centre in London was selected for this project. Electronic records of 667 patients (non-coded in mental health lists) were analysed as a result of the absence of a Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) for mental health. Seventy-two non-coded patients exhibiting “same-class” as well as “adjunctive” and “augmentation” polypharmacy were identified. Their demographic and health data, including MH diagnoses, physical status, and lifestyle habits, were evaluated. This deprescribing prospective project included 68 patients and employed a model inspired by the Plan–Do–Study–Act (PDSA) cycle, focusing on reducing psychotropic, adjunctive, and augmentative medications while monitoring mental health control through face-to-face consultations using the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Assessment-7 (GAD-7) scores, alongside physical health parameters. Results: The project revealed a significant decrease in the average number of psychotropic and adjunct medications from initial consultations to the end of the 18-month period. Additionally, a marked reduction in reported side effects and drug interactions was observed. Improvements in mental health control, as evidenced by PHQ-9 and GAD-7 scores, were noted. Physical health parameters, including BMI, blood pressure, heart rate, HbA1c, and cholesterol levels, also showed significant improvements. Educational initiatives for patients and clinicians were successfully implemented, contributing to these positive outcomes. Discussion: The project faced challenges like balancing medication reduction with mental health stability, patient apprehension, and the absence of standardised protocols. However, the successful reduction in medication numbers and the improvement in health outcomes highlight the effectiveness of the model. This project underscores the necessity of a tailored approach to MH polypharmacy, emphasising continuous education, clinical titration, and adherence to guidelines. Future research is needed to develop clear guidelines for medication combination in mental health care and to understand the long-term effects of polypharmacy in mental health populations. Conclusions: This project demonstrates the potential for significant improvements in the management of MH polypharmacy. By carefully managing medication reductions and employing a comprehensive care approach, including patient education and clinician training, the project achieved improvements in both mental and physical health outcomes. These findings suggest a promising direction for future practices in MH polypharmacy management. Full article