scholarly journals Adopting and sustaining a Virtual Fracture Clinic model in the District Hospital setting – a quality improvement approach

2017 ◽  
Vol 6 (1) ◽  
pp. u220211.w7861 ◽  
Author(s):  
Kartik Logishetty
Keyword(s):  
Quality Improvement ◽  
District Hospital ◽  
Hospital Setting ◽  
Fracture Clinic ◽  
Virtual Fracture Clinic

888 Challenges in The Management of Lower Gastrointestinal Bleeding in General Surgery: Developing Consistent Practice and Application of BSG Guidelines

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Bhojwani ◽  
M Ahmed ◽  
F Mahmood ◽  
C Sellahewa ◽  
C Desai
Keyword(s):  
Risk Stratification ◽  
Gastrointestinal Bleeding ◽  
District Hospital ◽  
Hospital Setting ◽  
Lower Gastrointestinal Bleeding ◽  
Shock Index ◽  
Retrospective Audit ◽  
Ct Angiogram ◽  
Sensitive Tool ◽  
The Uk

Abstract Introduction Lower gastrointestinal bleeding (LGIB) accounts for 3% of all surgical referrals in the UK, with an in-hospital mortality of 3.4%. The BSG 2019 guidelines recommend risk stratification as per Oakland scoring, inpatient lower GI endoscopy for admissions and CT-angiography for unstable patients. This study evaluates the delivery of these outcomes in a district hospital setting. Method Retrospective audit assessing all acute LGI bleed admissions from 01-07-2019 to 28-02-2020 at Russells Hall Hospital. Shock Index (SI) and Oakland score used to stratify patients into unstable, stable-major and stable-minor LGIB. Compliance with BSG standards was assessed by review of investigations and emergent patient management. Results 143 patients (Median age = 70years) evaluated, with 64 admissions having no formal risk stratification (OAKLAND-score) documented. Only 12 admissions underwent inpatient LGI endoscopy with sigmoid diverticulosis the most common pathology (39.3%). CT-angiogram was the initial investigation for 75% of patients admitted with unstable LGIB. Conclusions OAKLAND-scoring is a sensitive tool to stratify LGIB patients based on clinical parameters. Application of BSG-2019 guidelines and developing consistency in management is challenged by the lack of routine access to LGI endoscopy and tools to manage bleeding endoscopically.

scholarly journals 688 Rapid Implementation of Virtual Fracture Clinic During COVID 19 Reduces Both Face-To-Face Appointments and Facilitates Rapid Feedback and Education to Be Delivered to The Emergency Department

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Havenhand ◽  
L Hoggett ◽  
A Bhutta
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Prospective Data ◽  
Fracture Clinic ◽  
Face To Face ◽  
Return Rates ◽  
Acute Hospitals ◽  
Virtual Fracture Clinic ◽  
Improve Patient

Abstract Introduction COVID-19 has dictated a shift towards virtual clinics. Pennine Acute Hospitals NHS Trust serves over a million patients with a significant number of face-to-face fracture clinics. Introduction of a Virtual Fracture Clinic (VFC) reduces hospital return rates and improves patient experience. The referral data can be used to give immediate monthly feedback to the referring department to further improving patient flow. Method Prospective data was collected for all referrals to VFC during March 2020. Data included referral diagnosis, actual diagnosis, referrers grade, and final outcome. Results 630 referrals were made to VFC. 347 (55%) of those referrals were directly discharged without the need for physical consultation. Of these 114 (32%) were injuries which can be discharged by the Emergency Department with an advice leaflet using existing pathways. Of the remaining discharges 102 (29%) were query fractures or sprains; and 135 (39%) were minor fractures; which needed only advice via a letter and no face to face follow up. Conclusions Implementation of VFC leads to a decrease in physical appointments by 55% saving 347 face to face appointments. The new system has also facilitated effective audit of referrals in order to further improve patient flow from the Emergency Department via feedback mechanisms and education.

Targeted reduction in neurosurgical laboratory utilization: resident-led effort at a single academic institution

2014 ◽  
Vol 120 (1) ◽  
pp. 173-177 ◽  
Author(s):  
Seunggu J. Han ◽  
Rajiv Saigal ◽  
John D. Rolston ◽  
Jason S. Cheng ◽  
Catherine Y. Lau ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Financial Incentives ◽  
Laboratory Tests ◽  
Medical Center ◽  
Hospital Setting ◽  
Cost Savings ◽  
Fiscal Year ◽  
Incentive Program ◽  
Neurosurgical Patients

Object Given economic limitations and burgeoning health care costs, there is a need to minimize unnecessary diagnostic laboratory tests. Methods The authors studied whether a financial incentive program for trainees could lead to fewer unnecessary laboratory tests in neurosurgical patients in a large, 600-bed academic hospital setting. The authors identified 5 laboratory tests that ranked in the top 13 of the most frequently ordered during the 2010–2011 fiscal year, yet were least likely to be abnormal or influence patient management. Results In a single year of study, there was a 47% reduction in testing of serum total calcium, ionized calcium, chloride, magnesium, and phosphorus. This reduction led to a savings of $1.7 million in billable charges to health care payers and $75,000 of direct costs to the medical center. In addition, there were no significant negative changes in the quality of care delivered, as recorded in a number of metrics, showing that this cost savings did not negatively impact patient care. Conclusions Engaging physician trainees in quality improvement can be successfully achieved by financial incentives. Through the resident-led quality improvement incentive program, neurosurgical trainees successfully reduced unnecessary laboratory tests, resulting in significant cost savings to both the medical center and the health care system. Similar programs that engage trainees could improve the value of care being provided at other academic medical centers.

scholarly journals Nurses’ Knowledge on Delirium Prevention and Detection in Hospitalized Adults: A Quality Improvement Project

2021 ◽  
Author(s):  
Kayla Deery
Keyword(s):  
Quality Improvement ◽  
Educational Intervention ◽  
Medical Condition ◽  
Hospital Setting ◽  
Chronically Ill ◽  
Measurement Model ◽  
Assessment Method ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Nurses Knowledge

Delirium, recognized as a medical and psychological emergency, is a symptom of an acute medical condition. Despite the prevalence of delirium in the hospital setting, it continues to be unrecognized, resulting in poor patient outcomes, and exorbitant healthcare cost. Patients with dementia who are chronically ill, as well as patients previously diagnosed with delirium, represent a vulnerable population and require closer surveillance due to their predisposing factors. This quality improvement project goal is to increase nurses’ knowledge and understanding of delirium. This was completed through providing education to medical-surgical nurses on the causes of delirium (predisposing and precipitating factors), prevention, use of the confusion assessment method (CAM) screening tool, and detection of delirium. The change in knowledge was measure through an investigator created, 10-question multiple choice, pretest-posttest measurement model. Of the 58 nurses, nine responded and completed the pretest (N=9, 15.5%), while seven completed the educational intervention posttest (N=7, 12%). Results of the quality improvement project yielded a 22.1% increase in nurses’ knowledge after the educational intervention. Despite the low participation rate, this project revealed a positive correlation between the educational intervention and nurses’ knowledge.

scholarly journals AB066. SOH21AS168. Remote delivery of the satellite virtual fracture clinic—a pilot report of the first 500 cases

2021 ◽  
Vol 5 ◽  
pp. AB066-AB066
Author(s):  
Andrew Jerome Hughes ◽  
Darren Patrick Moloney ◽  
Caroline Fraser ◽  
Joan Dembo ◽  
Andrew Hughes ◽  
...  
Keyword(s):  
Fracture Clinic ◽  
Virtual Fracture Clinic

Assessment of Cost-Effective Antibiotic Therapy in the Management of Infections in Cancer Patients

1994 ◽  
Vol 28 (1) ◽  
pp. 105-111 ◽  
Author(s):  
Michael A. Cimino ◽  
Coleman M. Rotstein ◽  
Jason E. Moser
Keyword(s):  
Quality Improvement ◽  
Antibiotic Therapy ◽  
Clinical Pharmacist ◽  
Hospital Setting ◽  
Cost Savings ◽  
Cost Effective ◽  
Baseline Period ◽  
Economic Benefits ◽  
Consensus Approach ◽  
Quality Improvement Effort

OBJECTIVE: To describe the economic benefits of a quality improvement effort directed at optimizing clinical outcome. DESIGN: A before—after observational design was used to evaluate the cost-effectiveness of a consensus approach to antimicrobial therapy. SETTING: The evaluation was conducted at a cancer research hospital. PATIENTS: Oncology patients requiring parenteral antibiotic therapy were consecutively observed. MAIN OUTCOME MEASURES: Outcome (clinical and microbiologic response), safety, and cost of therapy were assessed during a baseline period and compared to a period during which the consensus approach was used. INTERVENTIONS: The influence of a designated individual, in this case a clinical pharmacist, responsible for promotion of the consensus approach was explored. RESULTS: The consensus approach in combination with the promotional efforts of the clinical pharmacist was associated with a 13 percent increase in overall clinical response and a reduction of pathogen persistence from 22 to 11 percent. No difference in the average number of adverse effects per patient was observed over the two observation periods. These findings were associated with an estimated $22000/month cost savings. The consensus approach alone, without benefit of the clinical pharmacist, was not associated with improved therapeutic outcome or cost savings over the same observation periods. CONCLUSIONS: These data suggest that a consensus approach to antibiotic therapy can be cost-effective. An individual, such as a clinical pharmacist, may add significantly to quality improvement and cost-effective efforts in a hospital setting.

Sign in / Sign up

Export Citation Format

Share Document