The effect of language discordance on the experience of palliative care: A scoping review

PLoS ONE · 2025-04-02 · 5 citations

BACKGROUND: Internationally, research demonstrates consistent disparities in access to palliative care services for those in underserved communities with life-limiting conditions. OBJECTIVES: This outcomes-oriented scoping review examines the impact of language discordance on palliative care (PC) experiences. It seeks to answer the question: what are the PC experiences of individuals who do not speak the same language as their care provider? The review explored the range and depth of existing research and synthesizing trends across studies. DESIGN: Online databases were used to find articles published in English or French, from January 1, 2010, to February 5, 2024. Inclusion criteria included studies that explored the relationship between palliative, end-of-life or hospice care, as well as advance care planning in the context of language discordance between individual and health care provider. This scoping review was originally designed to explore Canadian official language minority communities, but was broadened to an international search for a more robust dataset. RESULTS: A total of 39 articles were included in the review, 23 qualitative studies, nine quantitative studies and seven mixed-methods studies. The following elements were extracted from eligible articles: country, study design, target population and definitions, participant characteristics, definitions of PC, outcomes studied, findings related to the study aims, as well as author-defined study limitations and next steps. Areas for further research were identified, as were areas for policy and practice change. Studies used various perspectives of PC, often synonymizing it with end-of-life and hospice care, as well as advanced care planning. There was no contextual definition of language barriers in the studies and no studies that explored the PC in any Canadian official language minority communities. The importance of in-language resources, accessibility of skilled interpreters, education in cross-cultural care were all common themes in the literature. CONCLUSIONS: From a variety of perspectives, studies generally found that language discordance has a negative impact on the quality of accessibility of palliative, end-of-life and hospice care, as well as advanced care planning. Given that Canada's population is becoming increasingly linguistically diverse, there is a need to better understand the impact of receiving PC from individuals who speak another language on both the quality of PC and quality of life at the end of life.

Perspectives in Perioperative Quality Improvement: Case Studies in Positive Deviance Using Real‐World Data

Pediatric Anesthesia · 2025-06-17 · 1 citations

INTRODUCTION: Healthcare quality/safety efforts frequently carry negative themes. This 'find and fix' method typically highlights little about the presence but rather the absence of quality and safety. Positive deviance (PD) is an approach that instead focuses on spreading success rather than eliminating errors. We describe four PD case studies from two pediatric health systems where procedural quality outcomes were improved. METHODS: Utilizing common continuous quality improvement methods, multidisciplinary teams assessed and improved clinical processes. AdaptX (Seattle, WA), a software solution that allows clinicians to extract continuously updated, aggregated health data from EMRs, was used to analyze data using statistical process control methods. Funnel charts identified PD providers for key processes. The team leader interviewed, observed, and documented their practice. Team members tested these new processes in clinical practice utilizing Plan-Do-Study-Act (PDSA) cycles. The team monitored real-time data to guide each PDSA cycle decision. Once finalized, the team disseminated this new best practice standard across the staff. RESULTS: Reduction in surgical prep time yielded a sustained 35% increase in monthly procedure volumes. Gastroenterology anesthesia improvements coupled with a second procedural room led to a sustained 74% increase in monthly case counts. Improvements in Post-Anesthesia Care Unit duration and on-time performance reduced case durations, staff overtime, and increased operational capacity. Balance measures were unchanged. DISCUSSION: These PD methods successfully improved the timeliness of procedural processes and capacity without adverse impacts on other quality measures. Real-time, democratized access to data made finding PD providers easy and eased the spread of this practice, facilitating sustained improvement in outcomes. This approach aligns with clinicians' desire to provide the best care, thus enhancing staff engagement. CONCLUSIONS: The PD approach improved procedural efficiency in two unique and unaffiliated pediatric healthcare systems. Future efforts will focus on PD beyond the procedural domain and in additional healthcare institutions.

Épidermolyse bulleuse simplex traité par sirolimus topique

Annales de Dermatologie et de Vénéréologie - FMC · 2025-11-13

Patient-Controlled Analgesia for Managing Pain in Adults Receiving Palliative Care: A Scoping Review

Pain Management Nursing · 2025-03-30 · 2 citations

Enhancing Outcomes in Clinical Practice: Lessons Learned in the Quality Improvement Trenches

Anesthesia & Analgesia · 2024-03-06 · 2 citations

Hansen, Elizabeth E. MD, PhD; Chiem, Jennifer L. MD; Low, Daniel K. MBBS; Rampersad, Sally E. MB; Martin, Lynn D. MD, MBA Author Information

Optimizing pediatric tonsillectomy outcomes with an opioid sparing anesthesia protocol: Learning and continuously improving with real‐world data

Pediatric Anesthesia · 2024-08-30 · 5 citations

INTRODUCTION: This quality improvement initiative is a continued pursuit to optimize outcomes by iteratively improving our opioid sparing anesthesia protocol for tonsillectomy with or without adenoidectomy at our pediatric ambulatory surgical center through data driven Plan-Do-Study-Act cycles. METHODS: From 1/2015 through 12/2023, our standardized tonsillectomy protocol underwent nine procedure-specific perioperative Plan-Do-Study-Act cycles, three procedure-specific postoperative prescription Plan-Do-Study-Act cycles, and four general ambulatory surgical center enhanced recovery Plan-Do-Study-Act cycles. We analyzed data from the medical record using statistical process control charts. The primary outcome measure was the percent of patients requiring intravenous opioid in the post anesthesia care unit. Secondary outcomes included maximum post anesthesia care unit pain score, the percent of patients requiring treatment for nausea and/or vomiting in the post anesthesia care unit, and the number of postoperative opioid prescription dosages. Balancing measures were average post anesthesia care unit length of stay, percent of patients with prolonged Post Anesthesia Care Unit length of stay (>120 min), and 30-day reoperation rate. RESULTS: A total of 5654 tonsillectomy with or without adenoidectomy cases were performed at our ambulatory surgical center from 2015 to 2023. The incidence of intravenous opioid administered in the post anesthesia care unit initially rose with opioid free anesthesia launch, but subsequently decreased below the target of 10%. Maximum post anesthesia care unit pain scores rose from mean 3.6 to 4.5, but subsequently returned to the baseline of 3.5, while the incidence of postoperative nausea and/or vomiting improved. The average post anesthesia care unit length of stay increased by 10 min with opioid free anesthesia; however, prolonged post anesthesia care unit stay and 30-day reoperation rates were unchanged. CONCLUSIONS: The continued refinement of our opioid sparing anesthesia protocol has led to reduced perioperative and home opioid use, stable maximum post anesthesia care unit pain scores, and improved postoperative nausea and vomiting rates, with only a slight increase in mean post anesthesia care unit length of stay.

Suprazygomatic Maxillary Nerve Block and Postoperative Opioid Use in Children Undergoing Adenotonsillectomy

JAMA Otolaryngology–Head & Neck Surgery · 2024-09-26

Enhanced recovery program in ambulatory pediatric urology: A quality improvement initiative

Journal of Pediatric Urology · 2024-05-03 · 3 citations

Transforming into a Learning Health System: A Quality Improvement Initiative

Pediatric Quality and Safety · 2024-05-01 · 4 citations

Background: The Institute of Medicine introduced the Learning Healthcare System concept in 2006. The system emphasizes quality, safety, and value to improve patient outcomes. The Bellevue Clinic and Surgical Center is an ambulatory surgical center that embraces continuous quality improvement to provide exceptional patient-centered care to the pediatric surgical population. Methods: We used statistical process control charts to study the hospital's electronic health record data. Over the past 7 years, we have focused on the following areas: efficiency (surgical block time use), effectiveness (providing adequate analgesia after transitioning to an opioid-sparing protocol), efficacy (creating a pediatric enhanced recovery program), equity (evaluating for racial disparities in surgical readmission rates), and finally, environmental safety (tracking and reducing our facility's greenhouse gas emissions from inhaled anesthetics). Results: We have seen improvement in urology surgery efficiency, resulting in a 37% increase in monthly surgical volume, continued adaptation to our opioid-sparing protocol to further reduce postanesthesia care unit opioid administration for tonsillectomy and adenoidectomy cases, successful implementation of an enhanced recovery program, continued work to ensure equitable healthcare for our patients, and more than 85% reduction in our facility's greenhouse gas emissions from inhaled anesthetics. Conclusions: The Bellevue Clinic and Surgical Center facility is a living example of a learning health system, which has evolved over the years through continued patient-centered QI work. Our areas of emphasis, including efficiency, effectiveness, efficacy, equity, and environmental safety, will continue to impact the community we serve positively.

Winning Hearts and Minds: Leading Change

Cambridge University Press eBooks · 2023-05-25