Continuous monitoring and feedback of quality of recovery indicators for anaesthetists: a qualitative investigation of reported effects on professional behaviour

Patient and healthcare provider perceptions on using patient-reported experience measures (PREMs) in routine clinical care: a systematic review of qualitative studies

BACKGROUND

Patient-reported experience measures (PREMs) assess quality-of-care from patients' perspectives. PREMs can be used to enhance patient-centered care and facilitate patient engagement in care. With increasing quality improvement studies in clinical practice, the use of PREMs has surged. As a result, knowledge about stakeholder experiences of using PREMs to assess quality of care across diverse clinical settings is needed to inform PREM implementation efforts. To address this, this review examines the qualitative literature on patient and healthcare provider experiences of using PREMs in clinical practice.

METHODS

Medline, Embase and PsycInfo were systematically searched from inception to May 2021. Additional searching of reference lists for all included articles and relevant review articles were performed. Retrieved articles were screened for eligibility by one reviewer and 25% cross-checked by a second reviewer across all stages of the review. Full texts meeting eligibility criteria were appraised against the COREQ checklist for quality assessment and thematic analysis was used to analyze textual data extracted from the results.

RESULTS

Electronic searches identified 2683 records, of which 20 studies met eligibility criteria. Extracted data were synthesized into six themes: facilitators to PREM implementation; barriers to PREM implementation; healthcare providers' perspectives towards using PREMs; patients' perspectives towards using PREMs; advantages of using PREMs in clinical practice; limitations and practical considerations to reduce resistance of PREM usage. The primary factors facilitating and impeding the use of PREMs include organizational-, staff- and patient-related factors.

CONCLUSION

Results can be used to guide the usage and implementation of PREMs in clinical settings by addressing the identified barriers and building on the perceived benefits to encourage adoption of PREMs. Results around facilitators to PREM implementation and practical considerations could also promote appropriate use of PREMs by healthcare providers, helping to improve practice and the quality of care based on patient feedback.

[Dexmedetomidine alleviates cognitive dysfunction induced by tibial fracture in rats]

OBJECTIVE

To study the effect of dexmedetomidine (Dex) on cognitive dysfunction induced by tibial fracture in rats.

METHODS

Sixteen male SD rats were randomized into control group and tibial fracture group, and the behavior indicators were measured on days 1, 3, 5 and 7 after tibial fracture and the expressions of CX3L1 protein and mRNA in the hippocampus were detected. Another 24 male SD rats were randomly divided into control group, tibial fracture group, and tibia fracture with CX3CL1 antibody group, and the behavior indicators and hippocampal CX3L1 protein expression were evaluated after corresponding treatments. In another experiment, we randomized 24 male SD rats into control group, tibial fracture group and tibial fracture with Dex treatment, and tested their hippocampal CX3L1 protein and mRNA expressions as well as the behavior indicators after the treatments.

RESULTS

Compared with the control rats, the rats with tibial fracture spent significantly less time in the novel arm on days 1, 3, 5 and 7 after the fracture (P < 0.05) with obviously lowered expressions of CX3L1 protein and mRNA in the hippocampus (P < 0.05). In the rats with tibial fracture, treatment with CX3CL1 antibody further decreased the time spent in the novel arm (P < 0.05) and the expression level of CX3L1 protein in the hippocampus (P < 0.05); In contrast, treatment with Dex significantly increased the time spent time in the novel arm (P < 0.05) and enhanced the hippocampal expressions of CX3L1 protein and mRNA in rats with tibial fractures (P < 0.05).

CONCLUSIONS

Dex can alleviate cognitive dysfunction induced by tibial fracture in rats by increasing the expression of CX3CL1 in the hippocampus.

Improvement Science in Anaesthesia

PURPOSE OF REVIEW

This article offers an overview of the history and features of Improvement Science in general and some of its applications to Anaesthesia in particular.

RECENT FINDINGS

Improvement Science is an evolving discipline aiming to generate learning from quality improvement interventions. An increasingly common approach to improving Anaesthesia services is to employ large-scale perioperative data measurement and feedback programmes. Improvement Science offers important insights on questions such as which indicators to collect data for; how to capture that data; how it can be presented in engaging visual formats; how it could/should be fed back to frontline staff and how they can be supported in their use of data to generate improvement.

SUMMARY

Data measurement and feedback systems represent opportunities for anaesthetists to work with multidisciplinary colleagues to help improve services and outcomes for surgical patients. Improvement Science can help evaluate which approaches work, and in which contexts, and is therefore of value to healthcare commissioners, providers and patients.