546 QUALITY IMPROVEMENT PROJECT: IMPROVING CONTENT IN DISCHARGE SUMMARIES FOR CODING

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
C Alcock ◽  
P Oluwamayowa ◽  
E Wallace

Abstract Introduction Hospital coding provides a pivotal service, integral to data collection, national statistics and hospital finances. The system of accurately coding depends almost entirely on the information put into Electronic Discharge Letters (EDLs). This project aims to up skill doctors with the expertise of the coding department, so that the EDLs reflect more accurately the experiences of the patient in hospital. Method Cycle 1; A member from the coding department was invited to the ward once a week to join with junior doctors writing their discharge letter. The coding from the discharge letters produced during this time were compared to those immediately prior to the coding department’s involvement. Cycle 2; The lead author and a member from the coding team took a sample of 12 notes from the Ambulatory Emergency Clinic (AEC), for patients presenting in January and February of 2020. Results Cycle 1; there was no significant difference in the number of co-morbidities or revenue gained from EDLs written with the support of the coding team compared to doctors writing ELDs independently Cycle 2; For 9 of the 12 patients (75%), co-morbidities were added. This changed the Healthcare Resource Group coded of 5 patients, resulting in an increasing the revenue to the hospital by £757 on average. For the number of patients seen in AEC in January, this could represent £218,271 of lost revenue, in addition to other benefits of accurate record keeping. Conclusion The role of the physician cannot increase indefinitely, and there is a wealth of knowledge and experience to be gained from our colleagues in the coding department. This collaboration in assiduously improving the service that our patients receive brings the possibility of large financial gains as well as more accurate health care records.

Chemotherapy ◽  
2021 ◽  
pp. 1-8
Author(s):  
Angelo Onorato ◽  
Andrea Napolitano ◽  
Silvia Spoto ◽  
Lorena Incorvaia ◽  
Antonio Russo ◽  
...  

<b><i>Background:</i></b> Fatigue is a common distressing symptom for patients living with chronic or acute diseases, including liver disorders and cancer (<i>Cancer-Related Fatigue</i>, CRF). Its etiology is multifactorial, and some hypotheses regarding the pathogenesis are summarized, with possible shared mechanisms both in cancer and in chronic liver diseases. A deal of work has investigated the role of a multifunctional molecule in improving symptoms and outcomes in different liver dysfunctions and associated symptoms, including chronic fatigue: S-adenosylmethionine (SAM; AdoMet). The aim of this work is actually to consider its role also in oncologic settings. <b><i>Patients and Methods:</i></b> Between January 2006 and December 2009, at the University Campus Bio-Medico of Rome, 145 patients affected by colorectal cancer in adjuvant (<i>n</i> = 91) or metastatic (<i>n</i> = 54; <i>n</i> = 40 with liver metastases) setting and treated with oxaliplatin-based regimen (FOLFOX for adjuvant and bevacizumab + XELOX for metastatic ones), 76 of which with the supplementation of S-adenosylmethionine (AdoMet; 400 mg b.i.d.) (57% of adjuvant patients and 44% of metastatic ones) and 69 without AdoMet supplementation, were evaluated for fatigue prevalence using the Functional Assessment of Chronic Illnesses Therapy-Fatigue (FACIT-F) questionnaire, at 3 and 6 months after the beginning of oncologic treatment. Notably, the number of patients with liver metastases was well balanced between the group of patients treated with AdoMet and those who were not. <b><i>Results:</i></b> Among patients receiving oxaliplatin-based chemotherapy, both in adjuvant and in metastatic settings, after just 3 months from the beginning of chemotherapy, mean scores from questionnaire domains like FACIT-F subscale (7.9 vs. 3.1, <i>p</i> = 0.006), FACIT physical (6.25 vs. 3.32, <i>p</i> = 0.020), FACIT emotional (4.65 vs. 2.19, <i>p</i> = 0.045), and FACIT-F total score (16.5 vs. 8.27, <i>p</i> = 0.021) were higher in those receiving supplementation of AdoMet, resulting in reduced fatigue; a significant difference was maintained even after 6 months of treatment. <b><i>Discussion and Conclusions:</i></b> Mechanisms and strategies for managing CRF are not fully understood. This work aimed at investigating the possible role of S-adenosylmethionine supplementation in improving fatigue scores in a specific setting of cancer patients, using a FACIT-F questionnaire, a well-validated quality of life instrument widely used for the assessment of CRF in clinical trials.


2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19547-e19547
Author(s):  
K. Khodadad ◽  
S. Karimi ◽  
Z. Esfahani Monfared

e19547 Background: MCM6 is a proliferative marker, which in contrary to Ki67, is involved in all cell cycle phases, including early G1. We evaluated MCM6 expression in Hodgkin's disease (HD) patients in order to find any correlation between MCM6 expression and treatment outcome. Methods: Formalin-fixed paraffin-embedded lymph node specimens of 55 patients with HD treated with ABVD regimen (± radiotherapy) were assessed for MCM6 expression by IHC. The percentage of nuclear positivity in RS and mononuclear Hodgkin cells was evaluated in each case. Clinical data, response to treatment and relapse rates were obtained from patients’ medical records. These data were analyzed by SPSS software. Results: Mean MCM6 expression was 80.7% (ranging 35%-99%) with no significant difference between histology subtypes. In univariate analysis, MCM6 expression was not statistically significant for B-symptoms (P=0.27), sex (P=0.91), stage (P=0.18) and response to treatment (P=0.53), but was significant for age (P=0.008) (≤23 vs >23 yrs old). The MCM6 mean expression between relapsed and non-relapsed groups was marginally significant (21% vs 29.4%, P=0.057). In multivariate analysis, we evaluated MCM6 expression, B-symptoms, stage, response rate and age for relapse. None of risk factors were statistically significant predictor for relapse, including MCM6 expression (P=0.238), however, were significant regarding to response (P<0.001) and stage (P=0.048). We divided patients in 4 quartiles based on their MCM6 expression (Q1<74.25%, N=13, Q2=74.26–85.5%, N=14, Q3=85.6–91.75%, N=13, Q4>91.75%, N=12). Relapse and PFS were not significantly different between these quartiles (P=0.27 and P=0.83, respectively). Conclusions: Our study on a limited number of patients revealed MCM6 is not a strong predictor for treatment outcome in patients with HD. Our findings can be possibly explained by early G1 arrest of tumor cells and the role of cytokine production in pathogenesis of HD. We believe determining the accurate predictive role of proliferative markers needs to be focused on the markers which are exclusively involved in S phase. No significant financial relationships to disclose.


2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
J Arumugam ◽  
R Laud ◽  
P Naydenova

Abstract Introduction Communication between the hospital and primary care regarding the death of a patient is incredibly important. Previous literature surrounding this area has shown that it is often done poorly, resulting in substandard documentation. Furthermore, lack of information for General Practitioners (GPs) means it is difficult for them to enter discussions with families, which can negatively impact on the bereavement process. The previous expectation was that an electronic discharge summary was completed, but that this was not optimally designed to inform GPs about the circumstances surrounding the death. Reasons given that summaries were not completed included: the busy workload of junior doctors and the lack of awareness of their importance. Methods The aim of our quality improvement project was to ensure 80% of GPs received notification and information about a patient’s death by August 2018. Following an initial cycle to assess the baseline notification rates, we developed a standardized death notification letter following feedback from local GPs. This included information such as date of death, if the coroner had been informed and a brief summary of events. Following introduction of the letter, we recorded the uptake and then gained further feedback regarding the ways in which it could be improved. A final cycle was then implemented. Results Baseline data showed an electronic discharge letter was only being completed in 13.3% of cases (n=3/21). Following introduction of the new letter, 83.6% were completed (n=56/67). Conclusions In conclusion, the introduction of a simple and standardized letter template has vastly increased the notification of GPs about a patient’s death from our hospital. Limitations of our project included the varying numbers of deaths in audited periods and some hospital teams having a separate process in place.


Author(s):  
Shailesh B. Patil ◽  
Milind B. Patil

Background: It is certain from clinical experience of many that one or more hemorrhages in early pregnancy can still end up in good fetal outcome. So, our study deals with comparison of cytohormonal study in pregnancy and threatened abortion. The study was conducted with the aim of utilizing colpocytogram as a tool in assessing and treating cases of threatened abortion and comparing them with normal pregnant women.Methods: Patients attending antenatal care unit on outdoor basis and labelled as normal pregnancy cases were considered as control group. The patients of threatened abortion were studied when they were admitted in Gynecology department for indoor treatment. Patients were studied taking into consideration their age, parity, number of abortions, complaints (P/V bleeding, pain in abdomen), gestational age, per abdomen and per vaginal findings and also USG findings and vaginal smear pattern.Results: Maximum number of patients was present in the age group of 21-25 years in both the groups. While only 13.33% had normal smear pattern in threatened abortion group. 86.67% patients in threatened abortion group showed abnormal smear pattern. There is statistically significant difference was found (p<0.05). There is statistically significant was found (P<0.01) and indicates good effects of the drug on the vaginal epithelium.Conclusions: The cytohormonal study acts as a simple, reliable, good, noninvasive method for evaluation of hormonal pattern in normal pregnancy and threatened abortion. 


2013 ◽  
Vol 85 (3) ◽  
pp. 143 ◽  
Author(s):  
Giangiacomo Ollandini ◽  
Giovanni Liguori ◽  
Stanislav Ziaran ◽  
Tomáš Málek ◽  
Giorgio Mazzon ◽  
...  

Objectives: To determine whether there are differences in sperm parameters improvement after different varicocele correction techniques. To determine the role of age in sperm parameters improvement. Methods: 2 different European centers collected pre- and postoperative sperm parameters of patients undergoing varicocele correction. Among 463 evaluated patients, 367 were included. Patients were divided in procedure-related and age-related groups. Ivanissevich inguinal open surgical procedure (OS), lymphatic-sparing laparoscopic approach (LSL) and retrograde percutaneous transfemoral sclerotization (RPS) were performed. As outcome measurements sperm count (millions/mL, SC) and percentage of mobile sperms were analyzed. Univariate and multivariate regression between the defined groups; bivariate regression analysis between age and sperm count and motility. Results: Number of patients: OS 78; LSL 85; RPS 204. Mean age 30.2 (SD 6.83); postoperative SC increased from 18.2 to 30.1 (CI 95% 27.3-32.9; p &lt; 0,001); motility from 25.6 to 32.56% (30.9-34.2; p &lt; 0.001). OS: SC varied from 16.9 to 18.2 (p &lt; 0.001); sperm motility from 29% to 33% (p &lt; 0.001). LSL: SC from 15.5 to 17.2 (p &lt; 0.001); motility from 27 to 31% (p &lt; 0.001). RPS: SC from 18.9 to 36.2 (p &lt; 0.001); motility from 24% to 32% (p &lt; 0.001). Univariate and multivariate analysis confirmed the significant difference of SC variation in RPS, compared to the other groups (p &lt; 0.001). No significance between LSL and OS (p = 0.826). No significant differences regarding motility (p = 0.8). Conclusions: Varicocele correction is confirmed useful in improving sperm parameters; sclerotization technique leads to a better sperm improvement compared to other studied procedures; improvement in seminal parameters is not affected by age of the patients treated.


Cancers ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 34
Author(s):  
Enrico Vizza ◽  
Valentina Bruno ◽  
Giuseppe Cutillo ◽  
Emanuela Mancini ◽  
Isabella Sperduti ◽  
...  

Objective: The aim of our study was to investigate the role of the excised vaginal cuff length as a prognostic factor in terms of DFS and recurrence rate/site, in low-risk endometrial cancer (EC) patients. Moreover, we correlated the recurrence with the expression of L1CAM. Material and Methods: From March 2001 to November 2016, a retrospective data collection was conducted of women undergoing surgical treatment for low-risk EC according to ESMO-ESGO-ESTRO consensus guidelines. Patients were divided into three groups according to their vaginal cuff length: V0 without vaginal cuff, V1 with a vaginal cuff shorter than 1.5 cm and V2 with a vaginal cuff longer than or equal to 1.5 cm. Results: 344 patients were included in the study: 100 in the V0 group, 179 in the V1 group and 65 in the V2 group. The total recurrence rate was 6.1%: the number of patients with recurrence was 8 (8%), 10 (5.6%) and 3 (4.6%), in the V0, V1 and V2 group, respectively. No statistically significant difference was found in the recurrence rate among the three groups. Although the DFS was higher in the V2 group, the result was not significant. L1CAM was positive in 71.4% of recurrences and in 82% of the distant recurrences. Conclusions: The rate of recurrence in patients with EC at low risk of recurrence does not decrease as the length of the vaginal cuff removed increases. Furthermore, the size of the removed vaginal cuff does not affect either the site of recurrence or the likelihood of survival.


2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S185-S186
Author(s):  
Beth A Shields ◽  
Kaitlin A Pruskowski ◽  
Alicia M Williams ◽  
Leopoldo C Cancio

Abstract Introduction Nutrition is a core component of care for the critically ill burn patient. The Society for Critical Care Medicine recommends initiating enteral nutrition (EN) within 4–6 hours of injury for burn patients, while simultaneously recommending waiting until hemodynamic stability is achieved for critical care patients. The goal of this analysis was to evaluate tolerance of EN during periods of different pressor requirements and lactate levels. Methods We performed a retrospective evaluation on all burn patients admitted to our intensive care unit in 2018 who received EN. This performance improvement project was approved by our regulatory compliance division. Lactate levels and vasopressor use just prior to EN initiation, the highest EN rates and gastric residual volumes during the 24 hours after initiation, and ischemic bowel and aspiration after EN initiation were recorded. Significance was accepted at p&lt; 0.05. Results EN was initiated at 30 ± 20 hours after admission in 58 patients with the following characteristics: 47 ± 19 years old, 29 ± 24% TBSA burn, 13 mechanical ventilator days (IQR: 5–30), 15% mortality. The highest EN rate reached was 100 ± 49 mL/hr during the first 24 hours after initiation. Lactate levels were 1.9 mmol/L at the time of EN initiation (IQR: 1.6–2.4 mmol/L), with a maximum of 4.9 mmol/L. Lactate levels did not have a significant correlation with gastric residual volumes (p=0.532). Most (59%) patients did not have vasopressor requirements, but 21% required vasopressin only, 2% required norepinephrine only, and 19% required a combination of vasopressin and norepinephrine. Those who received norepinephrine received 3.3 ± 1.7 mcg/min, with a maximum of 7 mcg/min. There was a significant difference in gastric residual volumes between patients who had no vasopressor requirements compared to those who required vasopressors [13 mL (IQR: 0–200 mL) vs. 240 mL (IQR: 21–430 mL), p=0.014)]; however, the number of patients with gastric residual volumes over 500 mL was not significantly different (3% vs. 17%, p=0.149). When examining patients receiving vasopressin alone, there was a significant but weak correlation between vasopressin dose and gastric residual volumes (p=0.047, R2=0.339); however, when examining only patients receiving norepinephrine, there was no correlation between norepinephrine dose and gastric residual volumes (p=0.905, R2=0.002). There was 1 episode of aspiration and 1 episode of ischemic bowel, both of which occurred 3 days after EN initiation. EN was initiated without vasopressors running and lactate levels were normal in both cases. Conclusions The majority of patients tolerated EN initiation with vasopressor dosing of norepinephrine up to 7 mcg/min and lactate up to 4.9 mmol/L. Applicability of Research to Practice We found no indication for holding EN for lactate levels under 5 mmol/L and norepinephrine under 8 mcg/min.


2014 ◽  
Vol 18 (1 (69)) ◽  
Author(s):  
R. V. Sabadosh ◽  
O. V. Pyptiuk ◽  
A. Ye. Bohush ◽  
V. D. Skrypko ◽  
M. D. Ryziuk ◽  
...  

In order to compare the role of the small and great saphenous veins (SSV and GSV) in the development of acute varicose thrombophlebitis in the lower limbs (AVTLL), 236 patients with thrombotic process in 250 limbs have been examined. The number of frequency of thrombosis among the limbs with reflux both in SSV and in GSV presented the role of these veins at AVTLL most objectively. According to this value, there was no statistically significant difference betweenSSV and GSV (p=0,669): 49,0 % (95 % CI 34,8-63,4 %) versus 45,1 % (95 % CI 31,1-59,7 %). This result showed that traditionally declared higher frequency of thrombosis in GSV among the total number of patients with AVTLL was caused by the more frequent presence of abnormal reflux in this vein solely. The frequency of thrombosis in the tributaries of GSV was significantly higher than the frequency of thrombosis in SSV tributaries, regardless of groups which were compared (all p<0.05). Results of the study indicate that the role of SSV at AVTLL is often underestimated, and a thorough examination of the pathology of its system can improve the treatment effects of the patients with AVTLL.


BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S192-S192
Author(s):  
Jemma Hazan ◽  
Mikail Ozer ◽  
Yathooshan Ramesh ◽  
Richard Westmoreland

AimsA Quality Improvement project with the aim to increase the number of patients discharged with a GP discharge summary from the Chase Farm Place of Safety over a 12 month time period by 50%.BackgroundAn initial audit was conducted at Chase Farm Place of Safety (POS) to see if patients held under Section 136 of the Mental Health Act (S136) and then discharged home had a GP discharge letter completed and sent. The audit revealed that 0.02% of patients who were under S136 and discharged home did have a discharge letter sent to the GP.As a result of the initial audit, key stakeholders were contacted, and involved in the intervention design and implementation. The intervention was introduced and all doctors working in the trust were emailed the new protocolMethodWe implemented the following intervention:If a patient was registered at a GP Practice then the nursing staff in the POS copied the entry of the discharging doctor from the electronic progress notes and pasted this in to the S136 discharge template on the electronic progress notes and this was emailed to the GP.We informed Doctors to be aware that their entry would go out to the GP and should contain the following: Impression, Outcome/Plan, Specific Risk /Safeguarding concerns and specific management plans.ResultIn the initial audit the notes of all patients discharged from the POS under S136 were reviewed over a 3 month period between November and January 2018. We found that 2 out of 89 patients (0.02%) had a completed GP summary which was emailed to the GP Practice.After the intervention was introduced the notes were audited between July and September 2019. We found 33 out of 60 patients (55%) had a completed GP summary which was emailed to the GP Practice.ConclusionThere was an improvement of 54.8% in the number of discharge summaries. Further consideration needs to be given to improving this percentage and understanding what remaining barriers there are.


BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S170-S170
Author(s):  
Helen Allis ◽  
Mariam Zahedi ◽  
Thomas Stephenson ◽  
Michael Newson ◽  
Anil Kumar

AimsThere have been long-standing concerns about communication and safety on the Bethlem site out-of-hours due to its size, acuity and the number of specialist services; these issues were exacerbated by the COVID-19 pandemic. A Quality Improvement Project was designed to address communication and safety concerns from the on-call team at the Bethlem Royal psychiatric hospital out-of-hours through the introduction of weekend safety huddles.MethodDaily weekend safety huddles were introduced to improve communication regarding workload, acuity, new admissions, seclusion reviews, deteriorating patients; and to improve team cohesiveness and trainee support out-of-hours.The QIP team involved the deputy medical director, the associate director for speciality units, consultants, the college tutor, specialty registrars and core psychiatry trainees. Prior to initiating the huddles, the QIP team met to decide which specialties to involve, to agree on an agenda and liaise with other sites regarding existing huddles. Once the huddles began in April 2020, the team met periodically to agree next courses of action and to troubleshoot. The huddles initially involved acute services and eventually included CAMHS, Forensic, Older Adults, Specialist Units, all on-call consultants, the on-call registrar, two core trainees, the psychiatric liaison manager and the duty senior nurse.ResultData were gathered throughout the QIP using Likert scale surveys which were sent to all junior doctors on the out-of-hours rota. Paper surveys were used initially but were later replaced with Microsoft Forms to ensure anonymity.The percentage of respondents who answered “most of the time” or “all of the time” increased across all parameters when comparing data from before and after implementation of the safety huddles.These results included improvement in: understanding of workload and acuity (9% before vs 69% after), discussion of new admissions on site (4% before vs 90% after), discussion of patients with deteriorating mental health (35% before vs 90% after) and physical health (22% before vs 83% after), understanding of number of patients in seclusion (61% before vs 93% after) and feeling part of a cohesive “on-call” team (17% before vs 86% after). In addition, the results suggested a reduction in frequency of safety concerns on site (83% answered at least “sometimes” before vs 62% after).ConclusionThe results of the final survey demonstrated a measurable and positive impact on communications between the out-of-hours team, improved team cohesiveness and a reduction in safety concerns. The lessons learnt also influenced decisions made in formatting safety huddles at other trust sites.


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