Barriers to Participation in a Structured Quality Improvement Initiative to Reduce Avoidable Emergency Department...

Area of Science:

• Healthcare Management
• Surgical Quality Improvement
• Patient Safety

Background:

• Quality improvement (QI) initiatives in multi-institutional hospital settings are understudied.
• Factors negatively affecting QI initiatives, specifically reducing avoidable emergency department (ED) visits post-bariatric surgery, were investigated across 17 hospitals.

Purpose of the Study:

• To explore participant perspectives on barriers to implementing a QI initiative for bariatric surgery.
• To identify themes explaining ineffective implementation or outcomes of the QI program.

Main Methods:

• Qualitative investigation using semistructured group interviews with 17 sites (42 interviews) in a statewide bariatric QI program.
• Descriptive content analysis to identify challenges, facilitators, and barriers to QI program implementation.
• Analyses conducted using MAXQDA software.

Main Results:

• Barriers identified across hospitals included lack of buy-in, provider accessibility issues, insufficient resources, and patient-related barriers.
• Initiative effectiveness was hindered when not aligned with site-specific drivers of ED visits (e.g., patient access to care).
• Customization to existing hospital systems and staff engagement (employees, surgeons, leadership) was crucial for success.

Conclusions:

• Findings can guide future site-specific interventions to reduce unnecessary postoperative ED visits.
• A nuanced approach, adaptable to facility needs and resources, is necessary for effective QI implementation.
• Addressing barriers related to buy-in, provider access, resources, and patient care is essential for improving bariatric surgery outcomes.