Background

Since 2015, the National Institute for Health and Care Excellence (NICE) guidelines have recommended antenatal magnesium sulfate (MgSO4) for mothers in preterm labour (<30 weeks’ gestation) to reduce the risk of cerebral palsy (CP) in the preterm baby. However, the implementation of this guideline in clinical practice was slow, and MgSO4 use varied between maternity units. In 2018, the PRrevention of Cerebral palsy in PreTerm labour (PReCePT) programme, an evidence-based quality improvement (QI) intervention to improve use of MgSO4, was rolled out across England. Earlier evaluation found this programme to be effective and cost-effective over the first 12 months. We extended the original evaluation to determine the programme’s longer-term impact over 4 years, its impact in later preterm births, the impact of the COVID-19 pandemic, and to compare MgSO4 use in England (where PReCePT was implemented) to Scotland and Wales (where it was not).

Methods

Quasi-experimental longitudinal study using data from the National Neonatal Research Database on babies born <30 weeks’ gestation and admitted to a National Health Service neonatal unit. Primary outcome was the percentage of eligible mothers receiving MgSO4, aggregated to the national level. Impact of PReCePT on MgSO4 use was estimated using multivariable linear regression. The net monetary benefit (NMB) of the programme was estimated.

Results

MgSO4 administration rose from 65.8% in 2017 to 85.5% in 2022 in England. PReCePT was associated with a 5.8 percentage points improvement in uptake (95% CI 2.69 to 8.86, p<0.001). Improvement was greater when including older preterm births (<34 weeks’ gestation, 8.67 percentage points, 95% CI 6.38 to 10.96, p<0.001). Most gains occurred in the first 2 years following implementation. PReCePT had a NMB of £597 000 with 89% probability of being cost-effective. Following implementation, English uptake appeared to accelerate compared with Scotland and Wales. There was some decline in use coinciding with the onset of the pandemic.

Conclusions

The PReCePT QI programme cost-effectively improved use of antenatal MgSO4, with anticipated benefits to the babies who have been protected from CP.

Background

The Child Opportunity Index (COI) is a multidimensional measure of US neighbourhood-level conditions needed for healthy development. COI is associated with healthcare delivery and outcomes. Formal quality improvement (QI) may influence the relationship between COI, quality of care and outcomes in children.

Objective

To assess the association between COI and paediatric sepsis care delivery and outcomes and determine if baseline disparities in care change over time among hospitals in the Improving Pediatric Sepsis Outcomes (IPSO) collaborative.

Methods

Retrospective cohort study of IPSO patients probabilistically linked to the Pediatric Health Information System database from 2017 to 2021. Primary exposure was COI. We estimated differences in the proportions of patients in each COI quintile identified via standardised sepsis recognition protocols (screening tool, huddle documentation and/or order set use) and who received a bundle of recommended care (standardised sepsis recognition, plus bolus <1 hour and antibiotic <3 hours). We further assessed the timeliness of each bundle component and mortality. We evaluated changes in standardised sepsis recognition over time using generalised linear models.

Results

31 260 sepsis cases from 24 hospitals were included. Cross-sectional analysis over the entire study period found patients in the Very High COI quintile were most likely to be identified via standardised recognition protocols and receive IPSO’s recommended care bundle (67.7% and 46%, respectively). Over time, standardised sepsis recognition improved for all; the greatest improvements were among inpatients in the Very Low COI quintile.

Conclusion

Disparities exist in paediatric sepsis care delivery by COI. Over the course of the IPSO collaborative, care improved most for children in the lowest COI quintile. QI collaboratives focused on standardisation and shared learning may reduce disparities.

Background

Regulation plays a central role in health and social care systems, particularly in ensuring quality, safety and accountability. However, there is limited understanding of how organisations effectively implement and adhere to these regulatory requirements. In particular, little is known about how providers of residential care facilities for people with disabilities (RCF-D) navigate and apply statutory care regulations.

Methods

We conducted semistructured interviews with managers of RCF-D. Participant recruitment followed a purposive maximum variation sampling approach. 19 participants were interviewed, representing 22 RCF-D and 16 provider organisations. Interview data were analysed using a mixed deductive–inductive approach.

Results

Most managers were supportive of regulatory goals, creating a more favourable environment for successful implementation. By making sense of regulatory requirements and sharing insights across their organisations, managers facilitated smoother implementation. Crucially, building strong internal and external networks played a pivotal role in driving success. Collaborative relationships with inspectors, centred on a shared commitment to improving residents’ lives, further strengthened the implementation process.

Conclusion

Managers of RCF-D devised a range of strategies to manage compliance, balancing regulatory demands with problem-solving and relationship-building. These efforts were supported by a collaborative approach to working with inspectors, which fostered a shared commitment to improving residents’ lives. Our findings offer practical guidance for organisations seeking to improve regulatory compliance through effective relationship management and resource alignment. Future research could investigate how framing regulation as an adaptive intervention could further enhance implementation and sustain compliance.

Background

There is increasing interest in how patient complaint material can be used to highlight areas requiring quality improvement (QI) in healthcare. However, knowledge of using complaint material to initiate or monitor QI is limited.

Objectives

This review explored the use of complaint material in QI by identifying problems related to substandard care that were addressed by QI initiatives, exploring how complaint material was used before or after a QI initiative, and mapping changes in complaint material after QI initiatives.

Methods

This scoping review followed the Joanna Briggs Institute methodology and adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews reporting guideline.

Eligibility criteria

Studies were included if a QI initiative was initiated or monitored using complaint material. Eligible designs included observational studies, QI projects, pre-intervention and post-intervention studies and randomised controlled trials. Audio, online and symptom-based complaints were excluded.

Information sources

A systematic search was conducted on 10 December 2024 in Embase, Medline, CINAHL and Web of Science, and additional sources, with no language or date limitations.

Synthesis of results

Substandard problems targeted by QI initiatives were categorised using the Healthcare Complaints Analysis Tool by two independent coders. Findings were synthesised narratively and summarised using frequency analyses where applicable.

Results

We identified 58 QI initiatives, most frequently targeting safety (n=39). Before QI, complaint material was usually analysed through review (n=19), counts (n=17), content categorisation (n=9) or root cause analysis (n=2). After QI, analyses included counts (n=34), rates (n=20), content categorisation (n=7) and review (n=4). Reviewing or categorisation methods were often unspecified. Among studies using complaints as an outcome, most reported complaint reductions (n=43), while a few reported increases (n=2) or mixed results (n=4).

Discussion

The QI initiatives primarily targeted patient safety and applied simple quantitative analyses. Some studies relied on reviews or categorisations without reporting the validation or reliability of the used tools. Improved reporting standards are needed to strengthen learning. Furthermore, while QI initiatives appear to have the potential to change complaint patterns, this finding should be interpreted with caution, as this is based on a scoping review.

Other

Preregistered protocol: https://osf.io/6g4qw.

Introduction

Quality improvement (QI) and implementation science (IS) are distinct, yet related fields that aspire to improve the quality of healthcare for all people. QI is a systematic, data-driven approach to continuous problem solving in healthcare, with a focus on enhancing the efficiency, quality and safety of care delivery.1 Emerging in the mid-to-late twentieth century, QI identifies and analyses local problems, develops and implements targeted structural and process-focused solutions, and evaluates their outcomes. Separately, IS emerged in the late twentieth century due to growing awareness of the need to bridge the gap between research findings and their application in real-world settings. IS, defined as the study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine healthcare and public health settings, emphasises improving healthcare processes and outcomes.2 While the disciplines share common goals, the fields diverge with respect...