A pilot initiative to enhance quality improvement teaching with simulation.

BACKGROUND: Quality Improvement and Patient Safety (QIPS) is a recognised competency across residency programmes. Although a variety of teaching modalities exist, many do not represent the multifaceted clinical environment that trainees work in. Residents have reported challenges in linking QIPS classroom-based learning with their clinical duties. High-fidelity simulation has been used to bridge this gap within clinical skills teaching and therefore has potential to address this issue in QIPS learning. APPROACH: We developed and piloted four high-fidelity simulation scenarios with 15 surgical residents (Orthopaedics, General Surgery, Gynaecology and Neurosurgery). Each scenario contained elements of both latent and active safety errors. Residents were provided with a short pre-reading from an open-access resource on basic QIPS methodology and underwent a debriefing by a trained QIPS faculty. Residents were then tasked to apply their learning to their scenario to develop a QIPS-focused solution. EVALUATION: Objective knowledge acquisition was assessed with the Quality Improvement Knowledge Assessment Tool-Revised (QIKAT-R) in conjunction with a survey based upon the Kirkpatrick Model of Learning. Overall, residents agreed that the simulation was helpful in learning QIPS methodology and agreed that they could perform fundamental QIPS tasks. The average QIKAT-R score demonstrated a trend towards improvement. IMPLICATIONS: High-fidelity simulation is a potential means to provide residents with hands-on experience in QIPS knowledge acquisition and application. Future directions should aim to compare the efficacy of simulation with other teaching modalities and evaluate the long-term impact of QIPS teaching on resident behaviours and motivation to take part in QIPS initiatives.

Wait times in the management of non-small cell lung carcinoma before, during and after regionalization of lung cancer care: a high-resolution analysis.

Background: Timeliness can have a substantial effect on treatment outcomes, prognosis and quality of life for patients with lung cancer. We sought to evaluate changes in wait times for patients with non-small cell lung carcinoma (NSCLC) and to identify bottlenecks in cancer care. Methods: We included patients who received treatment with curative intent or palliative treatment for NSCLC, diagnosed through mediastinal staging by a thoracic surgeon. Data were collected from 3 cohorts over 3 time periods: before the regionalization of lung cancer care (2005-2007, C1), immediately postregionalization (2011-2013, C2) and 5 years after regionalization (2016-2017, C3). Total wait time and delays along treatment pathways were compared across cohorts using multivariate Cox proportionality models. Results: Our total sample size was 299 patients. Overall, there was no significant difference in total wait time among the 3 cohorts. However, wait time from symptom onset to first physician visit significantly increased in C3 compared with C2 (hazard ratio [HR] 0.41, p < 0.01) and C1 (HR 0.43, p < 0.01). Time from first physician visit to computed tomography (CT) scan significantly decreased in C3 compared with C2 (HR 1.54, p < 0.01). Time from abnormal CT scan to first surgeon visit also significantly decreased in C2 (HR 1.43, p < 0.01) and C3 (HR 4.47, p < 0.01) compared with C1, and between C3 and C2 (HR 2.67, p < 0.01). In contrast, time from first surgeon visit to completion of staging significantly increased in C2 (HR 0.36, p < 0.01) and C3 (HR 0.24, p < 0.01) compared with C1, as well as between C3 and C2 (HR 0.60, p < 0.01). Time to first treatment after completion of staging was significantly shorter for C3 than C1 (HR 1.58, p < 0.01). Conclusion: Trends toward a reduction in wait time are evident 5 years after the regionalization of lung cancer care, primarily led by shorter wait times for CT scans and thoracic surgeon consults. However, wait times can further be reduced by addressing delays in staging completion and patient and provider education to identify the early signs of NSCLC.

Contexte: La rapidité d'intervention peut avoir un effet considérable sur l'issue du traitement, le pronostic et la qualité de vie des patients atteints d'un cancer du poumon. Nous avons voulu évaluer les changements des temps d'attente des patients ayant un carcinome pulmonaire non à petites cellules et recenser les obstacles aux soins oncologiques. Méthodes: Nous avons inclus des patients ayant reçu un traitement curatif ou palliatif pour un carcinome pulmonaire non à petites cellules diagnostiqué par stadification de lésions médiastinales par un chirurgien thoracique. Les données ont été recueillies auprès de 3 cohortes, à 3 moments : avant la régionalisation des soins oncologiques (2005­2007; C1), immédiatement après la régionalisation (2011­2013; C2) et 5 ans après la régionalisation (2016­2017; C3). Le temps d'attente total et les délais au cours du processus de traitement des cohortes ont été comparés au moyen de modèles à risques proportionnels de Cox multivariés. Résultats: Au total, l'échantillon comptait 299 patients. Dans l'ensemble, aucune différence statistiquement significative n'a été observée entre les 3 cohortes pour ce qui est du temps d'attente total. Cependant, la C3 présentait un temps d'attente entre l'apparition des symptômes et la première consultation médicale significativement plus long que la C2 (rapport de risque [RR] 0,41; p < 0,01) et que la C1 (RR 0,43; p < 0,01). Le temps d'attente entre la première consultation médicale et la tomodensitométrie (TDM) était par contre significativement plus court dans la C3 que dans la C2 (RR 1,54; p < 0,01). Le délai entre l'obtention d'un résultat anormal à la TDM et la première consultation chirurgicale était également significativement moindre dans la C2 (RR 1,43; p < 0,01) et dans la C3 (RR 4,47; p < 0,01) que dans la C1, mais aussi entre la C3 et la C2 (RR 2,67; p < 0,01). À l'inverse, le temps écoulé entre la première consultation chirurgicale et la fin de la stadification était significativement plus long dans la C2 (RR 0,36; p < 0,01) et la C3 (RR 0,24; p < 0,01) que dans la C1; il en était également ainsi entre la C3 et la C2 (RR 0,60; p < 0,01). Enfin, le délai entre le premier traitement et la fin de la stadification était significativement plus court dans la C3 que dans la C1 (RR 1,58; p < 0,01). Conclusion: Cinq ans après la régionalisation des soins oncologiques, on peut observer une réduction des temps d'attente, principalement une diminution du temps d'attente pour une TDM ou une consultation chirurgicale. Les temps d'attente pourraient être davantage raccourcis par une réduction des délais dans la stadification, ainsi que par la sensibilisation des patients et des fournisseurs de soins à l'égard de la reconnaissance des signes précoces de carcinome pulmonaire non à petites cellules.