Development and testing of the Stakeholder Quality Improvement Perspectives Survey (SQuIPS).

BACKGROUND: To create a theory-informed survey that quality improvement (QI) teams can use to understand stakeholder perceptions of an intervention. METHOD: We created the survey then performed a cross-sectional survey of QI stakeholders of three QI projects. The projects sought to: (1) reduce unplanned extubations in a neonatal intensive care unit; (2) maintain normothermia during colorectal surgery and (3) reduce specimen processing errors for ambulatory gastroenterology procedures. We report frequencies of responses to survey items, results of exploratory factor analysis, and how QI team leaders used the results. RESULTS: Overall we received surveys from 319 out of 386 eligible stakeholders (83% response rate, range for the three QI projects 57%-86%). The QI teams found that the survey results confirmed existing concerns (eg, the intervention would not make work easier) and revealed unforeseen concerns such as lack of consensus about the overall purpose of the intervention and its importance. The results of our factor analysis indicate that one 7-item scale (Cronbach's alpha 0.9) can efficiently measure important aspects of stakeholder perceptions, and that two additional Likert-type items could add valuable information for leaders. Two QI team leaders made changes to their project based on survey responses that indicated the intervention made stakeholders' jobs harder, and that there was no consensus about the purpose of the intervention. CONCLUSIONS: The Stakeholder Quality Improvement Perspectives Survey was feasible for QI teams to use, and identified stakeholder perspectives about QI interventions that leaders used to alter their QI interventions to potentially increase the likelihood of stakeholder acceptance of the intervention.

Extensive Cutaneous Mastocytosis After Pregnancy.

Mastocytosis is an uncommon disease involving the proliferation of mast cells within at least one organ system, most commonly the skin. One rare variant is telangiectasia macularis eruptive perstans (TMEP). The telangiectatic tan-brown macules are highly characteristic, although a biopsy is indicated to confirm the diagnosis. We present a 33-year-old white woman who presented for a skin check with concern for a four- to six-year history of "moles" present on the majority of body surface area. Her lesions presented shortly after her first pregnancy and spared sun-exposed face, neck, and extremities. Both of these features are rather unusual in TMEP. In this asymptomatic patient, workup focused on excluding systemic manifestations and discussion of cosmetic treatments. Punch biopsies revealed nests of CD117+ mast cells as well as increased basal melanocytes. Because the lesions spared sun-exposed regions, sunbathing was advised for initial treatment.