scholarly journals P085: A low-cost solution to high-risk problem: enhancing communication of emergency physician x-ray interpretations to reading radiologist

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S106-S107
Author(s):  
D.J. MacKinnon ◽  
M. McGowan ◽  
T. Dowdell ◽  
G. Bandiera
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Data Collection ◽  
Reporting System ◽  
Low Cost ◽  
Emergency Physicians ◽  
X Ray ◽  
It Systems ◽  
User Friendly ◽  
The Impact

Introduction: There was a recognized lack of available system for Emergency Physicians (EPs) to communicate their x-ray interpretations to the reading Radiologist; this resulted in unnecessary flagging of cases with significant findings already seen by the EP or the possibility of incorrectly assuming a finding was seen by the EP. Our aim was to develop an IT-based system that permitted Radiologists to view EPs documented x-ray interpretations real-time. Based on engagement with both groups, it was essential that the system be user friendly and not add significantly to an already busy workload. Methods: An online reporting system was introduced in 2011, but with complaints that interpretations were not readily accessible, nor automatic. A revised system was launched in 2014 with 2 improvements: i) EP entered interpretation onto “sticky note” in PACs directly; and ii) EP interpretation “popped up” when a film was opened by Radiologist. Results: Both systems allowed data collection of the percentage of events EPs entered an interpretation. Prior to 2011, 0% of films had EP interpretations available to Radiologist, 33% with initial, and 53% with PACS. The revised system has enabled EPs to enter their x-ray interpretation which has resulted in improvement both subjectively, based on regular feedback from both EPs and Radiologists, and objectively. Conclusion: From this and other quality improvement initiatives, we have learned the importance of engaging frontline practitioners in process changes, specifically the impact on workflow. Also, utilizing existing IT systems and resources can result in positive change with minimal costs.

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

2015 ◽  
Vol 4 (5) ◽  
pp. 47 ◽  
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.

scholarly journals The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0257941
Author(s):  
Claudia de Souza Gutierrez ◽  
Katia Bottega ◽  
Stela Maris de Jezus Castro ◽  
Gabriela Leal Gravina ◽  
Eduardo Kohls Toralles ◽  
...  
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Clinical Deterioration ◽  
Surgical Patients ◽  
Predictive Tool ◽  
Postoperative Death ◽  
High Risk Patients ◽  
Death Probability ◽  
Risk Patients ◽  
The Impact

Background Practical use of risk predictive tools and the assessment of their impact on outcome reduction is still a challenge. This pragmatic study of quality improvement (QI) describes the preoperative adoption of a customised postoperative death probability model (SAMPE model) and the evaluation of the impact of a Postoperative Anaesthetic Care Unit (PACU) pathway on the clinical deterioration of high-risk surgical patients. Methods A prospective cohort of 2,533 surgical patients compared with 2,820 historical controls after the adoption of a quality improvement (QI) intervention. We carried out quick postoperative high-risk pathways at PACU when the probability of postoperative death exceeded 5%. As outcome measures, we used the number of rapid response team (RRT) calls within 7 and 30 postoperative days, in-hospital mortality, and non-planned Intensive Care Unit (ICU) admission. Results Not only did the QI succeed in the implementation of a customised risk stratification model, but it also diminished the postoperative deterioration evaluated by RRT calls on very high-risk patients within 30 postoperative days (from 23% before to 14% after the intervention, p = 0.05). We achieved no survival benefits or reduction of non-planned ICU. The small group of high-risk patients (13% of the total) accounted for the highest proportion of RRT calls and postoperative death. Conclusion Employing a risk predictive tool to guide immediate postoperative care may influence postoperative deterioration. It encouraged the design of pragmatic trials focused on feasible, low-technology, and long-term interventions that can be adapted to diverse health systems, especially those that demand more accurate decision making and ask for full engagement in the control of postoperative morbi-mortality.

scholarly journals Resilience measurement of Padang city’s infrastructures toward multi-hazard

2020 ◽  
Vol 156 ◽  
pp. 01003
Author(s):  
Giani Ananda ◽  
Taufika Ophiyandri ◽  
Edi Hasymi
Keyword(s):  
High Risk ◽  
Data Collection ◽  
Qualitative Methods ◽  
Fault Line ◽  
Eurasian Plate ◽  
Assessment Data ◽  
Meeting Point ◽  
Australian Plate ◽  
Infrastructure Resilience ◽  
The Impact

The complexity of geographical conditions and regional morphology of Padang City have caused it to be at high risk of multi-hazard. Padang City is located near the meeting point of the Indo-Australian Plate and the Eurasian Plate, and also on the Sumatra Fault line (Semangko Fault). Therefore, strong infrastructures are needed in order to minimize the impact of the risk of multi-hazard. This study is conducted to measure the resilience of Padang City’s infrastructures toward multi-hazard and provide recommendations to improve the resilience of Padang City’s infrastructures toward Multi-hazard. This study was conducted with qualitative methods and presented quantitatively in the form of diagrams. The measurement is carried out based on the concept of city toughness measurements made by UNISDR known as the "Scorecard". This study only focuses on essential 8 about "Increase Infrastructure Resilience" and essential 10 about "Expedite Recovery and Build Back Better". From this study, it can be concluded that the resilience of Padang City infrastructures is still relatively low so several recommendations that are expected will increase the resilience of Padang City’s infrastructures are proposed, that are; in-depth assessment, data collection and supervision monitoring of infrastructures, important assets, and protective infrastructure.

A multicenter quality improvement initiative on the impact of pharmacists’ postdischarge follow-up to reduce medication-related acute care episodes

2020 ◽  
Vol 77 (12) ◽  
pp. 938-942
Author(s):  
Lydia Noh ◽  
Kristina Heimerl ◽  
Rita Shane
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Acute Care ◽  
Academic Medical Centers ◽  
Quality Improvement Initiative ◽  
Medical Centers ◽  
Academic Medical ◽  
Risk Patients ◽  
The Impact

Abstract Purpose This multicenter quality improvement initiative aims to measure and quantify pharmacists’ impact on reducing medication-related acute care episodes (MACEs) for high-risk patients at an increased risk for readmission due to drug-related problems (DRPs). Methods This was a prospective, multicenter quality improvement initiative conducted at 9 academic medical centers. Each participant implemented a standardized methodology for evaluating MACE likelihood to demonstrate the impact of pharmacist postdischarge follow-up (PDFU). The primary outcome was MACEs prevented, and the secondary outcome was DRPs identified and resolved by pharmacists. During PDFU, pharmacists were responsible for identification and resolution of DRPs, and cases were reviewed by physicians to confirm whether potential MACEs were prevented. Results A total of 840 patients were contacted by 9 participating academic medical centers during a 6-week data collection period. Of these, 328 cases were identified as MACEs prevented during PDFU by pharmacists, and physician reviewers confirmed that pharmacist identification of DRPs during PDFU prevented 27.9% of readmissions. Pharmacist identified 959 DRPs, 2.8% (27) of which were identified as potentially life threatening. Potentially serious or significant DRPs made up 56.6% (543) of the DRPs, and 40.6% (389) were identified as having a low capacity for harm. Conclusion The results demonstrate that PDFU of high-risk patients reduces DRPs and prevents MACEs based on physician confirmation. Implementation of MACE methodology provides health-system pharmacy departments the ability to demonstrate pharmacists’ value in transitions of care and assist in expanding pharmacist services.

DXS: Differential absorption x-ray spectroscopy

1992 ◽  
Vol 50 (2) ◽  
pp. 1738-1739
Author(s):  
Robert M. Fisher
Keyword(s):  
Abrupt Change ◽  
Low Cost ◽  
X Ray ◽  
Cost System ◽  
Routine Work ◽  
Precise Adjustment ◽  
Filter Array ◽  
Filter Thickness ◽  
User Friendly ◽  
X Ray Absorption

X-ray spectrochemical analysis, with either energy-dispersive (EDS) or wavelength-dispersive (WDS) systems, is is used extensively by electron microscopists to determine the chemical composition of selected features in a wide variety of specimens. Several decades of development have yielded efficient and rugged detector crystals and goniometer hardware as well as sophisticated, but user-friendly, software for quantitative chemical and image analysis. Nevertheless an alternative system, based on differential x-ray absorption with "balanced" transmission filters (DXS™) has attractive advantages as a simple, low cost, system for qualitative x-ray microanalysis which does not require liquid nitrogen. Computer processing of intensities obviates the former need for impossibly-precise adjustment of filter thickness. However the filter array must be preset for analysis of the elements that are believed to be present for routine work.DXS analysis is based on the abrupt change in x-ray absorption that occurs between particular elements. This is illustrated by the different mass absorption coefficients for Fe and Cr K radiation for a series of filters in increasing atomic number from Ti to Co as shown in Figure 1 (1,2).

In Situ Neonatal Mock Codes: Assessing the Impact

2020 ◽  
Vol 39 (1) ◽  
pp. 29-34
Author(s):  
Emily K. Rivera ◽  
Leah M. Siple ◽  
Eunice J. Wicks ◽  
Heather S. Johnson ◽  
Caren M. Skov
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Outcome Measures ◽  
Nursing Staff ◽  
Neonatal Resuscitation ◽  
Confidence Levels ◽  
Mock Codes ◽  
The Impact

PurposeTo assess the impact of a quality improvement (QI) project to increase nursing staff confidence in responding to neonatal emergencies.DesignMandatory neonatal emergency in situ scenarios done quarterly.SampleBedside NICU nursing staff and the subset of NICU nurses that attend all high-risk deliveries and neonatal emergencies on the obstetrics unit.Outcome MeasuresConfidence levels in responding to neonatal emergencies, demonstrating neonatal resuscitation skills, and communicating effectively during an emergency.ResultsSixty-eight NICU nurses completed the pre- and postintervention surveys. Self-reported confidence levels increased in all areas measured. Overall, the percentage of nursing staff that reported confidence in being able to participate in a neonatal emergency increased from 48 percent to 77 percent.

scholarly journals ENT Quality Improvement Program as a tool to improve the collection of morbidity and mortality data: a multisite audit carried out over 6 months

2019 ◽  
Vol 8 (3) ◽  
pp. e000501 ◽  
Author(s):  
Rachel Edmiston ◽  
Rajesh Anmolsingh ◽  
Sadie Khwaja ◽  
B Nirmal Kumar
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
Outcome Measures ◽  
Quality Improvement Program ◽  
Morbidity And Mortality ◽  
Mortality Data ◽  
General Anaesthetic ◽  
Low Grade ◽  
Improvement Program ◽  
User Friendly

ObjectiveThis project aims to assess the role of a standardised process of data collection to improve morbidity and mortality data across the region.DesignSix hospitals within the North West (UK) were recruited and adopted the ENT Quality Improvement Program (QIP) into their daily practice. Monthly anonymous data were sent back to the reviewer for trend analysis.Outcome measuresFour outcome measures were defined: (1) number of cases recorded within the region each month; (2) assessment of the severity of cases and trends; (3) assessment of action plans reviewing any changes in practice made as a result of using this tool; (4) long-term use of the tool and qualitative feedback from units.Results162 patients over the 6 months were included with 180 case discussions. 170 of these were morbidities and 10 were mortalities. Mortality was more frequent in patients with a diagnosis of head and neck cancer. Of the 162 patients, 133 encountered postoperative complications. Post-tonsillectomy (62/133 47%) and post-thyroid surgery (19/133 14%) complications were the most frequently encountered. 66% of the complications were low grade with 18% requiring management under general anaesthetic. Actions plans included four policy reviews with the introduction of three new policies. All sites found the tool user-friendly and are continuing to use it beyond the data collection period.ConclusionsThe ENT QIP has been found to be a simple, user-friendly tool which has improved the quality of data over the six sites and resulted in improvements in practice. Implementation of the tool allows clinicians to critically appraise their practice and to reflect as well as to demonstrate how complications have resulted in change.

Open source digital library on open educational resources

2019 ◽  
Vol 37 (6) ◽  
pp. 1022-1039 ◽  
Author(s):  
Nur Ahammad
Keyword(s):  
Open Source ◽  
Digital Library ◽  
Low Cost ◽  
Open Educational Resources ◽  
Educational Resources ◽  
Institutional Repository ◽  
Content Type ◽  
Library Community ◽  
User Friendly ◽  
The Impact

Purpose This paper aims to explain the implementation procedure of DSpace at the Library of Independent University, Bangladesh. This paper shows how DSpace is promoting open educational resources (OER) movement and demonstrates the ease of implementing DSpace in an institution. Moreover, the purpose of this paper is to encourage library professionals to participate in the OER movement by implementing DSpace in their libraries. Design/methodology/approach The requirements for implementing DSpace have been shown in this paper. It also describes the system model of an academic repository (DSpace)/digital library (DL). In addition, the paper describes the legal issues for submitting an item in DSpace and self-submission process of an item as well as shows impact of DSpace on OER. Findings Open source software and Open Access Institutional Repository software has a fundamental role in promoting OER. DSpace is perfect for building a DL or an institutional repository in libraries, especially for developing country libraries because this demands low cost and it is easy to implement in libraries as well as is user-friendly. Originality/value This paper will help to understand the role of the library community and librarians about OER. It will also show the impact of DL on OER. In addition, this paper encourages librarians to participate in OER movement.

scholarly journals SAIGE-BRUSH: an efficient, user-friendly and low cost cloud implementation for genome-wide association studies

2021 ◽  
Author(s):  
Tonya M Brunetti ◽  
Nikita Pozdeyev ◽  
Michelle Daya ◽  
Kathleen C Barnes ◽  
Nicholas Rafaels ◽  
...  
Keyword(s):  
Personalized Medicine ◽  
Data Collection ◽  
Association Studies ◽  
Low Cost ◽  
Genome Wide Association ◽  
Data Sets ◽  
Genome Wide Association Studies ◽  
Genome Wide ◽  
User Friendly ◽  
Cloud Implementation

SAIGE-Biobank Re-Usable SAIGE Helper (SAIGE-BRUSH) allows users with little computational expertise to utilize SAIGE for GWAS with parallelization and data collection on biobank data sets. This implementation requires no installation and has additional features not programmed within the original SAIGE framework, such as concurrency, reproducibility, reusability, scalability, association analysis results filtering and output plots. This is all achieved without writing any code from the user. This implementation is currently being utilized by the Biobank at the Colorado Center for Personalized Medicine (CCPM) on Google Cloud but is flexible for a number of architectures available to genetic analysts. Availability: This open source implementation is freely available at https://github.com/tbrunetti/SAIGE-BRUSH and is licensed under the MIT License. Contact: Chris Gignoux at [email protected] & Nick Rafaels at [email protected] Supplemental Material: For detailed user documentation, please visit https://saige-brush.readthedocs.io/en/latest/

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