scholarly journals 1632 Improving Excision Margins in Skin Oncology

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Y Ibrahim ◽  
Z Li ◽  
K Vijayasurej ◽  
M Malik ◽  
E Jones ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Compliance Rate ◽  
Complete Excision ◽  
Improvement Project ◽  
Excision Margin ◽  
Operative Note ◽  
Non Melanoma Skin Cancer ◽  
Retrospective Audit ◽  
Excision Margins ◽  
The Uk

Abstract Aim There are 152,000 new non-melanoma skin cancer (NMSC) cases in the UK every year, and excision and reconstruction of basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) form a significant part of the clinical workload in plastic surgery. In this quality improvement project, we aimed to identify and improve our unit’s compliance of guidelines for excision margins for NMSCs. Method A retrospective audit was undertaken in June 2020 to determine compliance with British Association of Dermatology and local guidelines on excision margins for NMSCs. A repeat audit was undertaken in October 2020 following quality improvement interventions. Results The first audit cycle examined 66 lesions in total. Guidelines were met in 53% (BCCs) and 50% (SCCs) of lesions. 12% of lesions had unclear documentation of margins. 16 lesions had margins that were too small as according to the risk factors present. These findings were presented to the department, and a new operative note template specifically designed for skin oncology was launched. Key audit findings were displayed along with the guidelines on posters. A repeat cycle was undertaken in October 2020, which examined 52 lesions. Significant improvement was seen with 100% documentation, and excision margin guideline compliance rate of 71% (BCCs) and 79% (SCCs). Conclusions Adequate excision margins in skin oncology is vital to ensure complete excision and to minimise the risk of recurrence. Our project demonstrates significant improvement in excision margin compliance through the launch of a specific operative note template and information posters.

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.

Improvement of hand hygiene compliance among health professional staff of Neonatology Department in Nyamata Hospital

2016 ◽  
Vol 24 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Solange Umulisa ◽  
Angele Musabyimana ◽  
Rex Wong ◽  
Eva Adomako ◽  
April Budd ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Compliance Rate ◽  
Professional Staff ◽  
Routine Practice ◽  
Improve Hand Hygiene ◽  
Improvement Project ◽  
Content Type ◽  
Hygiene Compliance

Purpose The purpose of this study is to improve the hand hygiene compliance in a hospital in Rwanda. Hand hygiene is a fundamental routine practice that can greatly reduce risk of hospital-acquired infections; however, hand hygiene compliance in the hospital was low. Design/methodology/approach A multiple-strategy intervention was implemented with a focus on ensuring stable water supply was available through installing mobile hand hygiene facilities. Findings The intervention significantly increased the overall hand hygiene compliance rate by 35 per cent. The compliance for all of the five hand hygiene moments and all professions also significantly increased. Practical implications By implementing an intervention that involved multiple strategies to address the root causes of the problem, this quality improvement project successfully created an enabling environment to increase hand hygiene compliance. The hospital should encourage using the strategic problem-solving method to conduct more quality improvement projects in other departments. Originality/value Findings from this study may be useful for hospitals in similar settings seeking to improve hand hygiene compliance.

scholarly journals A Hospital-Wide Intervention to Improve Compliance With TNM Cancer Staging Documentation

2021 ◽  
pp. 1-10
Author(s):  
Jason H. Lee ◽  
Tariq Mohamed ◽  
Celia Ramsey ◽  
Jihoon Kim ◽  
Shelly Kane ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Quality Improvement ◽  
Clinical Decision Making ◽  
Compliance Rate ◽  
Clinical Decision ◽  
Cancer Staging ◽  
Marrow Transplant ◽  
Improvement Project ◽  
Logistic Regression Models ◽  
Oncologic Patients

Background: Accurate oncologic staging meeting clinical practice guidelines is essential for guideline adherence, quality assessment, and survival outcomes. However, timely and uniform documentation in the electronic health record (EHR) at the time of diagnosis is a challenge for providers. This quality improvement project aimed to increase provider compliance of timely clinical TNM (cTNM) or pathologic TNM (pTNM) staging for newly diagnosed oncologic patients. Methods: Providers in the following site-specific oncologic teams were included: head and neck, skin, breast, genitourinary, gastrointestinal, lung and thoracic, gynecologic, colorectal, and bone marrow transplant. Interventions to facilitate timely cTNM and pTNM staging included standardized EHR-based workflows, learning modules, stakeholder meetings, and individualized provider training sessions. For most teams, staging was considered compliant if it was completed in the EHR within the first 7 days of the calendar month after the date of the patient visit. Factors associated with staging compliance were analyzed using logistic regression models. Results: From January 1, 2014, to December 31, 2018, 7,787 preintervention and 5,152 postintervention new patient visits occurred. During the preintervention period, staging was compliant in 5.6% of patients compared with 67.4% of patients after intervention (P<.001). In the final month of the postintervention period, the overall staging compliance rate was 78.1%. At most recent tracking, staging compliance was 95%, 97%, and 93% in December 2019, January 2020, and February 2020, respectively. Logistic regression found that increasing years of provider experience was associated with decreased staging compliance. Conclusions: High rates of staging compliance in complex multidisciplinary academic oncologic practice models can be achieved via comprehensive quality improvement and structured initiatives. This approach serves as a model for improving oncologic documentation systems to facilitate clinical decision-making and multidisciplinary coordination of care.

scholarly journals Extreme preterm birth in the right place: a quality improvement project

2019 ◽  
Vol 105 (4) ◽  
pp. 445-448 ◽  
Author(s):  
Katherine Edwards ◽  
Lawrence Impey
Keyword(s):  
Quality Improvement ◽  
Preterm Birth ◽  
Place Of Birth ◽  
Improvement Project ◽  
Sustained Improvement ◽  
Premature Babies ◽  
Specialist Centre ◽  
Improvement Programme ◽  
The Uk ◽  
The Right

Extreme preterm birth is a major precursor to mortality and disability. Survival is improved in babies born in specialist centres but for multiple reasons this frequently does not occur. In the Thames Valley region of the UK in 2012–2014, covering 27 000 births per annum, about 50% of extremely premature babies were born in a specialist centre. Audit showed a number of potential areas for improvement. We used regional place of birth data and compared the place of birth of extremely premature babies for 2 years before our intervention and for 4 years (2014–2018) after we started. We aimed to improve the proportion of neonates born in a specialist centre with three interventions: increasing awareness and education across the region, by improving and simplifying the referral pathway to the local specialised centre, and by developing region-wide guidelines on the principal precursors to preterm birth: preterm labour and expedited delivery for fetal growth restriction. There were 147 eligible neonates born within the network in the 2 years before the intervention and 80 (54.4%) were inborn in a specialised centre. In the 4 years of and following the intervention, there were 334 neonates of whom 255 were inborn (76.3%) (relative risk of non-transfer 0.50 (95% CI 0.39 to 0.65), p<0.001). Rates showed a sustained improvement. The proportion of extremely premature babies born in specialist centres can be significantly improved by a region-wide quality improvement programme. The interventions and lessons could be used for other areas and specialties.

scholarly journals Consensus standards of healthcare for adults and children with inflammatory bowel disease in the UK

2019 ◽  
Vol 11 (3) ◽  
pp. 178-187 ◽  
Author(s):  
Rukshana Kapasi ◽  
Jackie Glatter ◽  
Christopher A Lamb ◽  
Austin G Acheson ◽  
Charles Andrews ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Quality Improvement ◽  
Bowel Disease ◽  
Care Delivery ◽  
Service Development ◽  
Term Care ◽  
Improvement Project ◽  
Adults And Children ◽  
Inflammatory Bowel ◽  
The Uk

ObjectiveSymptoms and clinical course during inflammatory bowel disease (IBD) vary among individuals. Personalised care is therefore essential to effective management, delivered by a strong patient-centred multidisciplinary team, working within a well-designed service. This study aimed to fully rewrite the UK Standards for the healthcare of adults and children with IBD, and to develop an IBD Service Benchmarking Tool to support current and future personalised care models.DesignLed by IBD UK, a national multidisciplinary alliance of patients and nominated representatives from all major stakeholders in IBD care, Standards requirements were defined by survey data collated from 689 patients and 151 healthcare professionals. Standards were drafted and refined over three rounds of modified electronic-Delphi.ResultsConsensus was achieved for 59 Standards covering seven clinical domains; (1) design and delivery of the multidisciplinary IBD service; (2) prediagnostic referral pathways, protocols and timeframes; (3) holistic care of the newly diagnosed patient; (4) flare management to support patient empowerment, self-management and access to specialists where required; (5) surgery including appropriate expertise, preoperative information, psychological support and postoperative care; (6) inpatient medical care delivery (7) and ongoing long-term care in the outpatient department and primary care setting including shared care. Using these patient-centred Standards and informed by the IBD Quality Improvement Project (IBDQIP), this paper presents a national benchmarking framework.ConclusionsThe Standards and Benchmarking Tool provide a framework for healthcare providers and patients to rate the quality of their service. This will recognise excellent care, and promote quality improvement, audit and service development in IBD.

scholarly journals 1631 The Pen is Mightier than the Sword; but the Keyboard may be Better

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Morrison ◽  
A Brunt
Keyword(s):  
Relevant Information ◽  
National Standards ◽  
Poor Adherence ◽  
Improvement Project ◽  
Online System ◽  
Operative Note ◽  
Ensure Patient Safety ◽  
Data Points ◽  
Operation Note ◽  
The Uk

Abstract Introduction Operation notes ensure patient safety through continuity of care, and act as reliable treatment records. Notes must be legible, accessible, and contain all relevant information. Specific standards are outlined in the Good Surgical Practice Guidelines (2014) by the Royal College of Surgeons of England. Audits in the UK show poor adherence to these standards. Online operative note systems are becoming more common, but variety still exists in operations notes. This work assessed operative note standards in an orthopaedic department and assessed the utility of electronic operative note systems. Method This was a prospective quality improvement project. Operation notes for all emergency orthopaedic operations were audited against national standards. An online operation note system was introduced and re-audit carried out following implementation. Results Initial audit noted poor adherence to standards. An online operative note system was introduced. A second audit with 96 patients was undertaken. Uptake of the software was low, with 10% of notes being online. 19 of 21 information points showed improved standards adherence with the online system versus other methods. In the remaining 2 areas 100% of notes adhered to standards in both methods. The online system had 100% adherence in 19 data points, and 90% in the remaining 2. Conclusions Online note softwares have various benefits, including improved adherence to standards. Other benefits exist, such as databasing of operations for review and audit. These systems appear reliable and beneficial for operative documentation and are easily implemented; however, some work is still required to change old habits and improve uptake.

scholarly journals Increasing use of an endotracheal intubation safety checklist in the emergency department

2021 ◽  
Vol 10 (4) ◽  
pp. e001575
Author(s):  
Cameron William Whytock ◽  
Matthew Stephen Atkinson
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Endotracheal Intubation ◽  
Low Cost ◽  
Methodological Approach ◽  
Improvement Project ◽  
North West ◽  
The North ◽  
Qualitative Feedback ◽  
The Uk

Endotracheal intubation (ETI) is a high-risk procedure often performed in the emergency department (ED) in critically unwell patients. The fourth National Audit Project by The Royal College of Anaesthetists found the risk of adverse events is much higher when performing the intervention in this setting compared with a theatre suite, and therefore use of a safety checklist is recommended. This quality improvement project was set in a large teaching hospital in the North West of the UK, where anaesthesia and intensive care clinicians are responsible for performing this procedure. A retrospective baseline audit indicated checklist use was 16.7% of applicable cases. The project aim was to increase the incidence of checklist use in the ED to 90% within a 6-month period. The model for improvement was used as a methodological approach to the problem along with other quality improvement tools, including a driver diagram to generate change ideas. The interventions were targeted at three broad areas: awareness of the checklist and expectation of use, building a favourable view of the benefits of the checklist and increasing the likelihood it would be remembered to use the checklist in the correct moment. After implementation checklist use increased to 84%. In addition, run chart analysis indicated a pattern of nonrandom variation in the form of a shift. This coincided with the period shortly after the beginning of the interventions. The changes were viewed favourably by junior and senior anaesthetists, as well as operating department practitioners and ED staff. Limitations of the project were that some suitable cases were likely missed due to the method of capture and lack of anonymous qualitative feedback on the changes made. Overall, however, it was shown the combination of low-cost interventions made was effective in increasing checklist use when performing emergency ETI in the ED.

scholarly journals 45 Quality Improvement Project on Delirium Care in Older Patients at Mid Yorkshire Hospitals NHS Trust (MYHT)

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
H Mon ◽  
R Holt
Keyword(s):  
Quality Improvement ◽  
Older Patients ◽  
The Elderly ◽  
Quality Improvement Project ◽  
Care Plan ◽  
Improvement Project ◽  
Nice Guideline ◽  
Delirium Prevention ◽  
Barriers To Use ◽  
The Uk

Abstract Background To improve delirium care in older patients admitted to a large district general NHS Trust in the UK, a quality improvement project was conducted. Introduction The national NICE guidelines (CG103) and recent SIGN guidelines recommend delirium is diagnosed by a clinical assessment based on DSM criteria (e.g. CAM or 4AT) and managed by identifying and treating the causes alongside multicomponent interventions. The results of MYHT’s 2018 delirium audit showed the use of CAM or 4AT was 32.5% and delirium care plan was 20%. A quality improvement project was developed and implemented for 6 weeks on a frailty admission unit. Method The quality improvement project introduced a delirium care checklist sticker for medical notes in cases of suspected delirium, brief education sessions for ward doctors regarding delirium care and use of the sticker and reminder emails, all implemented by the elderly medicine registrar. The target measures were completion of stickers, 4AT and delirium care plan. Data was collected by the registrar once a week for 6 weeks and entered into a run chart. Feedback was collected from staff on barriers to use. Results 31 patients with suspected delirium has their notes reviewed. The sticker use gradually reduced from 57% of cases in week 1, to 0% in week 6. The 4ATwas completed in 57%, 50% and 100% of cases in the first 3 weeks, but dropped to 40%, 4.2% and 1.3% in the last 3 weeks. A delirium care plan was initiated in 42% and 37% of cases in the first two weeks but ended at 0% by week 6. Barriers included a lack of education sessions from week 2 onwards due to registrar on call shifts. Also junior doctor changeover in week 3. Feedback indicated barriers were time taken to complete, and confusion over ownership of completing 4AT and care plan between medical and nursing teams. Conclusion Although a delirium care checklist sticker and brief education sessions can improve delirium care, sustained improvement requires ongoing education and addressing barriers to completion. References 1. National Institute for Health and Care Excellence (2019) Delirium: prevention, diagnosis and management (NICE Guideline CG103). Available at: https://www.nice.org.uk/guidance/cg103 Accessed 21/09/2019]. 2. Scottish Intercollegiate Guidelines Network (2019) risk reduction and management of delirium (SIGN Guideline 157). Available at https://www.sign.ac.uk/assets/sign157.pdf. Accessed 21/09/2019.

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