Improving the Bilirubin Management Program in the Newborn Nursery: Background, Aims, and Protocol

Neonatology ◽  
2020 ◽  
Vol 117 (3) ◽  
pp. 358-364
Author(s):  
Timothy M. Bahr ◽  
Julie H. Shakib ◽  
Carole H. Stipelman ◽  
Kensaku Kawamoto ◽  
Kelly Cail ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hospital Readmissions ◽  
Management Program ◽  
Evidence Based ◽  
Change Analysis ◽  
Improvement Program ◽  
Improvement Project ◽  
University Of Utah ◽  
Bilirubin Encephalopathy ◽  
Intermountain Healthcare

<b><i>Background:</i></b> Practices to detect and manage hyperbilirubinemia in newborn nurseries are highly variable. American Academy of Pediatrics guidelines in 1999, 2004, and 2009 have generated, perhaps unintentionally, divergent practices that might not all be of equivalent value. Evidence-based progress is needed to define less invasive, less expensive, uniform, and safe methods to reduce ER visits and hospital readmissions for jaundice treatment and bilirubin encephalopathy. <b><i>Objectives:</i></b> This research briefing is intended to inform readers of a new prospective quality improvement program aimed at testing the value of specific changes in newborn nursery hyperbilirubinemia detection and management. This new program includes predetermined means of assessing those specific changes, which relate to diagnosis, safety, outcomes, and cost. <b><i>Methods:</i></b> In this briefing, we present the perceived problems in our present bilirubin management system, as voiced by stakeholders. We report our proposed means to test minimization of those problems utilizing already acquired data on approximately 400,000 well babies in the Intermountain Healthcare system of hospitals in the western USA. We then describe our methods of assessing specific outcomes in a pre- versus postpractice change analysis. <b><i>Results and Conclusions:</i></b> The University of Utah Newborn Nursery will implement a quality improvement project in bilirubin management during 2020 to test the feasibility and effectiveness of several changes to our current bilirubin management program. We maintain that the improved understanding generated by this project will be a step toward new evidence-based strategies for reducing ER visits and hospital readmissions for jaundice treatment and preventing bilirubin encephalopathy.

scholarly journals Evidence-Based Practice Implementation: Case Report of the Evolution of a Quality Improvement Program in a Multicenter Physical Therapy Organization

2015 ◽  
Vol 95 (4) ◽  
pp. 588-599 ◽  
Author(s):  
Joel M. Stevans ◽  
Christopher G. Bise ◽  
John C. McGee ◽  
Debora L. Miller ◽  
Paul Rockar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Case Report ◽  
Physical Therapy ◽  
Care Quality ◽  
Routine Practice ◽  
Evidence Based ◽  
Implementation Barriers ◽  
Improvement Program ◽  
Improvement Project ◽  
Systems Perspective

Background and Purpose Our nation's suboptimal health care quality and unsustainable costs can be linked to the failure to implement evidence-based interventions. Implementation is the bridge between the decision to adopt a strategy and its sustained use in practice. The purpose of this case report is threefold: (1) to outline the historical implementation of an evidence-based quality improvement project, (2) to describe the program's future direction using a systems perspective to identify implementation barriers, and (3) to provide implications for the profession as it works toward closing the evidence-to-practice gap. Case Description The University of Pittsburgh Medical Center (UPMC) Centers for Rehab Services is a large, multicenter physical therapy organization. In 2005, they implemented a Low Back Initiative utilizing evidence-based protocols to guide clinical decision making. Outcomes The initial implementation strategy used a multifaceted approach. Formative evaluations were used repeatedly to identify barriers to implementation. Barriers may exist outside the organization, they can be created internally, they may result from personnel, or they may be a direct function of the research evidence. Since the program launch, 3 distinct improvement cycles have been utilized to address identified implementation barriers. Discussion Implementation is an iterative process requiring evaluation, measurement, and refinement. During this period, behavior change is actualized as clinicians become increasingly proficient and committed to their use of new evidence. Successfully incorporating evidence into routine practice requires a systems perspective to account for the complexity of the clinical setting. The value the profession provides can be enhanced by improving the implementation of evidence-based strategies. Achieving this outcome will require a concerted effort in all areas of the profession. New skills will be needed by leaders, researchers, managers, and clinicians.

A quality improvement project to reduce restrictive interventions in a mental health service

2021 ◽  
pp. 1-12
Author(s):  
Darren Savarimuthu ◽  
Katja Jung
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Positive Impact ◽  
Essential Elements ◽  
Quality Improvement Project ◽  
Psychiatric Ward ◽  
Quality Improvement Initiative ◽  
Successful Implementation ◽  
Evidence Based ◽  
Improvement Project

Background/aims This article describes a quality improvement project that aimed to reduce restrictive interventions on an acute psychiatric ward. In light of a service level agreement and based on a trust-wide target, the purpose of the project was to reduce restrictive interventions by 20% within a period of 6 months. It was also anticipated that a least restrictive environment could have a positive impact on patient experience. Methods Three evidence-based interventions were introduced to the ward during the quality improvement project. These included positive behaviour support, the Safewards model and the productive ward initiative. Results There was a 63% reduction in restrictive interventions over a 6-month period through the successful implementation of a series of evidence-based interventions to manage behaviours that challenge on the mental health ward. Conclusions The project identified collaborative team working, staff training and adequate resources as essential elements in the success of the quality improvement initiative. However, co-production was found to be crucially significant in bringing sustainable changes in ward environment and in addressing restrictive practices.

scholarly journals Evidence-based practice ‘on-the-go’: using ViaTherapy as a tool to enhance clinical decision making in upper limb rehabilitation after stroke, a quality improvement initiative

2019 ◽  
Vol 8 (3) ◽  
pp. e000592 ◽  
Author(s):  
Nicola J Hancock ◽  
Kathryn Collins ◽  
Charlie Dorer ◽  
Steven L Wolf ◽  
Mark Bayley ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Upper Limb ◽  
Stroke Rehabilitation ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Improvement Project ◽  
Upper Limb Rehabilitation ◽  
Community Rehabilitation ◽  
Limb Rehabilitation

Recovery of upper limb function after stroke is currently sub-optimal, despite good quality evidence showing that interventions enabling repetitive practice of task-specific activity are effective in improving function. Therapists need to access and engage with such evidence to optimise outcomes with people with stroke, but this is challenging in fast-paced stroke rehabilitation services. This quality improvement project aimed to investigate acceptability and service impact of a new, international tool for accessing evidence on upper limb rehabilitation after stroke—‘ViaTherapy’—in a team of community rehabilitation therapists. Semi-structured interviews were undertaken at baseline to determine confidence in, and barriers to, evidence-based practice (EBP) to support clinical decision making. Reported barriers included time, lack of access to evidence and a research-practice disconnect. The clinicians then integrated use of ‘ViaTherapy’ into their practice for 4 weeks. Follow-up interviews explored the accessibility of the tool in community rehabilitation practice, and its impact on clinician confidence, treatment planning and provision. Clinicians found the tool, used predominantly in mobile device app format, to be concise and simple to use, providing evidence ‘on-the-go’. Confidence in accessing and using EBP grew by 22% from baseline. Clinicans reported changes in intensity of delivery of interventions, as rapid access to recommended doses via the tool was available. Following this work, the participating health and social care service provider changed provision of therapists’ technology to enable use of apps. Barriers to use of EBP in stroke rehabilitation persist; the baseline situation here supported the need for more accessible means of integrating best evidence into clinical processes. This quality improvement project successfully integrated ViaTherapy into clinical practice, and found that the tool has potential to underpin positive changes in upper limb therapy service delivery after stroke, by increasing accessibility to, use of and confidence in EBP. Definitive evaluation is now indicated.

Optimizing nutrition in patients with cirrhosis may reduce hospital readmissions in medium and high risk groups: a quality improvement project

2020 ◽  
Vol 73 ◽  
pp. S690-S691
Author(s):  
Angela Liaros ◽  
Christine Connolly ◽  
Lucy Potter ◽  
Lisa Jones ◽  
Tamsin Gledhill ◽  
...  
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Hospital Readmissions ◽  
Risk Groups ◽  
Quality Improvement Project ◽  
Improvement Project
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