The impact of regional STEMI systems on protocol use and quality improvement initiatives in community hospitals without cardiac catheterization laboratories

Objective: Cardiac catheterization procedures provide tremendous benefits to modern healthcare and the benefit derived by the patient should far outweigh the radiation risk associated with a properly optimized procedure. With increasing utilization of such procedures, there is growing concern regarding the magnitude and variations of dose to patients associated with procedure complexity and techniques parameters. Therefore, this study investigated radiation dose to patients from six cardiac catheterization procedures at our facility and suggest possible initial dose values for benchmark for patient radiation dose from these procedures. This initial benchmark data will be used for clinical radiation dose management which is essential for assessing the impact of any quality improvement initiatives in the cardiac catheterization laboratory. Methods: We retrospectively analyzed the dose parameters of 1000 patients who underwent various cardiac catheterization procedures: left heart catheterization (LH), percutaneous coronary intervention (PCI), complex PCI, LH with complex PCI, LH with PCI and cardiac resynchronization therapy (CRT) pacemaker in our cardiac catheterization laboratories. Patient’s clinical radiation dose data [kerma–area–product (KAP) and air-kerma at the interventional reference point (Ka,r)] and technique parameters (fluoroscopy time, tube potential, current, pulse width and number of cine images) along with demographic information (age, height and weight) were collected from the hospital’s RIS (Synapse), Sensis/Syngo Dynamics and Siemens Sensis Stats Manager electronic database. Statistical analysis was performed with the IBM SPSS Modeler v. 18.1 software. Results: The overall patient median age was 67.0 (range: 26.0–97.0) years and the median body mass index (BMI) was 28.8 (range: 15.9–61.7) kg/m2 . The median KAP for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 44.4 (4.1–203.2), 80.2 (18.9–208.5), 83.7 (48.0–246.1), 113.8 (60.9–284.5), 91.7 (6.0–426.0) and 51.1 (7.0–175.9) Gy-cm2 . The median Ka,r for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 701.0 (35.3–3794.0), 1384.7 (291.7–4021.8), 1607.0 (883.5–4448.3), 2260.2 (867.4–5311.9), 1589.3 (100.2–7237.4) and 463.8 (67.7–1695.9) mGy respectively. Conclusion: We have analyzed patient radiation doses from six commonly used procedures in our cardiac catheterization laboratories and suggested possible initial values for benchmark from these procedures for the fluoroscopy time, KAP and air-kerma at the interventional reference point based on our current practices. Our data compare well with published values reported in the literature by investigators who have also studied patient doses and established benchmark dose levels for their facilities. Procedure-specific benchmark dose data for various groups of patients can provide the motivation for monitoring practices to promote improvements in patient radiation dose optimization in the cardiac catheterization laboratories. Advances in knowledge: We have investigated local patients’ radiation doses and established benchmark radiation data which are essential for assessing the impact of any quality improvement initiatives for radiation dose optimization.

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The Institute for Healthcare Improvement–NeuroPoint Alliance collaboration to decrease length of stay and readmission after lumbar spine fusion: using national registries to design quality improvement protocols

Journal of Neurosurgery Spine ◽

10.3171/2020.5.spine20457 ◽

2020 ◽

Vol 33 (6) ◽

pp. 812-821

Author(s):

Scott L. Zuckerman ◽

Clinton J. Devin ◽

Vincent Rossi ◽

Silky Chotai ◽

E. Hunter Dyer ◽

...

Keyword(s):

Quality Improvement ◽

Length Of Stay ◽

Discharge Planning ◽

Lumbar Fusion ◽

Nonparametric Tests ◽

Learning System ◽

Design Quality ◽

Implementation Phase ◽

Healthcare Improvement ◽

The Impact

OBJECTIVENational databases collect large amounts of clinical information, yet application of these data can be challenging. The authors present the NeuroPoint Alliance and Institute for Healthcare Improvement (NPA-IHI) program as a novel attempt to create a quality improvement (QI) tool informed through registry data to improve the quality of care delivered. Reducing the length of stay (LOS) and readmission after elective lumbar fusion was chosen as the pilot module.METHODSThe NPA-IHI program prospectively enrolled patients undergoing elective 1- to 3-level lumbar fusions across 8 institutions. A three-pronged approach was taken that included the following phases: 1) Research Phase, 2) Development Phase, and 3) Implementation Phase. Primary outcomes were LOS and readmission. From January to June 2017, a learning system was created utilizing monthly conference calls, weekly data submission, and continuous refinement of the proposed QI tool. Nonparametric tests were used to assess the impact of the QI intervention.RESULTSThe novel QI tool included the following three areas of intervention: 1) preoperative discharge assessment (location, date, and instructions), 2) inpatient changes (LOS rounding checklist, daily huddle, and pain assessments), and 3) postdischarge calls (pain, primary care follow-up, and satisfaction). A total of 209 patients were enrolled, and the most common procedure was a posterior laminectomy/fusion (60.2%). Seven patients (3.3%) were readmitted during the study period. Preoperative discharge planning was completed for 129 patients (61.7%). A shorter median LOS was seen in those with a known preoperative discharge date (67 vs 80 hours, p = 0.018) and clear discharge instructions (71 vs 81 hours, p = 0.030). Patients with a known preoperative discharge plan also reported significantly increased satisfaction (8.0 vs 7.0, p = 0.028), and patients with increased discharge readiness (scale 0–10) also reported higher satisfaction (r = 0.474, p < 0.001). Those receiving postdischarge calls (76%) had a significantly shorter LOS than those without postdischarge calls (75 vs 99 hours, p = 0.020), although no significant relationship was seen between postdischarge calls and readmission (p = 0.342).CONCLUSIONSThe NPA-IHI program showed that preoperative discharge planning and postdischarge calls have the potential to reduce LOS and improve satisfaction after elective lumbar fusion. It is our hope that neurosurgical providers can recognize how registries can be used to both develop and implement a QI tool and appreciate the importance of QI implementation as a separate process from data collection/analysis.

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An evaluation of the implementation of quality improvement (QI) in primary care dentistry: a multi-method approach

BMJ Open Quality ◽

10.1136/bmjoq-2019-000839 ◽

2021 ◽

Vol 10 (2) ◽

pp. e000839

Author(s):

Heather Cassie ◽

Vinay Mistry ◽

Laura Beaton ◽

Irene Black ◽

Janet E Clarkson ◽

...

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Case Studies ◽

Quality Care ◽

Theoretical Domains Framework ◽

Team Members ◽

Knowledge And Skills ◽

Scottish Government ◽

The Impact

ObjectivesEnsuring that healthcare is patient-centred, safe and harm free is the cornerstone of the NHS. The Scottish Patient Safety Programme (SPSP) is a national initiative to support the provision of safe, high-quality care. SPSP promotes a coordinated approach to quality improvement (QI) in primary care by providing evidence-based methods, such as the Institute for Healthcare Improvement’s Breakthrough Series Collaborative methodology. These methods are relatively untested within dentistry. The aim of this study was to evaluate the impact to inform the development and implementation of improvement collaboratives as a means for QI in primary care dentistry.DesignA multimethod study underpinned by the Theoretical Domains Framework and the Kirkpatrick model. Quantitative data were collected using baseline and follow-up questionnaires, designed to explore beliefs and behaviours towards improving quality in practice. Qualitative data were gathered using interviews with dental team members and practice-based case studies.ResultsOne hundred and eleven dental team members completed the baseline questionnaire. Follow-up questionnaires were returned by 79 team members. Twelve practices, including two case studies, participated in evaluation interviews. Findings identified positive beliefs and increased knowledge and skills towards QI, as well as increased confidence about using QI methodologies in practice. Barriers included time, poor patient and team engagement, communication and leadership. Facilitators included team working, clear roles, strong leadership, training, peer support and visible benefits. Participants’ knowledge and skills were identified as an area for improvement.ConclusionsFindings demonstrate increased knowledge, skills and confidence in relation to QI methodology and highlight areas for improvement. This is an example of partnership working between the Scottish Government and NHSScotland towards a shared ambition to provide safe care to every patient. More work is required to evaluate the sustainability and transferability of improvement collaboratives as a means for QI in dentistry and wider primary care.

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Engaging community pharmacists in quality improvement (QI): a qualitative case study of a partnership between a Higher Education Institute and Local Pharmaceutical Committees

BMJ Open Quality ◽

10.1136/bmjoq-2020-001047 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001047

Author(s):

Asam Latif ◽

Nargis Gulzar ◽

Fiona Lowe ◽

Theo Ansong ◽

Sejal Gohil

Keyword(s):

Quality Improvement ◽

Focus Groups ◽

Qualitative Methodology ◽

Positive Impact ◽

Community Pharmacists ◽

Educational Institute ◽

Collaboration And Communication ◽

Improve Service Quality ◽

The Impact

BackgroundQuality improvement (QI) involves the use of systematic tools and methods to improve the quality of care and outcomes for patients. However, awareness and application of QI among healthcare professionals is poor and new strategies are needed to engage them in this area.ObjectivesThis study describes an innovative collaboration between one Higher Educational Institute (HEI) and Local Pharmaceutical Committees (LPCs) to develop a postgraduate QI module aimed to upskill community pharmacists in QI methods. The study explores pharmacist engagement with the learning and investigates the impact on their practice.MethodsDetails of the HEI–LPCs collaboration and communication with pharmacist were recorded. Focus groups were held with community pharmacists who enrolled onto the module to explore their motivation for undertaking the learning, how their knowledge of QI had changed and how they applied this learning in practice. A constructivist qualitative methodology was used to analyse the data.ResultsThe study found that a HEI–LPC partnership was feasible in developing and delivering the QI module. Fifteen pharmacists enrolled and following its completion, eight took part in one of two focus groups. Pharmacists reported a desire to extend and acquire new skills. The HEI–LPC partnership signalled a vote of confidence that gave pharmacists reassurance to sign up for the training. Some found returning to academia challenging and reported a lack of time and organisational support. Despite this, pharmacists demonstrated an enhanced understanding of QI, were more analytical in their day-to-day problem-solving and viewed the learning as having a positive impact on their team’s organisational culture with potential to improve service quality for patients.ConclusionsWith the increased adoption of new pharmacist’s roles and recent changes to governance associated with the COVID-19 pandemic, a HEI–LPC collaborative approach could upskill pharmacists and help them acquire skills to accommodate new working practices.

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29 The impact of teicoplanin in prevention of implantable cardiac electrical devices infection. A single centre quality improvement audit

10.1136/heartjnl-2018-ics.29 ◽

2018 ◽

Author(s):

RB Pharithi ◽

P Flynn ◽

L Murphy ◽

M Hensey ◽

D O’Hare ◽

...

Keyword(s):

Quality Improvement ◽

Single Centre ◽

Electrical Devices ◽

The Impact

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Group Electronic Monitoring of Hand Hygiene on Inpatient Units: A Multicenter Cluster Randomized Quality Improvement Study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.518 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s38-s39

Author(s):

Jerome Leis ◽

Jeff Powis ◽

Allison McGeer ◽

Daniel Ricciuto ◽

Tanya Agnihotri ◽

...

Keyword(s):

Quality Improvement ◽

Hand Hygiene ◽

Electronic Monitoring ◽

Current Approach ◽

Antibiotic Resistant ◽

Guide Unit ◽

Cluster Randomized ◽

Healthcare Associated ◽

The Impact ◽

Inpatient Units

Background: The current approach to measuring hand hygiene (HH) relies on human auditors who capture <1% of HH opportunities and rapidly become recognized by staff, resulting in inflation in performance. Our goal was to assess the impact of group electronic monitoring coupled with unit-led quality improvement on HH performance and prevention of healthcare-associated transmission and infection. Methods: A stepped-wedge cluster randomized quality improvement study was undertaken across 5 acute-care hospitals in Ontario, Canada. Overall, 746 inpatient beds were electronically monitored across 26 inpatient medical and surgical units. Daily HH performance as measured by group electronic monitoring was reported to inpatient units who discussed results to guide unit-led improvement strategies. The primary outcome was monthly HH adherence (%) between baseline and intervention. Secondary outcomes included transmission of antibiotic resistant organisms such as methicillin resistant Staphylococcus aureus (MRSA) and other healthcare-associated infections. Results: After adjusting for the correlation within inpatient units, there was a significant overall improvement in HH adherence associated with the intervention (IRR, 1.73; 95% CI, 1.47–1.99; P < .0001). Monthly HH adherence relative to the intervention increased from 29% (1,395,450 of 4,544,144) to 37% (598,035 of 1,536,643) within 1 month, followed by consecutive incremental increases up to 53% (804,108 of 1,515,537) by 10 months (P < .0001). We identified a trend toward reduced healthcare-associated transmission of MRSA (0.74; 95% CI, 0.53–1.04; P = .08). Conclusions: The introduction of a system for group electronic monitoring led to rapid, significant, and sustained improvements in HH performance within a 2-year period.Funding: NoneDisclosures: None

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Patient Safety/Quality Improvement Primer, Part III: The Role of Simulation

Otolaryngology ◽

10.1177/01945998211013314 ◽

2021 ◽

pp. 019459982110133

Author(s):

Ellen S. Deutsch ◽

Sonya Malekzadeh ◽

Cecelia E. Schmalbach

Keyword(s):

Patient Safety ◽

Quality Improvement ◽

Control Charts ◽

Neck Surgery ◽

Resident Training ◽

Statistical Process ◽

Ensure Patient Safety ◽

Statistical Process Control Charts ◽

The Individual ◽

The Impact

Simulation training has taken a prominent role in otolaryngology–head and neck surgery (OTO-HNS) as a means to ensure patient safety and quality improvement (PS/QI). While it is often equated to resident training, this tool has value in lifelong learning and extends beyond the individual otolaryngologists to include simulation-based learning for teams and health systems processes. Part III of this PS/QI primer provides an overview of simulation in medicine and specific applications within the field of OTO-HNS. The impact of simulation on PS/QI will be presented in an evidence-based fashion to include the use of run and statistical process control charts to assess the impact of simulation-guided initiatives. Last, steps in developing a simulation program focused on PS/QI will be outlined with future opportunities for OTO-HNS simulation.

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Applying quality improvement principles to improve accident and emergency department overcrowding and flow in Rwanda: a case study

Journal of Hospital Administration ◽

10.5430/jha.v4n5p47 ◽

2015 ◽

Vol 4 (5) ◽

pp. 47 ◽

Cited By ~ 3

Author(s):

Jean Claude Byiringiro ◽

Rex Wong ◽

Caroline Davis ◽

Jeffery Williams ◽

Joseph Becker ◽

...

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Success Factors ◽

Low Cost ◽

Post Intervention ◽

Triage System ◽

Accident And Emergency ◽

Number Of Patients ◽

Accident And Emergency Department ◽

The Impact

Few case studies exist related to hospital accident and emergency department (A&E) quality improvement efforts in lowerresourced settings. We sought to report the impact of quality improvement principles applied to A&E overcrowding and flow in the largest referral and teaching hospital in Rwanda. A pre- and post-intervention study was conducted. A linked set of strategies included reallocating room space based on patient/visitor demand and flow, redirecting traffic, establishing a patient triage system and installing white boards to facilitate communication. Two months post-implementation, the average number of patients boarding in the A&E hallways significantly decreased from 28 (pre-intervention) to zero (post-intervention), p < .001. Foot traffic per dayshift hour significantly decreased from 221 people to 160 people (28%, p < .001), and non-A&E related foot traffic decreased from 81.4% to 36.3% (45% decrease, p < .001). One hundred percent of the A&E patients have been formally triaged since the implementation of the newly established triage system. Our project used quality improvement principles to reduce the number of patients boarding in the hallways and to decrease unnecessary foot traffic in the A&E department with little investment from the hospital. Key success factors included a collaborative multidisciplinary project team, strong internal champions, data-driven analysis, evidence-based interventions, senior leadership support, and rapid application of initial implementation learnings. Results to date show the application of quality improvement principles can help hospitals in resource-limited settings improve quality of care at relatively low cost.

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