scholarly journals SP4.1.6 Introduction of Concentric digital and remote consent into clinical practice during the COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Edward St John ◽  
Dafydd Loughran
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Royal College ◽  
Healthcare Providers ◽  
Patient Feedback ◽  
High Satisfaction ◽  
Average Patient ◽  
Unwarranted Variation ◽  
Form Information

Abstract Introduction Paper-based consent processes are associated with errors of omission, illegibility and unwarranted variation. During the COVID-19 pandemic the Royal College of Surgeons (England) released guidelines supporting the use of remote consent. The aim was to evaluate the introduction of Concentric, a digital consent application, into clinical practice. Method Between April 2020-Jan 2021, Concentric was used optionally for medical consent during registered service evaluations. Data was obtained from Concentric analytics. User and patient feedback was obtained via optional satisfaction surveys. Results 3417 Concentric consent episodes for 356 unique procedures were performed by 170 clinicians across 16 specialties from 13 healthcare providers. Patients were aged 7-101years, (median 58, IQR 30). Of the completed consent episodes (n = 2799), consent was given; remotely in 23% of episodes, and on the day of surgery in 67%. Consent form information was shared digitally with 82% of patients. Average patient user experience was 8.8 out of 10 (1 very poor - 10 excellent, n = 594). 546/594 (91.9%) patients agreed that Concentric provided all the information they needed to know. Clinicians (n = 23) rated the quality of the consent process with Concentric as 4.8 out of 5 with all supporting the use of Concentric across the Trust. Conclusion Concentric has been successfully introduced into clinical practice. Patients and clinicians report high satisfaction scores. Remote consent is feasible and trends in consent practice, such as day of surgery consent can be easily identified and can guide quality improvement work. The introduction of digital consent solutions should be considered for all units.

Quality of Care: Performance Measurement and Quality Improvement in Clinical Practice

2021 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Clinical Practice ◽  
Performance Measurement ◽  
Clinical Performance ◽  
The United States ◽  
Performance Measure ◽  
Care Performance

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement. This review contains 1 figure, 3 tables, and 56 references Keywords: Quality of care, performance measure, quality improvement, clinical practice, sigma six, transparency

scholarly journals The use of patient feedback by hospital boards of directors: a qualitative study of two NHS hospitals in England

2017 ◽  
Vol 27 (2) ◽  
pp. 103-109 ◽  
Author(s):  
Robert Lee ◽  
Juan I Baeza ◽  
Naomi J Fulop
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Qualitative Study ◽  
Boards Of Directors ◽  
National Health Service Foundation ◽  
Patient Feedback ◽  
Qualitative Feedback ◽  
Hospital Boards ◽  
Foundation Trusts

BackgroundAlthough previous research suggests that different kinds of patient feedback are used in different ways to help improve the quality of hospital care, there have been no studies of the ways in which hospital boards of directors use feedback for this purpose.ObjectivesTo examine whether and how boards of directors of hospitals use feedback from patients to formulate strategy and to assure and improve the quality of care.MethodsWe undertook an in-depth qualitative study in two acute hospital National Health Service foundation trusts in England, purposively selected as contrasting examples of the collection of different kinds of patient feedback. We collected and analysed data from interviews with directors and other managers, from observation of board meetings, and from board papers and other documents.ResultsThe two boards used in-depth qualitative feedback and quantitative feedback from surveys in different ways to help develop strategies, set targets for quality improvement and design specific quality improvement initiatives; but both boards made less subsequent use of any kinds of feedback to monitor their strategies or explicitly to assure the quality of services.Discussion and conclusionsWe have identified limitations in the uses of patient feedback by hospital boards that suggest that boards should review their current practice to ensure that they use the different kinds of patient feedback that are available to them more effectively to improve, monitor and assure the quality of care.

scholarly journals Practice Variation Research in Degenerative Lumbar Disc Surgery: A Literature Review on Design Characteristics and Outcomes

2021 ◽  
pp. 219256822110648
Author(s):  
Juliëtte J. C. M. Van Munster ◽  
Vera de Weerdt ◽  
Ilan J. Y. Halperin ◽  
Amir H. Zamanipoor Najafabadi ◽  
Peter Paul G. van Benthem ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Literature Review ◽  
Degenerative Disc Disease ◽  
Practice Variation ◽  
Case Mix ◽  
Disc Disease ◽  
Explanatory Variables ◽  
Unwarranted Variation ◽  
Over Time

Study Design Literature review. Objective To describe whether practice variation studies on surgery in patients with lumbar degenerative disc disease used adequate study methodology to identify unwarranted variation, and to inform quality improvement in clinical practice. Secondary aim was to describe whether variation changed over time. Methods Literature databases were searched up to May 4th, 2021. To define whether study design was appropriate to identify unwarranted variation, we extracted data on level of aggregation, study population, and case-mix correction. To define whether studies were appropriate to achieve quality improvement, data were extracted on outcomes, explanatory variables, description of scientific basis, and given recommendations. Spearman’s rho was used to determine the association between the Extreme Quotient (EQ) and year of publication. Results We identified 34 articles published between 1990 and 2020. Twenty-six articles (76%) defined the diagnosis. Prior surgery cases were excluded or adjusted for in 5 articles (15%). Twenty-three articles (68%) adjusted for case-mix. Variation in outcomes was analyzed in 7 articles (21%). Fourteen articles (41%) identified explanatory variables. Twenty-six articles (76%) described the evidence on effectiveness. Recommendations for clinical practice were given in 9 articles (26%). Extreme Quotients ranged between 1-fold and 15-fold variation and did not show a significant change over time (rho= −.33, P= .09). Conclusions Practice variation research on surgery in patients with degenerative disc disease showed important limitations to identify unwarranted variation and to achieve quality improvement by public reporting. Despite the availability of new evidence, we could not observe a significant decrease in variation over time.

scholarly journals eRegCom – Quality Improvement Dashboard for healthcare providers and Targeted Client Communication to pregnant women using data from an electronic health registry to improve attendance and quality of antenatal care: study protocol for a multi-arm cluster randomized trial

2020 ◽  
Author(s):  
Kjersti Mørkrid ◽  
Binyam Bogale ◽  
Eatimad Abbas ◽  
Khadija Abu Khader ◽  
Itimad Abu Ward ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Controlled Trial ◽  
Healthcare Providers ◽  
Health Systems Strengthening ◽  
Trial Registration ◽  
Client Communication ◽  
Cluster Randomized

Abstract Background: This trial evaluates interventions that utilize data entered at point-of-care in the Palestinian maternal and child eRegistry to generate Quality Improvement Dashboards (QID) for healthcare providers and Targeted Client Communication (TCC) via short message service (SMS) to clients. The aim is to assess the effectiveness of the automated communication strategies from the eRegistry on improving attendance and quality of care for pregnant women.Methods: This four-arm cluster randomized controlled trial will be conducted in the West Bank and the Gaza Strip, Palestine, and includes 138 clusters (primary healthcare clinics) enrolling from 45 to 3000 pregnancies per year. The intervention tools are the QID and the TCC via SMS, automated from the eRegistry built on the District Health Information Software 2 (DHIS2) Tracker. The primary outcomes are appropriate screening and management of anemia, hypertension, and diabetes during pregnancy; and timely attendance to antenatal care. Primary analysis, at the individual-level taking the design effect of the clustering into account, will be done as intention-to-treat.Discussion: This trial, embedded in the implementation of the eRegistry in Palestine, will inform the use of digital health interventions as a health systems strengthening approach.Trial registration: ISRCTN, trial registration number: 10520687, registered 18 October 2018, http://www.isrctn.com/ISRCTN10520687

scholarly journals Satisfação com a Especialidade entre os Internos da Formação Específica em Portugal

2015 ◽  
Vol 28 (2) ◽  
pp. 209 ◽  
Author(s):  
Maria João Martins ◽  
Inês Laíns ◽  
Bruno Brochado ◽  
Manuel Oliveira-Santos ◽  
Pedro Pinto Teixeira ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Total Population ◽  
Medical Profession ◽  
Cross Sectional Study ◽  
Study Data ◽  
Medical Residents ◽  
Cross Sectional ◽  
High Satisfaction ◽  
Degree Of Satisfaction

<strong>Introduction:</strong> The satisfaction with the medical profession has been identified as an essential factor for the quality of care, the wellbeing of patients and the healthcare systems’ stability. Recent studies have emphasized a growing discontent of physicians, mainly as a result of changes in labor relations.<br /><strong>Objectives: </strong>To assess the perception of Portuguese medical residents about: correspondence of residency with previous expectations; degree of satisfaction with the specialty, profession and place of training; reasons for dissatisfaction; opinion regarding clinical practice in Portugal and emigration intents.<br /><strong>Material and Methods:</strong> Cross-sectional study. Data collection was conducted through the “Satisfaction with Specialization Survey”, created in an online platform, designed for this purpose, between May and August 2014.<br /><strong>Results: </strong>From a total population of 5788 medical residents, 804 (12.25 %) responses were obtained. From this sample, 77% of the responses were from residents in the first three years. Results showed that 90% of the residents are satisfied with their specialty, 85% with the medical profession and 86% with their place of training. Nevertheless, results showed a decrease in satisfaction over the final years of residency. The overall assessment of the clinical practice scenario in Portugal was negative and 65% of residents have plans to emigrate after completing their residency.<br /><strong>Conclusion:</strong> Portuguese residents revealed high satisfaction levels regarding their profession. However, their views on Portuguese clinical practice and the results concerning the intent to emigrate highlight the need to take steps to reverse this scenario.

scholarly journals Connecting funds with quality outcomes in health care: a blueprint for a Clinical Practice Improvement Payment

2007 ◽  
Vol 31 (5) ◽  
pp. 54 ◽  
Author(s):  
Michael Ward ◽  
Sandra A Daniels ◽  
Gary J Walker ◽  
Stephen Duckett
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Clinical Practice ◽  
Quality Of Health Care ◽  
Geographic Variations ◽  
Quality Outcomes ◽  
Practice Improvement ◽  
Global Problem

There are significant geographic variations in the quality of health care, often with substantial gaps between what is known to be achievable and what is actually achieved in practice. This is a global problem that has persisted for many years despite a variety of conventional quality improvement initiatives. Attention has therefore recently turned to realignment of funding with specified levels of desired quality of care as an alternative. This paper outlines one approach that will be introduced as a pilot in Queensland.

scholarly journals Critical appraisal of clinical practice guidelines for the management of COVID-19: protocol for a systematic review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Thanansayan Dhivagaran ◽  
Umaima Abbas ◽  
Fahad Butt ◽  
Luckshann Arunasalam ◽  
Oswin Chang
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Healthcare Providers ◽  
World Health ◽  
High Quality ◽  
Agree Ii ◽  
Agree Ii Instrument

Abstract Background In December 2019, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 was identified as the cause of an acute respiratory disease, coronavirus disease 2019 (COVID-19). Given the lack of validated treatments, there is an urgent need for a high-quality management of COVID-19. Clinical practice guidelines (CPGs) are one tool that healthcare providers may use to enhance patient care. As such, it is necessary that they have access to high-quality evidence-based CPGs upon which they may base decisions regarding the management and use of therapeutic interventions (TI) for COVID-19. The purpose of the proposed study is to assess the quality of CPGs that make management or TI recommendations for COVID-19 using the AGREE II instrument. Methods The proposed systematic review will identify CPGs for TI use and/or the management of COVID-19. The MEDLINE, EMBASE, CINAHL, and Web of Science databases, as well as the Guidelines International Network, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network, and the World Health Organization websites, will be searched from December 2019 onwards. The primary outcome of this study is the assessed quality of the CPGs. The quality of eligible CPGs will be assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. Descriptive statistics will be used to quantify the quality of the CPGs. The secondary outcomes of this study are the types of management and/or TI recommendations made. Inconsistent and duplicate TI and/or management recommendations made between CPGs will be compared across guidelines. To summarize and explain the findings related to the included CPGs, a narrative synthesis will also be provided. Discussion The results of this study will be of utmost importance to enhancing clinical decision-making among healthcare providers caring for patients with COVID-19. Moreover, the results of this study will be relevant to guideline developers in the creation of CPGs or improvement of existing ones, researchers who want to identify gaps in knowledge, and policy-makers looking to encourage and endorse the adoption of CPGs into clinical practice. The results of this review will be published in a peer-reviewed journal and presented at conferences. Systematic review registration International Prospective Register for Systematic Reviews (PROSPERO)—CRD42020219944

scholarly journals African primary care research: Quality improvement cycles

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Claire Van Deventer ◽  
Bob Mash
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Clinical Practice ◽  
Clinical Care ◽  
Research Quality ◽  
Project Proposal ◽  
Research Project ◽  
Primary Care Research ◽  
Care Research

Improving the quality of clinical care and translating evidence into clinical practice is commonly a focus of primary care research. This article is part of a series on primary care research and outlines an approach to performing a quality improvement cycle as part of a research assignment at a Masters level. The article aims to help researchers design their quality improvement cycle and write their research project proposal.

scholarly journals Developing a Strategy for the Improvement in Patient Experience in a Canadian Academic Department of Surgery

2018 ◽  
Vol 6 (1) ◽  
pp. 11-20
Author(s):  
Lindy Luo ◽  
Alan J Forster ◽  
Kathleen Gartke ◽  
John Trickett ◽  
Fraser D Rubens
Keyword(s):  
Quality Improvement ◽  
Patient Experience ◽  
Care Delivery ◽  
Communication Styles ◽  
Quality Improvement Process ◽  
Ottawa Hospital ◽  
Patient Feedback ◽  
Multidisciplinary Group ◽  
Surgery Department

Patient experience (PE) is recognized as a key component in the quality of health-care delivery. Public reporting of hospital, division, and physician-specific PE results has added to the momentum of adopting strategies to augment this metric of care. The Ottawa Hospital embarked on a journey to improve PE as a pillar of its quality improvement plan. This article demonstrates the efforts of a single surgery department from one large urban center to improve in-hospital PE in the rapidly changing environment of medicine and surgery. A multidisciplinary group within the department and a focus group of previous surgical inpatients were organized to address immediate challenges related to inpatient PE issues. We identified concrete strategies to optimize pain control, perceptions of patient respect and dignity, perceptions of surgeon availability, discharge medication understanding, and overall experience. Also, we identified a need in our department for timely patient feedback, improved communication styles in our staff and trainees, and an internal curriculum offering additional training for our staff and residents. We anticipate that the current results would be of significant interest to other departments wishing to optimize their PE profile as part of the ongoing quality improvement process at hospitals across North America.

Sign in / Sign up

Export Citation Format

Share Document