BackgroundNarrative data about the patient experience of surgery can help healthcare professionals and administrators better understand the needs of patients and their families as well as provide a foundation for improvement of procedures, processes and services. However, units often lack a methodological framework to analyse these data empirically and derive key areas for improvement. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is aimed at improving the quality of surgical care by collecting patient data and reporting risk-adjusted surgical outcomes for each participant hospital in the programme. Though qualitative data about patient experience are captured as part of the NSQIP database, to date no framework or methodology has been proposed, or reported on, to analyse these data for the purposes of quality improvement. The goal of this study was to demonstrate the feasibility of using content analysis to empirically derive key areas for quality improvement from a sample of 3601 narrative comments about paediatric surgery from patients and families at British Columbia Children’s Hospital.Study designThematic content analysis conducted on a total of 3601 patient and family narratives received between 2011 and 2018.ResultsOverall satisfaction with care was high and experiences with healthcare providers at the hospital were positive. Areas for improvement were identified in the themes of health outcomes, communication and surgery timelines. Results informed follow-up interprofessional quality improvement initiatives.ConclusionsRecording and analysing patient experience data as part of validated quality improvement programmes such as ACS NSQIP can provide valuable and actionable information to improve quality of care.

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Background Bacterial meningitis remains a significant cause of morbidity and mortality in infants, necessitating appropriate and timely investigations and treatment. Despite this, there are no current Canadian practice guidelines outlining the recommended management of infants with bacterial meningitis beyond empiric antimicrobial choice. As bacterial meningitis remains one of the most severe infectious diseases managed by general pediatricians, it warrants an attempt at practice standardization. Objectives The purpose of this study is to review and identify variation in the timing and frequency of lumbar punctures (LPs) and the use of neuroimaging for the management of bacterial meningitis for infants less than 90 days of age at BC Children’s & Women’s Hospital (BCCWH). Design/Methods A retrospective chart review at BCCWH identified confirmed, presumed or possible bacterial meningitis in infants less than 90 days of age over a five-year period (2013-2018). Anonymized data was collected from medical charts, de-identified and stored in REDCap. Results Eighty-one patients were included. Fifty-three percent of all patients had a delay in receiving an initial LP. The most common reasons for delays were that the patient was too unstable (42%) or that the first LP attempt was unsuccessful (26%). Forty-six percent of all patients had only one LP while 36% had at least one repeat LP. Most repeat LPs were done within 7 days of diagnosis. Twenty-nine percent of patients had an end of treatment LPs. Of all patients, 80% had neuroimaging. Head ultrasound (US) was the most commonly used imaging modality for both first image (68%) and subsequent images (64%). Seventeen percent of patients received a CT scan and 15% an MRI as their first image. In most cases, there was no clear clinical indication for imaging noted other than a diagnosis of meningitis (44%). Conclusion This retrospective study confirms that there is variability in the management of bacterial meningitis with respect to lumbar punctures and neuroimaging in young infants. The findings demonstrate LPs are commonly delayed, and suggest a need to develop clearly defined criteria for evaluating instability before an initial LP. Furthermore, the findings raise concern regarding the common practice of ordering head ultrasound for meningitis, given lower sensitivity in detecting disease complications and therefore disputed clinical utility.