Comprehensive Quality Improvement Research Articles

Reliability and construct validation of the Blended Learning Usability Evaluation–Questionnaire with interprofessional clinicians in Canada : a methodological study

Purpose: To generate Cronbach’s alpha and further mixed methods construct validity evidence for the Blended Learning Usability Evaluation–Questionnaire (BLUE-Q).Methods: Forty interprofessional clinicians completed the BLUE-Q after finishing a 3-month long blended learning professional development program in Ontario, Canada. Reliability was assessed with Cronbach’s α for each of the 3 sections of the BLUE-Q and for all quantitative items together. Construct validity was evaluated through the Grand-Guillaume-Perrenoud et al. framework, which consists of 3 elements: congruence, convergence, and credibility. To compare quantitative and qualitative results, descriptive statistics, including means and standard deviations for each Likert scale item of the BLUE-Q were calculated.Results: Cronbach’s α was 0.95 for the pedagogical usability section, 0.85 for the synchronous modality section, 0.93 for the asynchronous modality section, and 0.96 for all quantitative items together. Mean ratings (with standard deviations) were 4.77 (0.506) for pedagogy, 4.64 (0.654) for synchronous learning, and 4.75 (0.536) for asynchronous learning. Of the 239 qualitative comments received, 178 were identified as substantive, of which 88% were considered congruent and 79% were considered convergent with the high means. Among all congruent responses, 69% were considered confirming statements and 31% were considered clarifying statements, suggesting appropriate credibility. Analysis of the clarifying statements assisted in identifying 5 categories of suggestions for program improvement.Conclusion: The BLUE-Q demonstrates high reliability and appropriate construct validity in the context of a blended learning program with interprofessional clinicians, making it a valuable tool for comprehensive program evaluation, quality improvement, and evaluative research in health professions education.

Understanding and measuring workplace violence in healthcare: a Canadian systematic framework to address a global healthcare phenomenon

BackgroundGlobally, healthcare institutions have seen a marked rise in workplace violence (WPV), especially since the Covid-19 pandemic began, affecting primarily acute care and emergency departments (EDs). At the University Health Network (UHN) in Toronto, Canada, WPV incidents in EDs jumped 169% from 0.43 to 1.15 events per 1000 visits (p < 0.0001). In response, UHN launched a comprehensive, systems-based quality improvement (QI) project to ameliorate WPV. This study details the development of the project’s design and key takeaways, with a focus on presenting trauma-informed strategies for addressing WPV in healthcare through the lens of health systems innovation.MethodsOur multi-intervention QI initiative was guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework. We utilized the SEIPS 101 tools to aid in crafting each QI intervention. ResultsUsing the SEIPS 3.0 framework and SEIPS 101 tools, we gained a comprehensive understanding of organizational processes, patient experiences, and the needs of HCPs and patient-facing staff at UHN. This information allowed us to identify areas for improvement and develop a large-scale QI initiative comprising 12 distinct subprojects to address WPV at UHN. ConclusionsOur QI team successfully developed a comprehensive QI project tailored to our organization’s needs. To support healthcare institutions in addressing WPV, we created a 12-step framework designed to assist in developing a systemic QI approach tailored to their unique requirements. This framework offers actionable strategies for addressing WPV in healthcare settings, derived from the successes and challenges encountered during our QI project. By applying a systems-based approach that incorporates trauma-informed strategies and fosters a culture of mutual respect, institutions can develop strategies to minimize WPV and promote a safer work environment for patients, families, staff, and HCPs.

Status of Sepsis Care in European Hospitals: Results from an International Cross-Sectional Survey.

Early detection, standardized therapy, adequate infrastructure and strategies for quality improvement should constitute essential components of every hospital's sepsis plan. To investigate the extent to which recommendations from the sepsis guidelines are implemented and the availability of infrastructure for the care of patients with sepsis in acute hospitals. A multidisciplinary cross-sectional questionnaire was used to investigate sepsis care in hospitals. This included the use of sepsis definitions, the implementation of sepsis guideline recommendations, diagnostic and therapeutic infrastructure, antibiotic stewardship, and quality improvement initiatives in hospitals. 1023 hospitals in 69 countries were included. Most of them, 835 (81.6%) were from Europe. Sepsis screening was used in 54.2% of emergency departments(EDs), 47.9% of wards, and 61.7% of intensive care units(ICUs). Sepsis management was standardized in 57.3% of EDs, 45.2% of wards and in 70.7% of ICUs. The implementation of comprehensive quality improvement initiatives(QIIs) was associated with increased screening (EDs +33.3%; wards +44.4%; ICUs +23.8% absolute difference) and increased standardized sepsis management (EDs +33.6%; wards +40.0%; ICUs: +17.7% absolute difference) compared to hospitals without QIIs. 9.8% of hospitals had implemented ongoing QIIs, and 4.6% had invested in sepsis programs. The findings indicate that there is considerable room for improvement in a large number of mainly European hospitals, particularly with regards to early identification and standardized management of sepsis, the availability of guidelines, diagnostic and therapeutic infrastructure, and the implementation of QIIs. Further efforts are required to implement a more comprehensive and appropriate quality of care.

A multidisciplinary comprehensive nursing Management Approach for Catheter-related bloodstream infections.

Catheter-related bloodstream infection (CR-BSI) stands as one of the leading causes of hospital-acquired infections, often resulting in high healthcare expenditure and mortality rates. Despite efforts, reducing the incidence of CR-BSI remains a significant challenge. This study aimed to assess the impact of a multidisciplinary organizational intervention on reducing intravenous CR-BSI. A quality improvement team was established to implement various interventions, utilizing the FOCUS-PDCA continuous quality improvement model and fishbone diagram for analysis and improvement. After the interventions, operational indicators for catheter insertion, maintenance, and removal improved from 82.50% ± 1.15%, 83.60% ± 1.60%, and 81.60% ± 1.80-95.30% ± 1.00%, 96.20% ± 1.62%, and 97.25% ± 0.50%, respectively. Additionally, catheter dwell time decreased from 7.50 ± 0.85 days to 3.50 ± 0.75 days, and the quarterly infection rate was reduced from 2.328% ± 1.85-0.305% ± 0.95% following the implementation of the intervention. Despite the available evidence, there remains a noticeable gap between the ideal evidence-based practices and their practical implementation. We aim to eradicate CR-BSIs within the surgical intensive care units (ICUs) of hospitals. To achieve this goal, we have introduced a comprehensive quality improvement framework designed not only to benefit our own ICU but also to serve as a model for implementation in other similar healthcare settings.

The Airway Lead and the Creation of a Comprehensive Emergency Airway Quality Program

BackgroundEmergency Department (ED) Intubation is one of the most critical times during a patient's hospital course. Ideal performance requires training, equipment, and mindset to overcome the barriers of anatomy, physiology, and human factors. ObjectivesWe believe that EDs should use the same model of quality improvement and leadership for intubation as other critical procedures such as ED ultrasound. DiscussionThis paper delineates one program's creation of a comprehensive airway quality improvement (QI) program and will hopefully serve as a roadmap for other centers. ConclusionsThe creation of an airway QI program headed by a designated airway lead has the potential to improve patient care and procedural success in the ED.

Impact of a Comprehensive Quality Improvement Initiative for Reducing AUS Rates in Thyroid FNA Cytology: an Institutional Experience

Impact of a Comprehensive Quality Improvement Initiative for Reducing AUS Rates in Thyroid FNA Cytology: an Institutional Experience

Current situation and improvement measures of junior middle school English writing teaching

Junior middle school English writing teaching is an important part of training students' comprehensive English ability, but the current teaching situation is not ideal, there are many problems. These problems not only affect students' writing ability, but also have a negative impact on their overall English level improvement. Through the review of the existing literature, the in-depth analysis of the teaching situation and its causes, this paper comprehensively discusses the existing problems in junior middle school English writing teaching, and puts forward a variety of practical measures for improvement. Through the investigation and analysis of the current teaching situation, it is found that teachers generally have problems in writing teaching such as single teaching mode, low participation of students and insufficient writing guidance. In addition, insufficient teaching resources and unscientific evaluation methods further restrict the improvement of students' writing ability. In response to these problems, this paper proposes a series of improvement measures, such as optimizing the teaching mode, enriching the teaching content, strengthening teacher training, improving the evaluation system, etc., in order to comprehensively improve the quality of junior middle school English writing teaching, promote the development of students' writing ability, and lay a solid foundation for future English learning and comprehensive quality improvement.

Moving the needle: Quality improvement strategies to achieve guideline-concordant care of obstetric patients with severe hypertension

ObjectivesTo improve timely treatment and follow-up of birthing individuals with severe hypertension. Study designA quality improvement (QI) initiative was implemented at an academic tertiary care center in the United States of America for individuals with obstetric hypertensive emergencies. Statistical process control charts were utilized to track process measures and interventions tested through plan-do-study-act cycles. Measures were disaggregated by race and ethnicity to identify and improve disparities. Main outcome measuresTreatment of hypertensive events within 60 min, receipt of blood pressure (BP) device at discharge and completed postpartum follow-up BP check within 7 days of discharge. ResultsAll process measures showed statistically significant improvements. The primary process measure, timely treatment of hypertensive emergencies, improved from 29 % to 76 %. Receipt of BP device improved from 37 % to 91 % and follow-up BP checks from 58 % to 81 %. No racial or ethnic disparities were noted at baseline or after interventions. Readmission rates within 6 weeks of delivery increased from 2.3 % to 6.1 % for the cohort with no severe morbidity or mortality events after discharge. Strategies associated with improvement included project launch with establishment of the “why,” telehealth, simulation, a video display of quality metrics on the birthing unit, promoting BP cuff access, and automated orders. ConclusionsThis comprehensive QI initiative provides novel improvement strategies for the management of individuals with severe hypertensive disorders of pregnancy for the timely treatment of severe BP, attainment of home BP devices, and follow-up after discharge. Quality improvement methodology is practical and essential for achieving guideline-concordant care.

Reducing Stimulant Prescribing Error: A Quality Improvement Initiative in Pediatric Outpatient Setting.

To evaluate the impact of the Songklanagarind ADHD Multidisciplinary Assessment and Care Team for Quality Improvement (SAMATI) initiative on reducing stimulant prescribing errors in a pediatric outpatient setting. A retrospective study examined attention deficit hyperactivity disorder (ADHD) registry data from January 2017 to June 2023 to assess the impact of the SAMATI initiative, implemented in early 2020. This initiative, integrating multiple components such as audit and feedback, clinical pharmacist involvement, and Electronic Medical Record utilization, aimed to enhance ADHD medication management. Using interrupted time series and control chart analyses, the study evaluated the initiative's effect on reducing stimulant prescribing errors. Additionally, parental satisfaction was measured to gauge the initiative's overall success. Out of 282 patients enrolled, 267 were included in the final analysis after exclusions. Post-intervention analysis showed significant reductions in various prescribing errors per thousand prescriptions: prescribing without concern drug-condition interaction (443 to 145, p < 0.001), prescribing without adequate monitoring (115 to 14, p < 0.001), lack of regular office visits (98 to 21, p = 0.007), and inappropriate dosage (66 to 14, p = 0.05). Medication errors severity classification also showed significant changes, with notable decreases in classes C and D errors. Parental satisfaction improved from 84% to 95%. The SAMATI initiative significantly reduced stimulant prescribing errors and enhanced parental satisfaction in ADHD care management. This study demonstrates the potential of comprehensive quality improvement strategies in improving medication management in pediatric healthcare. Further research in diverse settings is warranted to confirm these findings.

Enhancing student creativity in Chinese universities: The role of teachers’ spiritual leadership and the mediating effects of positive psychological capital and sense of self-esteem

Creativity is considered a key competency in contemporary society and is crucial for college students’ personal growth and future career development. There are many internal and external factors affecting college students’ creativity, among which teacher leadership, an external factor, is substantial. In light of this, this study introduces a new, more detailed theoretical framework that considers the mechanism of influence of teachers’ spiritual leadership on college students’ creativity. Moreover, among the intrinsic influences on college students’ creativity, psychological resources are particularly important; thus, this study selected two variables, positive psychological capital and sense of self-respect, to explore their dual mediating effects in the relationship between spiritual leadership and college students’ creativity. With 697 Chinese college students as the research object, this study collected relevant data through a questionnaire-based survey and statistically analyzed it using SPSS and AMOS. The results show that college teachers’ spiritual leadership has a positive effect on college students’ creativity, and positive psychological capital and sense of self-respect mediate this relationship. Complementing the currently insufficient literature on the factors influencing the development of college students’ creativity, this study provides a perspective that allows for a deeper understanding of the formation process of college students' creativity by exploring the interrelatedness of several factors and elucidating the influence mechanism between them. The results can help optimize programs and strategies to improve college students’ creativity. Specifically, they suggest that by cultivating and enhancing college teachers’ spiritual leadership, educational institutions and organizations can promote the development of college students’ creativity and provide support for students’ comprehensive quality improvement. Simultaneously, paying attention to the establishment of college students’ psychological resources can enhance the level of college students’ creativity.

Research on the Training Path of Higher Vocational Students’ Comprehensive Quality Based on the Modern Apprenticeship System

The modern apprenticeship system is a training mode suitable for the cooperation between vocational education schools and enterprises to train high-quality technical talents. However, due to problems such as imperfect mechanisms, unclear responsibilities, and inadequate integration of resources, the modern apprenticeship system has no significant effect on talent cultivation. In view of these problems, this paper takes Yibin Vocational and Technical College as an example, implements the second batch of modern apprenticeship pilot projects promoted by the Ministry of Education, and explores the training path of modern apprenticeship from four aspects: optimizing the school-enterprise collaboration mechanism, two-way mutual employment of two teachers, co-construction and sharing of school-enterprise resources, and jointly promoting the comprehensive quality improvement plan of students. This paper hopes to provide a certain reference for the cultivation of the comprehensive quality of modern apprenticeship students.

Implementation of Laparoscopic Nissen Fundoplications in a Developing South African Pediatric Surgical Service.

Pediatric laparoscopic Nissen fundoplication (LNF) has become the standard approach at many centers. We developed a minimal access surgery (MAS) training curriculum to enhance the delivery of MAS for pediatric patients in a resource-limited setting. We reviewed our 10-year experience in implementing and performing LNF at our institution. We described the challenges of implementing MAS training for LNF and how we addressed them. Beneficial technical considerations were described. A retrospective review was performed on all pediatric LNFs performed. We performed 268 LNFs. Specialists or trainees under supervision performed all LNFs. The trainee group performed 43 LNFs (16%). The median operative time for the specialists was 94 min (interquartile range [IQR] 50), and the trainee group was 140 min (IQR 62.5). The median number of cases performed until we improved operative time amongst the trainees was nine (IQR 3). There were seven repeat LNFs, and 11 cases were converted to open. The overall complication rate was 8.9%. A reduction in complications among specialists occurred over the years. The 30-day mortality post-LNF was 0.7%. LNF can be successfully introduced at a tertiary training centre in South Africa with good outcomes. A comprehensive quality improvement program, including MAS training, supported this.

Hospital based interventional study implementation of supervised quality improvement protocol in reducing surgical site infections in obstetrics and gynaecological major surgeries: A study protocol

Background Surgical site infections (SSIs) pose a significant challenge in obstetric and gynaecological surgeries, with incidence rates ranging from 0.5% to 15%. These infections not only impact patient outcomes but also contribute to extended hospital stays and increased healthcare costs. To address this issue, a hospital-based interventional study is proposed, focusing on the implementation of a comprehensive quality improvement protocol within the Department of Obstetrics and Gynecology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha. Methods The study will include approximately 800 obstetric and gynaecological surgeries per year. Ethical approval has been obtained and written informed consent will be obtained from all enrolled women. The intervention involves the implementation of a surgical site infection prevention quality improvement protocol, encompassing elements such as standardized pre-operative antiseptic agents, proper cleaning procedures, and the use of injectable cefazolin. A structured proforma will be developed for data collection, covering demographic details, surgical parameters, surgeon characteristics, and post-operative outcomes. Expected outcome This study aims to assess the efficacy of the quality improvement protocol in reducing the incidence of surgical site infections. We anticipate that the implementation of this protocol will lead to a significant reduction in SSIs, improving patient outcomes and safety in obstetric and gynaecological surgeries. The study's findings will not only contribute to the body of knowledge on infection prevention but will also serve as a valuable framework for enhancing surgical safety in similar healthcare settings. Continuous evaluation and refinement of the protocol will be crucial for sustained success in reducing SSIs and improving overall patient care.

The Status Quo and Countermeasures of College Students' Academic Style Construction

The academic style construction of college students is an important content of college education, which is of great significance for cultivating students' comprehensive quality and improving the quality of education. This paper analyses the problems in learning attitude, learning method, learning environment and learning habits through the investigation and research on the current situation of college students' academic style construction, and discusses the personal and environmental factors that affect college students' academic style construction. On this basis, countermeasures for the construction of college students' academic style are proposed, including measures at the school level and individual level. This study aims to provide targeted guidance and suggestions for the construction of college students' academic style, and to promote the comprehensive quality improvement of college students and the improvement of education quality.

Enhancing Tracheostomy Care Proficiency: Evaluating the Impact of Online Interprofessional Tracheostomy Education Program

Background Evidence suggests that many clinicians lack confidence in managing tracheostomy patients effectively. This gap is further exacerbated by the influx of new healthcare providers who may have received insufficient training in tracheostomy care. Consequently, there is a pressing need to evaluate the effectiveness of training interventions to enhance clinicians’ confidence and competence in tracheostomy care. This study aims to assess the effectiveness of an interprofessional online training program in improving healthcare professionals’ confidence and proficiency in tracheostomy care. Local Problem Interprofessional healthcare providers’ have expressed lack of experience and confidence in managing tracheostomy patients. Method We used a pre-test, post-test approach, assessing self-reports of caregiver experience and confidence regarding tracheostomy care. Participants included nurses, allied health therapists, and respiratory therapists at a large urban inpatient rehabilitation hospital. Interventions An interprofessional online tracheostomy training program was developed for staff as the last step of a comprehensive quality improvement project. Results Ninety-eight (98) subjects responded to the pre-training survey, and 35 responded to the post-training survey. Prior to training, nurses reported being “very confident” in suctioning (70.9%) and stoma care (58.2%), but less so in other aspects of care. Fewer allied health therapists reported confidence in tracheostomy-related skills; however, respiratory therapists reported proficiency in most skills. Clinicians with more work experience exhibited higher levels of confidence compared to new graduates in stoma care and cleaning, emergency care, and capping and speaking valve precautions. However, 40-73% of clinicians still reported lower levels of confidence in tracheostomy-related skills. Following training, there was an increased trend of confidence in most skills, especially for nurses; however, confidence remained low in managing tracheostomy emergencies (17.6%) and identifying the differences between tracheostomy and laryngectomy (20%). Conclusions Online training may improve confidence in tracheostomy care, but critical content may necessitate multiple primary teaching methods to achieve mastery. Additional methods such as simulations, hands-on skills practice, and bedside rounds can be beneficial for material synthesis.

The Life Cycle of a Code White: A Framework for Managing Workplace Violence

A global challenge affecting health care organizations in the Covid-19 pandemic recovery era has been an increase in the incident frequency as well as qualitative severity and complexity of workplace violence (WPV) incidents. In Ontario, Canada, WPV in health care settings is often managed using an emergency response procedure known as a Code White (CW). The Toronto-based University Health Network (UHN) — a research and teaching hospital network with four centers of care and about 18,000 employees (including about 1,200 physicians and 3,900 registered nurses), a learning institute serving about 17,500 learners, and a research team with about 1,150 principal investigators — has engaged in a comprehensive quality improvement (QI) framework with the view to fully understand the complexity of CWs and effectively implement and evaluate complex interventions required to address the multidimensional problem of WPV. As part of this effort, UHN has developed the Life Cycle of a Code White (LCCW) by leveraging principles of System Engineering Initiative for Patient Safety 101, including the application of a journey map to outline the steps and involvement of specific functional units in CW incidents. This task necessitated extensive engagement with diverse stakeholders across the organization. The authors provide an example of how the LCCW initiative can be applied to enable the organization to operationalize the complexity of CW QI, catalyzing the formation of a formal CW governance structure, 12 distinct QI initiatives, and 17 quality indicators to inform data-driven change management.

Optimizing workflow of urgent stroke endovascular intervention: A focused lean six sigma project

IntroductionUrgent endovascular intervention is currently accepted as the primary and critical therapeutic approach to patients whose acute ischemic stroke results from a large arterial occlusion (LAO). In this context, one of the quality metrics most widely applied to the assessment of emergency systems performance is the “door-to-puncture” (D-P) time. We undertook a project to identify the subinterval of the D-P metric causing the most impact on workflow delays and created a narrowly focused project on improving such subinterval. MethodsUsing the DMAIC (i.e., define, measure, analyze, improve and control) approach, we retrospectively reviewed our quality stroke data for calendar year (CY) 2021 (i.e., baseline population), completed a statistical process control assessment, defined the various subintervals of the D-P interval, and completed a Pareto analysis of their duration and their proportional contribution to the D-P interval. We retooled our workflow based on these analyses and analyzed the data resulting from its implementation between May and December 2022 (i.e., outcome population). ResultsThe baseline population included 87 patients (44 men; mean age = 67.2 years). Their D-P process was uncontrolled, and times varied between 35-235 minutes (Mean = 97; SD = 38.40). Their door to angiography arrival (D-AA) subinterval was significantly slower than their arrival to puncture (AA-P) (73.4 v. 23.5 minutes; p < 0.01), accounted for 73% of the average length of the D-P interval. The group page activation to angiography arrival (GP-AA) subinterval accounted for 41.5% of the entire D-AA duration, making it the target of our project. The outcome population originally consisted of 38 patients (15 men; mean age = 70.3 years). Their D-P process was controlled, its times varying between 43-177 minutes (Mean = 85.8; SD = 34.46), but not significantly difference than the baseline population (p = 0.127). Their target subinterval GP-AA varied between 0-37 minutes and was significantly improved from the baseline population (Mean = 13.21 v. 29.68; p < 0.001). ConclusionsIt seems feasible and reasonable to analyze the subinterval components of complex quality metrics such as the D-P time and carry out more focused quality improvement projects. Care must be exercised when interpreting the impact on overall system performance, due to unexpected variations within interdependent subprocesses. The application of a robust and comprehensive LSS continuous quality improvement process in any CSC will have to include individualized focused projects that simultaneously control the different components of overall system performance.

Analysis of the Influence Path of Civic Education on Students’ Comprehensive Quality Enhancement in Colleges and Universities under the Perspective of Three-Whole Parenting

Abstract The concept of “three whole education” has become the focus of the reform of ideological and political education, and the collaborative education of ideological and political education has become an inevitable trend in the development of ideological and political education in colleges and universities in the new era. This study starts from the ideological and political education in colleges and universities, analyzes the influence path of the improvement of students’ comprehensive quality under the perspective of three-whole-parenting, and constructs a system of ideological and political education based on three-whole-parenting. On this basis, in order to further analyze the effectiveness of comprehensive quality improvement, the quantile trace regression model is constructed, and a prediction model for the learning effectiveness of Civic and Political Education is established by combining the dynamic data of students’ status and characteristics. The results show that the error of the achievement prediction model is within ±2 points, and the correlation coefficients of the dimensions of social factors and social factors are greater than 0.426 and 0.51, respectively, which have a more significant effect on the improvement of comprehensive quality. School factors, family factors, and social factors are able to significantly positively affect the dimensions. P is less than 0.001, the college Civic Education on students’ comprehensive quality of the score of the average increase of about 27 points. This study proposes a solution path for exploring the influence factors of Civic and Political Education based on Three-Whole Parenting.

Innovative Approaches to Safe Surgery: A Narrative Synthesis of Best Practices.

By encompassing a wide range of best practices within the ever-changing realm of modern surgical care, this exhaustive narrative compendium attempts to unravel the complex tapestry of novel approaches to safe surgery. Within the context of a dynamic surgical environment, this research endeavors to illuminate and integrate state-of-the-art methods that collectively methodically improve patient safety. The narrative elucidates a diverse array of practices that seek to revolutionize the paradigm of safe surgery, emphasizing technological progress, patient-centric approaches, and global viewpoints. The combined effectiveness of these methods in fostering an all-encompassing culture of safety, improving surgical precision, and decreasing complications is revealed by the results obtained from their implementation. The recognition of the dynamic interplay among multiple components, including the active participation of patients, the integration of cutting-edge technologies, and the establishment of comprehensive quality improvement programs, is fundamental to this narrative. By their collective composition, these components support the notion that secure surgical practices are intricate and interrelated. The present synthesis functions as a fundamental resource for healthcare professionals, policymakers, and researchers, providing an enlightening examination of the current condition of secure surgical practices. By emphasizing the promotion of innovation, continuous development, and the utmost quality of patient care, it offers a strategic guide for navigating the complex terrain of safe surgery. In the ever-evolving landscape of surgical care, this narrative synthesis serves as a guiding principle for stakeholders striving to understand better and implement safe surgical procedures in various healthcare environments.

Enhancing Bone Marrow Biopsy Sample Quality: A Comprehensive Quality Improvement Study at UNM Cancer Center

Introduction Adequate samples from bone marrow biopsies are required for pathologists to diagnose and monitor hematologic conditions accurately. These biopsies involve the extraction of bone marrow samples in two main forms: an aspirate and a core biopsy. In some cases, additional molecular testing may be conducted for the purposes of diagnosis and classification. The journey of a bone marrow sample from the patient's bedside to the laboratory is a complex process that involves the collaboration of numerous participants and interconnected systems to ensure the integrity and accuracy of the results. At our cancer center, we initiated a quality improvement (QI) project to assess the baseline success rate of bone marrow sample collection, identify areas for improvement in collection, form and implement targeted interventions, and then measure the project's success. Methods In this QI study, we utilized an A3 model which included 1) assessing the current state of bone marrow biopsy samples at our institution 2) reviewing the current process of collection 3) analysis to identify the root causes affecting quality 4) Identifying our goal state 5) implementing interventions to improve the quality and 6) follow up to evaluate the effectiveness of our interventions against the stated goal. To identify the current state, we assessed the quality of 101 bone marrow biopsy samples collected from May to October 2022, focusing on the aspirate, clot, and biopsy sections. Two pathologists reviewed 20 of these samples at random to re-read them and defined inadequate aspirate and clots as those which were ‘aspicular’ or ‘paucispicular’ and inadequate trephine biopsies as those that were reported as ‘limited’ or ‘inadequate’ for interpretation. This limited analysis was hypothesis generating and we relied on descriptions of aspirate quality and core length in the biopsy reports for the remaining samples. We observed different providers and technicians performing bone marrow biopsies to understand the current process of collection across our institution. Our system analysis identified the following issues: Non-standardized collection technique, communication errors between technicians and providers in terms of core length and aspirate adequacy, and technician proficiency in identifying spicules and core length To address these issues, we wrote a guideline outlining the recommended standard technique and performed a training for all providers. This guideline included a standard communication guideline between technicians and providers. Technicians underwent additional training in terms of identifying spicules and measuring core length. We set a pre-defined goal of success as 70% adequacy for bone marrow biopsy aspirates and 90% adequacy for core biopsies. Following our interventions, we started collecting post-intervention bone marrow biopsies in May 2023 and plan to evaluate the adequacy of 100 bone marrow samples Results Samples were categorized as those performed by interventional radiology (IR) providers and non-IR providers (advanced practice providers, attendings, and fellows).At baseline, the adequacy rates for aspirate, clot, and biopsy sections were 35%, 36%, and 87%, respectively, for IR providers, and 63%, 70%, and 67%, respectively, for non-IR providers. (Table 1)We plan to evaluate 100 samples post-intervention and to date, we have evaluated 20 samples. Among IR cases, adequacy rates for aspirate, clot, and biopsy sections were 69%, 85%, and 92%, respectively. For non-IR cases, adequacy rates were 86%, 100%, and 86%, respectively. (Table 2) Although additional samples are needed to confirm our results, there is thus far a noticeable improvement in the rate of adequate sample collection for both IR and non-IR providers. While not included in the current analysis, we plan to add patient factors that may affect sample collection such as Body Mass Index or use of sedation in our final analysis to address potential confounders. Conclusion Through our QI study, we aimed to enhance the quality of bone marrow biopsy samples at our institution. Preliminary results demonstrate improvements in the rate of adequate sample collection for aspirate and core biopsies following our quality interventions. Future studies will explore the impact of patient and disease factors on sample quality and also assess whether the improved outcomes are sustained at a later point in time with additional follow up.