Using a stakeholder co-design approach to develop interventions for quality improvement based on patient complaints

Background: While research into complaints made about hospitals is increasing, this has yet to be translated into interventions to improve quality and safety. Incorporating the views of stakeholders into learning from complaints can be an effective means of bridging the gap between research and implementation in patient safety research. Aims: The aim of the study is to assess whether a co-design approach involving stakeholders is feasible and effective for identifying interventions to address issues from patient complaints. Methods: A series of online workshops and surveys were utilized to collate the views of stakeholders including patients, healthcare providers, health system researchers, and healthcare managers on how to improve quality and safety in care. Findings of previous analyses of patient complaints were used to identify the focus of this study and guide participants. The strength and feasibility of the interventions outlined by participants was subsequently assessed. Results: Thirty-two interventions were outlined across the two workshops. These were ranked by participants using the APEASE model. Participants considered the co-design approach an appropriate and effective way to identify interventions for quality and safety improvement. Conclusions: Stakeholder co-design demonstrated excellent potential for suggesting interventions to improve patient safety based on the findings of complaints analyses

Learning from complaints about hospital care

Complaints are often seen as a negative experience in healthcare, with patients or family members writing about poor experiences of care, or things that went wrong. These things that go wrong may be small issues or major problems. Patient complaints are usually written with the aim of helping to improve healthcare for future patients. Patients may have a perspective that differs from healthcare providers. For example, providers might not know about how patients dignity was respected, whether they experienced delays, or how they were interacted with. Patients, however, know all of these things. It is known that patient insights into their care can improve healthcare. However, these insights may not be considered to the same extent as staff measures of quality and safety of care. Most assessments of quality of care in Irish healthcare services are focused on healthcare workers’ opinions, statistics about observable events (e.g., how many patients got an infection in hospital), or investigating large errors. Until recently, complaints have not been used by hospitals or the healthcare service in Ireland to make broad improvements to healthcare delivery. While these complaints receive individual responses, there is no focus on analysing these complaints together and using this data to learn about key issues in specific services and the healthcare system. This means that patients’ desire, and ability, to contribute to identifying problems and potential solutions are limited. Researchers at the London School of Economics have developed the Healthcare Complaints Analysis Tool (HCAT)1 that guides the systematic analysis of the cause and severity of complaints. The Health Research Board (HRB) and Health Service Executive (HSE) funded research project utilised the HCAT to analyse complaints received about Irish healthcare organisations. The research involved the collaboration of researchers, HSE managerial staff, healthcare workers, and quality and patient safety professionals in hospitals.An Applied Partnership Award funded by the Health Research Board and the HSE Quality Assurance and Verification Division (Grant number APA-2017-006)non-peer-reviewe

Changes in peristomal skin condition and user experience of a novel ostomy barrier ring with assisted flow: a 6-week feasibility study

PURPOSE: This purpose of this study was to evaluate a novel barrier ring with an assisted flow mechanism by assessing changes in peristomal moisture-associated skin damage (MASD) and perceptions of comfort, security, handling, and discretion in persons with an ileostomy for 6 months or longer. DESIGN: Single-arm, open-labeled feasibility study. SUBJECTS AND SETTINGS: Twenty participants (aged ≥18 years) with an ileostomy for 6 months or more participated in the study and 12 completed data collection. The primary reason for dropouts concerned compatibility issues with the barrier ring when used with certain convex pouching systems. METHODS: Participants used the barrier ring along with their normal ostomy pouching system for a period of 6 weeks. Changes in skin condition were assessed using the Ostomy Skin Tool (OST). Participants' perception of the barrier rings' comfort, security, handling, and discretion were also recorded on a 10-point scale, where participants would offer a low score if their experience was negative and a higher score if their experience was positive. Participants changed pouches and barrier rings at their own discretion. For participants who completed the study, the average skin condition and median ratings of comfort, security, handling, and discretion at 6 weeks were compared to baseline values. RESULTS: Twelve of the 20 participants (60%) completed the study. For those who completed, the mean score on the OST decreased from 6.2 ± 1.90 (mean ± SD) at baseline to 3.4 ±1.73 at 6 weeks, indicating a mean reduction of 2.8 (95% CI, −1.6 to −3.9; P < .001). The peristomal skin condition of 9 participants improved, whereas 3 experienced no change. All participants who completed the study rated comfort, handling, security, and discretion highly (median score 10 at baseline and at 6 weeks). CONCLUSIONS: Study findings indicate the novel ostomy barrier ring may reduce levels of peristomal MASD in persons living with an ileostomy, though a more extensive trial with a control group is recommende

An analysis of complaints about hospital care in the Republic of Ireland

BACKGROUND: Patients and family members make complaints about their hospital care in order to express their dissatisfaction with the care received and prompt quality improvement. Increasingly, it is being understood that these complaints could serve as important data on how to improve care if analysed using a standardized tool. The use of the Healthcare Complaints Analysis Tool (HCAT) for this purpose has emerged internationally for quality and safety improvement. Previous work has identified hot spots (areas in care where harm occurs frequently) and blind spots (areas in care that are difficult for staff members to observe) from complaints analysis. This study aimed to (i) apply the HCAT to a sample of complaints about hospital care in the Republic of Ireland (RoI) to identify hot spots and blind spots in care and (ii) compare the findings of this analysis to a previously published study on hospital complaints in the UK. METHODS: A sample of complaints was taken from 16 hospitals in the RoI in Quarter 4 of 2019 (n = 641). These complaints were coded using the HCAT to classify complaints by domain, category, severity, stage of care and harm. Chi-squared tests were used to identify hot spots, and logistic regression was used to identify blind spots. The findings of this study were compared to a previously published UK study that used HCAT to identify hot spots and blind spots. RESULTS: Hot spots were identified in Irish hospital complaints while patients were receiving care on the ward, during initial examination and diagnosis, and while they were undergoing operations or procedures. This aligned with hot spots identified in the UK study. Blind spots were found for systemic problems, where patients experience multiple issues across their care. CONCLUSIONS: Hot spots and blind spots for patient harm can be identified in hospital care using the HCAT analysis. These in turn could be used to inform improvement interventions, and direct stakeholders to areas that require urgent attention. This study also highlights the promise of the HCAT for use across different healthcare systems, with similar results emerging from the RoI and the UK

Inhibition of RNA polymerase I transcription initiation by CX-5461 activates non-canonical ATM/ATR signaling

RNA polymerase I (Pol I)-mediated transcription of the ribosomal RNA genes (rDNA) is confined to the nucleolus and is a rate-limiting step for cell growth and proliferation. Inhibition of Pol I by CX-5461 can selectively induce p53-mediated apoptosis of tumour cells in vivo. Currently, CX-5461 is in clinical trial for patients with advanced haematological malignancies (Peter Mac, Melbourne).Here we demonstrate that CX-5461 also induces p53-independent cell cycle checkpoints mediated by ATM/ATR signaling in the absence of DNA damage. Further, our data demonstrate that the combination of drugs targeting ATM/ATR signaling and CX-5461 leads to enhanced therapeutic benefit in treating p53-null tumours in vivo, which are normally refractory to each drug alone. Mechanistically, we show that CX-5461 induces an unusual chromatin structure in which transcriptionally competent relaxed rDNA repeats are devoid of transcribing Pol I leading to activation of ATM signaling within the nucleoli. Thus, we propose that acute inhibition of Pol transcription initiation by CX-5461 induces a novel nucleolar stress response that can be targeted to improve therapeutic efficacy

Dietary-Induced Bacterial Metabolites Reduce Inflammation and Inflammation-Associated Cancer via Vitamin D Pathway

Environmental factors, including westernised diets and alterations to the gut microbiota, are considered risk factors for inflammatory bowel diseases (IBD). The mechanisms underpinning diet-microbiota-host interactions are poorly understood in IBD. We present evidence that feeding a lard-based high-fat (HF) diet can protect mice from developing DSS-induced acute and chronic colitis and colitis-associated cancer (CAC) by significantly reducing tumour burden/incidence, immune cell infiltration, cytokine profile, and cell proliferation. We show that HF protection was associated with increased gut microbial diversity and a significant reduction in Proteobacteria and an increase in Firmicutes and Clostridium cluster XIVa abundance. Microbial functionality was modulated in terms of signalling fatty acids and bile acids (BA). Faecal secondary BAs were significantly induced to include moieties that can activate the vitamin D receptor (VDR), a nuclear receptor richly represented in the intestine and colon. Indeed, colonic VDR downstream target genes were upregulated in HF-fed mice and in combinatorial lipid-BAs-treated intestinal HT29 epithelial cells. Collectively, our data indicate that HF diet protects against colitis and CAC risk through gut microbiota and BA metabolites modulating vitamin D targeting pathways. Our data highlights the complex relationship between dietary fat-induced alterations of microbiota-host interactions in IBD/CAC pathophysiology

Inhibition of RNA polymerase I transcription initiation by CX-5461 activates non-canonical ATM/ATR signaling

RNA polymerase I (Pol I)-mediated transcription of the ribosomal RNA genes (rDNA) is confined to the nucleolus and is a rate-limiting step for cell growth and proliferation. Inhibition of Pol I by CX-5461 can selectively induce p53-mediated apoptosis of tumour cells in vivo. Currently, CX-5461 is in clinical trial for patients with advanced haematological malignancies (Peter Mac, Melbourne). Here we demonstrate that CX-5461 also induces p53-independent cell cycle checkpoints mediated by ATM/ATR signaling in the absence of DNA damage. Further, our data demonstrate that the combination of drugs targeting ATM/ATR signaling and CX-5461 leads to enhanced therapeutic benefit in treating p53-null tumours in vivo, which are normally refractory to each drug alone. Mechanistically, we show that CX-5461 induces an unusual chromatin structure in which transcriptionally competent relaxed rDNA repeats are devoid of transcribing Pol I leading to activation of ATM signaling within the nucleoli. Thus, we propose that acute inhibition of Pol transcription initiation by CX-5461 induces a novel nucleolar stress response that can be targeted to improve therapeutic efficacy