59. A Novel Virtual Biologics Clinic Leads to Improved Patient Experience, Enhanced Research Recruitment and Cost Savings: Results of A Quality Improvement Project

Highlights Abstract Background: The process for patients to receive a peripherally inserted central catheter (PICC) has been unclear, allowing for delays in care and discharge and increased costs. To address these problems, a vascular access team implemented the Lean process. The purpose was to evaluate the effect of an ultrasound initiative to insert peripheral intravenous lines (IVs) and midlines and modification of PICC insertion hours on the nurses’ workflow and patient outcomes. Methods: This quality improvement project used retrospective data analysis. Patients’ data from fiscal year (FY) 2010 to FY 2019 was analyzed using descriptive statistics, independent t tests for continuous data, and a Poisson regression for count data. Results: After the ultrasound initiative, the volume of PICC insertions decreased by 20%, which represents a significant reduction. The mean cost also decreased from $171,681 to $147,620. Although there was no substantial cost saving, the total cost was reduced by 14%. After implementation of ultrasound guidance for peripheral IV and midline access, the central line–associated bloodstream infection (CLABSI) rate dropped by 70%. The estimated treatment cost for CLABSI significantly decreased from $481,600 to $156,800. After implementation, the total estimated cost savings was $1,624,000. Modified PICC insertion hours resulted in significantly reduced mean hours from order time to insertion. Conclusions: Standard work and process improvements using the Lean process were effective. The ultrasound initiative decreased unnecessary PICC insertions, reduced cost, and decreased the CLABSI rate. Modified PICC insertion hours enhanced the nurses’ work by reducing the average time from PICC order to placement.

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Early discharge planning in preterm low birth weight babies: A quality improvement project

Proceedings of Singapore Healthcare ◽

10.1177/2010105816676827 ◽

2016 ◽

Vol 26 (2) ◽

pp. 98-101

Author(s):

Amudha Jayanthi Anand ◽

Mei Chien Chua ◽

Siok Hong Khoo ◽

Poh Leng Yuen ◽

Mary Choi Wan Fong ◽

...

Keyword(s):

Quality Improvement ◽

Birth Weight ◽

Low Birth Weight ◽

Phase 1 ◽

Cost Savings ◽

Early Discharge ◽

Quality Improvement Project ◽

Phase 2 ◽

Low Birth Weight Infants ◽

Improvement Project

Introduction: Extended hospitalization of low birth weight infants increases risk of medical and psychosocial complications. Our aim was to reduce the length of hospitalization and assess safety and cost savings of discharging infants at a weight of 1900 g instead of 2000 g, as has been the practice. Methods: This is a single-centre, nurse led quality improvement project done at a tertiary neonatal unit in Singapore with primary outcome of reducing average length of stay in selected low birth weight infants. In phase 1, infants with birth weight between 1000 and 1700 g were discharged at 1900 g, provided they met the discharge criteria. Interventions were introduced in phase 2 after interim analysis for the two most common causes for delayed discharge: poor bottling skills and waiting time for scheduled herniotomy. Results: In phase 1, the mean hospitalization stay was reduced by 5.5 days, with 21% of the babies discharged at 1900 g. The safety of the intervention was assessed by rehospitalization rates, and found to be negligible. Interventions introduced in phase 2 to address the two major causes of delayed discharge did not improve the outcome. The estimated cost savings for each subsidized patient after implementation of the interventions was S$340–1100 over the two phases. Conclusion: Though only 21% of eligible infants could be discharged early, the study helped us identify key areas of intervention to facilitate early discharge of preterm infants. These included improving babies’ sucking skills, planning for early surgery, and providing adequate parental training. Safety and cost savings appear to be promising as well.

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