123 Quality Improvement Project on Completion of Respect Form in the Community At Jean Bishop Integrated Care Centre (ICC)

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
H Mon ◽  
S Kar ◽  
L Bridge
Keyword(s):  
Clinical Care ◽  
Emergency Situation ◽  
Published Data ◽  
Improvement Project ◽  
Team Members ◽  
Spot Check ◽  
Future Care ◽  
Audit Team ◽  
System 1 ◽  
Giving Feedback

Abstract Background ReSPECT (Recommendation Summary Plan for Emergency Care and Treatment) form was designed to communicate a personalized set of recommendations for a patient’s clinical care in an emergency situation and priorities over other aspects of future care. AIMS & OBJECTIVE 1)To measure ReSPECT Form completion rates at ICC and proportion of forms uploaded on the system and this compared with the published data 2 to improve performance where possible through QI process 3) Re-auditing after interventions. Methods All patients who attended the ICC from 1st October 2019 to 21st October 2019 were audited. Altogether 80 patients’ notes on system 1 and Lorenzo were reviewed. After initial results, interventions such as displaying the poster of salient results and recommendations in ICC clinic rooms, giving feedback to key team members were performed by the audit team. Results 9 patients already had ReSPECT forms. From the remaining 71 patients, 57 discussions (80%) were taken place and 29 forms (41%) were completed while 28 were not for definite reasons. ReSPECT discussion was not initiated for recorded reasons in 9 cases and without reason in 5 cases. Out of 29 completed forms, 24(82%) were uploaded on the system. After the interventions, the re-audit cycle with 16 cases in which 13(94%) had ReSPECT discussions and 6 forms were completed. Discussion In comparison with NHS forth valley ReSPECT report, we had a better figure in completion forms (41% Vs 39%) and the number uploaded on system (82% vs 79%). After interventions, 81% had either ReSPECT forms completed or discussion which is much improved. Conclusion From this study, the overall improvement in performance was seen with simple interventions but further spot check QIPs and regular training sessions to team member will be essential for sustainability.

Estimating performance from capabilities in business process improvement

2016 ◽  
Vol 22 (6) ◽  
pp. 1099-1117 ◽  
Author(s):  
Boyd A. Nicholds ◽  
John P.T. Mo
Keyword(s):  
Process Improvement ◽  
Business Process ◽  
Expected Improvement ◽  
Management Decision ◽  
Published Data ◽  
Performance Gain ◽  
Data Set ◽  
Business Process Improvement ◽  
Improvement Project ◽  
Content Type

Purpose The research indicates there is a positive link between the improvement capability of an organisation and the intensity of effort applied to a business process improvement (BPI) project or initiative. While a degree of stochastic variation in applied effort to any particular improvement project may be expected there is a clear need to quantify the causal relationship, to assist management decision, and to enhance the chance of achieving and sustaining the expected improvement targets. The paper aims to discuss these issues. Design/methodology/approach The paper presents a method to obtain the function that estimates the range of applicable effort an organisation can expect to be able to apply based on their current improvement capability. The method used analysed published data as well as regression analysis of new data points obtained from completed process improvement projects. Findings The level of effort available to be applied to a process improvement project can be expressed as a regression function expressing the possible range of achievable BPI performance within 90 per cent confidence limits. Research limitations/implications The data set applied by this research is limited due to constraints during the research project. A more accurate function can be obtained with more industry data. Practical implications When the described function is combined with a separate non-linear function of performance gain vs effort a model of performance gain for a process improvement project as a function of organisational improvement capability is obtained. The probability of success in achieving performance targets may be estimated for a process improvement project. Originality/value The method developed in this research is novel and unique and has the potential to be applied to assessing an organisation’s capability to manage change.

Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre: a quality improvement project using statistical process control

2018 ◽  
Vol 27 (8) ◽  
pp. 633-642 ◽  
Author(s):  
Rikke von Benzon Hollesen ◽  
Rie Laurine Rosenthal Johansen ◽  
Christina Rørbye ◽  
Louise Munk ◽  
Pierre Barker ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Process Control ◽  
Statistical Process Control ◽  
Clinical Care ◽  
University Hospital ◽  
Vacuum Extraction ◽  
Statistical Process ◽  
Academic Medical Centre ◽  
Improvement Project ◽  
Care Bundles

BackgroundA safe delivery is part of a good start in life, and a continuous focus on preventing harm during delivery is crucial, even in settings with a good safety record. In January 2013, the labour unit at Copenhagen University Hospital, Hvidovre, undertook a quality improvement (QI) project to prevent asphyxia and reduced the percentage of newborns with asphyxia by 48%.MethodsThe change theory consisted of two primary elements: (1) the clinical content, including three clinical bundles of evidence-based care, a ‘delivery bundle’, an ‘oxytocin bundle’ and a ‘vacuum extraction bundle’; (2) an implementation theory, including improving skills in interpretation of cardiotocography, use of QI methods and participation in a national learning network. The Model for Improvement and Deming’s system of profound knowledge were used as a methodological framework. Data on compliance with the care bundles and the number of deliveries between newborns with asphyxia (Apgar <7 after 5 min or pH <7) were analysed using statistical process control.ResultsCompliance with all three clinical care bundles improved to 95% or more, and the percentages of newborns with pH <7 and Apgar <7 after 5 min were reduced by 48% and 31%, respectively. In general, the QI approach strengthened multidisciplinary teamwork, systematised workflow and structured communication around the deliveries. Changes included making a standard memo in the medical record, the use of a bedside whiteboard, bedside handovers, shared decisions with a peer when using an oxytocin infusion and the use of a checklist before vacuum extractions.ConclusionThis QI project illustrates how aspects of patient safety, such as the prevention of asphyxia, can be improved using QI methods to more reliably implement best practice, even in high-performing systems.

EP.TU.672Privacy and security in surgical communication: Is Signal app the future?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hock Ping Cheah ◽  
Samantha Quah ◽  
Kenneth Wong
Keyword(s):  
Clinical Care ◽  
Good Alternative ◽  
Security And Privacy ◽  
Junior Doctors ◽  
Patient Privacy ◽  
User Privacy ◽  
Main Method ◽  
Team Members ◽  
Private Data ◽  
Efficiency And Effectiveness

Abstract Aims Electronic communication amongst surgical team members improves the team's ability to care for patients. Security and privacy of patient data are significant concerns. Recent controversy involving private data collection with WhatsApp has led to many users changing to other forms of messaging apps to protect user privacy. The aim of this study is the analyse the efficiency and effectiveness of the Signal messaging app in a research setting in Australia. Methods Members of our research group comprising three junior doctors and a supervising consultant surgeon used the Signal app as our main method of communication to discuss matters relating to our various research projects. No patient details were discussed in the messaging app. Results A total of 234 personal and 148 group messages were sent during the study period in a group and personal message setting. Most messages including picture files sent were received within one minute by the recipient. We did encounter a 24 hour period where Signal encountered some technical difficulties and some messages did not go through. Conclusion Signal messaging app is a good alternative to WhatsApp messaging app with better user privacy protection. With more user uptake on Signal app, it has the potential to be used for clinical care as Signal also provides end-to-end encryption to protect patient privacy.

Activity

2020 ◽  
pp. 171-189
Keyword(s):  
Subject Matter ◽  
Audit Report ◽  
Planning Study ◽  
Team Members ◽  
Audit Evidence ◽  
Audit Team ◽  
It Audit ◽  
Area Planning

Ascertaining the degree of correspondence between audit area assertions or direct subject matter and audit criteria is a professional mandate. Under normal circumstances, audit area planning, study, and testing permit IT audit team members submitting working papers for review by the in-charge IT auditor. Preceding IT audit report preparation, the in-charge IT auditor must review documented inconsistencies and departures from applicable IT principles discovered during the engagement. Moreover, the in-charge IT auditor must apply an in-depth understanding of what constitutes appropriate audit evidence. Chapter 7 conveys evidential working papers expectations that assist in ensuring appropriate audit engagement fieldwork. Chapter 7 also discusses the assessment of audit findings and the evaluation of audit working papers.

scholarly journals A service improvement project exploring the extent of need for allied health care professionals within neuro-oncology in Velindre Cancer Centre.

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv9-iv9
Author(s):  
Rachel Evans ◽  
Hayley Williams ◽  
Lisa Love-Gould ◽  
Owen Tilsley ◽  
James Powell ◽  
...  
Keyword(s):  
Patient Education ◽  
Health Care Professionals ◽  
Service Improvement ◽  
Language Therapy ◽  
Support Worker ◽  
Improvement Project ◽  
Cancer Centre ◽  
Future Care ◽  
Limited Opportunity ◽  
Research And Education

Abstract Given the highly complex and holistic needs of neuro-oncology patients, gold standard guidelines recommend that support is best served by a coordinated multi-disciplinary team (MDT) to provide seamless care from diagnosis to end of life (NICE 2018). Allied Healthcare Professionals (AHPs) including occupational therapy (OT), physiotherapy (PT), speech and language therapy (SLT) and dietitians (DT) are recognised as key professions within the MDT. As there is no designated AHP team at Velindre Cancer Centre, input can be reactive and fragmented with limited opportunity for patient education or service developments. The aim of the project was to scope and evaluate the level of AHP need the neuro-oncology population attending Velindre Cancer Centre. A service improvement grant funded a Band 4 Therapies support worker to conduct the project. The project involved a number of elements including the implementation of a revised neuro-oncology screening tool, strategic effort to improve patient education and self-management and engaging patients and staff to guide future service developments. The mixed methods approach yielded rich quantitative and qualitative data. The results demonstrated that whilst AHP input was beneficial to patient care, significant unmet needs were highlighted and demands for services exceeded the teams’ capacity. Therefore a designated neuro-oncology therapies team should be a central consideration for future care to enable timely, responsive, equitable and seamless MDT working. Greater AHP resource would also enable greater AHP involvement in research and education to revolutionise care in order to fully meet the needs of this vulnerable and complex patient group.

scholarly journals Conflict in the emergency department: Retreat in order to advance

CJEM ◽  
2003 ◽  
Vol 5 (06) ◽  
pp. 429-433 ◽  
Author(s):  
Jan Ahuja ◽  
Pam Marshall
Keyword(s):  
Emergency Department ◽  
Clinical Care ◽  
Professional Relationships ◽  
Collaborative Approach ◽  
Team Members ◽  
Working Together

ABSTRACT Conflict that exists within a team providing services in an emergency department has the potential to be destructive to clinical care and professional relationships. A collaborative approach involving members of the team guided by a neutral facilitator can be effective in addressing important issues and creating solutions that are acceptable to the individuals and the group. By working together in such a facilitated setting, relationships between the team members can be strengthened while problems are being solved.

Meeting the Quality Assurance Challenges of the 1980s: Team Auditing by Toxicologists and QA Professionals

1984 ◽  
Vol 3 (2) ◽  
pp. 129-139 ◽  
Author(s):  
B. Kristin Hoover ◽  
Judith K. Baldwin
Keyword(s):  
Quality Assurance ◽  
Large Scale ◽  
Product Liability ◽  
Regulatory Requirements ◽  
Team Members ◽  
Short Period ◽  
Professional Isolation ◽  
Cost Efficient ◽  
Major Factors ◽  
Audit Team

The major challenge of the 1980s is to continue to provide a productive contribution to the conduct of scientific research. Major factors that may be expected to affect the ability of quality assurance to meet this challenge are economics, ever changing and expanding regulatory requirements, increasing test complexity, computerization, and continuing product liability needs. Team auditing is an effective way to utilize resources to meet the requirements imposed by these factors. This approach results in a highly cost-efficient use of personnel in order to accomplish large and difficult tasks in a short period of time. In addition, it can decrease the need for large-scale training programs and be used as a method for upgrading present staff expertise. Individual perspectives are broadened as team members learn from each other. Morale is improved as the professional isolation of working alone or in small units is overcome. If team auditing is to be successful, it must be properly planned and executed. The team must be selected, objectives established, methods defined, and time constraints determined. These factors and ways to build a cohesive audit team capable of accomplishing specific goals will be discussed in detail. In addition, useful applications of this approach will be suggested.

Improving PICC use and outcomes in hospitalised patients: an interrupted time series study using MAGIC criteria

2017 ◽  
Vol 27 (4) ◽  
pp. 271-278 ◽  
Author(s):  
Lakshmi Swaminathan ◽  
Scott Flanders ◽  
Mary Rogers ◽  
Yvonne Calleja ◽  
Ashley Snyder ◽  
...  
Keyword(s):  
Time Series ◽  
Clinical Care ◽  
Interrupted Time Series ◽  
Patient Characteristics ◽  
Absolute Difference ◽  
Improvement Project ◽  
Multimodal Intervention ◽  
Hospitalised Patients ◽  
Quasi Experimental ◽  
Future Work

BackgroundAlthough important in clinical care, reports of inappropriate peripherally inserted central catheter (PICC) use are growing.ObjectiveTo test whether implementation of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) can improve PICC use and patient outcomes.DesignQuasi-experimental, interrupted time series design at one study site with nine contemporaneous external controls.SettingTen hospitals participating in a state-wide quality collaborative from 1 August 2014 to 31 July 2016.Patients963 hospitalised patients who received a PICC at the study site vs 6613 patients at nine control sites.InterventionA multimodal intervention (tool, training, electronic changes, education) derived from MAGIC.MeasurementsAppropriateness of PICC use and rates of PICC-associated complications. Segmented Poisson regression was used for analyses.ResultsAbsolute rates of inappropriate PICC use decreased substantially at the study site versus controls (91.3% to 65.3% (−26.0%) vs 72.2% to 69.6% (−2.6%); P<0.001). After adjusting for underlying trends and patient characteristics, however, a marginally significant 13.8% decrease in inappropriate PICC use occurred at the study site (incidence rate ratio 0.86 (95% CI 0.74 to 0.99; P=0.048)); no change was observed at control sites. While the incidence of all PICC complications decreased to a greater extent at the study site, the absolute difference between controls and intervention was small (33.9% to 26.7% (−7.2%) vs 22.4% to 20.8% (−1.6%); P=0.036).LimitationsNon-randomised design limits inference; the most effective component of the multimodal intervention is unknown; effects following implementation were modest.ConclusionsIn a multihospital quality improvement project, implementation of MAGIC improved PICC appropriateness and reduced complications to a modest extent. Given the size and resources required for this study, future work should consider cost-to-benefit ratio of similar approaches.

Prevention of Central Venous Catheter-Associated Bloodstream Infections in Pediatric Intensive Care Units A Performance Improvement Collaborative

2009 ◽  
Vol 30 (7) ◽  
pp. 645-651 ◽  
Author(s):  
Howard E. Jeffries ◽  
Wilbert Mason ◽  
Melanie Brewer ◽  
Katie L. Oakes ◽  
Esther I. Mufioz ◽  
...  
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Pediatric Intensive Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Evidence Based ◽  
Central Venous ◽  
Improvement Project ◽  
Team Members ◽  
Prevention Interventions

Objective.The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based intervention.Methods.An observational study was conducted in 26 freestanding children's hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative. CVC-associated BSI protocols were implemented using a collaborative process that included catheter insertion and maintenance bundles, daily review of CVC necessity, and daily goals. The primary goal was either a 50% reduction in the CVC-associated BSI rate or a rate of 1.5 CVC-associated BSIs per 1,000 CVC-days in each ICU at the end of a 9-month improvement period. A 12-month sustain period followed the initial improvement period, with the primary goal of maintaining the improvements achieved.Results.The collaborative median CVC-associated BSI rate decreased from 6.3 CVC-associated BSIs per 1,000 CVC-days at the start of the collaborative to 4.3 CVC-associated BSIs per 1,000 CVC-days at the end of the collaborative. Sixty-five percent of all participants documented a decrease in their CVC-associated BSI rate. Sixty-nine CVC-associated BSIs were prevented across all teams, with an estimated cost avoidance of $2.9 million. Hospitals were able to sustain their improvements during a 12-month sustain period and prevent another 198 infections.Conclusions.We conclude that our collaborative quality improvement project demonstrated that significant reduction in CVC-associated BSI rates and related costs can be realized by means of evidence-based prevention interventions, enhanced communication among caregivers, standardization of CVC insertion and maintenance processes, enhanced measurement, and empowerment of team members to enforce adherence to best practices.

How I treat symptomatic splenomegaly in patients with myelofibrosis

Blood ◽  
2009 ◽  
Vol 113 (22) ◽  
pp. 5394-5400 ◽  
Author(s):  
Ruben A. Mesa
Keyword(s):  
Stem Cell ◽  
Adverse Effects ◽  
Stem Cell Transplantation ◽  
Clinical Care ◽  
Close Monitoring ◽  
Massive Splenomegaly ◽  
Blast Phase ◽  
Careful Patient ◽  
Future Care ◽  
Treatment Refractory

Managing patients with myelofibrosis (MF), either those with primary MF or those whose MF has evolved from antecedent polycythemia vera or essential thrombocythemia, presents many challenges to the hematologist. MF patients have a range of debilitating disease manifestations (eg, massive splenomegaly, cytopenias, constitutional symptoms, and transformation to a treatment-refractory blast phase). Cure is potentially achievable through allogeneic stem cell transplantation; however, this therapy is either inappropriate or not feasible for the majority of patients. Therefore, remaining therapies are palliative but can be of significant value to some MF patients. In particular, management of symptomatic splenomegaly remains one of the most perplexing aspects of MF clinical care. Using medications is the simplest approach for reducing splenomegaly, yet achieving symptomatic response without undue myelosuppression is challenging. Splenectomy or radiotherapy offers benefit, but careful patient selection and close monitoring are required because both have the potential for dangerous adverse effects. Experimental medical therapies, such as JAK2 inhibitors, show promise and may soon play an important role in the management of symptomatic splenomegaly in MF patients. Future care of MF patients, including splenomegaly management, will continue to require the hematologist to select therapeutic options carefully in the context of realistic, achievable goals.

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