Despite the benefits of quality improvement (QI) training, there is a scarcity of information on QI teaching formats for undergraduate pharmacy education. The Evidence-based Practice for Improving ...Quality (EPIQ) workshop was evaluated as a teaching format for a group of multi-year undergraduate pharmacy students, assessing knowledge acquisition and learner reactions.
Using a convergent mixed-method analysis, 10-item pre- and post-workshop multiple-choice questionnaires measured students' knowledge acquisition of foundational QI concepts. A six-item pre- and post-workshop survey and a voluntary post-workshop focus group evaluated students' attitudes towards QI training and the teaching format. Mann-Whitney U non-parametric test was used to analyze the quantitative data, while thematic analysis was applied to analyze the qualitative data.
Twenty-nine pharmacy students participated in the workshop. There was a statistically significant improvement in pharmacy students’ QI knowledge before and after participating in the workshop (77% vs. 86%, P = .008). The evaluation of the EPIQ teaching format resulted in three important findings: (1) undergraduate pharmacy students identified a QI learning need; (2) the EPIQ workshop effectively provided foundational QI literacy for all pharmacy student years using a “learning by sharing” methodology and pharmacy-specific case studies; and (3) interested students may benefit from an experiential elective to apply QI techniques.
The perceived value of QI training for pharmacy students using the EPIQ workshop was demonstrated: students expressed an interest in lifelong learning and a desire to pursue QI projects at school, during a clinical rotation, or at work.
Canadian medical schools offer limited clinical dermatology training. In addition, there is a lack of educational resources that are designed specifically for clerkship students that focus on the ...multidisciplinary nature of dermatology.
After developing case-based educational resources to address the lack of clinical exposure and learning of multidisciplinary care in dermatology, this study aimed to evaluate the educational intervention and gather feedback for future module development.
Ten online interactive dermatology case-based modules involving 14 other disciplines were created. Medical students (n = 89) from two Canadian schools were surveyed regarding perceptions of the existing dermatology curriculum. Among 89 students, 46 voluntarily completed the modules, and a survey (a five-point Likert scale ratings) including narrative feedback was provided to determine an improvement in dermatology knowledge and understanding of multidisciplinary care.
Among 89 surveyed students, only 17.1% agreed that their pre-clerkship dermatology education was sufficient and 10.2% felt comfortable managing patients with skin conditions in a clinical setting. Among 46 students, 95.7% of students agreed that the modules fit their learning style (4.17 ± 0.73 on Likert scale) with positive narrative feedback. 91.3% agreed or strongly agreed that the modules enhanced their dermatology knowledge (4.26 ± 0.61). 79.6% of students agreed that the modules helped with understanding the multidisciplinary nature of dermatological cases (3.98 ± 0.81). Student comfort to manage skin conditions increased 7.7 times from 10.2% to 78.3% post-module.
Clerkship students had limited knowledge of dermatologic conditions; the case-based modules were able to successfully address these deficits and assist students in understanding the multidisciplinary nature of dermatology.
Background
Indiscriminate use of laboratory blood testing in hospitals contributes to patient discomfort and healthcare waste. Patient engagement in low‐value healthcare can help reduce overuse. ...Understanding patient experience is necessary to identify opportunities to improve patient engagement with in‐hospital laboratory testing.
Objectives
To understand patient experience with the process of in‐hospital laboratory blood testing.
Methods
We used a qualitative study design via semistructured interviews conducted online or over the phone. Participants were adult patients or family members/caregivers (≥18 years of age) with a recent (within 12 months of interview) experience of hospitalization in Alberta or British Columbia, Canada. We identified participants through convenience sampling and conducted interviews between May 2021 and June 2022. We analysed transcripts using thematic content analysis. Recruitment was continued until code saturation was reached.
Results
We interviewed 16 participants (13 patients, 1 family member and 2 caregivers). We identified four themes from patients' experiences of in‐hospital laboratory blood testing: (i) patients need information from healthcare teams about expected blood testing processes, (ii) blood draw processes should consider patient comfort and preferences, (iii) patients want information from their healthcare teams about the rationale and frequency of blood testing and (iv) patients need information on how their testing results affect their medical care.
Conclusion
Current laboratory testing processes in hospitals do not facilitate shared decision‐making and patient engagement. Patient engagement with laboratory testing in hospitals requires an empathetic healthcare team that provides clear communication regarding testing procedures, rationale and results, while considering patient preferences and offering opportunities for involvement.
Patient or Public Contribution
We interviewed 16 patients and/or family members/caregivers regarding their in‐hospital laboratory blood testing experiences. Our findings show correlations between patient needs and patient recommendations to make testing processes more patient‐centred. To bring a lived‐experience lens to this study, we formed a Patient Advisory Council with 9–11 patient research partners. Our patient research partners informed the research design, co‐developed participant recruitment strategies, co‐conducted data collection and informed the data analysis. Some of our patient research partners are co‐authors of this manuscript.
Urine testing on asymptomatic patients is not aligned with guidelines; however, stroke survivors have trouble communicating symptoms, and urinary tract infections (UTIs) are a recognised poststroke ...complication. All stroke inpatients at a tertiary rehabilitation hospital underwent urine testing on admission. We led a quality improvement (QI) project on one stroke rehabilitation unit aimed to reduce admission urine testing from 100% to 0%. Baseline audit representing 2 weeks of admissions identified 27 of 28 patients had urine tests; however, none required UTI treatment despite 3 positive culture results. Estimated cost of testing was $C675. QI tools identified that a standardised paper-based admission form facilitated automatic urine testing. Project intervention strategies included education, clinicians crossing off urine orders and unit clerks flagging unaddressed orders for reassessment. A chart audit after 4 weeks and prescriber survey after 6 months assessed impact. Postintervention audit (n=23) revealed 1 patient had admission urine tests, 22 orders were crossed out, 1 chart was flagged and estimated testing cost declined from $C675 to $C25. Six urine tests were completed after admission and two patients required UTI treatment. Post 6 months, unit clerks assumed the role to cross out the order on the standardised form, and no patient had routine admission urine testing. There was no clinical benefit in screening for UTIs prior to stroke rehabilitation. This project is a practical example of deadopting a practice promoted by standardised order forms.
IntroductionLaboratory blood testing is one of the most high-volume medical procedures and continues to increase steadily with instances of inappropriate testing resulting in significant financial ...implications. Studies have suggested that the design of a standard hospital admission order form and laboratory request forms influence physician test ordering behaviour, reducing inappropriate ordering and promoting resource stewardship.Aim/methodTo redesign the standard medicine admission order form-laboratory request section to reduce inappropriate blood urea nitrogen (BUN) testing.ResultsA redesign of the standard admission order form used by general internal medicine physicians and residents in two large teaching hospitals in one health zone in Alberta, Canada led to a significant step reduction in the ordering of the BUN test on hospital admission.ConclusionsRedesigning the standard medicine admission order form-laboratory request section can have a beneficial effect on the reduction in BUN ordering altering physician ordering patterns and behaviour.
Abstract Background Laboratory test overuse in hospitals is a form of healthcare waste that also harms patients. Developing and evaluating interventions to reduce this form of healthcare waste is ...critical. We detail the protocol for our study which aims to implement and evaluate the impact of an evidence-based, multicomponent intervention bundle on repetitive use of routine laboratory testing in hospitalized medical patients across adult hospitals in the province of British Columbia, Canada. Methods We have designed a stepped-wedge cluster randomized trial to assess the impact of a multicomponent intervention bundle across 16 hospitals in the province of British Columbia in Canada. We will use the Knowledge to Action cycle to guide implementation and the RE-AIM framework to guide evaluation of the intervention bundle. The primary outcome will be the number of routine laboratory tests ordered per patient-day in the intervention versus control periods. Secondary outcome measures will assess implementation fidelity, number of all common laboratory tests used, impact on healthcare costs, and safety outcomes. The study will include patients admitted to adult medical wards (internal medicine or family medicine) and healthcare providers working in these wards within the participating hospitals. After a baseline period of 24 weeks, we will conduct a 16-week pilot at one hospital site. A new cluster (containing approximately 2–3 hospitals) will receive the intervention every 12 weeks. We will evaluate the sustainability of implementation at 24 weeks post implementation of the final cluster. Using intention to treat, we will use generalized linear mixed models for analysis to evaluate the impact of the intervention on outcomes. Discussion The study builds upon a multicomponent intervention bundle that has previously demonstrated effectiveness. The elements of the intervention bundle are easily adaptable to other settings, facilitating future adoption in wider contexts. The study outputs are expected to have a positive impact as they will reduce usage of repetitive laboratory tests and provide empirically supported measures and tools for accomplishing this work. Trial Registration This study was prospectively registered on April 8, 2024, via ClinicalTrials.gov Protocols Registration and Results System (NCT06359587). https://classic.clinicaltrials.gov/ct2/show/NCT06359587?term=NCT06359587&recrs=ab&draw=2&rank=1
Correspondence to Pamela Mathura; Pam.Mathura@albertahealthservices.ca Introduction Visual photographic approaches have steadily gained momentum in health services research in the last 20 years; ...however, its use in quality improvement (QI) is sparse.1 Currently, the traditional A3 QI story board is an integral component for sharing health service improvement efforts. Named after the A3 international paper size of approximately 11″ × 17″, this one page/poster provides a visually concise synopsis of the problem, the root causes identified, the resolution and metrics that indicate resolution effect.2 The benefit of the A3 QI storyboard approach is in the thinking and behaviours it stimulates along with facilitating dialogue.3 Photovoice is a visual participatory method in which photographic images are taken to strengthen and supplement the more robust metrics involved in QI.4 The photographic image triangulates with the conventionally generated quantitative and qualitative findings to create a more comprehensive QI story.5 6 In QI studies that have used photographic images, the rationale for inclusion are, first, to alleviate challenges related to change acceptance as healthcare employees may gain a better understanding of why the improvement is a priority. ...to facilitate collaboration between different stakeholder groups, and lastly the photographs may lead to a more direct understanding of people, their life experiences and perceptions enabling others to empathise and understand the QI effort.7 Within the setting of healthcare, engaging providers and patients, obtaining their buy-in and understanding their unique perspectives/experience are essential to improve the quality of care.8–10 Here, we describe an initiative that undertook the inclusion of photovoice within the healthcare QI storyboard to convey the improvement effort beyond the usual narratives and metrics of a traditional A3 storyboard. Halvorsrud et al used photovoice to tell the story of ethnic minority people’s struggle with mental illness,8 Balbale et al enlightened the public on the perspectives of healthcare employees,9 and Kramer et al used photovoice to create a successful community health campaign.10 The use of photographic approaches in aforementioned projects allowed for greater engagement of participants and stakeholders with the identified problem, making it an invaluable addition to any QI project.
BackgroundA coalition (Strategic Clinical Improvement Committee), with a mandate to promote physician quality improvement (QI) involvement, identified hospital laboratory test overuse as a priority. ...The coalition developed and supported the spread of a multicomponent initiative about reducing repetitive laboratory testing and blood urea nitrogen (BUN) ordering across one Canadian province. This study’s purpose was to identify coalition factors enabling medicine and emergency department (ED) physicians to lead, participate and influence appropriate BUN test ordering.MethodsUsing sequential explanatory mixed methods, intervention components were grouped as person focused or system focused. Quantitative phase/analyses included: monthly total and average of the BUN test for six hospitals (medicine programme and two EDs) were compared pre initiative and post initiative; a cost avoidance calculation and an interrupted time series analysis were performed (participants were divided into two groups: high (>50%) and low (<50%) BUN test reduction based on these findings). Qualitative phase/analyses included: structured virtual interviews with 12 physicians/participants; a content analysis aligned to the Theoretical Domains Framework and the Behaviour Change Wheel. Quotes from participants representing high and low groups were integrated into a joint display.ResultsMonthly BUN test ordering was significantly reduced in 5 of 6 participating hospital medicine programmes and in both EDs (33% to 76%), resulting in monthly cost avoidance (CAN$900–CAN$7285). Physicians had similar perceptions of the coalition’s characteristics enabling their QI involvement and the factors influencing BUN test reduction.ConclusionsTo enable physician confidence to lead and participate, the coalition used the following: a simply designed QI initiative, partnership with a coalition physician leader and/or member; credibility and mentorship; support personnel; QI education and hands-on training; minimal physician effort; and no clinical workflow disruption. Implementing person-focused and system-focused intervention components, and communication from a trusted local physician—who shared data, physician QI initiative role/contribution and responsibility, best practices, and past project successes—were factors influencing appropriate BUN test ordering.
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