scholarly journals Facilitators of interdepartmental quality improvement: a mixed-methods analysis of a collaborative to improve pediatric community-acquired pneumonia management

2018 ◽  
Vol 28 (3) ◽  
pp. 215-222 ◽  
Author(s):  
JoAnna K Leyenaar ◽  
Christine B Andrews ◽  
Emily R Tyksinski ◽  
Eric Biondi ◽  
Kavita Parikh ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Clinical Care ◽  
Quality Measures ◽  
Community Acquired Pneumonia ◽  
Categorical Variables ◽  
Antibiotic Prescribing ◽  
Successful Implementation ◽  
Narrow Spectrum ◽  
Clinical Departments

BackgroundEmergency medicine and paediatric hospital medicine physicians each provide a portion of the initial clinical care for the majority of hospitalised children in the USA. While these disciplines share goals to increase quality of care, there are scant data describing their collaboration. Our national, multihospital learning collaborative, which aimed to increase narrow-spectrum antibiotic prescribing for paediatric community-acquired pneumonia, provided an opportunity to examine factors influencing the success of quality improvement efforts across these two clinical departments.ObjectiveTo identify barriers to and facilitators of interdepartmental quality improvement implementation, with a particular focus on increasing narrow-spectrum antibiotic use in the emergency department and inpatient settings for children hospitalised with pneumonia.MethodsWe used a mixed-methods design, analysing interviews, written reports and quality measures. To describe hospital characteristics and quality measures, we calculated medians/IQRs for continuous variables, frequencies for categorical variables and Pearson correlation coefficients. We conducted in-depth, semistructured interviews by phone with collaborative site leaders; interviews were transcribed verbatim and, with progress reports, analysed using a general inductive approach.Results47 US-based hospitals were included in this analysis. Qualitative analysis of 35 interview transcripts and 142 written reports yielded eight inter-related domains that facilitated successful interdepartmental quality improvement: (1) hospital leadership and support, (2) quality improvement champions, (3) evidence supporting the intervention, (4) national health system influences, (5) collaborative culture, (6) departments’ structure and resources, (7) quality improvement implementation strategies and (8) interdepartmental relationships.ConclusionsThe conceptual framework presented here may be used to identify hospitals’ strengths and potential barriers to successful implementation of quality improvement efforts across clinical departments.

scholarly journals General Practitioners’ Attitudes toward Municipal Initiatives to Improve Antibiotic Prescribing—A Mixed-Methods Study

Antibiotics ◽  
2019 ◽  
Vol 8 (3) ◽  
pp. 120 ◽  
Author(s):  
Marthe Sunde ◽  
Marthe Marie Nygaard ◽  
Sigurd Høye
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Mixed Methods ◽  
General Practitioners ◽  
Treatment Guidelines ◽  
National Level ◽  
Medical Officer ◽  
Mixed Methods Study ◽  
Antibiotic Prescribing ◽  
E Mail

Antimicrobial stewardship (AMS) interventions directed at general practitioners (GPs) contribute to an improved antibiotic prescribing. However, it is challenging to implement and maintain such interventions at a national level. Involving the municipalities’ Chief Medical Officer (MCMO) in quality improvement activities may simplify the implementation and maintenance, but may also be perceived challenging for the GPs. In the ENORM (Educational intervention in NORwegian Municipalities for antibiotic treatment in line with guidelines) study, MCMOs acted as facilitators of an AMS intervention for GPs. We explored GPs’ views on their own antibiotic prescribing, and their views on MCMO involvement in improving antibiotic prescribing in general practice. This is a mixed-methods study combining quantitative and qualitative data from two data sources: e-mail interviews with 15 GPs prior to the ENORM intervention, and online-form answers to closed and open-ended questions from 132 GPs participating in the ENORM intervention. The interviews and open-ended responses were analyzed using systematic text condensation. Many GPs admitted to occasionally prescribing antibiotics without medical indication, mainly due to pressure from patients. Too liberal treatment guidelines were also seen as a reason for overtreatment. The MCMO was considered a suitable and acceptable facilitator of quality improvement activities in general practice, and their involvement was regarded as unproblematic (scale 0 (very problematic) to 10 (not problematic at all): mean 8.2, median 10). GPs acknowledge the need and possibility to improve their own antibiotic prescribing, and in doing so, they welcome engagement from the municipality. MCMOs should be involved in quality improvement and AMS in general practice.

scholarly journals Quality Improvement in Juvenile Idiopathic Arthritis: a Mixed-methods Implementation Pilot of the CAPTURE-JIA Dataset

2022 ◽  
Author(s):  
Flora Mcerlane ◽  
Chris Anderson ◽  
Saskia Lawson-Tovey ◽  
Barbara Lee ◽  
Chris Lee ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Quality Improvement ◽  
Mixed Methods ◽  
Data Collection ◽  
Clinical Care ◽  
Data Collection Tool ◽  
Collection System ◽  
Electronic Data ◽  
Data Collection System ◽  
Electronic Data Collection

Abstract BackgroundA significant proportion of children and young people with juvenile idiopathic arthritis (JIA) do not achieve inactive disease during the first two years following diagnosis. Refinements to clinical care pathways have the potential to improve clinical outcomes but a lack of consistent and contemporaneous clinical data presently precludes standard setting and implementation of meaningful quality improvement programmes. This study was the first to pilot clinical data collection and analysis using the CAPTURE-JIA dataset, and to explore patient and clinician-reported feasibility and acceptability data.MethodsA multiphase mixed-methods approach enabled prospective collection of quantitative data to examine the feasibility and efficacy of dataset collection and of qualitative data informing the context and processes of implementation. An initial paper pilot informed the design of a bespoke electronic data collection system (the Agileware system), with a subsequent electronic pilot informing the final CAPTURE-JIA data collection tool. ResultsPaper collection of patient data was feasible but time-consuming in the clinical setting. Phase 1 paper pilot data (121 patients) identified three themes: problematic data items (14/62 data items received >40% missing data), formatting of data collection forms and a clinician-highlighted need for digital data collection, informing Phase 2 electronic data collection tool development. Patients and families were universally supportive of the collection and analysis of anonymised patient data to inform clinical care. No apparent preference for paper / electronic data collection was reported by families. Phase 3 electronic pilot data (38 patients) appeared complete and the system reported to be easy to use. Analysis of the study dataset and a dummy longitudinal dataset confirmed that all eleven JIA national audit questions can be answered using the electronic system. ConclusionsMulticentre CAPTURE-JIA data collection is feasible and acceptable, with a bespoke data collection system highlighted as the most satisfactory solution. The study is informing ongoing work towards a streamlined and flexible national paediatric data collection system to drive quality improvement in clinical care.

scholarly journals Learning from the Implementation of a Quality Improvement Intervention in Australian General Practice: A Qualitative Analysis of a CVD Preventive Care Project

2021 ◽  
Author(s):  
Charlotte Hespe ◽  
Edwina Brown ◽  
Lucie Rychetnik
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Health System ◽  
Financial Incentives ◽  
Clinical Care ◽  
Quality Improvement Intervention ◽  
Successful Implementation ◽  
Full Potential ◽  
Australian General Practice ◽  
General Practices

Abstract BackgroundQuality-improvement collaborative (QIC) initiatives aim to reduce gaps in clinical care provided in the healthcare system. This study provides a qualitative evaluation of a QIC project (QPulse) in Australian general practice focused on improving cardiovascular disease (CVD) assessment and management. MethodsThis qualitative-methods study explored implementing a QIC project by a Primary Health Network (PHN) in 34 general practices. Qualitative analyses examined in-depth interviews with participants and stakeholders focusing on barriers and enablers to implementation in our health system. They were analysed thematically using the Complex Systems Improvement framework (CSI), focusing on strategy, culture, structure, workforce, and technology.ResultsDespite strategic engagement with QPulse objectives across the health system, implementation barriers associated with this program were considerable for both PHN and the general practices. Adoption of the QIC process was reliant on engaged leadership, practice culture, systems for clear communication, tailored education and regular clinical audit and review. Practice ownership, culture and governance, rather than practice size and location, were related to successful implementation. Financial incentives for both the PHN and general practice were identified as prerequisites for systematised quality improvement (QI) projects in the future, along with individualised support and education provided to each practice. Technology was both an enabler and a barrier, and the PHN was seen as key to assisting the successful adoption of the available tools. ConclusionsImplementation of QI programs remains a potential tool for achieving better health outcomes in General Practice. However, enablers such as individualised education and support provided via a meso-level organisation, financial incentives, and IT tools and support are crucial if the full potential of QI programs are to be realised in the Australian healthcare setting. Trial registrationACTRN12615000108516, UTN U1111-1163-7995.

scholarly journals Antibiotic prescribing practices in general surgery: a mixed methods quality improvement project

2021 ◽  
Vol 3 (3) ◽  
pp. 100166 ◽  
Author(s):  
Georgia Lamb ◽  
Georgina Phillips ◽  
Esmita Charani ◽  
Alison Holmes ◽  
Giovanni Satta
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
General Surgery ◽  
Quality Improvement Project ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Improvement Project

scholarly journals 56 Antibiotic Prescribing for Open Fractures - A Quality Improvement Project to Enhance BOAST 4 Attainment

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Imsirovic ◽  
T J Walton ◽  
P J H Drake ◽  
E Guryel
Keyword(s):  
Quality Improvement ◽  
Surgical Management ◽  
Open Fractures ◽  
Quality Improvement Project ◽  
Antibiotic Prescribing ◽  
Successful Implementation ◽  
University Hospitals ◽  
Improvement Project ◽  
The Mean ◽  
Mean Time

Abstract Introduction Open fractures are associated with increased infection rates and the evidence shows timely administration of prophylactic antibiotics within one hour of injury improves the outcomes. Method A multi-cycle audit was carried out retrospectively for patients presenting to Brighton and Sussex University Hospitals NHS Trust (BSUH) with an open limb fracture in 2018-2020. Targeted teaching was carried out for orthopaedic trainees, prompt posters created and alterations to the trauma clerking proforma were implemented. Results In first cycle, 48 (92.3%) out of total 52 patients were prescribed antibiotics prior to definitive surgical management, with a mean time to administration of 271 minutes. Of these, 41 (78.8%) received prescriptions according to BSUH guidelines. The use of STAT ‘once-only’ prescriptions was found to significantly reduce the mean time to administration for 154 minutes. In second cycle, all of 29 patients (100%) were prescribed antibiotics prior to definitive surgical management, with a reduced mean time to administration (233 minutes). Of these, 26 (89.7%) received prescriptions according to BSUH guidelines, and a significantly greater proportion received initial STAT prescriptions (51.7% vs. 15.4%). Conclusions This quality improvement project has demonstrated the successful implementation of targeted changes to improve the attainment of BOAST 4 guidelines.

scholarly journals Developing the infrastructure to support the optimisation of antibiotic prescribing using the learning healthcare system to improve healthcare services in the provision of primary care in England

2020 ◽  
Vol 27 (1) ◽  
pp. e100147
Author(s):  
Victoria Palin ◽  
Edward Tempest ◽  
Chirag Mistry ◽  
Tjeerd P van Staa
Keyword(s):  
Primary Care ◽  
Healthcare System ◽  
Clinical Care ◽  
Healthcare Services ◽  
Antibiotic Prescribing ◽  
Successful Implementation ◽  
Care Providers ◽  
Level Data ◽  
Learning Healthcare System ◽  
Periodic Feedback

IntroductionThe learning healthcare system (LHS) underpinned by data analysis and feedback to clinical care providers is thought to improve quality of care. The work aimed to implement an LHS for antibiotic prescribing in primary care in England.MethodDeidentified patient-level data from general practices were processed and analysed at regular intervals (fortnightly increments). A dashboard application was developed and implemented displaying analytical graphics to give periodic feedback to clinicians, tailored to each clinical site. Benchmarking parameters were established by the analysis of two large national primary care datasets allowing peer-to-peer comparisons. To date, the dashboard is available to 70 English practices.ConclusionsSuccessful implementation and uptake of the secure technical LHS infrastructure for the analysis and feedback to clinicians of their antibiotic prescribing demonstrate a great appetite for this type of frequent prescribing review in primary care, combining advanced data analytics with tailored feedback.

scholarly journals Evaluating the success of the tele-pathology system in governmental hospitals in Kuwait: an explanatory sequential mixed methods design

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ali Jasem Buabbas ◽  
Tareq Mohammad ◽  
Adel K. Ayed ◽  
Hawraa Mallah ◽  
Hamza Al-Shawaf ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Mixed Methods ◽  
Support Services ◽  
User Satisfaction ◽  
Technical Support ◽  
Successful Implementation ◽  
System Quality ◽  
Mixed Methods Design ◽  
Telepathology System

Abstract Background Telepathology is the practice of reviewing and exchanging pathological images through telecommunication systems to obtain diagnoses remotely. Studying the factors that make such a system successful and favourable is important to ensure the merits of its implementation in clinical practice. Objective This study aims to evaluate the success of a telepathology system from the users’ perspectives, using specific evaluation criteria, namely: system quality, information quality, technical service quality, user satisfaction, and benefits. Methods A sequential explanatory mixed methods design was adopted in this study, which consists of two phases. Initially, a questionnaire was distributed via WhatsApp to all of the pathologists (total: 45) working at governmental hospitals in Kuwait. Followed by, semi-structured interviews with ten senior pathologists. Results Forty pathologists responded to the questionnaire, giving an 89% response rate. There were 42.5% of the respondents aged between 35–44 years old, and 52.5% were male. The quantitative results reveal that most of the respondents were satisfied with the quality of the telepathology system with a mean of 2.6025 (Standard Deviation (SD) = 0.47176), whereas they were dissatisfied with the quality of the information with a mean of 2.4100 (SD = 1.580) and the technical support services with a mean of 2.2750 (SD = 0.99535). In addition, there was disagreement on the benefits of telepathology in clinical practice among the pathologists with a mean of 2.4667 (SD = 0.77552). The qualitative results indicate that the lack of interest in and little experience with using the system were behind the general dissatisfaction of most of the respondents. All of the interviewees were satisfied with the performance of the telepathology system and considered it successful; however, the quality of the technical support services, including training workshops, was deemed deficient. Conclusion This study concluded that telepathology system in Kuwait is functioning well and has been successful in its implementation; however, pathologists are dissatisfied with it, mainly due to the deficient quality of the technical support services provided. In addition, the successful implementation of such advanced technologies requires careful steps to be taken on multiple levels: technical, organisational, and managerial. Recommendations were suggested.

scholarly journals Influenza With an Infiltrate: Investigating the New Community-Acquired Pneumonia Guidelines

2020 ◽  
Vol 41 (S1) ◽  
pp. s302-s302
Author(s):  
Amanda Barner ◽  
Lou Ann Bruno-Murtha
Keyword(s):  
Demographic Data ◽  
Retrospective Chart Review ◽  
Vaccination Rate ◽  
Community Acquired Pneumonia ◽  
Teaching Hospitals ◽  
Antibiotic Prescribing ◽  
Supporting Evidence ◽  
Radiographic Findings ◽  
Significant Difference ◽  
The Impact

Background: The Infectious Diseases Society of America released updated community-acquired pneumonia (CAP) guidelines in October 2019. One of the recommendations, with a low quality of supporting evidence, is the standard administration of antibiotics in adult patients with influenza and radiographic evidence of pneumonia. Procalcitonin (PCT) is not endorsed as a strategy to withhold antibiotic therapy, but it could be used to de-escalate appropriate patients after 48–72 hours. Radiographic findings are not indicative of the etiology of pneumonia. Prescribing antibiotics for all influenza-positive patients with an infiltrate has significant implications for stewardship. Therefore, we reviewed hospitalized, influenza-positive patients at our institution during the 2018–2019 season, and we sought to assess the impact of an abnormal chest x-ray (CXR) and PCT on antibiotic prescribing and outcomes. Methods: We conducted a retrospective chart review of all influenza-positive admissions at 2 urban, community-based, teaching hospitals. Demographic data, vaccination status, PCT levels, CXR findings, and treatment regimens were reviewed. The primary outcome was the difference in receipt of antibiotics between patients with a negative (<0.25 ng/mL) and positive PCT. Secondary outcomes included the impact of CXR result on antibiotic prescribing, duration, 30-day readmission, and 90-day mortality. Results: We reviewed the medical records of 117 patients; 43 (36.7%) received antibiotics. The vaccination rate was 36.7%. Also, 11% of patients required intensive care unit (ICU) admission and 84% received antibiotics. Moreover, 109 patients had a CXR: 61 (55.9%) were negative, 29 (26.6%) indeterminate, and 19 (17.4%) positive per radiologist interpretation. Patients with a positive PCT (OR, 12.7; 95% CI, 3.43–60.98; P < .0007) and an abnormal CXR (OR, 7.4; 95% CI, 2.9–20.1; P = .000003) were more likely to receive antibiotics. There was no significant difference in 30-day readmission (11.6% vs 13.5%; OR, 0.89; 95% CI, 0.21–3.08; P = 1) and 90-day mortality (11.6% vs 5.4%; OR, 2.37; 95% CI, 0.48–12.75; P = .28) between those that received antibiotics and those that did not, respectively. Furthermore, 30 patients (62.5%) with an abnormal CXR received antibiotics and 21 (43.7%) had negative PCT. There was no difference in 30-day readmission or 90-day mortality between those that did and did not receive antibiotics. Conclusions: Utilization of PCT allowed selective prescribing of antibiotics without impacting readmission or mortality. Antibiotics should be initiated for critically ill patients and based on clinical judgement, rather than for all influenza-positive patients with CXR abnormalities.Funding: NoneDisclosures: None

scholarly journals Coping with COVID-19: medical students as strong and responsible stewards of their education

2021 ◽  
Author(s):  
Jacquelyn B. Kercheval ◽  
Deena Khamees ◽  
Charles A. Keilin ◽  
Netana H. Markovitz ◽  
Eve D. Losman
Keyword(s):  
Medical Students ◽  
Curriculum Development ◽  
De Novo ◽  
Traditional Approach ◽  
Clinical Care ◽  
Successful Implementation ◽  
Discussion Boards ◽  
Multiple Choice Questions ◽  
Continued Learning ◽  
Comprehensive Curriculum

Abstract Background Due to the COVID-19 pandemic, clinical rotations at the University of Michigan Medical School (UMMS) were suspended on March 17, 2020, per the Association of American Medical Colleges’ recommendations. No alternative curriculum existed to fill the educational void for clinical students. The traditional approach to curriculum development was not feasible during the pandemic as faculty were redeployed to clinical care, and the immediate need for continued learning necessitated a new model. Approach One student developed an outline for an online course on pandemics based on peer-to-peer conversations regarding learners’ interests and needs, and she proposed that students author the content given the immediate need for a curriculum. Fifteen student volunteers developed content to fill knowledge gaps, and expert faculty reviewers confirmed that the student authors had successfully curated a comprehensive curriculum. Evaluation The crowdsourced student content coalesced into a 40-hour curriculum required for all 371 clinical-level students at UMMS. This student-driven effort took just 17 days from outline to implementation, and the final product is a full course comprising five modules, multiple choice questions, discussion boards, and assignments. Learners were surveyed to gauge success, and 93% rated this content as relevant to all medical students. Reflection The successful implementation of this model for curriculum development, grounded in the Master Adaptive Learner framework, suggests that medical students can be entrusted as stewards of their own education. As we return to a post-pandemic “normal,” this approach could be applied to the maintenance and de novo development of future curricula.

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