scholarly journals Compression-Assisted Arthrocentesis of the Knee as a Quality Improvement Intervention

2018 ◽  
Author(s):  
James F. Bennett ◽  
Wilmer L. Sibbitt ◽  
Philip A. Band ◽  
Sabeen Yaqub ◽  
N. Suzanne Emil ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Corticosteroid Injection ◽  
Injection Pain ◽  
Quality Improvement Intervention ◽  
Mechanical Compression ◽  
Serious Adverse Events ◽  
Pain Scores ◽  
Symptomatic Knee ◽  
Yield Time ◽  
Improvement Intervention

ABSTRACTObjectiveThe present study reports the introduction of mechanical compression of the knee for arthrocentesis as quality improvement intervention in a procedure clinic.Methods430 consecutive symptomatic osteoarthritic knees underwent arthrocentesis followed by corticosteroid injection (1mg/kg of triamcinolone acetonide). The first 215 consecutive knees underwent conventional arthrocentesis and injection; the quality intervention of a mechanical compression brace was introduced, and the next 215 consecutive knees underwent mechanical compression-assisted arthrocentesis follow by injection. Pain scores, arthrocentesis success, fluid yield, time-to-next-intervention, injections/year, and medical costs were measured.ResultsNo serious adverse events occurred in 430 subjects. Diagnostic synovial fluid (≥2 ml) was obtained in 9.3% (20/215) without compression and 40.9% (88/215) with compression (p=0.00001, z for 95% CI= 1.96, Pierson). Mechanical compression was associated with a 231% increase in mean arthrocentesis volume: compression 5.3±11.2 ml, conventional 1.6±6.4 ml (CI of difference 2.0 <3.7< 5.4; p=0.00001). Time-to-next-intervention after compression-assisted arthrocentesis was longer: 6.9±3.5 months compared to conventional: 5.1±2.7 months (p<0.00001, 95% CI of difference 1.2 <1.8< 2.3). Mechanical compression was associated with a reduction in the number of corticosteroid injections administered per year: mechanical compression: 1.7±0.9 injections/year; conventional: 2.4±0.5 injections/year (p<0.00001, 95% CI of difference −0.83 < −0.70< −0.56). Mechanical compression did not increase overall yearly costs associated with management of the symptomatic knee (mechanical compression: $293.30/year/knee, conventional: $373.29/year/knee) (p<0.0001, 95% CI of difference 47 <80< 112).ConclusionsRoutine mechanical compression of the knee for arthrocentesis and injection is an effective bioengineering quality improvement intervention in a procedure clinic.

scholarly journals Evaluating context-specific evidence-based quality improvement intervention on lymphatic filariasis mass drug administration in Northern Ghana using the RE-AIM framework

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Alfred Kwesi Manyeh ◽  
Tobias Chirwa ◽  
Rohit Ramaswamy ◽  
Frank Baiden ◽  
Latifat Ibisomi
Keyword(s):  
Quality Improvement ◽  
Needs Assessment ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Northern Ghana ◽  
Quality Improvement Intervention ◽  
Evidence Based ◽  
Context Specific ◽  
Improvement Intervention

Abstract Background Over a decade of implementing a global strategy to eliminate lymphatic filariasis in Ghana through mass drug administration, the disease is still being transmitted in 11 districts out of an initial 98 endemic districts identified in 2000. A context-specific evidence-based quality improvement intervention was implemented in the Bole District of Northern Ghana after an initial needs assessment to improve the lymphatic filariasis mass drug administration towards eliminating the disease. Therefore, this study aimed to evaluate the process and impact of the lymphatic filariasis context-specific evidence-based quality improvement intervention in the Bole District of Northern Ghana. Method A cross-sectional mixed methods study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the context-specific evidence-based quality improvement intervention was employed. Quantitative secondary data was extracted from the neglected tropical diseases database. A community survey was conducted with 446 randomly selected participants. Qualitative data were collected from 42 purposively selected health workers, chiefs/opinion leaders and community drug distributors in the study area. Results The evaluation findings showed an improvement in social mobilisation and sensitisation, knowledge about lymphatic filariasis and mass drug administration process, willingness to ingest the medication and adherence to the direct observation treatment strategy. We observed an increase in coverage ranging from 0.1 to 12.3% after implementing the intervention at the sub-district level and reducing self-reported adverse drug reaction. The level of reach, effectiveness and adoption at the district, sub-district and individual participants’ level suggest that the context-specific evidence-based quality improvement intervention is feasible to implement in lymphatic filariasis hotspot districts based on initial context-specific needs assessment. Conclusion The study provided the groundwork for future application of the RE-AIM framework to evaluate the implementation of context-specific evidence-based quality improvement intervention to improve lymphatic filariasis mass drug administration towards eliminating the disease as a public health problem.

scholarly journals A quality improvement intervention to reduce emergency department radiography for bronchiolitis

2018 ◽  
Vol 137 ◽  
pp. 1-5 ◽  
Author(s):  
Joel Reiter ◽  
Adin Breuer ◽  
Oded Breuer ◽  
Saar Hashavya ◽  
David Rekhtman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Quality Improvement Intervention ◽  
Improvement Intervention
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