TP8.2.1 Quality Improvement Project: Improving the percentage of patients receiving their consent form copy

Abstract Aim Good practice set out by the GMC and DoH is to acquire written informed consent for surgery, despite it not being a legal requirement. Baseline data of 50 consecutive surgical cases, undertaken in the UK’s largest trust, found that only 12% of patients were being offered their consent form copy prior to surgery. We constructed a SMART aim to increase this percentage by 20% each month on the general surgical wards of a city hospital. Method On analysing the patients’ physical notes, the three primary drivers identified were factors intrinsic to the department, consent form and our patients; signifying there was a lack of standard awareness, education and safety-net to ensure sustainability. To tackle this in-turn, we designed three PDSA cycles: Departmental seminar and poster, legal education session, and theatre checklist adaptation. Results Following our first PDSA cycle, the mean percentage increased from 12% to 44%. Using projection analysis, we anticipate this to increase to 76% after the second PDSA cycle, and 100% after PDSA3, with 100% sustainability 1 year later. Conclusions Overall, our results to-date show that the proportion of patients receiving their consent form copy has improved following our first PDSA cycle, indicating that awareness plays an important role in the consenting process. We predict that education plays an equal role; and given the research supporting the implications of checklists, we forecast that this later element will be the ultimatum leading to 100% sustainability of patients receiving their consent form copy prior to surgery.

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EP.TU.785Quality Improvement Project: Improving Oxygen therapy prescription in surgical inpatients

British Journal of Surgery ◽

10.1093/bjs/znab311.102 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Mohammed Hamid ◽

Laith Al-Saket ◽

Arab Rawashdeh ◽

Raman Sudarsanam

Keyword(s):

Large City ◽

Safety Net ◽

British Thoracic Society ◽

City Hospital ◽

Improvement Project ◽

Pdsa Cycle ◽

Projection Analysis ◽

The Mean ◽

One Year ◽

Hospital Inpatients

Abstract Aims The 2015, British Thoracic Society (BTS) Oxygen audit demonstrated that 42% of hospital inpatients were using Oxygen without a prescription. National and local standards state that Oxygen, as a drug, should be routinely prescribed and checked along with regular medications and VTE risk assessment. Our baseline audit conducted over a two month period on the surgical wards of a large city hospital revealed that 78% of patients were not being prescribed oxygen. We set a SMART aim to increase the percentage of surgical inpatients being prescribed oxygen by 20% each month. Methods We used the trust e-prescription software to record our data, with three-stage verification and subsequent senior analysis of data. The three primary drivers identified were factors intrinsic to the department: lack of standard awareness, education and safety-net to ensure sustainability. To tackle these in-turns, we designed three PDSA cycles: Departmental poster, seminar with induction material, and system checklist notification. Results Following our first PDSA cycle, the mean percentage increased from 22% to 60%. Using projection analysis, we anticipate this to increase to > 75% after the second PDSA cycle, and >95% after PDSA3, with 100% sustainability one year later. Conclusion Our results to-date show that practice standards have improved following our first PDSA cycle, indicating that awareness played an important role. We predict that education will play an equal role; and given the research supporting the implications of checklists, we forecast that this later element will be the ultimatum leading to 100% sustainability of patients receiving oxygen prescription.

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Effect of Osteoporosis on Proximal Humerus Fractures

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320985399 ◽

2020 ◽

Vol 11 ◽

pp. 215145932098539

Author(s):

Anil Taskesen ◽

Ali Göçer ◽

Kadir Uzel ◽

Yüksel Uğur Yaradılmış

Keyword(s):

Surgical Outcomes ◽

Proximal Humerus ◽

City Hospital ◽

Proximal Humerus Fractures ◽

Fracture Type ◽

Age And Gender ◽

Humerus Fractures ◽

The Mean ◽

And Gender ◽

Fracture Types

Introduction: Proximal humerus fractures (PHF) constitute the majority of the most common osteoporotic fractures. Bone density measurements can affect treatment methods and outcomes. This study was aimed to investigate the effect of osteoporosis values, measured from direct radiographs, on fracture type, surgical outcomes. Methods: 248 patients over 50 years of age who presented to Mersin City Hospital between 2017 and 2020 with proximal humeral fractures were retrospectively evaluated. The age and gender of the patients and the fracture types were evaluated according to the AO classification system from the direct radiographs obtained at the time of admission were recorded. The Tingart cortical thickness and deltoid tuberosity index (DTI) measurements were used to assess osteoporosis status in all patients. Postoperative and follow-up radiographs of 45 patients, treated with fixed-angle proximal humeral locking plate, were evaluated for radiographic results and their correlations with osteoporosis measurements were examined. Results: According to the demographic characteristics of the patients, 171 patients were female and 77 patients were male (F/M: 3/1), and mean age was 69.2 ± 11.66 (50-95). Considering the bone quality parameters in all patients, the mean Tingart value was 5.8 ± 1.6 mm and the mean DTI was 1.43 ± 0.17, where there was a correlation between the Tingart value and DTI (r = 0.810 and p < 0.001). Although there was a statistically significant relationship between the osteoporosis parameters and age and gender (p < 0.001 and p = 0.023, respectively), main AO fracture types were not related to osteoporosis (p < 0.05). In the operated group (n = 48, 19%), 19 patients (42%) showed poor outcomes, which were not associated with age and osteoporosis parameters. Conclusion: This study was concluded that osteoporosis parameters differ between genders and age groups in patients with PHF, however osteoporosis is not the main factor affecting the fracture type and surgical outcomes.

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Quality improvement primer part 2: executing a quality improvement project in the emergency department

CJEM ◽

10.1017/cem.2017.393 ◽

2017 ◽

Vol 20 (4) ◽

pp. 532-538 ◽

Cited By ~ 9

Author(s):

Lucas B. Chartier ◽

Antonia S. Stang ◽

Samuel Vaillancourt ◽

Amy H. Y. Cheng

Keyword(s):

Health Care ◽

Emergency Department ◽

Emergency Medicine ◽

Quality Improvement ◽

Improvement Project ◽

Emergency Department Setting ◽

Pdsa Cycle ◽

Time To Antibiotics ◽

Final Article

ABSTRACTThe topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement. We will review what makes a good aim statement, the various categories of measures that can be tracked during a QI project, and the relative merits and challenges of potential change concepts and ideas. We will also present the Model for Improvement’s rapid-cycle change methodology, the Plan-Do-Study-Act (PDSA) cycle. The final article in this series will focus on the evaluation and sustainability of QI projects.

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744 A Quality Improvement Project on Timely Removal of Central Venous Catheters

British Journal of Surgery ◽

10.1093/bjs/znab259.748 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

S Devarakonda ◽

P J Korula ◽

S Kandasamy

Keyword(s):

Online Survey ◽

Blood Stream ◽

Central Line ◽

High Morbidity ◽

Alert System ◽

Improvement Project ◽

Central Lines ◽

Surgical Icu ◽

Intervention Adherence ◽

The Mean

Abstract Introduction Central Line-Associated Blood Stream Infections are associated with high morbidity and mortality. It is essential to ensure quality in insertion, maintenance, and timely removal of central lines. Our ICU follows a protocol to remove unused lines after five days. We have an electronic alert system to monitor these lines, and we wanted to audit its usage and improve its efficacy. Method This project was designed using QI methodology and was carried out in a Level III Surgical ICU. We implemented two PDSA cycles in August and December 2020. After the first cycle, an online survey was performed among ICU doctors to gauge their knowledge of the alert system and local protocols. Based on the above results, an educational session was carried out, showing a step-by-step guide to using the alert system, and a re-audit was done in December. Results The first cycle showed that alerts were created for only 17 (25%) of 68 lines. Also, the survey revealed that about 30% of doctors were unfamiliar with the alert system. After the intervention, adherence to the alert system increased to 65% (alerts for 41 of 63 lines). There was also a significant improvement in the mean number of central line days from 6.4 (SD = 3.1) to 4.2 (SD = 2.8) [P < .05]. Conclusions It is crucial to monitor central lines, and simple educational sessions about local protocols can bring success in implementing sustainable change in quality. We suggest hospitals have systems to monitor the central lines and regularly audit their effectiveness.

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‘CPR for Feet’ care bundle to improve foot assessment in inpatient diabetes

BMJ Open Quality ◽

10.1136/bmjoq-2017-000196 ◽

2018 ◽

Vol 7 (3) ◽

pp. e000196 ◽

Cited By ~ 1

Author(s):

Rhea O’Regan ◽

Ross MacDonald ◽

James G Boyle ◽

Katherine A Hughes ◽

Joyce McKenzie

Keyword(s):

Quality Improvement ◽

Nursing Staff ◽

Quality Improvement Project ◽

Care Bundle ◽

Staff Education ◽

Pressure Relief ◽

Improvement Project ◽

The Third ◽

Inpatient Diabetes ◽

Pdsa Cycle

AimsThe Scottish Inpatient Diabetes Foot Audit conducted in 2013 revealed that 57% of inpatients had not had their feet checked on admission, 60% of those at risk did not have pressure relief in place and 2.4% developed a new foot lesion. In response, the Scottish Diabetes Foot Action Group launched the ‘CPR for Feet’ campaign. The aim of this project was to raise awareness of the ‘Check, Protect and Refer’ (CPR) campaign as well as improve the assessment and management of inpatients with diabetes.MethodsA quality improvement project underpinned by Plan-Do-Study-Act (PDSA) methodology was undertaken. The first and second cycles focused on staff education and the implementation of a ‘CPR for Feet’ assessment checklist using campaign guidelines, training manuals and modules. The third and fourth cycles focused on staff feedback and the implementation of a ‘CPR for Feet’ care bundle.ResultsBaseline measurements revealed 28% of patients had evidence of foot assessment. Medical and nursing staff reported to be largely unaware of the ‘CPR for Feet’ campaign (13%). Fifty-two per cent of inpatients with diabetes had their feet assessed and managed correctly following the second PDSA cycle. After completion of the third and fourth PDSA this number improved further to 72% and all staff reported to be aware of the campaign.ConclusionsThe introduction of a ‘CPR for Feet’ care bundle improved the assessment of inpatients with diabetes.

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Secondary attack rate among high-risk contacts of COVID-19 paediatric index cases: a study at the beginning of the pandemic in Pune city of Western Maharashtra, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20214529 ◽

2021 ◽

Vol 8 (12) ◽

pp. 1920

Author(s):

Ganesh R. Jagadale ◽

Muralidhar P. Tambe ◽

Yallapa Jadhav ◽

Pradip S. Borle ◽

Malangori A. Parande ◽

...

Keyword(s):

Attack Rate ◽

Family Background ◽

Demographic Data ◽

Pediatric Case ◽

Unexplored Area ◽

The Mean ◽

Isolation Facilities ◽

Written Informed Consent ◽

Efficient Transmission ◽

Index Cases

Background: The COVID-19 was the emerging disease caused by SARS-COV2. Efficient transmission of this disease occurs through droplets and fomites. The susceptibility of children to coronavirus disease-19 (COVID-19) and transmission of COVID-19 from children to others is a relatively unexplored area. The aim of this study was to understand the transmission dynamics of severe acute respiratory syndrome coronavirus 2 in children. Study objectives were to estimate secondary attack rate of COVID-19 from paediatric index case during the early phase of pandemic in Pune city and to identify factors associated with transmission and development of the COVID-19 disease.Methods: This was a retrospective cohort study conducted in the month of June 2020. The sample includes 58 contacts of 11 laboratory confirmed pediatric index cases of COVID-19 from Pune municipal corporation after written informed consent. A confidential telephonic interview of parents was taken by using a prestructured questionnaire which includes socio-demographic data, family background, type of house, development of symptoms, outcome etc.Results: The mean age of primary pediatric case was 12.7±5.1 years. All of them were symptomatic. The SAR estimated was 55.2%. The factors significantly affecting SAR were comorbidity, no. of family members, type of family, overcrowding, no. of rooms, bedroom attached with toilet.Conclusions: The household SAR from paediatric patients is high and is closely associated with family size and other household characteristics. Hence, home quarantine should be advocated in smaller families with appropriate isolation facilities; more emphasis is given to co-morbid individuals.

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Implementation of a provincial acute stroke pathway and its impact on access to advanced stroke care in Saskatchewan

BMJ Open Quality ◽

10.1136/bmjoq-2020-001214 ◽

2021 ◽

Vol 10 (3) ◽

pp. e001214

Author(s):

Jessalyn K Holodinsky ◽

Vivian N Onaemo ◽

Ruth Whelan ◽

Gary Hunter ◽

Brett R Graham ◽

...

Keyword(s):

Acute Stroke ◽

Control Charts ◽

Systems Of Care ◽

Stroke Care ◽

High Variability ◽

Weighted Mean ◽

Improvement Project ◽

Outcome Severity ◽

The Mean ◽

Over Time

BackgroundFor ischaemic stroke, outcome severity is heavily time dependent. Systems of care need to be in place to ensure that patients with stroke are treated quickly and appropriately across entire health regions. Prior to this study, the province of Saskatchewan, Canada did not have a provincial stroke strategy in place.MethodsA quality improvement project was undertaken to create and evaluate a provincial stroke strategy. The Saskatchewan Acute Stroke Pathway was created using a multidisciplinary team of experts, piloted at five stroke centres and then implemented provincially. The number of stroke alerts, door-to-imaging, door-to-needle, door-to-groin puncture times and treatment rates were collected at all centres. Improvements over time were analysed using run charts and individuals control charts.ResultsThe number of stroke alerts province-wide trended upwards in the last 6 months of the study. There were no clear trends or shifts in the proportion of stroke alerts treated with alteplase or endovascular therapy. Across the province, the weighted mean door-to-imaging time decreased from 21 to 15 min, the weighted mean door-to-needle time decreased from 62 to 47 min and the mean door-to-groin puncture time decreased from 83 to 70 min. There was high variability in the degree of improvement from centre to centre.ConclusionsThe implementation of a province wide acute stroke pathway has led to improvement in stroke care on a provincial basis. Further work addressing intercentre variability is ongoing.

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SP2.1.5Does the introduction of ward round stickers improve surgical ward rounds?

British Journal of Surgery ◽

10.1093/bjs/znab361.025 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Vivek Sharma ◽

Emma Fitz-patrick ◽

Dhiraj Sharma

Keyword(s):

Quality Improvement ◽

Good Practice ◽

Ward Round ◽

Quality Improvement Project ◽

Improvement Project ◽

Vte Prophylaxis ◽

Baseline Performance ◽

Surgical Ward ◽

Ward Rounds ◽

Surgical Teams

Abstract Aims With surgical teams in the NHS pushed to their limit under unprecedented demands, simple and effective ways for maintaining standards of patient care are necessitated. This quality improvement project aims to implement user-friendly and coherent ward round stickers as an adjunct to surgical ward rounds to deliver standardised care. Methods Baseline performance was measured against The Royal College of Surgeons of Edinburgh Surgical Ward Round Toolkit. Five recorded items were studied including: bloods, venous thromboembolism (VTE) prophylaxis, regular medications, observations, and handover to nursing staff. The surgical team was informed of the audit but not over which dates it would be conducted. In the first cycle, data was collected over a 4 week period. Ward round stickers were then implemented and a second cycle was completed 2 months later over another 4 week period. Results Baseline performance recorded from 74 ward round entries showed checking of bloods, VTE, regular medications, observations and handover ranged from 0% to 65%. After the introduction of ward round stickers, a second cycle was performed from 81 ward round entities. There was significant improvement from baseline with compliance in recording all five items > 85%. Conclusion This quality improvement project showed that the use of stickers as an adjunct to surgical ward round is a simple and effective way of evidencing good practice against recommended standards.

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Quality improvement project aimed at improving the reliability of spontaneous awakening trials in a district general intensive care unit

BMJ Open Quality ◽

10.1136/bmjoq-2018-000518 ◽

2019 ◽

Vol 8 (2) ◽

pp. e000518

Author(s):

Donna Ferraioli ◽

Laura Ferguson ◽

Martin Carberry

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Improvement ◽

Good Practice ◽

Retrospective Case ◽

Median Percentage ◽

Improvement Project ◽

Beneficial Effects ◽

Care Guidelines ◽

Light Sedation

Traditionally regarded as good practice, continuous infusions of sedation and analgesic medications are used to reduce anxiety and distress and facilitate care of mechanically ventilated patients in the intensive care unit (ICU). Growing evidence has demonstrated that use of such infusions prolongs days spent invasively ventilated, increases the incidence of ICU acquired weakness and delirium and subsequently increasing the duration of their ICU and hospital stay. Several critical care guidelines recommend titrating to light sedation ±a daily sedation hold or spontaneous awakening trial (SAT). Given the known beneficial effects of sedation holds, we aimed to increase their use within our ICU, a 10-bedded unit with mixed ICU and high-ependency unit facilities in National Health Service Scotland. A retrospective case note review was performed to obtain baseline data of SAT eligible patients who received a sedation hold. The model for improvement 1 was used to implement an ICU protocol based on the ‘Wake up and breath’ guidelines 2 and measure the improvements made. The median percentage of SAT eligible patients that received a sedation hold increased from 47% to 96% during the project period. No significant adverse events were reported during this period and a reduction in ventilation and unit stay was observed. Quality improvement methods have facilitated successful and safe integration of a daily sedation hold protocol in our ICU.

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Anxiety associated with colposcopy at Chris Hani Baragwanath Hospital, Johannesburg

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v15i2.208 ◽

2009 ◽

Vol 15 (2) ◽

pp. 5

Author(s):

MYH Moosa ◽

L Chait ◽

A Cohen ◽

L Diamond ◽

J Dunlop ◽

...

Keyword(s):

Trait Anxiety ◽

State Anxiety ◽

Significant Negative Correlation ◽

Cross Sectional Study ◽

Anxiety Score ◽

Cross Sectional ◽

High Incidence ◽

The Mean ◽

Written Informed Consent ◽

Colposcopy Clinic

Given the high incidence of cervical cancer in South Africa and the distress it causes, we aimed to determine the extent of anxiety in patients undergoing colposcopy at Chris Hani Baragwanath (CHB) Hospital, Johannesburg. Method. A descriptive and cross-sectional study design was applied on a convenient sample of patients from the waiting area of the colposcopy clinic at CHB Hospital. Females attending a first colposcopy appointment were invited to participate by completing the State-Trait Anxiety Inventory (STAI) after written informed consent had been obtained. Results. Among a total of 31 women, the mean STAI score for state anxiety was 46.77 (SD=12.92) and the mean STAI score for trait anxiety was 46.81 (SD=9.50); 51.6% of the patients had a STAI state anxiety score of >50, while 41.9% of the patients had a STAI trait anxiety score >50. There was no significant association between either elevated STAI state or trait anxiety scores and age group ( χ 2 =1.77; p= 0.18 and χ 2 =0.001; p= 0.98, respectively); marital status ( χ 2 =0.301; p= 0.58 and χ 2 =0.834; p= 0.36); level of education ( χ 2 =0.444; p= 0.51 and χ 2 =2.40; p= 0.12); employment status ( χ 2 =1.78; p= 0.18 and χ 2 =0.001; p= 0.98); monthly income ( χ 2 =1.15; p= 0.28 and χ 2 =0.03; p= 0.86) or using stimulants ( χ 2 =0.416; p= 0.52 and χ 2 =0.394; p= 0.53). There was a significant negative correlation between age and STAI state anxiety scores ( r 2 =0.004; p= 0.017) and a positive correlation between age and STAI trait anxiety scores ( r 2 =0.004; p= 0.019).Conclusion. This study reported significantly elevated trait anxiety scores relating to colposcopy and emphasises the need to identify the anxiety and institute a plan to ameliorate it with information booklets, leaflets, video colposcopy and educational counselling.

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