The origins and development of the Cardiac Neurodevelopmental Outcome Collaborative: creating innovative clinical, quality improvement, and research opportunities

AbstractCompared to the general population, individuals with complex congenital heart disease are at increased risk for deficits in cognitive, neurodevelopmental, psychosocial, and physical functioning, resulting in a diminished health-related quality of life. These deficits have been well described over the past 25 years, but significant gaps remain in our understanding of the best practices to improve neurodevelopmental and psychosocial outcomes and health-related quality of life for individuals with paediatric and congenital heart disease. Innovative clinical, quality improvement, and research opportunities with collaboration across multiple disciplines and institutions were needed to address these gaps. The Cardiac Neurodevelopmental Outcome Collaborative was founded in 2016 with a described mission to determine and implement best practices of neurodevelopmental and psychosocial services for individuals and their families with paediatric and congenital heart disease through clinical, quality improvement, and research initiatives. The vision is to be a multi-centre, multi-national, multi-disciplinary group of healthcare professionals committed to working together and partnering with families to optimise neurodevelopmental outcomes for individuals with paediatric and congenital heart disease through clinical, quality, and research initiatives, intending to maximise quality of life for every individual across the lifespan. This manuscript describes the development and organisation of the Cardiac Neurodevelopmental Outcome Collaborative.

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1157. GET IT OUT! Nurses and Clinical Quality Improvement Specialists Drive Initiative to Reduce Standardized Utilization Ratios for Indwelling Urinary Catheters in Hospitalized Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1020 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S413-S414

Author(s):

Aldo Martinez ◽

Deborah Parilla ◽

Melissa Green ◽

Anne Murphy ◽

Sylvia Suarez-Ponce ◽

...

Keyword(s):

Quality Improvement ◽

Urinary Tract ◽

Night Shift ◽

Healthcare Research ◽

Hospitalized Patients ◽

Urinary Catheters ◽

Clinical Quality ◽

Tract Infections ◽

Clinical Quality Improvement ◽

Critical Reviews

Abstract Background Urinary tract infections (UTIs) account for 34% of all healthcare-associated infections (HAI). Urinary catheters (UC) are placed in 15–25% of hospitalized patients and >75% of HAI UTIs are UC-related. Bacteria introduced via UC can colonize the bladder within 3 days. So, the greatest risk factor for acquiring a catheter-associated urinary tract infection (CAUTI) is prolonged use of indwelling UC. Nursing (RN) staff noted inconsistency with appropriate use of UC and commonly UC remained in place well after their original indication had expired. Methods As part of a multi-faceted approach for quality improvement and patient safety, we rolled out an Agency for Healthcare Research and Quality (AHRQ)-based initiative to reduce UC days/Standardized Utilization Ratio (SUR). Daily critical reviews of the indication for UC were conducted by two groups. First, frontline night shift RN staff identified patients who no longer had a valid justification for continued UC. They handed-off the information to day-shift RNs, who recommend removal of UC during daily rounds with the physician teams. A second review was performed by Clinical Quality Improvement Specialists (CQIS) based on defined criteria from our nursing decatheterization protocol. Their discontinue UC recommendations were also sent to the care teams. The critical reviews of UC for CAUTI reduction started with 4 ICUs in August 2018, with additional ICUs added in December, January and March. Monthly UC SURs were tracked Results Figure 1 shows the number of UCs recommended for removal by RNs vs. CQIS (bars), as well as the percent discordance between RNs and CQIS (line). CQIS identified many more removable UCs than the RNs (888 vs. 256). 211 UC were removed after RN recommendations, and an additional 386 UCs were removed as a result of the CQIS audits. Figure 2 shows the marked corresponding decline in our SUR over this intervention. Conclusion As more units participated in the initiative, we saw increasing numbers of “discontinue UC” recommendations. Over time there was also a moderate decrease in the discordance between RN and CQIS recommendations for UC removal. CQIS routinely identified many more UCs to be removed compared with RNs, and more than doubled the number of discontinued UC. Notably, the UC SUR markedly improved, decreasing from 0.98 to 0.78. Disclosures All authors: No reported disclosures.

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Clinical quality improvement project: finding a repeatable approach for improving STAT lab testing

Leadership in Health Services ◽

10.1108/13660750310474508 ◽

2003 ◽

Vol 16 (2) ◽

pp. 1-5

Author(s):

Lynette Lutes ◽

Sarvesh Logsetty ◽

Jan McGuinness ◽

Joan M. Carlson

Keyword(s):

Quality Improvement ◽

Pilot Project ◽

Improvement Project ◽

Clinical Quality ◽

University Of Alberta ◽

Improved Performance ◽

The University ◽

Culture Of Quality ◽

Quality Process ◽

Clinical Quality Improvement

Explores the development of a clinical quality improvement pilot project at the University of Alberta Hospital and Stollery Children’s Hospital which aimed to establish a team of individuals that could disseminate a culture of quality improvement and develop a framework for a quality process that could be replicated and repeated. Outcomes of the clinical pilot project included improved performance as well as opportunities to learn some key lessons around team membership and involvement.

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