scholarly journals SP2.2.11Improving the quality of the documented weekend surgical handover: Implementation of a handover sticker within an urban teaching hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Lewis Gall ◽  
Laura Meney ◽  
Andrew Macdonald
Keyword(s):  
Teaching Hospital ◽  
Discharge Planning ◽  
Surgical Team ◽  
Post Intervention ◽  
Improvement Project ◽  
Surgical Department ◽  
Chi Squared ◽  
Test Requirements ◽  
Future Work

Abstract Aim Effective, high-quality patient handovers between the surgical team are essential for safe transfer of responsibility for patient care whilst ensuring continued patient-safety and supporting good clinical governance. Weekend handovers provide a particular challenge, with error potential, when patients are cared for by multiple different healthcare professionals. This project aimed to improve the documentation of the weekend handover for the surgical inpatients of a busy UK teaching hospital. Method Quality Improvement project performed within a single General Surgical department between August and October 2020. An initial casenote audit on 3 consecutive Fridays compared available handover information against RCS guidance. A comprehensive surgical weekend handover sticker was designed and all members of the surgical team educated in its use. Following sticker introduction, handover quality was similarly re-audited. **=p<0.00001 using Chi-squared/Fisher exact. Results 138 inpatient records were evaluated in cycle 1 and 135 in cycle 2, with the proportion containing a weekend handover increased post-intervention (96 vs. 82%,p=0.0004). Handover quality improved following sticker introduction with more frequent documentation of: diagnosis (96 vs. 21%**); need for imaging review (94 vs. 29%**); intravenous fluid plan (84 vs. 21%**); blood test requirements (94 vs. 24%**); mode of nutrition (90 vs. 24%**); antibiotics (90 vs. 30%**); drug monitoring (90 vs. 1%**); discharge planning (94 vs. 44%**) and escalation plan (87 vs. 0%**). Conclusion Introduction of a sticker has significantly improved the quality of documented handover available to the responsible on-call team. Future work will assess sticker impact on quality of care and clinical outcomes.

scholarly journals Improving quality and assessment of referrals to the Enfield Crisis Resolution and Home Treatment Team (ECRHTT)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S202-S202
Author(s):  
Margarita Kousteni ◽  
John Cousins ◽  
Ajay Mansingh ◽  
Maja Elia ◽  
Yumnah Ras ◽  
...  
Keyword(s):  
Home Treatment ◽  
Absolute Difference ◽  
List Type ◽  
Treatment Team ◽  
Crisis Resolution ◽  
Post Intervention ◽  
Improvement Project ◽  
Consultant Psychiatrist ◽  
The Impact

AimsTriaging referrals to crisis resolution and home treatment teams is a significant undertaking requiring experienced and dedicated staff. We observed that the volume of inappropriate referrals to ECRHTT was high, and that staff processing these often felt inexperienced or lacking in confidence to discharge them back to the referrers and signpost them to appropriate services.The aims of this quality improvement project (QIP) were: a)to reduce the number of inappropriate referrals received by the teamb)to reduce the number of inappropriate referrals accepted by the teamThis would significantly improve access and flow to the service and facilitate better patient care.MethodA pilot study was first completed of the quality (appropriateness/ inappropriateness) and source of all referrals to ECRHTT in January 2019 (n = 177).Subsequently, the consultant psychiatrist for ECRHTT based himself within the assessment team. He was able to closely monitor the referrals, at the same time as providing medical input to patients at their first point of contact. To evaluate the impact of this intervention, the percentage of inappropriate referrals accepted pre- and post-change was compared by re-auditing all referrals received in February 2019 (n = 175).Further interventions were instigated to improve referral quality. These included continuation of psychiatric medical input to the assessment team, teaching sessions for GPs and the crisis telephone service, and weekly meetings with psychiatric liaison and community mental health teams (CMHTs). Change was measured by reassessing the quality of all referrals made to ECRHTT in February 2020 (n = 215).Result46.9% of inappropriate referrals to ECRHTT were accepted in January 2019 compared to 16.9% in February 2019 following the addition of medical input to the assessment team. The absolute difference was 30% (95% CI: 14%–44%, p < 0.001).71% of referrals from GPs were inappropriate in January 2019 compared to 36% in February 2020 post-intervention (difference 35%, 95% CI: 8.84%–55.4%, p < 0.05). Inappropriate referrals from CMHTs decreased from 55.5% to 12% (difference 43.5%, 95% CI: 9.5%–70.3%, p < 0.05). Overall, the percentage of inappropriate referrals fell from 38% to 27.4%, a difference of 10.6% (95% CI: 1.3%–19.8%, p < 0.05). The percentage of inappropriate referrals from liaison teams did not change significantly.ConclusionThis piece of work shows that better engagement with referral sources significantly improved the quality of referrals made to ECRHTT. Interventions included medical input at the point of referral, teaching sessions for general practitioners as well as ongoing liaison with referring teams.

scholarly journals Feasibility of Implementing a Tai Chi Program in an Assisted Living Facility: Reducing Fall Risks and Improving Quality of Life

2021 ◽  
Vol 10 (6) ◽  
pp. 1277
Author(s):  
Yingying Chen ◽  
Deborah Ringdahl ◽  
Rachel Trelstad-Porter ◽  
Olga V. Gurvich
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Assisted Living ◽  
Tai Chi ◽  
Fear Of Falling ◽  
Post Intervention ◽  
Improvement Project ◽  
Fall Risks ◽  
Relative Change

One in four American older adults fall every year, resulting in injuries, death, and significant financial burden. Although fall etiology is multifactorial, the medical problems and aging factors that lead to unsteady gait and imbalance represent one of the major fall risks among older adults. A growing number of research studies support the health benefits of regular Tai Chi (TC) practice including improved physical, cognitive, and psychological function. The purpose of this quality improvement project was to assess the feasibility of establishing a 12-week (45 min per session) Tai Chi (TC) program (Sun Style Tai Chi) in a 75 bed assisted living facility as well as to evaluate the potential of the TC program to improve the fear of falling and functional mobility (as proxy for fall risk) and quality of life (QoL). A nurse who was a certified TC instructor taught the program. Twenty-three participants, 96% female and 96% white, mean (SD) age 83 (±7) years, attended one or more TC classes. Class attendance, self-reported questionnaires (e.g., fear of falling, QoL), and objective measure Timed Up and Go (TUG) were used to collect data. Nine participants (39%) completed 9 out of 12 sessions. Eleven participants (48%) completed both pre- and post-intervention measurements and twelve (52%) provided feedback on a post-intervention satisfaction survey. Participants showed 20% improvement in fear of falling (mean relative change) and 21% decrease (mean relative change) in TUG test (p = 0.001) with no clinically important changes in QoL. This quality improvement project suggested that TC is a feasible exercise that might have the potential to reduce risk of falls in older adults, and the program was well accepted with no serious or other adverse events reported. Further research studies are needed to examine the potential effects of TC programs with an appropriately powered RCT and longer intervention period.

scholarly journals EP.TU.682Antibiotic Stewardship Within A General Surgery Department – A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Toks Fadipe
Keyword(s):  
Data Collection ◽  
Antimicrobial Stewardship ◽  
Low Frequency ◽  
Electronic Prescribing ◽  
Junior Doctors ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Improvement Project ◽  
Surgical Department ◽  
Chi Squared

Abstract Background Antimicrobial stewardship involves a coherent set of actions geared towards responsible use of antimicrobials. NICE antimicrobial stewardship guidance forms the basis for trust wide standards; the surgical department inconsistently complies to these standards. Aims Use of PDSA framework to improve departmental antibiotic prescribing practices. Methods Data collection via Meditech™ prescribing records and documentation. ‘Snapshots’ of antibiotic prescriptions for surgical inpatients taken collecting the following data: Cycle 1 data collection in August/September 2020, followed by a presentation distributed to junior doctors detailing importance of accurate prescribing. Cycle 2 data collection in October/November 2020 was followed by a summary of documentation/prescribing guidelines being circulated to surgical juniors. The final data collection period took place in November 2020. Analysis via Chi-Squared test. Results Interventions improved prescribing of correct antibiotics (75 to 89.3%), and documentation of IV antibiotic prescriptions with courses longer than 72 hours (p &lt; 0.05). Similar insigificant improvements observed with reviewing prescriptions within 72 hours and samples sent to microbiology. Discussion Low frequency of samples sent to microbiology as antibiotics often used for surgical prophylaxis and continued post-operatively without prior cultures. Brief documentation on the ward round, accentuated by constraints enforced by Covid-19 pandemic. Conclusion Positive changes can be achieved from simple interventions. Sustainable changes in prescribing practices require engagement of entire clinical team and amendments to electronic prescribing.

scholarly journals 1702 A Proforma To Improve Documentation of Surgical Ward Rounds

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E Armstrong ◽  
M Koronfel
Keyword(s):  
District General Hospital ◽  
Ward Round ◽  
Post Intervention ◽  
Improvement Project ◽  
Vte Prophylaxis ◽  
Surgical Ward ◽  
Management Plans ◽  
Ward Rounds ◽  
Assess Quality

Abstract Aim The ward round is an important vehicle in the care of surgical inpatients. Good quality documentation is essential in recording patient progress over time and communicating clearly between multidisciplinary team (MDT) members. This quality improvement project aimed to implement a standardised proforma to improve the quality of ward round documentation, improving MDT communication and patient safety. Method Ward round entries from an elective surgical unit at a District General Hospital were retrospectively reviewed using a fifteen-item checklist to assess quality of documentation. These criteria were divided into: A re-audit was performed following introduction of a ward round proforma using the same criteria. Results The pre-intervention arm included 41 entries and the post-intervention arm included 27 entries. Improvements were seen in twelve of the fifteen criteria assessed. The greatest improvements were seen in documentation of management plans; documentation of discharge plan improved from 58.5% to 100%, VTE prophylaxis from 42% to 100% and drain/ catheter plan from 42 to 93%. Documentation of two criteria (signature and bleep) decreased and documentation of date remained at 100%. Conclusions The use of a standardised proforma improves documentation of surgical ward rounds, particularly patient’s’ onward management plans. Further modifications to the proforma could aim to improve documentation of bleep and signature.

scholarly journals Establishing a tracking system in human resources department to improve the completeness of personnel files at a district hospital in Rwanda

2016 ◽  
Vol 5 (5) ◽  
pp. 66 ◽  
Author(s):  
Consolatrice Ibyimana ◽  
Rex Wong ◽  
Eva Adomako ◽  
Stephanie Lukas ◽  
Francine Birungi ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Tracking System ◽  
Completion Rate ◽  
Post Intervention ◽  
Improvement Project ◽  
Custom Made ◽  
Missing Items ◽  
Significant Effort

Introduction: For decades, many low and mid income countries (LMIC) have invested significant effort to improve access to and quality of health care, with less attention paid to the non-clinical, administrative hospital management. Accordingly, a practical personnel filing system was designed and implemented to improve file management efficiency.Methods: Setting: The quality improvement project took place in a rural hospital in Rwanda. Design: A pre- and post-intervention study design to assess the effect of the intervention between January 2015 and February 2016. File auditing and time study were conducted. Intervention: A custom-made computer database to manage documents in a personnel file, standardized follow up process and policy were created and implemented. Measures: The pre- and post-intervention completeness of all personnel file and the average time to identify the missing items in a personnel file were measured to evaluate the effect of the project.Results: The completion rate of personnel files increased from 83% pre-intervention to 96% post-intervention. The average time to identify missing items significantly reduced from 6 minutes 30 seconds pre-intervention to 49.6 seconds (p < .001).Conclusions: This project demonstrates that quality improvement principles can help address administrative issues in a resource-challenged setting. By utilizing available resources to implement an intervention that focused on creating an easy and efficient process, the personnel file completion rate has increased considerably and the time needed to identify missing items significantly decreased. The hospital should apply the same strategic problem solving methodology to conduct other quality improvement projects.

scholarly journals Improving the effectiveness of a paediatric handbook for new house officers

2021 ◽  
pp. 201010582110084
Author(s):  
Justin Liang Yi Wee ◽  
Chun Yi Ting ◽  
Duo-Tong Cheng ◽  
Sheau Yun Kan ◽  
Zhi Lin Kang ◽  
...  
Keyword(s):  
Perceived Usefulness ◽  
Utilization Rate ◽  
Clinical Competency ◽  
Clinical Quiz ◽  
Open Book ◽  
Post Intervention ◽  
Improvement Project ◽  
Clinical Scenarios ◽  
New Material

Background and objectives: To help house officers adjust quickly to their new responsibilities, a departmental handbook is provided. As this had not been updated recently and was underutilised, a quality improvement project was undertaken to improve this resource. Methods: The handbook was updated and new material added based on feedback from house officers and senior medical staff. Subsequently, house officers were surveyed on their utilization rate of the new handbook and its usefulness in various clinical scenarios. An open-book clinical quiz was administered to gauge their clinical competency. Results: There was a 26.8% increase in the proportion of house officers who used the handbook more than once every 2–3 days compared to pre-intervention. There was a significant improvement in quiz scores from 26.7/40 to 31.1/40 between the pre-intervention ( n=19) and post-intervention ( n=37) groups ( p<0.001), as well as perceived usefulness of the handbook in various clinical scenarios as measured on a 10-point Likert scale. Conclusions: We find that improvement in the quality of a handbook for paediatric house officers is associated with increase in its utilization and benefits to their clinical competency and confidence level, especially on call. To increase the utilization rate of the handbook, both the user interface and content need to be improved.

scholarly journals SWE and SMI ultrasound techniques for monitoring needling treatment of ankylosing spondylitis: study protocol for a single-blinded randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mengyu Wang ◽  
Wen Fu ◽  
Lingcui Meng ◽  
Jia Liu ◽  
Lihua Wu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Flow ◽  
Ankylosing Spondylitis ◽  
Outcome Measures ◽  
Healthy Subjects ◽  
Acupuncture Group ◽  
Musculoskeletal Ultrasound ◽  
Sham Control ◽  
Post Intervention

Abstract Background Ankylosing spondylitis (AS) is a high-incidence disease in young men that interferes with patients’ physical and mental wellbeing and overall quality of life (QoL). It is often accompanied by arthralgia, stiffness, and limited lumbar flexibility. Acupuncture is safe and effective for reducing the symptoms of AS, but the underlying mechanisms by which it does so are not fully understood. Therefore, to objectively assess acupuncture efficacy, which is critical for patients making informed decisions about appropriate treatments, we will use shear-wave elastography (SWE) and superb microvascular imaging (SMI) ultrasound techniques to evaluate elasticity of lumbar paraspinal muscles and blood flow to the sacroiliac joint (SIJ) in AS. Methods We will recruit a total of 60 participants diagnosed with AS and 30 healthy subjects. Participants will be randomly allocated 1:1 to either an acupuncture group or a sham control acupuncture group. Primary-outcome measures will be musculoskeletal ultrasound, Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Metrology Index (BASMI), and the Visual Analogue Scale (VAS) for pain. Secondary outcome measures will be the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Function Index (BASFI), and Fatigue Scale-14 (FS-14). We will monitor the effect of acupuncture or sham acupuncture on blood flow and SIJ inflammation using SMI, lumbar-muscle stiffness using SWE and the lumbar paraspinal-muscle cross-sectional area (CSA) using a two-dimensional (2D) grayscale imaging. QoL, physical function, and fatigue will be assessed using an evaluation scale or questionnaire developed for this study, with outcomes measured by the ASQoL, BASMI, BASDAI, BASFI, and FS-14. Healthy subjects will not receive acupuncture but undergo only musculoskeletal ultrasound at baseline. Acupuncture and sham control acupuncture interventions will be conducted for 30 min, 2–3 times/week for 12 weeks. Musculoskeletal ultrasound will be conducted at baseline and post-intervention, while other outcomes will be measured at baseline, 6 weeks, and post-intervention. The statistician, outcome assessor, and participants will be blinded to treatment allocation. Discussion The results of this single-blinded, randomized trial with sham controls could help demonstrate the efficacy of acupuncture and clarify whether musculoskeletal ultrasound could be used to evaluate AS. Trial registration ClinicalTrials.gov ChiCTR2000031476. Registered 3 April 2020.

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