Rapid conversion of Tai Chi classes from face‐to‐face to virtual during the COVID‐19 pandemic: A quality improvement project

Background: Evidence shows systems change interventions improve care and outcomes for stroke patients. Geopolitical boundaries have been a barrier to improving regional systems of care. Despite efforts nationally, regionally, and locally alteplase use for ischemic stroke has remained low and door to needle (DTN) times exceeded 60 minutes. Kentucky created the Stroke Encounter Quality Improvement Project (SEQIP) in 2009 to share best practices and improve stroke systems of care across the Commonwealth. Purpose: The aim was to utilize and share best practice models among 23 SEQIP hospitals in KY to improve tPA utilization, decrease DTN times, and improve outcomes. Methods: Hospitals implemented a statewide quality improvement plan focused on identifying barriers, removing barriers, and implementing best practice strategies regarding thrombolytic therapy. Accountability was achieved with ongoing GWTG data tracking, teleconferences, and face to face meetings from January 2009 through December 2018 sharing strategies and solutions for best practice. Results: SEQIP’s participating hospitals achieved significant improvement in thrombolytic administration over 10 years. The percent of all AIS patients receiving tPA increased from 4.61% in 2009 to 8.80% in 2018 (OR=2.0, p <0.0001). Alteplase use in eligible patients arriving by 2 hours and treated by 3 hours improved from 59.6% to 88.5% (OR=5.2, p <0.0001). Alteplase use in eligible patients arriving by 3.5 hours to 4.5 hours increased from 24.9% to 55.1% (OR=5.0, p <0.0001). Median DTN times decreased from 74 minutes to 49 minutes (p<0.0001). Complication rates of symptomatic hemorrhage were consistent with NINDS data and < 6% from 2009-2018. The tPA in-hospital mortality rate in 2009 was 11.7% and by 2018, decreased to 3.6% (p=0.00016). In 2009, 28.4% of tPA patients were discharged home and by 2018, that had increased to 47.9% (p <0.00001). In 2009, 32.1% of tPA patients were able to walk independently at d/c and by 2018 had increased to 43.6% (p = 0.00359). Conclusions: Geopolitical boundaries can be overcome and collaboration can be sustained among competing hospitals through sharing of best practices to safely increase utilization of tPA in eligible patients, decrease DTN times, and improve outcomes.

Download Full-text

Development and implementation of a Telenephrology dashboard for active surveillance of kidney disease: a quality improvement project

BMC Nephrology ◽

10.1186/s12882-020-02077-0 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Melissa L. Swee ◽

M. Lee Sanders ◽

Kantima Phisitkul ◽

George Bailey ◽

Angie Thumann ◽

...

Keyword(s):

Quality Improvement ◽

Kidney Disease ◽

Early Detection ◽

Lean Six Sigma ◽

Iowa City ◽

Quality Improvement Project ◽

Improvement Project ◽

Face To Face ◽

Detection And Identification ◽

Control Framework

Abstract Background Kidney disease accounts for more than 49 billion dollars in healthcare expenditures annually. Early detection and intervention may reduce the burden of disease. We describe a quality improvement project to develop a telenephrology dashboard that proactively monitors kidney disease. Methods One hundred eighty-four thousands Veterans within the Iowa City Veterans Affairs Health Care System were eligible for telenephrology consultation. The dashboard accessed the charts of 53,085 Veterans at risk for kidney disease. We utilized Lean-Six Sigma tools and principles and the Define-Measure-Analyze-Improve-Control Framework to develop and deploy a telenephrology dashboard in 4 community-based outpatient clinics (CBOCs). The primary measure was the number of days to complete consultation. Secondary measures included number of electronic consultations per month, distance and cost of Veteran travel saved, and number of steps for completion of consult. Results The data of 1384 Veterans at the 4 CBOCs were analyzed by the telenephrology dashboard, of which 459 generated telenephrology consults. The number of days to complete any type of consultation was unchanged (48.9 days in 2019, compared to 41.6 days in 2017). The average Veteran saved between $21.60 to $63.90 per trip to Iowa City. Between March 2019 and August 2019, there were 27.3 telenephrology consults per month. The number of steps needed to complete the consult request was decreased from 13 to 9. Conclusions Utilization of the telenephrology dashboard system contributed to an increase in consultations completed through electronic means without decreasing face-to-face consults. Electronic consults now outnumber traditional face-to-face consultations at our institution. Telenephrology consultation improved early detection and identification of kidney disease and saved time and costs for Veterans in travel, but did not decrease the average number of days to complete consultation requests.

Download Full-text

The Reliability of Telemedicine for Hospice Face-to-Face Recertification Visits: A Quality Improvement Project (FR408D)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2019.12.121 ◽

2020 ◽

Vol 59 (2) ◽

pp. 452

Author(s):

John Massone ◽

Michael McHale ◽

Jennifer Portz ◽

Kira Elsbernd ◽

Susan Moore

Keyword(s):

Quality Improvement ◽

Quality Improvement Project ◽

Improvement Project ◽

Face To Face

Download Full-text

Development and Implementation of a Telenephrology Dashboard for Active Surveillance of Kidney Disease: A Quality Improvement Project

10.21203/rs.3.rs-19195/v1 ◽

2020 ◽

Author(s):

Melissa L Swee ◽

M. Lee Sanders ◽

Kantima Phisitkul ◽

George Bailey ◽

Angie Thumann ◽

...

Keyword(s):

Quality Improvement ◽

Kidney Disease ◽

Early Detection ◽

Lean Six Sigma ◽

Iowa City ◽

Quality Improvement Project ◽

Improvement Project ◽

Face To Face ◽

Detection And Identification ◽

Control Framework

Abstract Background : Kidney disease accounts for more than 50 billion dollars in healthcare expenditures annually. Early detection and intervention may reduce the burden of disease. We describe a quality improvement project to develop a telenephrology dashboard that proactively monitors kidney disease. Methods : 184,000 Veterans within the Iowa City Veterans Affairs Health Care System were eligible for telenephrology consultation. The dashboard accessed the charts of 53,085 Veterans at risk for kidney disease. We utilized Lean-Six Sigma tools and principles and the Define-Measure-Analyze-Improve-Control Framework to develop and deploy a telenephrology dashboard in 4 community-based outpatient clinics (CBOCs). The primary measure was the number of days to complete consultation. Secondary measures included number of electronic consultations per month, distance and cost of Veteran travel saved, and number of steps for completion of consult. Results : The data of 1,384 Veterans at the 4 CBOCs were analyzed by the telenephrology dashboard, of which 459 generated telenephrology consults. The number of days to complete any type of consultation was unchanged (48.9 days in 2019, compared to 41.6 days in 2017). The average Veteran saved between $21.60 to $63.90 per trip to Iowa City. Between March 2019 and August 2019, there were 27.3 telenephrology consults per month. The number of steps needed to complete the consult request was decreased from 13 to 9. Conclusions : Utilization of the telenephrology dashboard system contributed to an increase in consultations completed through electronic means without decreasing face-to-face consults. Electronic consults now outnumber traditional face-to-face consultations at our institution. Telenephrology consultation improved early detection and identification of kidney disease and saved time and costs for Veterans in travel, but did not decrease the average number of days to complete consultation requests.

Download Full-text

Effects of Simulation Video on Parental Recall of Seizure First Aid: A Quality Improvement Project

Journal of Child Neurology ◽

10.1177/0883073820939390 ◽

2020 ◽

Vol 35 (13) ◽

pp. 908-911

Author(s):

Xinran Maria Xiang ◽

Daniella Miller

Keyword(s):

Quality Improvement ◽

Action Plan ◽

First Aid ◽

Emergency Department Visits ◽

Quality Improvement Project ◽

Improvement Project ◽

Face To Face ◽

Counseling Group ◽

Video Group ◽

Parental Recall

Many parents of children do not recall anticipatory guidance on acute seizure management, which can lead to unnecessary emergency department visits. This quality improvement project evaluated if adding a video simulation of seizure first aid improved parental recall. Parents of children with seizures were randomized to standard verbal counseling or video group, which were shown a video simulation of seizure first aid. All families also received a standardized written action plan. Eighty-three patients were randomized from July to October 2018. Overall, 53% of families who received standard counseling accurately recalled seizure first aid compared with 31% in video group (χ2 = 3.24, P = .07). Among families without baseline knowledge of seizure first aid, 43% in the standard counseling group recalled accurately compared with 16% of video group (χ2 = 4.52, P = .03). These results underscore the importance of face-to-face patient education despite the popularity of video-based media. Future Plan-Do-Study-Act cycles will include piloting a hands-on seizure first aid simulation with mannequins.

Download Full-text