scholarly journals 244 Does Direct Admission to ICU In Emergency Laparotomy Patients with A NELA Score ≥ 10% Affect Outcome at Fiona Stanley Hospital?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Shepherd ◽  
A Foster
Keyword(s):  
Critical Care ◽  
Quality Improvement ◽  
New Zealand ◽  
Surgical Patients ◽  
Emergency Laparotomy ◽  
Improvement Project ◽  
Code Blue ◽  
Retrospective Audit ◽  
Direct Admission ◽  
Surgical Unit

Abstract Introduction The Australian and New Zealand Emergency Laparotomy Audit (ANZELA) is a quality improvement project based on UK NELA. Direct admission to ICU post-operatively for patients with a NELA ≥ 10% is recommended. In the current pandemic, the use of critical care beds must be rationalised. We investigated if patients with NELA ≥ 10% experienced worse outcomes if admitted to the ward post-operatively (instead of ICU). Method We performed a retrospective audit of emergency laparotomies at Fiona Stanley Hospital over 6 months December 2019 – May 2020. NELA scores were obtained from the ANZELA database and patient notes reviewed to identify post-operative unplanned ICU admissions and mortalities. Results Twenty-four (30%) emergency laparotomy patients had a NELA ≥ 10%. Ten (42%) patients were admitted to the ward post-operatively. There were no unplanned ICU admissions in this group. Two (20%) patients had a documented ‘code blue’ but were managed conservatively on the ward. No patients in this group died within 30 days. Conclusions Post-operative ward admission in selected patients with NELA ≥ 10% does not result in unplanned ICU admissions or increased mortality at a tertiary Acute Surgical Unit. This data is reassuring as we expect future ICU bed shortages for non-COVID surgical patients during the pandemic.

Evaluation of the safety of inter-hospital transfers of critically ill patients led by advanced critical care practitioners

2021 ◽  
Vol 30 (8) ◽  
pp. 470-476
Author(s):  
Gavin Denton ◽  
Lindsay Green ◽  
Marion Palmer ◽  
Anita Jones ◽  
Sarah Quinton ◽  
...  
Keyword(s):  
Critical Care ◽  
Quality Improvement ◽  
Critically Ill ◽  
Process Of Care ◽  
Related Complication ◽  
Improvement Project ◽  
Hospital Transfer ◽  
The Uk ◽  
Critically Ill Adults ◽  
Ill Adults

Introduction: Ten thousand inter-hospital transfers of critically ill adults take place annually in the UK. Studies highlight deficiencies in experience and training of staff, equipment, stabilisation before departure, and logistical difficulties. This article is a quality improvement review of an advanced critical care practitioner (ACCP)-led inter-hospital transfer service. Methods: The tool Standards for Quality Improvement Reporting Excellence was used as the format for the review, combined with clinical audit of advanced critical care practitioner-led transfers over a period of more than 3 years. Results: The transfer service has operated for 8 years; ACCPs conducted 934 critical care transfers of mechanically ventilated patients, including 286 inter-hospital transfers, between January 2017 and September 2020. The acuity of transfer patients was high, 82.2% required support of more than one organ, 49% required more than 50% oxygen. Uneventful transfer occurred in 81.4% of cases; the most common patient-related complication being hypotension, logistical issues were responsible for half of the complications. Conclusion: This quality improvement project provides an example of safe and effective advanced practice in an area that is traditionally a medically led domain. ACCPs can provide an alternative process of care for critically ill adults who require external transfer, and a benchmark for audit and quality improvement.

scholarly journals Assessing Nurses’ Knowledge of Noise in the Intensive Care Unit: An Educational Intervention Project

2021 ◽  
Author(s):  
Jennifer Fortes
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Quality Improvement ◽  
Educational Intervention ◽  
Quality Improvement Project ◽  
Minimal Risk ◽  
Improvement Project ◽  
Staff Members ◽  
Nurses Knowledge

Noise in the intensive care unit (ICU) has been studied for over thirty years, but it continues to be a significant problem and a top complaint among patients. Staff members are now reporting detrimental health effects from excessive noise. One of the significant factors of inadequate noise control in the ICU is that nurses have insufficient awareness regarding the hospital noise issue and its negative impact on health status. The level of knowledge of clinical staff on the topic of noise is not known. A quality improvement project to explore noise in the ICU could facilitate better understanding of the phenomenon and formulation of new ways to continue to reduce noise at a community hospital in Massachusetts. The purpose of this quality improvement project was to evaluate nurses’ knowledge of the potentially harmful effects of noise on patients as well as on nurses, to identify opportunities for improvement of the environment, and to conduct an educational intervention aimed at reducing noise in the intensive care unit. The methodology for this project included a pre-test, followed by an educational session, and completion of a post-test. The participants included registered nurse staff members in the Intensive Care Unit (ICU) and the Critical Care Unit (CCU). Exclusion criteria included staff members who are not registered nurses. The project posed minimal risk. No identifying or biographical data was collected, and results included analysis of aggregate data. Descriptive statistics were used to assist with analysis. Results were disseminated to the staff of the ICU and CCU, posted on a bulletin board in the critical care area, presented as a poster presentation at the Spring RIC MSN Symposium, and available as a manuscript on the RIC Digital Commons.

EP.FRI.857 Audit and quality improvement project; data entry into the NELA database from Royal Stoke university hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nandu Nair ◽  
Vasileios Kalatzis ◽  
Madhavi Gudipati ◽  
Anne Gaunt ◽  
Vishnu Machineni
Keyword(s):  
Quality Improvement ◽  
Data Entry ◽  
Quality Improvement Project ◽  
University Hospital ◽  
Emergency Laparotomy ◽  
Data Set ◽  
Improvement Project ◽  
Hospital Database ◽  
Case Ascertainment ◽  
Project Data

Abstract Aims During the period December-2018 to November-2019 a total of 84 cases were entered on the NELA website, corresponding to HES data suggesting 392 laparotomies. This suggests a possible case acquisition of 21% prompting us to look at our data acquisition in detail. Methods Interrogation of the NELA data from January–March 2020 was done from NELA website and hospital records. Results Analysis revealed that during this period 45 patients had laparotomy recorded whereas hospital database recorded 68 laparotomies. Of the 45 cases entered on the NELA database, only 1 patient had a complete data set entered.  22 cases had 87% data entry and 22 cases had <50% of the data fields completed. Firstly, we were not capturing all patients who underwent an emergency laparotomy and secondly our data entry for the patients we did report was incomplete.  This led us to engage in a quality improvement project with following measures - Conclusions We re-assessed the case ascertainment and completeness of data collection in the period April 2020 – June 2020 and case ascertainment rate increased to 54% and all the entries were complete and locked.

Two‐year outcomes from the Australian and New Zealand Emergency Laparotomy Audit‐Quality Improvement pilot study

2021 ◽  
Author(s):  
◽  
R James Aitken ◽  
Ben Griffiths ◽  
Jill Van Acker ◽  
Edmond O'Loughlin ◽  
...  
Keyword(s):  
Quality Improvement ◽  
New Zealand ◽  
Pilot Study ◽  
Audit Quality ◽  
Emergency Laparotomy

scholarly journals Identifying Nurses’ Perceived Barriers to Mobilizing Patients on a Medical-Surgical Unit: A Quality Improvement Project

2021 ◽  
Author(s):  
Jil Lukin
Keyword(s):  
Quality Improvement ◽  
Functional Decline ◽  
Quality Improvement Project ◽  
Perceived Barriers ◽  
Negative Effects ◽  
Convenience Sample ◽  
Acute Care Nurses ◽  
Improvement Project ◽  
Provider Barriers ◽  
Surgical Unit

Researchers have found that low and moderate levels of mobility are independently associated with greater functional decline in activities of daily living (ADLs) at discharge (Zisberg et al., 2011) and that bedrest promotes declines in muscle mass and muscle strength (Coker et al., 2014; Dirks et al., 2016). The negative effects of low mobility and immobility are recognized by nurses, yet most acute care nurses do not prioritize the mobilization of their patients. Interventions to increase mobilization of hospitalized patients may be more effective if they are barrier targeted. The purpose of this quality improvement project was to identify nurses’ perceived barriers to mobilizing patients on a medical-surgical unit in a community hospital. The project used a 26-item 5-point Likert style survey adapted from the Overall Provider Barriers survey; a validated self-administered survey developed by Hoyer et al. (2015). The survey identified nurses’ perceived barriers in three domains: knowledge, attitudes, and behaviors. A convenience sample of 28 nurses participated in the survey. Results demonstrated that three of the four most reported perceived barriers were in the behaviors domain, which assessed external factors that could influence the respondent’s decision to mobilize or to not mobilize a patient. The highest barriers in the behaviors domain were inadequate staffing, lack of time, and patient resistance to being mobilized. The third highest overall barrier was the perception that increasing patient mobilization would be more work for nurses. This item was in the attitudes domain, which assessed the respondent’s perception of patient safety, needs, and outcomes of mobilization and perception of available time, workload, and ability to mobilize patients. Results were consistent with previous studies that explored barriers to mobilization. Practical implications of the findings are discussed.

Using SQUIRE 2.0 as a Guide for Planning Your Quality Improvement Project

2017 ◽  
Vol 37 (6) ◽  
pp. 72-80 ◽  
Author(s):  
Julie M. Stausmire ◽  
Charla Ulrich
Keyword(s):  
Critical Care ◽  
Quality Improvement ◽  
Performance Improvement ◽  
Critical Care Unit ◽  
Critical Care Nurses ◽  
Time Constraints ◽  
Real Difference ◽  
Improvement Project ◽  
Part Quality ◽  
The Third

This article is the third of a 4-part quality improvement resource series for critical care nurses interested in implementing system process or performance improvement projects. Part 1 defined the differences between research and quality improvement. Part 2 discussed how nurses and managers could identify meaningful quality improvement projects that will make a real difference in their critical care unit while fitting within their time constraints and resources. Part 3 uses the recently revised Standards for Quality Improvement Reporting Excellence guidelines as a basis for designing, implementing, documenting, and publishing quality improvement projects.

Sign in / Sign up

Export Citation Format

Share Document