scholarly journals Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project

2020 ◽  
Author(s):  
Andrew C. Nixon ◽  
Julie Brown ◽  
Ailsa Brotherton ◽  
Mark Harrison ◽  
Judith Todd ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Geriatric Assessment ◽  
Screening Programme ◽  
Management Plan ◽  
Hazard Ratio ◽  
Adverse Outcomes ◽  
Quality Improvement Project ◽  
Clinical Frailty Scale ◽  
Improvement Project ◽  
Management Plans

Abstract Introduction The aims of this quality improvement project were to: (1) proactively identify people living with frailty and CKD; (2) introduce a practical assessment, using the principles of the comprehensive geriatric assessment (CGA), for people living with frailty and chronic kidney disease (CKD) able to identify problems; and (3) introduce person-centred management plans for people living with frailty and CKD. Methods A frailty screening programme, using the Clinical Frailty Scale (CFS), was introduced in September 2018. A Geriatric Assessment (GA) was offered to patients with CFS ≥ 5 and non-dialysis- or dialysis-dependent CKD. Renal Frailty Multidisciplinary Team (MDT) meetings were established to discuss needs identified and implement a person-centred management plan. Results A total of 450 outpatients were screened using the CFS. One hundred and fifty patients (33%) were screened as frail. Each point increase in the CFS score was independently associated with a hospitalisation hazard ratio of 1.35 (95% CI 1.20–1.53) and a mortality hazard ratio of 2.15 (95% CI 1.63–2.85). Thirty-five patients received a GA and were discussed at a MDT meeting. Patients experienced a median of 5.0 (IQR 3.0) problems, with 34 (97%) patients experiencing at least three problems. Conclusions This quality improvement project details an approach to the implementation of a frailty screening programme and GA service within a nephrology centre. Patients living with frailty and CKD at risk of adverse outcomes can be identified using the CFS. Furthermore, a GA can be used to identify problems and implement a person-centred management plan that aims to improve outcomes for this vulnerable group of patients.

524 QUALITY IMPROVEMENT PROJECT: INCORPORATING COMPREHENSIVE GERIATRIC ASSESSMENT INTO COMMUNITY HOSPITAL CLERKING

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
A Oates
Keyword(s):  
Quality Improvement ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Community Hospital ◽  
Quality Improvement Project ◽  
Junior Doctors ◽  
Medical Team ◽  
Improvement Project ◽  
Efficient Detection ◽  
User Friendly

Abstract Elderly patients transferred to community hospitals often have complex medical, social, psychological, functional and pharmacological backgrounds that require careful assessment in order to create and deliver a high quality, patient-centred care plan. Unfortunately, time pressures experienced by staff in acute hospitals can make Comprehensive Geriatric Assessment (CGA) unfeasible for every patient. Moreover, junior members of the medical team may be unsure as to which aspects of a patient’s background and presentation constitute important elements of a CGA. Failure to recognise and document pertinent issues can lead to prolonged admissions, disjointed care and failed discharges. Admission to a community hospital presents a convenient ‘checkpoint’ in the patient’s hospital journey at which to undertake a CGA. Recording the relevant information in an effective clerking proforma when the patient is admitted ensures that this information is displayed clearly and in a way that is accessible to all members of the multidisciplinary team. The pre-existing clerking proforma at Amersham Community Hospital omitted several important elements of CGA (such as examination of feet and gait, assessment of mood, FRAX-UK score, creation of a problem list etc.) The aim of this quality improvement project was to create a thorough, yet user-friendly and time-efficient clerking proforma which incorporated the important components of CGA. Using BGS guidance and NICE quality standards, alongside suggestions from the medical team, the existing clerking proforma was adapted and reformed. After one month, feedback from the team was used to further improve the clerking proforma, ensuring that it was user-friendly, whilst meeting the standards set out by NICE and BGS. This was repeated as part of a second PDSA cycle. The improved clerking proforma enables junior doctors to undertake a thorough and holistic assessment, promoting efficient detection of issues and the delivery of a higher quality of care.

scholarly journals 63 Quality Improvement Project: Should We be Doing More or Less Ct Head Scans in the Health Care of Older People Department?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i18-i20
Author(s):  
M Munir ◽  
T Shouter ◽  
H S Tay
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Older People ◽  
Management Plan ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Number Of Patients ◽  
New Findings ◽  
New Finding ◽  
Ct Head

Abstract Introduction Older people are likely to have more CT head scans given their multiple co- morbidities, being on anticoagulants, and increased falls. The aims of this quality improvement project (QIP) were to identify the number of patients who had CT head scan, the reason/indication of it, the number of patients who had new finding/s on it, actions taken on new findings, and whether the management plan was altered because of the CT scan. Methods Medical notes and CT head scan reports of all patients admitted to the Health Care of Older People department from April to September 2018 were reviewed to evaluate the indications of CT head scans, new findings, and management plans following the findings. Results 461 (10.7%) out of the 4323 patients discharged from the healthcare of older people department during April to September 2018 had CT head scans during admission. Frequent indications for CT head scans included delirium, falls and head injury. Only 46 (9.9%) patients had new finding/s on the CT head scan, and action was taken on 26 (56.5%) of these patients. The CT head scan changed the management plan of only 17 (3.6%) patients. Please see Table for more details. Conclusions By using our clinical judgement, following NICE guidelines on head injuries, educating our colleagues on the criteria for requesting a CT head scan, taking collateral histories about patients’ cognition and ascertaining the mechanism of fall, we can lessen the financial burden on the NHS and minimise the radiation exposure to our patients.

scholarly journals 887 A Quality Improvement Project: Implementation of a New Epistaxis Pathway

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Vasanthan ◽  
A Massoumi ◽  
M Forde ◽  
O Corbridge ◽  
S Sood
Keyword(s):  
Quality Improvement ◽  
Average Length ◽  
District General Hospital ◽  
Adverse Outcomes ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Average Length Of Stay ◽  
Patient Feedback ◽  
Patient Reported ◽  
Discharge Criteria

Abstract Introduction Epistaxis is one of the most common ENT conditions leading to unplanned hospital admission. This closed loop quality improvement project looked at epistaxis admissions, and whether patients could be safely managed on an ambulatory basis with unilateral intranasal packing, through the implementation of a new epistaxis pathway. Method Two prospective cycles at a District General Hospital. First cycle: three-month period (October-December 2018); recorded all patients admitted with epistaxis and the percentage with intranasal packing; criteria for discharge with unilateral intranasal packing created (including normal observations, normal clotting/haemoglobin, only on aspirin, safe home environment). Second cycle (after implementation of new pathway): two months (December 2019 and January 2020); recorded all patients admitted with epistaxis or discharged with unilateral intranasal packing; patient feedback obtained. Results First cycle: 31 epistaxis admissions; 12 patients met discharge criteria; average length of stay was 1.4 days. Second cycle: 22 epistaxis admissions; 4 admissions were avoided; 2 admissions were unnecessary according to new pathway; no patient-reported issues with pack at home. Conclusions Successful creation and initial implementation of pathway with no adverse outcomes. Approximately £1380 of savings through avoided admissions. Pathway expanded and successfully used during COVID-19 to include patients on anticoagulation as suitable for discharge with intranasal packing.

scholarly journals The Whittington Frailty Pathway: improving access to comprehensive geriatric assessment: an interdisciplinary quality improvement project

2019 ◽  
Vol 8 (4) ◽  
pp. e000798 ◽  
Author(s):  
John McGrath ◽  
Paula Almeida ◽  
Ruth Law
Keyword(s):  
Quality Improvement ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Hospital Setting ◽  
Admission Rate ◽  
National Guidelines ◽  
Clinical Frailty Scale ◽  
Record System ◽  
Improvement Project ◽  
Same Day Discharge

National guidelines mandate identification and tailored management of patients living with frailty who attend the acute hospital setting. We describe using quality improvement (QI) techniques to embed a system that allowed identification of frailty in older patients attending the emergency department (ED), creation of a clinical pathway to facilitate comprehensive geriatric assessment and appropriate same-day discharge of suitable patients. Integration of Clinical Frailty Scale (CFS) scoring within an electronic record system, a continuing programme of education and awareness, and dedicated project staff allows patients to be identified for an ambulatory frailty pathway. Our results show a sustained improvement over 9 months of the project, with 73% of patients over the age of 75 years presenting to ED by ambulance now receiving a CFS score. Over 300 patients have been identified, transferred to ambulatory care and treated via a new frailty pathway, with an admission rate for this cohort of 14%, compared with an overall admission rate of 50% for patients over 75 years. We report a decrease in overall ED admission of 1%. Analysis of patients discharged through this same-day pathway showed a 7-day ED reattendance rate of 15.1% and a 30-day readmission rate of 18.9%, which are comparable with current pathways. Consultant review estimated 87% of patients to have avoided a longer admission. Patient and staff satisfaction indicates this pathway to be feasible and acceptable to users. Our data suggest an ambulatory frailty pathway can deliver significant admission avoidance while maintaining low readmission rates. Similar schemes in other hospitals should consider using QI approaches to implementation of frailty pathways.

scholarly journals A quality improvement project to improve the number of section 136 GP discharge summaries from the place of safety

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S192-S192
Author(s):  
Jemma Hazan ◽  
Mikail Ozer ◽  
Yathooshan Ramesh ◽  
Richard Westmoreland
Keyword(s):  
Quality Improvement ◽  
Discharge Summary ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Time Period ◽  
Progress Notes ◽  
Number Of Patients ◽  
Management Plans ◽  
Discharge Letter ◽  
Discharge Summaries

AimsA Quality Improvement project with the aim to increase the number of patients discharged with a GP discharge summary from the Chase Farm Place of Safety over a 12 month time period by 50%.BackgroundAn initial audit was conducted at Chase Farm Place of Safety (POS) to see if patients held under Section 136 of the Mental Health Act (S136) and then discharged home had a GP discharge letter completed and sent. The audit revealed that 0.02% of patients who were under S136 and discharged home did have a discharge letter sent to the GP.As a result of the initial audit, key stakeholders were contacted, and involved in the intervention design and implementation. The intervention was introduced and all doctors working in the trust were emailed the new protocolMethodWe implemented the following intervention:If a patient was registered at a GP Practice then the nursing staff in the POS copied the entry of the discharging doctor from the electronic progress notes and pasted this in to the S136 discharge template on the electronic progress notes and this was emailed to the GP.We informed Doctors to be aware that their entry would go out to the GP and should contain the following: Impression, Outcome/Plan, Specific Risk /Safeguarding concerns and specific management plans.ResultIn the initial audit the notes of all patients discharged from the POS under S136 were reviewed over a 3 month period between November and January 2018. We found that 2 out of 89 patients (0.02%) had a completed GP summary which was emailed to the GP Practice.After the intervention was introduced the notes were audited between July and September 2019. We found 33 out of 60 patients (55%) had a completed GP summary which was emailed to the GP Practice.ConclusionThere was an improvement of 54.8% in the number of discharge summaries. Further consideration needs to be given to improving this percentage and understanding what remaining barriers there are.

569 Improving the Urology Post Take Ward Round with Best Clinical Practice and A Governance Checklist. Quality Improvement Project Within Belfast Health and Social Care Trust 2020

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
P McLoughlin ◽  
A McAdam
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Royal College ◽  
Management Plan ◽  
Ward Round ◽  
Quality Improvement Project ◽  
National Guidelines ◽  
Improvement Project ◽  
Ensure Patient Safety ◽  
Health And Social Care

Abstract Introduction The post take ward round (PTWR) is a vital element to ensure patient safety. Although well established as a necessity, often documentation is poor and does not accurately reflect a clinical assessment or generated management plan. This quality improvement project aimed to assess the pitfalls of the PTWR and improve these were possible in-line with best clinical practice. Method Audit standards were established using national guidelines, including those by the Royal College of Physicians, Royal College of Surgeons, GAIN guidelines and NICE. An initial audit was carried out against these guidelines. Following this, three distinct interventions were implemented namely, Junior Doctor Education Sessions, a Urology Consultant Email Circular, and the development of a Urology PTWR Checklist. After each intervention, a re-audit was carried out. Results Compliance with guidelines improved across all standards set. Overall compliance improved from 19.0% to 70.4% after our three interventions were implemented. Conclusions The results of the initial audit outlined that PTWR documentation is often very poor or severely lacking. Fortunately, this QIP demonstrates how the urology PTWR can be significantly improved with relatively simple measures.

Sign in / Sign up

Export Citation Format

Share Document