Improving emergency surgical care for patients with right iliac fossa pain at a regional scale: A quality improvement study using the Supported Champions implementation strategy

Feinberg, Joshua A; Flynn, Lorna; Woodward, Matthew; Pennell, Christopher; Higham, Helen; Morgan, Lauren; Holman, Lance; Tully, Patrick; McCulloch, Peter

doi:10.1016/j.ijsu.2018.08.003

Cited by 1 publication

(8 citation statements)

References 9 publications

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“…The primary aim of five QICs was to improve patient outcome indicators such as mortality or length of stay. 19–23 Four QICs had primary aims to improve process indicators: two related to time to surgery, 24 25 and one related to having a booked ‘to come in’ date for surgery 26 and one looking at implementation of a monitoring device. 27 The one remaining QIC had a broad aim of ‘providing… care of the highest quality’, 28 and looked for changes in a set of patient outcome and process measures.…”

Section: Resultsmentioning

confidence: 99%

“…The number of expert team-led sessions varied from 2 to 16 across the QICs. QI methods used included Plan–Do–Study–Act cycles, 19–22 28 lean-based QI methodology, 24 driver diagrams, 21 human factors 24 and systems analysis, 21 and the care bundle approach. 20 Data sources for the process and patient outcome indicators included national databases such as KH07 Central Returns, 26 national administrative hospital data (Hospital Episode Statistics), 19 22 23 25 national clinical registries the National Emergency Laparotomy Audit, 21 22 the National Hip Fracture Database 28 and the National Vascular Database, 19 as well as locally collected data.…”

Section: Resultsmentioning

confidence: 99%

“…An expert team leading the collaborative was a defining key feature of a QIC in this review. Eight studies described at least one attribute of at least one member of the expert team, including expertise, 24 28 30 job role 19 21 23 and employing organisation. 26 27 Multidisciplinary QI teams were described in seven studies, 19–22 24 25 27 30 and in the remainder the composition of the team was not discussed.…”

Section: Resultsmentioning

confidence: 99%

“…Resource availability appeared to be key, specifically with regard to time for staff to participate in QI activities, 22 24–26 28 30 33 financial resource 19 23 26–28 30 and human resource. 24 26 28 30 Members of one collaborative used sharing of local data to encourage the provision of extra resource. 19…”

Section: Resultsmentioning

confidence: 99%

“…The presence or absence of organisational leadership engagement was also important for the success of individual sites within the collaborative; support from senior leadership helped to overcome financial issues 27 and embed change, 19 but lack of leadership engagement was seen as a barrier to performance by several other studies. 24 26 30 …”

Section: Resultsmentioning

confidence: 99%

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Effectiveness of quality improvement collaboratives in UK surgical settings and barriers and facilitators influencing their implementation: a systematic review and evidence synthesis

et al. 2023

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BackgroundHigh-quality surgical care is vital to deliver the excellent outcomes patients deserve following surgical treatment. Quality improvement collaboratives (QICs) are based on a multicentre model for improving healthcare. They are increasingly used but their effectiveness in the context of surgical services is unclear. This review assessed effectiveness of QICs in National Health Service (NHS) surgical settings, and identified factors that influenced implementation.MethodsA systematic search of MEDLINE and EMBASE, as well as grey literature, was conducted in January 2022 to identify evaluations of QICs in NHS surgical settings. Data were extracted on the intervention, setting, study results and factors that were identified as facilitators or barriers. These were coded using the Consolidated Framework for Implementation Research (CFIR). The quality of study reports was assessed using Quality Improvement Minimum Criteria Set.ResultsFifteen reports on 10 QICs met inclusion criteria. The evaluations used study designs of different strength, with one using a stepped-wedge randomised controlled trial (RCT). Eight studies reported the QIC had been successful in achieving their principal aims, which covered a mix of patient outcomes and process indicators. The study based on the RCT found the QIC was not successful (no improvement in patient outcomes). Each article reported a range of facilitators and barriers to effectiveness of implementation of the QIC, which were spread across the CFIR domains (intervention, outer setting, inner setting, individuals and process). There were few barriers reported in the intervention domain that related to the QIC. There was no clear relationship between numbers of facilitators and barriers reported and effectiveness.ConclusionsStudies have reported QICs to be effective in increasingly complex contexts, but their results must be treated with caution. The evaluations often used weak study designs and the quality of reports was variable. Evaluation with strong study design should be integral to future QICs.PROSPERO registration numberCRD42022324970.

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Section: Resultsmentioning

confidence: 99%