Finding the Right Balance between Evidence for Judgment and Evidence for Quality Improvement

2006 ◽  
Vol 19 (1) ◽  
pp. 32-37 ◽  
Author(s):  
Benjamin T.B. Chan
Keyword(s):  
Quality Improvement ◽  
The Right

scholarly journals Extreme preterm birth in the right place: a quality improvement project

2019 ◽  
Vol 105 (4) ◽  
pp. 445-448 ◽  
Author(s):  
Katherine Edwards ◽  
Lawrence Impey
Keyword(s):  
Quality Improvement ◽  
Preterm Birth ◽  
Place Of Birth ◽  
Improvement Project ◽  
Sustained Improvement ◽  
Premature Babies ◽  
Specialist Centre ◽  
Improvement Programme ◽  
The Uk ◽  
The Right

Extreme preterm birth is a major precursor to mortality and disability. Survival is improved in babies born in specialist centres but for multiple reasons this frequently does not occur. In the Thames Valley region of the UK in 2012–2014, covering 27 000 births per annum, about 50% of extremely premature babies were born in a specialist centre. Audit showed a number of potential areas for improvement. We used regional place of birth data and compared the place of birth of extremely premature babies for 2 years before our intervention and for 4 years (2014–2018) after we started. We aimed to improve the proportion of neonates born in a specialist centre with three interventions: increasing awareness and education across the region, by improving and simplifying the referral pathway to the local specialised centre, and by developing region-wide guidelines on the principal precursors to preterm birth: preterm labour and expedited delivery for fetal growth restriction. There were 147 eligible neonates born within the network in the 2 years before the intervention and 80 (54.4%) were inborn in a specialised centre. In the 4 years of and following the intervention, there were 334 neonates of whom 255 were inborn (76.3%) (relative risk of non-transfer 0.50 (95% CI 0.39 to 0.65), p<0.001). Rates showed a sustained improvement. The proportion of extremely premature babies born in specialist centres can be significantly improved by a region-wide quality improvement programme. The interventions and lessons could be used for other areas and specialties.

Sustaining safety and delivery of oral chemotherapy utilizing lean methodology.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 218-218
Author(s):  
Marc Steven Hoffmann ◽  
Adam Neiberger ◽  
Gloria Solis ◽  
Marshall Johnson ◽  
Debbie Fernandez
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
Safety Data ◽  
Production Method ◽  
Error Reduction ◽  
Oral Chemotherapy ◽  
Multidisciplinary Teams ◽  
Care Providers ◽  
Targeted Interventions ◽  
The Right

218 Background: An oral chemotherapy safety event in 2017 prompted analysis of related workflows utilizing lean quality improvement methodology. Three kaizen workshops utilizing lean methodology with primary objectives to 1) develop safety standards for oral chemotherapy as rigorous as those for intravenous chemotherapy; 2) improve efficiency; and 3) design workflows that enable data collection and process control were conducted. Since 2017, our goal has been to sustain developed workflows to ensure oral chemotherapy patients have the right oral chemotherapy agent, at the right dose, at the right time, with independent and efficient safety checks by all care providers. Methods: After multidisciplinary teams participated in three kaizen workshops to develop workflows, education plans were developed and results were incorporated into the lean management system. The lean production method of Training Within Industry (TWI) was used to train physician, nursing, and pharmacy teams to the workflows. Results were communicated to key stakeholders weekly to monitor progress on workflow creation, spread, and process metrics designed to signal defects in the workflow. When processes were deemed ‘out of control,’ clinical team members provided regular and targeted interventions. Safety data were collected and correlated to surrogate outcomes for long-term impact assessment. Results: Interventions resulted in the following outcomes: 62 consecutive weeks with 99% reduction in oral chemotherapy defects reaching pharmacy. 86 consecutive weeks with 51% error reduction processing oral chemotherapy though a single EMR workflow. 57 consecutive weeks with 62% error reduction processing oral chemotherapy though a single EMR workflow. No serious safety events have occurred since 2017. Conclusions: Comprehensive quality improvement in our oral chemotherapy process has resulted in sustained safety, efficiency, and a data collection to signal when process defects occur. Multidisciplinary teams utilizing established lean methodology were critical to success.

Clinical governance

2020 ◽  
pp. 72-82
Author(s):  
Leroy C. Edozien
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Clinical Outcomes ◽  
Patient Experience ◽  
Clinical Governance ◽  
Service Users ◽  
Basic Principles ◽  
Analyse Data ◽  
Integrated Domains ◽  
The Right

Clinical governance is the totality of structures and processes that are in place to ensure that, as far as practicable, the right person receives the right treatment, in the right way, at the right time, in the right place, with the right outcome. This goal does not happen by chance; it has to be secured by conscious effort, and that effort—creating and sustaining the required structures and processes—has to be actively and efficiently managed. This chapter describes the basic principles of clinical governance and provides a framework—the RADICAL framework—for delivering and monitoring clinical governance. The framework comprises the following domains: Raise awareness, Apply quality improvement methodology, Design for quality (including safety), Involve service users, Collect and Analyse data, and Learn from experience. The lofty aims of achieving optimal clinical outcomes and the best possible patient experience are best achieved when clinical practice addresses these integrated domains.

scholarly journals ’INSPIRED’ COPD Outreach ProgramTM: Doing the Right Things Right

2014 ◽  
Vol 37 (5) ◽  
pp. 311 ◽  
Author(s):  
Graeme M Rocker ◽  
Jennifer Y Verma
Keyword(s):  
Quality Improvement ◽  
Substantial Reduction ◽  
Outreach Program ◽  
Chronic Obstructive ◽  
Evidence Based ◽  
Improvement Program ◽  
Care Experience ◽  
Individualized Care ◽  
The Right ◽  
Supportive Program

The well-documented gaps between needed and provided care for patients and families living with chronic obstructive pulmonary disease (COPD) mandate changes to clinical practice. The multifaceted evidence-based INSPIRED COPD Outreach ProgramTM was first implemented in Halifax, Nova Scotia, Canada in 2010 (INSPIRED = Implementing a Novel and Supportive Program of Individualized care for patients and families living with REspiratory Disease) and undergoes ongoing evaluation. By enhancing patient confidence to manage their illness more effectively in their homes and communities, there has been a sustained and substantial reduction in facility-based care in comparison with patient care experience pre-INSPIRED. Sustaining and spreading a program recently designated a leading practice by Accreditation Canada, and especially modifying the program as new evidence emerges, requires integrating and modeling at the ‘bedside’ both evidence-based medicine (‘doing the right things’) and quality improvement (‘doing them right’). In Canada, where COPD care gaps are common, a new pan-Canadian INSPIRED-based quality improvement program is supporting multidisciplinary healthcare teams to bridge the chasm between evidence and practice by working together to ‘do the right things right’ in COPD care.

Surgical prophylaxis

2016 ◽  
Author(s):  
Tamsin Oswald ◽  
Simon Jameson ◽  
Mike Reed
Keyword(s):  
Quality Improvement ◽  
Single Dose ◽  
Antibiotic Prophylaxis ◽  
Evidence Base ◽  
Infection Rates ◽  
Surgical Prophylaxis ◽  
Surgical Antibiotic Prophylaxis ◽  
The Right ◽  
The Impact

Surgical antibiotic prophylaxis remains a challenge, with a reported 30% of prescribing for this indication being inappropriate. The process of providing prophylaxis is a complex one—giving therapy only when indicated and using the right drug at the right dose at the right time and for the right duration (usually a single dose)—thus it is difficult to optimise. Additional challenges in this area include: lack of awareness of the impact of overuse of antimicrobials, anxiety about post-operative infections, suboptimal monitoring of infection rates, and the lack of an evidence base for prophylaxis in many procedures. This chapter discusses optimization of surgical prophylaxis and provides examples of successful quality improvement programmes that have overcome the challenges mentioned.

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