scholarly journals 887 A Quality Improvement Project: Implementation of a New Epistaxis Pathway

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Vasanthan ◽  
A Massoumi ◽  
M Forde ◽  
O Corbridge ◽  
S Sood
Keyword(s):  
Quality Improvement ◽  
Average Length ◽  
District General Hospital ◽  
Adverse Outcomes ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Average Length Of Stay ◽  
Patient Feedback ◽  
Patient Reported ◽  
Discharge Criteria

Abstract Introduction Epistaxis is one of the most common ENT conditions leading to unplanned hospital admission. This closed loop quality improvement project looked at epistaxis admissions, and whether patients could be safely managed on an ambulatory basis with unilateral intranasal packing, through the implementation of a new epistaxis pathway. Method Two prospective cycles at a District General Hospital. First cycle: three-month period (October-December 2018); recorded all patients admitted with epistaxis and the percentage with intranasal packing; criteria for discharge with unilateral intranasal packing created (including normal observations, normal clotting/haemoglobin, only on aspirin, safe home environment). Second cycle (after implementation of new pathway): two months (December 2019 and January 2020); recorded all patients admitted with epistaxis or discharged with unilateral intranasal packing; patient feedback obtained. Results First cycle: 31 epistaxis admissions; 12 patients met discharge criteria; average length of stay was 1.4 days. Second cycle: 22 epistaxis admissions; 4 admissions were avoided; 2 admissions were unnecessary according to new pathway; no patient-reported issues with pack at home. Conclusions Successful creation and initial implementation of pathway with no adverse outcomes. Approximately £1380 of savings through avoided admissions. Pathway expanded and successfully used during COVID-19 to include patients on anticoagulation as suitable for discharge with intranasal packing.

scholarly journals Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project

2020 ◽  
Author(s):  
Andrew C. Nixon ◽  
Julie Brown ◽  
Ailsa Brotherton ◽  
Mark Harrison ◽  
Judith Todd ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Geriatric Assessment ◽  
Screening Programme ◽  
Management Plan ◽  
Hazard Ratio ◽  
Adverse Outcomes ◽  
Quality Improvement Project ◽  
Clinical Frailty Scale ◽  
Improvement Project ◽  
Management Plans

Abstract Introduction The aims of this quality improvement project were to: (1) proactively identify people living with frailty and CKD; (2) introduce a practical assessment, using the principles of the comprehensive geriatric assessment (CGA), for people living with frailty and chronic kidney disease (CKD) able to identify problems; and (3) introduce person-centred management plans for people living with frailty and CKD. Methods A frailty screening programme, using the Clinical Frailty Scale (CFS), was introduced in September 2018. A Geriatric Assessment (GA) was offered to patients with CFS ≥ 5 and non-dialysis- or dialysis-dependent CKD. Renal Frailty Multidisciplinary Team (MDT) meetings were established to discuss needs identified and implement a person-centred management plan. Results A total of 450 outpatients were screened using the CFS. One hundred and fifty patients (33%) were screened as frail. Each point increase in the CFS score was independently associated with a hospitalisation hazard ratio of 1.35 (95% CI 1.20–1.53) and a mortality hazard ratio of 2.15 (95% CI 1.63–2.85). Thirty-five patients received a GA and were discussed at a MDT meeting. Patients experienced a median of 5.0 (IQR 3.0) problems, with 34 (97%) patients experiencing at least three problems. Conclusions This quality improvement project details an approach to the implementation of a frailty screening programme and GA service within a nephrology centre. Patients living with frailty and CKD at risk of adverse outcomes can be identified using the CFS. Furthermore, a GA can be used to identify problems and implement a person-centred management plan that aims to improve outcomes for this vulnerable group of patients.

Please reconcile, not wait a while

2019 ◽  
Vol 105 (2) ◽  
pp. 122-126
Author(s):  
Ashifa Trivedi ◽  
Sadhna Sharma ◽  
Richa Ajitsaria ◽  
Nicola J Davey
Keyword(s):  
Quality Improvement ◽  
District General Hospital ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Acute Setting ◽  
Paediatric Department ◽  
Medicines Reconciliation ◽  
The Mean ◽  
Patient Safety Incidents ◽  
Main Factor

A quality improvement project to increase the rate of paediatric medicines reconciliation was carried out in a district general hospital between April and July 2018. Baseline data collected from our paediatric ward shows that medicines reconciliation by doctors is only accurately completed 50% of the time. Evidence shows that medicines-related patient safety incidents are more likely when medicines reconciliation happens more than 24 hours after a person is admitted to an acute setting. The aim of this quality improvement project was therefore to ensure that 100% of paediatric patients have their regular medications prescribed by mid-day the day after admission. The paediatric pharmacy team reviewed all paediatric inpatient drug charts from Monday to Friday for 12 weeks. The number of regular medications and the number of medicines reconciled was recorded each day. The effectiveness of various interventions were reviewed using Plan–Do–Study–Act cycles. On average, 40 patients were reviewed each week. The mean reconciliation rate was 79%, and the worst rate was 0%. 100% reconciliation was achieved on 34 occasions and was achieved continuously for the last 3 weeks of data collection. A repeat audit carried out in September 2018 found the reconciliation rate was maintained at 100%. Multiple interventions occurred during this quality improvement project: teaching sessions for doctors, posters to raise awareness and questionnaires for parents/children to complete about their regular medications. The main factor for success in this project has been involving all members of the paediatric department including children and their parents.

scholarly journals Using Electronic Data Collection Platforms to Assess Complementary and Integrative Health Patient-Reported Outcomes: Feasibility Project (Preprint)

2019 ◽  
Author(s):  
Jolie N Haun ◽  
Amy C Alman ◽  
Christine Melillo ◽  
Maisha Standifer ◽  
Julie McMahon-Grenz ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Reported Outcomes ◽  
Primary Care Providers ◽  
Quality Improvement Project ◽  
Care Providers ◽  
Secure Messaging ◽  
Web Based ◽  
Improvement Project ◽  
Integrative Health ◽  
Patient Reported

BACKGROUND The Veteran Administration (VA) Office of Patient-Centered Care and Cultural Transformation is invested in improving veteran health through a whole-person approach while taking advantage of the electronic resources suite available through the VA. Currently, there is no standardized process to collect and integrate electronic patient-reported outcomes (ePROs) of complementary and integrative health (CIH) into clinical care using a web-based survey platform. This quality improvement project enrolled veterans attending CIH appointments within a VA facility and used web-based technologies to collect ePROs. OBJECTIVE This study aimed to (1) determine a practical process for collecting ePROs using patient email services and a web-based survey platform and (2) conduct analyses of survey data using repeated measures to estimate the effects of CIH on patient outcomes. METHODS In total, 100 veterans from one VA facility, comprising 11 cohorts, agreed to participate. The VA patient email services (Secure Messaging) were used to manually send links to a 16-item web-based survey stored on a secure web-based survey storage platform (Qualtrics). Each survey included questions about patient outcomes from CIH programs. Each cohort was sent survey links via Secure Messaging (SM) at 6 time points: weeks 1 through 4, week 8, and week 12. Process evaluation interviews were conducted with five primary care providers to assess barriers and facilitators to using the patient-reported outcome survey in usual care. RESULTS This quality improvement project demonstrated the usability of SM and Qualtrics for ePRO collection. However, SM for ePROs was labor intensive for providers. Descriptive statistics on health competence (2-item Perceived Health Competence Scale), physical and mental health (Patient-Reported Outcomes Measurement Information System Global-10), and stress (4-item Perceived Stress Scale) indicated that scores did not significantly change over time. Survey response rates varied (18/100, 18.0%-42/100, 42.0%) across each of the 12 weekly survey periods. In total, 74 of 100 participants provided ≥1 survey, and 90% (66/74) were female. The majority, 62% (33/53) of participants, who reported the use of any CIH modality, reported the use of two or more unique modalities. Primary care providers highlighted specific challenges with SM and offered solutions regarding staff involvement in survey implementation. CONCLUSIONS This quality improvement project informs our understanding of the processes currently available for using SM and web-based data platforms to collect ePROs. The study results indicate that although it is possible to use SM and web-based survey platforms for ePROs, automating scheduled administration will be necessary to reduce provider burden. The lack of significant change in ePROs may be due to standard measures taking a biomedical approach to wellness. Future work should focus on identifying ideal ePRO processes that would include standardized, whole-person measures of wellness.

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