Abstract 218: Expanding a Learning Collaborative Model in Chicago to Improve Door to Needle for Stroke Thrombolysis: Raising the Bar

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Shyam Prabhakaran ◽  
Renee M Sednew ◽  
Kathleen O’Neill
Keyword(s):  
Best Practices ◽  
Performance Improvement ◽  
Best Practice ◽  
Learning Collaborative ◽  
Collaborative Model ◽  
Stroke Registry ◽  
Chicago Area ◽  
Regional Collaboration ◽  
Content Expert ◽  
And Performance

Background: There remains significant opportunities to reduce door-to-needle (DTN) times for stroke despite regional and national efforts. In Chicago, Quality Enhancement for the Speedy Thrombolysis for Stroke (QUESTS) was a one year learning collaborative (LC) which aimed to reduce DTN times at 15 Chicago Primary Stroke Centers. Identification of barriers and sharing of best practices resulted in achieving DTN < 60 minutes within the first quarter of the 2013 initiative and has sustained progress to date. Aligned with Target: Stroke goals, QUESTS 2.0, funded for the 2016 calendar year, invited 9 additional metropolitan Chicago area hospitals to collaborate and further reduce DTN times to a goal < 45 minutes in 50% of eligible patients. Methods: All 24 hospitals participate in the Get With The Guidelines (GWTG) Stroke registry and benchmark group to track DTN performance improvement in 2016. Hospitals implement American Heart Association’s Target Stroke program and share best practices uniquely implemented at sites to reduce DTN times. The LC included a quality and performance improvement leader, a stroke content expert, site visits and quarterly meetings and learning sessions, and reporting of experiences and data. Results: In 2015, the year prior to QUESTS 2.0, the proportion of patients treated with tPA within 45 minutes of hospital arrival increased from 21.6% in Q1 to 31.4% in Q2. During the 2016 funded year, this proportion changed from 31.6% in Q1 to 48.3% in Q2. Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 24 Chicago area hospitals continues to impact times. Regional collaboration, data sharing, and best practice sharing should be a model for rapid and sustainable system-wide quality improvement.

Abstract TMP68: Expanding a Learning Collaborative Model in Chicago to Improve Door to Needle for Stroke Thrombolysis: Raising the Bar

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Shyam Prabhakaran ◽  
Renee M Sednew ◽  
Kathleen O’Neill
Keyword(s):  
Best Practices ◽  
Performance Improvement ◽  
Best Practice ◽  
Learning Collaborative ◽  
Collaborative Model ◽  
Stroke Registry ◽  
Chicago Area ◽  
Regional Collaboration ◽  
Content Expert ◽  
And Performance

Background: There remains significant opportunities to reduce door-to-needle (DTN) times for stroke despite regional and national efforts. In Chicago, Quality Enhancement for the Speedy Thrombolysis for Stroke (QUESTS) was a one year learning collaborative (LC) which aimed to reduce DTN times at 15 Chicago Primary Stroke Centers. Identification of barriers and sharing of best practices resulted in achieving DTN &lt; 60 minutes within the first quarter of the 2013 initiative and has sustained progress to date. Aligned with Target: Stroke goals, QUESTS 2.0, funded for the 2016 calendar year, invited 9 additional metropolitan Chicago area hospitals to collaborate and further reduce DTN times to a goal &lt; 45 minutes in 50% of eligible patients. Methods: All 24 hospitals participate in the Get With The Guidelines (GWTG) Stroke registry and benchmark group to track DTN performance improvement in 2016. Hospitals implement American Heart Association’s Target Stroke program and share best practices uniquely implemented at sites to reduce DTN times. The LC included a quality and performance improvement leader, a stroke content expert, site visits and quarterly meetings and learning sessions, and reporting of experiences and data. Results: In 2015, the year prior to QUESTS 2.0, the proportion of patients treated with tPA within 45 minutes of hospital arrival increased from 21.6% in Q1 to 31.4% in Q2. During the 2016 funded year, this proportion changed from 31.6% in Q1 to 48.3% in Q2. Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 24 Chicago area hospitals continues to impact times. Regional collaboration, data sharing, and best practice sharing should be a model for rapid and sustainable system-wide quality improvement.

Abstract 101: A Learning Collaborative Model to Improve Door to Needle Time for Stroke Thrombolysis in Chicago

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Shyam Prabhakaran ◽  
Kathleen O’Neill ◽  
Keyword(s):  
Best Practices ◽  
Ct Scanner ◽  
Learning Collaborative ◽  
Collaborative Model ◽  
Team Members ◽  
Stroke Registry ◽  
Face To Face ◽  
Regional Collaboration ◽  
Stroke Team ◽  
Get With The Guidelines

Background: Door-to-needle (DTN) times have remained suboptimal despite overall increases in tissue plasminogen activator use (tPA) for stroke in Chicago. The American Heart Association’s (AHA) Quality Enhancement for Speedy Thrombolysis in Stroke (QUESTS) initiative aimed to identify barriers to reduce DTN times at Chicago’s 15 primary stroke centers (PSCs) and increase the proportion of patients treated with tPA within 60 minutes of hospital arrival. Methods: Starting in January 2013, we used face-to-face and on-site meetings with each PSC’s stroke team members to share AHA Target Stroke best practices and strategies to reduce DTN time. A survey of current practice was completed at each site to determine opportunities for improvement and repeated at 1 year to assess implementation of new strategies. We used the Get With The Guidelines (GWTG) Stroke registry to aggregate baseline data DTN times and track performance in each quarter of 2013. Results: At baseline, 5 strategies were notably under-utilized at Chicago’s 15 PSCs: 1) Direct to CT scanner (baseline: 0 sites; 1 year: 5 sites); 2) pre-mixing tPA (baseline: 1 site; 1 year: 14 sites); 3) tPA prior to laboratory results (baseline: 3 sites; 1 year: 7 sites); 4) stroke code activation at triage (baseline: 4 sites; 1 year: 13 sites); and 5) streamlined consent process (baseline: 0 sites; 1 year: 12 sites. The proportion of patients treated within 60 minutes increased in each quarter of 2013 from 25% in quarter 1 to 60% in quarter 4 (p<0.01). The median DTN time decreased from 89.5 minutes in quarter 1 to 55 minutes in quarter 4 (p<0.01). Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 15 PSCs in Chicago, we observed major improvements within a few months. Regional collaboration and best practices sharing should be a model for rapid and sustainable system-wide quality improvement.

Abstract 18789: A Learning Collaborative Model to Improve Door to Needle Time for Stroke Thrombolysis in Chicago

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shyam Prabhakaran ◽  
Kathleen O’Neill ◽  
Keyword(s):  
Best Practices ◽  
Ct Scanner ◽  
Learning Collaborative ◽  
Collaborative Model ◽  
Team Members ◽  
Stroke Registry ◽  
Face To Face ◽  
Regional Collaboration ◽  
Stroke Team ◽  
Get With The Guidelines

Background: Door-to-needle (DTN) times have remained suboptimal despite overall increases in tissue plasminogen activator use (tPA) for stroke in Chicago. The American Heart Association’s (AHA) Quality Enhancement for Speedy Thrombolysis in Stroke (QUESTS) initiative aimed to identify barriers to reduce DTN times at Chicago’s 15 primary stroke centers (PSCs) and increase the proportion of patients treated with tPA within 60 minutes of hospital arrival. Methods: Starting in January 2013, we used face-to-face and on-site meetings with each PSC’s stroke team members to share AHA Target Stroke best practices and strategies to reduce DTN time. A survey of current practice was completed at each site to determine opportunities for improvement and repeated at 1 year to assess implementation of new strategies. We used the Get With The Guidelines (GWTG) Stroke registry to aggregate baseline data DTN times and track performance in each quarter of 2013. Results: At baseline, 5 strategies were notably under-utilized at Chicago’s 15 PSCs: 1) Direct to CT scanner (baseline: 0 sites; 1 year: 5 sites); 2) pre-mixing tPA (baseline: 1 site; 1 year: 14 sites); 3) tPA prior to laboratory results (baseline: 3 sites; 1 year: 7 sites); 4) stroke code activation at triage (baseline: 4 sites; 1 year: 13 sites); and 5) streamlined consent process (baseline: 0 sites; 1 year: 12 sites. The proportion of patients treated within 60 minutes increased in each quarter of 2013 from 25% in quarter 1 to 60% in quarter 4 (p<0.01). The median DTN time decreased from 89.5 minutes in quarter 1 to 55 minutes in quarter 4 (p<0.01). Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 15 PSCs in Chicago, we observed major improvements within a few months. Regional collaboration and best practices sharing should be a model for rapid and sustainable system-wide quality improvement.

Abstract TP313: A Metro Chicago Learning Collaborative Model to Improve Smoking Cessation Rates in Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Zachary Bulwa ◽  
Joy Rainey ◽  
Donna Kruse ◽  
Lynn Klassman ◽  
Renee Sednew ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Best Practices ◽  
Smoking Behavior ◽  
Learning Collaborative ◽  
Stroke Patients ◽  
Post Discharge ◽  
Collaborative Model ◽  
Chicago Area ◽  
History Of ◽  
Get With The Guidelines

Background: National guidelines for stroke care recommend that patients discharged with a stroke who have a history of smoking receive smoking cessation intervention prior to hospital discharge. However, less is known about the types of intervention provided and subsequent outcomes post-discharge. The Metro Chicago Smoking Cessation Initiative Pilot aimed to improve understanding of smoking cessation interventions provided at discharge, smoking behavior at 30 days post-discharge, and best practices and barriers for reducing smoking rates in stroke patients discharged from 20 Chicago area hospitals. Methods: A review of smoking cessation interventions provided at discharge and smoking cessation outcomes post-discharge for stroke patients discharged between August 1, 2018 and July 31, 2019 at 20 Chicago area participating hospitals was conducted using Get With The Guidelines® Stroke. The pilot used a Learning Collaborative model that included a quality improvement leader, smoking cessation/health behavior content experts, reporting of experiences and data, and sharing of best practices. All hospitals were required to attend quarterly online learning sessions and use Get With The Guidelines® Stroke for data entry. Results: Preliminary results from the 20 participating hospitals suggest smoking cessation counseling is the most commonly delivered intervention at discharge. Of the patients reached at 30 days post-discharge, 75% of those who reported at history of smoking at the time of their stroke were still using tobacco products. However, nearly 50% of those patients reported having made at least one attempt to quit. Conclusions: Preliminary results from this pilot project highlight the need for improved tracking of smoking cessation interventions provided at discharge and associated smoking behavior post-discharge, as well as the benefits of regional collaboration for identifying and implementing best practices.

Thinking Different Approach to Optimize Your Treaters

2021 ◽  
Author(s):  
Anand Kumar Singh ◽  
Aysha Alobeidli ◽  
Venugopal Bakthavachsalam
Keyword(s):  
Natural Gas ◽  
Best Practices ◽  
Performance Improvement ◽  
Change Process ◽  
Molecular Sieve ◽  
Critical Parameter ◽  
Treatment Process ◽  
Feasibility Studies ◽  
Management Change ◽  
And Performance

Abstract Natural gas coming from the well contains hydrocarbons, CO2, H2S, and water together with many other impurities. Molecular sieve treatment of the gas is required to make it suitable for the various applications. The several process and parameters considerations contribute to the reliable and optimized operation of molecular sieve natural gas treaters. The journey of this molecular sieve treater optimization commenced by conducting a thorough systematic study of all existing treater performance by considering various operating critical parameter. The technical feasibility studies were completed covering all the aspects like evaluating current performance of treater, conducting simulation for future capacity, licensor endorsement, conducting breakthrough test. Finally, study outcomes were implemented through management change process. The main benefits of optimization of molecular sieve treater process are to extend the service life of molecular sieve which enable us to increase the turnaround cycle of NGL trains. Significant reduction in CAPEX and OPEX cost were realized by reducing new fresh molecular sieve procurement, reducing disposal of molecular sieve waste material and expense of shutdown, achieving 100% HSE. This paper presents the typical operation issues and challenges in molecular sieve treatment process, best practices adopted for maximizing of existing assets considering the current and design scenarios, and performance improvement, which result to extend molecular sieve life, increase of NGL shutdown cycle and flaring reduction in trains.

Abstract TP385: Using a Learning Collaborative Model in Metro Chicago to Identify Best Practice Strategies for Emerging Topics: E-Cigarette Use in Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Renee Sednew ◽  
Zachary Bulwa ◽  
Joy Rainey ◽  
Donna Kruse ◽  
Lynn Klassman ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Best Practices ◽  
Cigarette Use ◽  
National Guidelines ◽  
Learning Collaborative ◽  
Post Discharge ◽  
Collaborative Model ◽  
Current Smoking ◽  
Cessation Intervention ◽  
Emerging Topics

Background: While learning collaborative models have been shown to aid implementation of published national guidelines, less is known about their role in informing health care providers about emerging topics not yet written into guidelines. National guidelines state that stroke patients who have a history of smoking should receive smoking cessation intervention prior to hospital discharge. However, guidelines do not include recommendations related to e-cigarette use. Launched July 2018, the Metro Chicago Smoking Cessation Initiative was a one-year pilot aimed at improving understanding of smoking cessation interventions provided at discharge, smoking behavior post-discharge, and best practices for reducing smoking rates at 20 Chicago area hospitals. While hospital practices and patient behavior around e-cigarettes was not an aim, the learning collaborative model enabled hospital participants to report their experiences and enact practice changes related to e-cigarettes. Methods: The pilot used a Learning Collaborative model that included a quality improvement leader, health behavior content experts, reporting of experiences and data, and sharing of best practices. Pilot participating hospitals were required to attend quarterly online learning sessions and use Get With The Guidelines® Stroke for data entry. Hospitals documented smoking cessation intervention provided at time of discharge and contacted patients via phone at 30 days post-discharge to gather data on current smoking use, quit attempts, and therapies used. Hospitals completed a baseline questionnaire reporting current smoking cessation practices and a mid-point questionnaire reporting changes to practice and experiences as a pilot participant. Responses were reviewed for themes related to e-cigarettes. Results: See Table 1 Conclusions: A Learning Collaborative Model may be a method for identifying strategies for practice changes prior to guideline recommendations.

Efficiency of pay for performance program on the brazilian judiciary

2014 ◽  
Author(s):  
Luis Cláudio de Jesus-Silva ◽  
Antônio Luiz Marques ◽  
André Luiz Nunes Zogahib
Keyword(s):  
Performance Improvement ◽  
Pay For Performance ◽  
Field Research ◽  
The State ◽  
Quantitative Approach ◽  
The Internet ◽  
Court Of Justice ◽  
And Performance ◽  
Compensation Program ◽  
Structured Questionnaire

This article aims to examine the variable compensation program for performance implanted in the Brazilian Judiciary. For this purpose, a survey was conducted with the servers of the Court of Justice of the State of Roraima - Amazon - Brazil. The strategy consisted of field research with quantitative approach, with descriptive and explanatory research and conducting survey using a structured questionnaire, available through the INTERNET. The population surveyed, 37.79% is the sample. The results indicate the effectiveness of the program as a tool of motivation and performance improvement and also the need for some adjustments and improvements, especially on the perception of equity of the program and the distribution of rewards.

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