The role of the institutional review board in quality improvement: a survey of quality officers, institutional review board chairs, and journal editors

Supporting the Pursuit of Quality Improvement Publication: What Your Organization Can Do Now

Many health care organizations encourage frontline staff to pursue quality improvement (QI), local spread of those improvements, and publication of their work. Although much has been written about building and sustaining a culture of continuous QI, less is known about how to support success in QI rigor, credibility, spread, and publication. In this perspective article, we offer QI leaders practical suggestions to identify challenges in publishing QI and strategies to overcome these challenges. Health care organizations can assist QI teams with publication by intentionally formalizing scholarship early in their QI project work, providing accountability, and connecting the QI team to necessary resources. A carefully designed program supporting QI publication can both improve the rigor of QI work and enhance the professional development of QI professionals.

Quality Improvement in Canadian Nephrology: Key Considerations in Ensuring Thoughtful Ethical Oversight

Purpose of review:

Quality improvement (QI) work is a cornerstone of health care, and a growing area within nephrology. With such growth comes the need to ensure that QI activities are implemented in an ethically responsible manner. The existing institutional research board (IRB) framework has largely focused on reviewing the ethical suitability of traditional research projects, and it can be challenging to know if QI initiatives require formal ethics oversight. Several tools have been developed to assist in distinguishing between the two, such as the “A pRoject Ethics Community Consensus Initiative” tool. Our objective was to demonstrate how QI is distinct from research, to outline how QI-focused IRB process is used across Canada, and to develop a practical aid for clinicians embarking on QI-related projects.

Sources of information:

Publicly available institutional Web sites from academic and select nonacademic sites across Canada.

Methods:

Institutional Web sites across all academic centers within Canada were examined to determine local QI-specific ethics review processes. We have provided examples of QI processes from select community sites. We have developed a tool to assist clinicians navigate the ethical challenges of QI projects and to determine whether their project may require ethics approval.

Key findings:

This overview of the considerations of the research ethics approval process helps clinicians to determine whether IRB approval is required for QI studies. Examples of the current ethical processes employed in both academic and community institutions across Canada demonstrate the variability between centers. We have included examples of fictional nephrology-oriented QI initiatives to illustrate when ethics approval may be considered, along with a flowchart. This summary highlights the opportunity for QI-specific IRB review processes to be standardized across Canada, along with the need for creation of a separate stream with dedicated expertise for QI project review.

Limitations:

We did not do a formal environmental scan of the QI IRB review process in all hospital institutions across Canada.

Ethical Issues in Patient Safety Research: A Systematic Review of the Literature

As many as 1 in 10 patients is harmed while receiving hospital care in wealthy countries. The risk of health care-associated infection in some developing countries is as much as 20 times higher. In response, in many global regions, increased attention has turned to the implementation of a broad program of safety research, encompassing a variety of methods. Although important international ethical guidelines for research exist, literature has been emerging in the last 20 years that begins to apply such guidelines to patient safety research specifically. This paper provides a review of the literature related to ethics, oversight, and patient safety research; identifies issues highlighted in articles as being of ethical relevance; describes areas of consensus regarding how to respond to these ethical issues; and highlights areas where additional ethical analysis and discussion are needed to provide guidance to those in the field.

Adverse events arising from a palliative care survey

Development of evidence-based practice requires investigation of the attitudes and needs of patients, families and healthcare professionals, particularly for sensitive subject areas. Cystic fibrosis (CF) is a recessively inherited life-limiting disorder resulting in early death. Patients with this condition generally expect that lung transplantation will be an available treatment option; however, this is uncertain. A dual approach to care that involves both preparing patients for transplant assessment, while simultaneously exploring acceptable palliative care options is needed. A survey amongst patients with CF, their families and health carers was conducted to understand their attitudes and needs in relation to end-of-life care. The survey encompassed five separate domains, with a total of 60 questions requiring approximately 20 min to complete. Of the 200 surveys sent to patients, 82 (41%) completed responses were received. The Institutional Ethics Committee received six complaints from families of seven patients (3.5% of those surveyed). This article explores the nature of the adverse responses to the survey. The majority of complaints were received from family members rather than from patients. Complaints described dissatisfaction with the topic, little warning about the study and felt it to be inappropriate for their family member's level of health. Survey instruments used to determine attitudes and needs in relation to end-of-life patient care are likely to elicit adverse responses that should be reported in a similar way to other investigational studies. Also arising from adverse responses and the complaint process, is the impact of criticism on study researchers.

Modifications of Graduate Public/ Community Health Nursing Internships to Facilitate Compliance with Institutional Review Board and Health Insurance Portability and Accountability Act (HIPAA) Regulations

This paper describes the changes that were made to a two-semester graduate internship course to facilitate student compliance with Institutional Review Board (IRB) and agency requirements for compliance with the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA). Students now spend the first semester of the internship developing collaborative relationships with the agency and conceptualizing, planning, and developing all aspects of the project, including preparing materials for an IRB review. A series of workshops about the IRB process, the Privacy Rule of HIPAA, and on-line resources have been developed. A password-protected web site and other resources were developed for preceptors. The result of the changes has been primarily positive. By having to conceptualize and develop the entire project at the beginning, students demonstrate a better understanding of program development and evaluation. Their writing has markedly improved. Preceptors like the course revisions, the convenience of on-line resources, and the enhanced course focus on the protection of health care information and of potential participants in health education programs or program evaluation projects.