Enhancing general practice referrals for women of refugee background to maternity care

2018 ◽  
Vol 24 (2) ◽  
pp. 123 ◽  
Author(s):  
Dannielle Vanpraag ◽  
Wendy Dawson ◽  
Bianca Bell ◽  
Elisha Riggs ◽  
Jo Szwarc ◽  
...  
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Maternity Care ◽  
Maternity Hospital ◽  
Communication Strategy ◽  
Country Of Birth ◽  
Improvement Strategy ◽  
Quality Improvement Strategy ◽  
Development Activity ◽  
Improvement Project

This paper presents the findings from a quality improvement project implemented by a maternity hospital located in a region of high refugee settlement. The project was designed to improve the completeness of general practice referral information to enable triage to maternity care that would best meet the needs of women of refugee background. Referral information included four data items – country of birth, year of arrival in Australia, language spoken and interpreter required – used in combination to provide a proxy measure of refugee background. A communication strategy and professional development activity engaged general practitioners (GPs) in the rationale for collecting the four data items on a new referral form. Audits of referrals to the maternity hospital before, and at two time points following the quality improvement activity, indicated that very few referrals were completed on the new form. There were modest improvements in the recording of two items – country of birth and interpreter required. Overall, two-thirds of referrals did not contain information on interpreter requirements. Changing practice will require a more cohesive approach involving GPs in the co-design of the form and development of the quality improvement strategy.

scholarly journals Structured yet simple approaches to primary care data quality improvements can indeed strike gold

2021 ◽  
Vol 27 (2) ◽  
pp. 143
Author(s):  
Abhijeet Ghosh ◽  
Elizabeth Halcomb ◽  
Sandra McCarthy ◽  
Christine Ashley
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Quality Improvement ◽  
Data Quality ◽  
Disease Surveillance ◽  
Data Entry ◽  
Structured Interviews ◽  
Improvement Strategy ◽  
Quality Improvement Strategy ◽  
Primary Care Data

General practice data provide important opportunities for both population health and within-practice initiatives to improve health. Despite its promise, a lack of accuracy affects the use of such data. The Sentinel Practices Data Sourcing (SPDS) project is a structured chronic disease surveillance and data quality improvement strategy in general practice. A mixed-methods approach was used to evaluate data quality improvement in 99 participating practices over 12 months. Quantitative data were obtained by measuring performance against 10 defined indicators, whereas 48 semi-structured interviews provided qualitative data. Aggregated scores demonstrated improvements in all indicators, ranging from minor to substantially significant improvements. Participants reported positively on levels of support provided, and acquisition of new knowledge and skills relating to data entry and cleansing. This evaluation provides evidence of the effectiveness of a structured approach to improve the quality of primary care data. Investing in this targeted intervention has the potential to create sustained improvements in data quality, which can drive clinical practice improvement.

scholarly journals Increasing adherence to plotting e-partograph: a quality improvement project in a rural maternity hospital in India

2021 ◽  
Vol 10 (Suppl 1) ◽  
pp. e001404
Author(s):  
Shuchi Jain ◽  
Pramod Kumar ◽  
Manish Jain ◽  
Megha Bathla ◽  
Shiv Joshi ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Control Charts ◽  
Neonatal Intensive Care ◽  
Data Entry ◽  
Birth Asphyxia ◽  
Maternity Hospital ◽  
Improvement Project ◽  
Mortality And Morbidity ◽  
Prolonged Labour ◽  
Labour Room

Abnormal prolonged labour and its effects are important contributors to maternal and perinatal mortality and morbidity worldwide. E-partograph is a modern tool for real-time computerised recording of labour data which improves maternal and neonatal outcome. The aim was to improve the rates of e-partograph plotting in all eligible women in the labour room from existing 30% to achieve 90% in 6 months through a quality improvement (QI) process.A team of nurses, obstetricians, postgraduates and a data entry operator did a root cause analysis to identify the possible reasons for the drop in e-partograph plotting to 30%. The team used process flow mapping and fish bone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles to address the issues identified.The interventions included training labour room staff, identification of eligible women and providing an additional computer and internet facility for plotting and assigning responsibility of plotting e-partographs. We implemented these interventions in five PDSA cycles and observed outcomes by using control charts. A set of process, output and outcome indicators were used to track if the changes made were leading to improvement.The rate of e-partograph plotting increased from 30% to 93% over the study period of 6 months from August 2018 to January 2019. The result has been sustained since the last PDSA cycle. The maternal outcome included a decrease in obstructed and prolonged labour with its associated complications from 6.2% to 2.4%. The neonatal outcomes included a decrease in admissions in the neonatal intensive care unit for birth asphyxia from 8% to 3.4%. It can thus be concluded that a QI approach can help in improving adherence to e-partography plotting resulting in improved maternal health services in a rural maternity hospital in India.

scholarly journals Implementation of a Quality Improvement Strategy to Increase Outpatient Kidney Transplant Referrals

2020 ◽  
Author(s):  
Samira Farouk ◽  
Sarah Atallah ◽  
Kirk N Campbell ◽  
Joseph A Vassalotti ◽  
Jaime Uribarri
Keyword(s):  
Quality Improvement ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Outpatient Setting ◽  
Improvement Strategy ◽  
Quality Improvement Strategy ◽  
Important Barrier ◽  
Transplant Evaluation ◽  
End Stage ◽  
The Impact

Abstract Background: Kidney transplantation remains the optimal therapy for patients with end stage kidney disease (ESKD), though a small fraction of patients on dialysis are on organ waitlists. An important barrier to preemptive kidney transplantation and successful waitlisting is timely referral to a kidney transplant center. We implemented a quality improvement strategy to improve outpatient kidney transplant referrals in a single center academic outpatient nephrology clinic. Methods: Over a 3 month period (July 1 - September 30, 2016), we assessed the baseline kidney transplantation referral rate at our outpatient nephrology clinic for patients 18 - 75 years old with an estimated glomerular filtration rate (eGFR) of less than 20 mL/min/1.73m 2 (2 values over 90 days apart). Charts were manually reviewed by two reviewers to look for kidney transplant referrals and documentation of discussions about kidney transplantation. We then performed a root cause analysis to explore potential barriers to kidney transplantation. Our intervention began on July 1, 2017 and included the implementation of a column in the electronic medical record (EMR) which displayed the patient's last eGFR as part of the clinic schedule. Physicians were given a document listing their patients to be seen that day with an eGFR of < 20 mL/min/1.73m 2 . Results: 54 unique patients with eGFR ≤ 20 ml/min/1.73 m 2 were identified who were seen in the Clinic between July 1, 2016 and September 30, 2016. 29.6% (16) eligible patients were referred for kidney transplantation evaluation. 69.5% (37) of these patients were not referred for kidney transplant evaluation. 46.3% (25) did not have documentation regarding kidney transplant in the EMR. Following the intervention, 66 unique patients met criteria for eligibility for kidney transplant evaluation. Kidney transplant referrals increased to 60.6% (p < 0.001). Conclusions: Our pilot implementation study of a strategy to improve outpatient kidney transplant referrals showed that a free, simple, scalable intervention can significantly improve kidney transplant referrals in the outpatient setting Next steps include further study of the impact of early referral to kidney transplant centers on preemptive and living donor kidney transplantation as well as successful waitlisting.

scholarly journals Midwives' evaluation of their role in crowdsourcing activities to improve the maternity experience: part 1

2019 ◽  
Vol 27 (6) ◽  
pp. 368-372 ◽  
Author(s):  
Sam Frewin ◽  
Sarah Church
Keyword(s):  
Quality Improvement ◽  
Maternity Care ◽  
Low Cost ◽  
Service Evaluation ◽  
Quality Improvement Project ◽  
Service Users ◽  
Improvement Project ◽  
Maternity Services ◽  
Creative Solutions ◽  
Evaluation Project

This is the first of two articles introducing crowdsourcing as a tool that offers creative solutions to address everyday challenges in maternity care. In this first article, crowdsourcing is defined and discussed, demonstrating how it can be used to discover many relatively low-cost ideas to improve maternity services. By engaging service users in crowdsourcing activities, quality improvement is shared and focused on issues that emerge from practice. This process has the potential to generate more innovative ways to improve maternity services and women's experiences of care. In the second article, the discussion will centre on a service evaluation project that studied midwives' involvement in a workshop as part of a quality improvement project.

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