P129 IBD care in the UK: A comprehensive, novel service assessment with feedback from 10,222 patients and 166 NHS organisations to inform a vision for quality improvement

Abstract Background The IBD Benchmarking Tool, comprising an online Service Self-Assessment and Patient Survey, has provided a unique and comprehensive picture of Inflammatory Bowel Disease (IBD) care across the UK. The aim was to evaluate current local service performance to facilitate future quality improvement. Methods The IBD Patient Survey (PS) ran from July to November 2019 and the Service Self-Assessment (SSA) from October 2019 to January 2020. Detailed views were collected of the quality of IBD care from patient and clinician perspectives, measured against the UK IBD Standards 2019.1 The IBD UK National Report will be published in April 2021. Results 10,222 patients completed the PS. 89% (9,100/10,222) had found it hard to cope with having Crohn’s or Colitis over the previous year. 72% (6,954/9,640) rated the quality of their care as excellent, very good or good and 28% (2,686/9,640) rated the quality of their care as fair or poor. The top three factors that predicted how highly people with IBD rated their quality of care were: feeling supported by a team of specialists; having regular reviews; and discussing wider life goals and priorities, as part of planning their care. 26% (535/2,089) had waited more than a year for their diagnosis. 41% (849/2,087) had visited Accident & Emergency at least once before being diagnosed. 32% (656/2,057) were not offered any information about their condition when diagnosed. 91% (8,284/9,099) did not have a personalised care plan. Over the previous 12 months, 70% (6,732/9,574) had one or more flares and 72% (1,622/2,250) of inpatient admissions were unplanned. A key finding from the SSA (166 centres: 134 adult, 32 paediatric) was that no adult IBD services reported meeting the IBD Standards’ recommendation for whole time equivalent (WTE) staffing across the IBD team. Where services reported meeting the WTE for IBD nurse specialists, patients were more likely to rate the quality of their care highly and to have regular clinical review of their Crohn’s or Colitis. Conclusion The results highlight four key areas for change: improvements in diagnosis and information provision; personalised care and support for self-management; faster access to specialist advice and treatment; and effective multidisciplinary team (MDT) working. The Report sets out recommendations for action in each of these areas. To our knowledge, this is the first time that healthcare professionals and patients have assessed care against a common set of standards. The IBD Benchmarking Tool provides location-matched service performance and patient experience as an exemplar for others to follow. Reference

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Attitudes towards frailty assessment in clinical practice among psychiatrists in the UK

Working with Older People ◽

10.1108/wwop-09-2019-0023 ◽

2019 ◽

Vol 23 (4) ◽

pp. 185-194 ◽

Cited By ~ 1

Author(s):

Kanthee Anantapong ◽

Anthea Tinker

Keyword(s):

Clinical Practice ◽

Psychiatric Patients ◽

Frailty Index ◽

Mental Illnesses ◽

Care Plan ◽

Structured Interviews ◽

Negative Stereotypes ◽

Content Type ◽

The Uk

Purpose Although there is substantial evidence about the association between frailty and mental illnesses in older people, there is currently little evidence about how this is integrated into psychiatric clinical practice. The purpose of this paper is to explore the attitudes of a sample of psychiatrists in the UK about the concept and assessment of frailty in their clinical practice. Design/methodology/approach This research used a qualitative approach with semi-structured interviews. Interview schedules and transcripts were analysed using thematic analysis. NVivo software and an audit trail were used for the data analysis. Findings There were ten respondents (all psychiatrists) in this study. From the interviews, it appeared that some respondents were not be fully familiar with existing concepts of frailty. However, from their perspectives, frailty appeared to be multidimensional, reversible and for some could be enhanced by older people’s ability. Negative stereotypes of being frail could undermine the accessibility to appropriate assessment and care. Existing multidisciplinary assessments, with some adjustments to the particular needs of psychiatric patients, can be used to establish a frailty index. Originality/value The concept of frailty, especially those concerning its multidimensional and homeostatic nature, should be further examined to make it more applicable to psychiatric practice. Without much more effort, frailty could be assessed within current psychiatric practices. This could constitute a care plan tailored for frail people with a psychiatric illness, so as to improve the outcomes of their treatment and quality of life.

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1423 Quality and Efficacy of Multidisciplinary Team (MDT) Discussion Quality Assessment Tools and Checklists: A Systematic Review

British Journal of Surgery ◽

10.1093/bjs/znab259.954 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

G Brown ◽

A Young ◽

R Rymell

Keyword(s):

Quality Improvement ◽

Quality Assessment ◽

Practical Method ◽

Included Study ◽

Assessment Tools ◽

Current Evidence ◽

Validity And Reliability ◽

High Standards ◽

The Uk

Abstract Aim MDT discussion is the gold standard for cancer care in the UK. With the cancer incidence and complexity of treatments both increasing, demand for MDT discussion is growing. The need for efficiency, whilst maintaining high standards, is therefore clear. Paper-based MDT quality assessment tools and discussion checklists may represent a practical method of monitoring and improving MDT practice. This review aims to describe and appraise these tools, as well as consider their value to quality improvement. Method MEDLINE, Embase and PsycInfo were searched using pre-defined terms. PRISMA methodology was followed throughout. Studies were included if they described the development of a relevant tool/checklist, or if an element of the methodology further informed tool quality assessment. To investigate efficacy, studies using a tool as a method of quality improvement in MDT practice were also included. Study quality was appraised using the COSMIN risk of bias checklist or the Newcastle-Ottawa scale, depending on study type. Results The search returned 6888 results. 17 studies were included, and 6 different tools were identified. Overall, methodological quality in tool development was adequate to very good for assessed aspects of validity and reliability. Clinician feedback was positive. In one study, the introduction of a discussion checklist improved MDT ability to reach a decision from 82.2% to 92.7%. Improvement was also noted in the quality of information presented and the quality of teamwork. Conclusions Several tools for assessing and guiding MDT discussions are available. Although limited, current evidence indicates sufficient rigour in their development and their potential for quality improvement.

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A Learning Outcome Inspired Survey Instrument for Assessing the Quality of Continuous Improvement Cycle

International Journal of Information and Communication Technology Education ◽

10.4018/ijicte.2019040107 ◽

2019 ◽

Vol 15 (2) ◽

pp. 108-129 ◽

Cited By ~ 3

Author(s):

Abdallah Namoun ◽

Ahmad Taleb ◽

Mohammed Al-Shargabi ◽

Mohamed Benaida

Keyword(s):

Quality Improvement ◽

Continuous Quality Improvement ◽

Delphi Study ◽

Assessment Tool ◽

Survey Instrument ◽

Assessment Instrument ◽

Self Assessment ◽

Continuous Quality ◽

System Requirements

Measuring the effectiveness of a continuous quality improvement cycle in education is a cumbersome and sophisticated process. This article contributes a comprehensive self-assessment instrument for identifying the strengths and weaknesses of all phases of a continuous quality improvement cycle, including planning, data collection, analysis and reporting, and implementation of improvements. To this end, a four round Delphi study soliciting a total of 23 program quality experts from four universities was conducted. The produced survey instrument contains a total of 50 questions. The instrument may be used by quality experts in education to judge the quality of their continuous quality improvement cycle that endeavours to assess the attainment of learning outcomes in various undergraduate educational programs. Moreover, the instrument could be exploited to infer relevant user and system requirements and guide the development of an automated self-assessment tool aimed at identifying the shortcomings in educational continuous quality improvement cycles.

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Importance of accessibility and opening hours to overall patient experience of general practice: analysis of repeated cross-sectional data from a national patient survey

British Journal of General Practice ◽

10.3399/bjgp18x697673 ◽

2018 ◽

Vol 68 (672) ◽

pp. e469-e477 ◽

Cited By ~ 3

Author(s):

Thomas E Cowling ◽

Azeem Majeed ◽

Matthew J Harris

Keyword(s):

General Practice ◽

Patient Experience ◽

Patient Survey ◽

Cross Sectional ◽

National Patient ◽

General Practices ◽

The Uk ◽

Multilevel Linear Regression ◽

Practice Patient

BackgroundThe UK government aims to improve the accessibility of general practices in England, particularly by extending opening hours in the evenings and at weekends. It is unclear how important these factors are to patients’ overall experiences of general practice.AimTo examine associations between overall experience of general practice and patient experience of making appointments and satisfaction with opening hours.Design and settingAnalysis of repeated cross-sectional data from the General Practice Patient Surveys conducted from 2011–2012 until 2013–2014. These covered 8289 general practice surgeries in England.MethodData from a national survey conducted three times over consecutive years were analysed. The outcome measure was overall experience, rated on a five-level interval scale. Associations were estimated as standardised regression coefficients, adjusted for responder characteristics and clustering within practices using multilevel linear regression.ResultsIn total, there were 2 912 535 responders from all practices in England (n = 8289). Experience of making appointments (β 0.24, 95% confidence interval [CI] = 0.24 to 0.25) and satisfaction with opening hours (β 0.15, 95% CI = 0.15 to 0.16) were modestly associated with overall experience. Overall experience was most strongly associated with GP interpersonal quality of care (β 0.34, 95% CI = 0.34 to 0.35) and receptionist helpfulness was positively associated with overall experience (β 0.16, 95% CI = 0.16 to 0.17). Other patient experience measures had minimal associations (β≤0.06). Models explained ≥90% of variation in overall experience between practices.ConclusionPatient experience of making appointments and satisfaction with opening hours were only modestly associated with overall experience. Policymakers in England should not assume that recent policies to improve access will result in large improvements in patients’ overall experience of general practice.

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Aspek Penting Akreditasi Puskesmas dalam Mendukung Implementasi Jaminan Kesehatan Nasional

Jurnal Penelitian dan Pengembangan Pelayanan Kesehatan ◽

10.22435/jpppk.v2i1.35 ◽

2018 ◽

pp. 10-16

Author(s):

Misnaniarti Misnaniarti ◽

Putri Kemala Destari

Keyword(s):

Risk Management ◽

Quality Improvement ◽

Patient Satisfaction ◽

Health Services ◽

Literature Review ◽

Performance Improvement ◽

Services Quality ◽

Policy Study ◽

Self Assessment

Abstrak Puskesmas memegang peran yang sangat penting dalam penyelenggaraan pelayanan kesehatan di Indonesia. Puskesmas dituntut untuk dapat menjamin perbaikan mutu, peningkatan kinerja dan penerapan manajemen risiko yang dilaksanakan secara berkesinambungan, sehingga perlu dilakukan penilaian melalui mekanisme akreditasi. Tujuan penulisan makalah ini adalah untuk mengkaji aspek penting penyelenggaraan akreditasi Puskesmas dalam mendukung implementasi Jaminan Kesehatan Nasional (JKN). Makalah ini merupakan studi kebijakan menggunakan literature review. Informasi diambil dari berbagai sumber terdiri dari kebijakan, pedoman dan hasil penelitian terkait akreditasi Puskesmas. Berdasarkan kajian diketahui bahwa Puskesmas wajib untuk diakreditasi secara berkala paling sedikit tiga tahun sekali, sebagai salah satu syarat fasilitas kesehatan tingkat pertama di JKN. Akreditasi dilakukan melalui tahap survei akreditasi dan penetapan akreditasi. Puskemas melakukan persiapan sebelumnya antara lain menyiapkan dokumen eksternal dan internal, termasuk melakukan studi banding untuk persiapan akreditasi. Persiapan lainnya adalah melakukan pendampingan dan Self Assessment. Pelaksanaan akreditasi di Puskesmas merupakan aspek penting dalam mendukung implementasi JKN sekaligus merupakan upaya meningkatkan kualitas layanan Puskesmas. Rekomendasi bagi Puskesmas untuk dapat melakukan persiapan secara konprehensif sebelum menyelenggarakan penilaian akreditasi. Pelayanan kesehatan yang dilakukan sesuai arah panduan akreditasi secara konsisten dan berkelanjutan, pada akhirnya dapat meningkatkan kualitas pelayanan dan kepuasan pasien secara berkesinambungan. Kata Kunci: Akreditasi, Kredensialing, Mutu, Puskesmas. Abstract Puskesmas have an important role in the implementation of health services in Indonesia. Puskesmas are required to guarantee the quality improvement, performance improvement and implementation of risk management are carried out sustainably, so it needs to be assessed through accreditation mechanism. The purpose of this paper is to review the important aspects of the implementation of Puskesmas accreditation in supporting the implementation of the National Health Insurance (JKN). This is a policy study using literature review. Information taken from various sources consists of policies, guidelines and research results related to Puskesmas accreditation. Based on this study known that Puskesmas are obliged to be accredited periodically at least every three years, requirements as First Level Health Facilities. Accreditation done through several stages such as accreditation survey and accreditation decision. Previously Puskemas do the preparation consist of preparing external and internal documents, including conducting comparative studies for preparation of accreditation. Other preparation are accompaniment and Self Assessment. Implementation of accreditation in Puskesmas are an important aspect in supporting the implementation of JKN as well as an effort to improve the services quality of Puskesmas. Recommendation for Puskesmas to do preparation comprehensively before implementation accreditation assessment. Health services that implementation based on the accreditation guidelines consistently and continuously, finally can improve the quality of service and patient satisfaction on sustainably. Keywords: neonatal, emergency, hospital, referal system

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A Learning Outcome Inspired Survey Instrument for Assessing the Quality of Continuous Improvement Cycle

Research Anthology on Preparing School Administrators to Lead Quality Education Programs ◽

10.4018/978-1-7998-3438-0.ch032 ◽

2021 ◽

pp. 702-724

Author(s):

Abdallah Namoun ◽

Ahmad Taleb ◽

Mohammed Al-Shargabi ◽

Mohamed Benaida

Keyword(s):

Quality Improvement ◽

Continuous Quality Improvement ◽

Delphi Study ◽

Assessment Tool ◽

Survey Instrument ◽

Assessment Instrument ◽

Self Assessment ◽

Continuous Quality ◽

System Requirements

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

Age and Ageing ◽

10.1093/ageing/afab030.06 ◽

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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Improving the quality of tracheostomy care

Breathe ◽

10.1183/20734735.011114 ◽

2014 ◽

Vol 10 (4) ◽

pp. 286-294 ◽

Cited By ~ 3

Author(s):

Hannah Zhu ◽

Preety Das ◽

Ralph Woodhouse ◽

Haytham Kubba

Keyword(s):

Quality Improvement ◽

Quality Of Care ◽

Cost Effective ◽

Education Institution ◽

List Type ◽

Common Purpose ◽

Preventable Harm ◽

The Uk ◽

Quality Improvement Collaboratives

Educational aimsTo understand the current challenges in the care of tracheostomy patientsTo understand principles of quality improvement collaboration and how this can improve the quality of care for tracheostomy patientsSummaryThe UK National Confidential Enquiry into Patient Outcomes and Death illustrates that there remains significant morbidity and mortality relating to patients with a tracheostomy, with much preventable harm. Challenges include the inherent complexity of the patient's underlying condition, wide variations in tracheostomy management, variable delivery of education for staff, patients and families, and difficult coordination of care between such a variety of individuals involved in performing, managing and ultimately removing tracheostomies.Quality-improvement collaboratives are groups of institutions with a common purpose who work together to drive positive change. They help support clinicians in developing skills and teams necessary to design and sustain quality-improvement cycles. They are a cost-effective way of rapidly disseminating improvement strategies and engaging in shared learning across institutions around the world. The Global Tracheostomy Collaborative aims to improve quality of care and outcomes through five interdependent key drivers: coordinated multidisciplinary team care, education, institution-wide protocols, family and patient-centred care, and metrics and outcomes using a specifically designed database.

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What Does a Systems Approach to Quality Improvement Look Like in Practice?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19020747 ◽

2022 ◽

Vol 19 (2) ◽

pp. 747

Author(s):

Sharon J. Williams ◽

Stephanie Best

Keyword(s):

Quality Improvement ◽

Systems Approach ◽

Secondary Data ◽

Healthcare Systems ◽

Care Quality ◽

Secondary Case ◽

Care Quality Commission ◽

Leadership Structure ◽

The Uk

Universally improving healthcare systems is difficult to achieve in practice with organisations implementing a range of quality improvement (QI) approaches, in varying and changing contexts, and efforts ranging from project-based improvements to whole system change. This study aimed to identify how organisations overcome the challenges to improving the quality of the services they deliver. Drawing on the eight challenges from the ‘Quality and Safety in Europe by Research (QUASER) hospital guide, we assessed eight cases reported by the UK-based regulator Care Quality Commission as improving their performance. A thematic analysis of these secondary data established that all eight challenges had been addressed or considered in varying degrees. Education and physical and technological challenges seemed less prominent than developments made to address other challenges such as developing leadership, structure, and culture to support improving quality. This paper relies on the analysis of secondary case data and one framework to assess improvement efforts. Further research is required to consider other models and frameworks and to collate longitudinal data to capture the dynamics and increasing the maturity of improving healthcare systems in practice.

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Quality and Efficacy of Multidisciplinary Team (MDT) Quality Assessment Tools and Discussion Checklists: A Systematic Review

10.21203/rs.3.rs-887717/v1 ◽

2021 ◽

Author(s):

George T F Brown ◽

Hilary L Bekker ◽

Alastair L Young

Keyword(s):

Quality Improvement ◽

Quality Assessment ◽

Practical Method ◽

Included Study ◽

Assessment Tools ◽

Current Evidence ◽

Validity And Reliability ◽

High Standards ◽

The Uk

Abstract Background MDT discussion is the gold standard for cancer care in the UK. With the incidence of cancer on the rise, demand for MDT discussion is increasing. The need for efficiency, whilst maintaining high standards, is therefore clear. Paper-based MDT quality assessment tools and discussion checklists may represent a practical method of monitoring and improving MDT practice. This reviews aims to describe and appraise these tools, as well as consider their value to quality improvement. Methods Medline, EMBASE and PsycInfo were searched using pre-defined terms. The PRISMA model was followed throughout. Studies were included if they described the development of a relevant tool, or if an element of the methodology further informed tool quality assessment. To investigate efficacy, studies using a tool as a method of quality improvement in MDT practice were also included. Study quality was appraised using the COSMIN risk of bias checklist or the Newcastle-Ottawa scale, depending on study type. Results The search returned 6888 results. 17 studies were included. In total 6 tools were identified. Overall, methodological quality in tool development was adequate to very good for assessed aspects of validity and reliability. Clinician feedback was positive. In one study, the introduction of a discussion checklist improved MDT ability to reach a decision from 82.2–92.7%. Improvement was also noted in the quality of information presented and the quality of teamwork. Conclusions Several tools for assessment and guidance of MDTs are available. Although limited, current evidence indicates sufficient rigour in their development and their potential for quality improvement.

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