Abstract WP237: Improved Thrombolysis Rates and Quality of Care for Stroke Patients Through a Provincial Emergency Department Quality Improvement Initiative

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Devin R Harris ◽  
Robert Stenstrom ◽  
Eric Grafstein ◽  
Mark Collison ◽  
Grant Innes ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measures ◽  
Large Scale ◽  
Primary Outcome ◽  
Baseline Data ◽  
Quality Improvement Initiative ◽  
Stroke Patients

Background: The care of stroke patients in the emergency department (ED) is time sensitive and complex. We sought to improve quality of care for stroke patients in British Columbia (B.C.), Canada, emergency departments. Objectives: To measure the outcomes of a large-scale quality improvement initiative on thrombolysis rates and other ED performance measures. Methods: This was an evaluation of a large-scale stroke quality improvement initiative, within ED’s in B.C., Canada, in a before-after design. Baseline data was derived from a medical records review study performed between December 1, 2005 to January 31, 2007. Adherence to best practice was determined by measuring selected performance indicators. The quality improvement initiative was a collaboration between multidisciplinary clinical leaders within ED’s throughout B.C. in 2007, with a focus on implementing clinical practice guidelines and pre-printed order sets. The post data was derived through an identical methodology as baseline, from March to December 2008. The primary outcome was the thrombolysis rate; secondary outcomes consisted of other ED stroke performance measures. Results: 48 / 81 (59%) eligible hospitals in B.C. were selected for audit in the baseline data; 1258 TIA and stroke charts were audited. For the post data, 46 / 81 (57%) acute care hospitals were selected: 1199 charts were audited. The primary outcome of the thrombolysis rate was 3.9% (23 / 564) before and 9.3% (63 / 676) after, an absolute difference of 5.4% (95% CI: 2.3% - 7.6%; p=0.0005). Other measures showed changes: administration of aspirin to stroke patients in the ED improved from 23.7% (127 / 535) to 77.1% (553 / 717), difference = 53.4% (95% CI: 48.3% - 58.1%; p=0.0005); and, door to imaging time improved from 2.25 hours (IQR = 3.81 hours) to 1.57 hours (IQR 3.0), difference = 0.68 hours (p=0.03). Differences were found in improvements between large and small institutions, and between health regions. Conclusions: Implementation of a provincial emergency department quality improvement initiative showed significant improvement in thrombolysis rates and adherence to other best practices for stroke patients. The specific factors that influenced improvement need to be further explored.

The Productive Ward Program™

2017 ◽  
Vol 49 (1) ◽  
pp. 28-38 ◽  
Author(s):  
Peter Van Bogaert ◽  
Danny Van heusden ◽  
Martijn Verspuy ◽  
Kristien Wouters ◽  
Stijn Slootmans ◽  
...  
Keyword(s):  
Social Capital ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Large Scale ◽  
Practice Environment ◽  
Job Outcomes ◽  
Decision Latitude ◽  
Improvement Programs ◽  
Quality Improvement Programs

Aim To investigate the impact of the quality improvement program “Productive Ward – Releasing Time to Care™” using nurses’ and midwives’ reports of practice environment, burnout, quality of care, job outcomes, as well as workload, decision latitude, social capital, and engagement. Background Despite the requirement for health systems to improve quality and the proliferation of quality improvement programs designed for healthcare, the empirical evidence supporting large-scale quality improvement programs impacting patient satisfaction, staff engagement, and quality care remains sparse. Method A longitudinal study was performed in a large 600-bed acute care university hospital at two measurement intervals for nurse practice environment, burnout, and quality of care and job outcomes and three measurement intervals for workload, decision latitude, social capital, and engagement between June 2011 and November 2014. Results Positive results were identified in practice environment, decision latitude, and social capital. Less favorable results were identified in relation to perceived workload, emotional exhaustion. and vigor. Moreover, measures of quality of care and job satisfaction were reported less favorably. Conclusion This study highlights the need to further understand how to implement large-scale quality improvement programs so that they integrate with daily practices and promote “quality improvement” as “business as usual.”

scholarly journals 130 Quality improvement project – improving the quality of care for homeless patients presenting to the homerton university hospital emergency department 2019-20

2020 ◽  
Vol 37 (12) ◽  
pp. 833.1-833
Author(s):  
Phoebe Leung ◽  
Jane Chambers ◽  
Amber Morris ◽  
Kobbina Arthur ◽  
Fenella Prowse ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Social History ◽  
Quality Improvement Project ◽  
University Hospital ◽  
History Taking ◽  
Improvement Project ◽  
Legal Duty

Aims/Objectives/BackgroundHomelessness is on the rise in the UK. The problem identified specific to homeless patient care was clinician understanding of the homeless person’s social needs to form an adequate discharge plan as well as completing their legal duty to refer such patients to the local housing authority.Methods/DesignThis quality improvement project (QIP) aimed to reduce the reattendance rate of homeless patients presenting to the Homerton University Hospital (HUH) Emergency Department (ED) by 20% from November 2019 to April 2020. This would be done by improving social history taking, signposting of patients to appropriate resources, and performing the legal duty to refer. Using the PDSA cycle method, interventions included a week of presentations to inform clinicians of the process measures; an advertising campaign; and a defined flowchart process for the duty to refer.Results/ConclusionsThe QIP yielded the following results in terms of median baselines: social history taking 60% to 88%, signposting to resources 30% to 67%, and duty to refer 0 to 41%. There was no change to the outcome measure of reattendance rate, maintained at 40% throughout the project and hence the QIP did not meet its SMART aim.However this may have been the result of the decision to cut short data collection time due to the unprecedented COVID-19 pandemic which saw overall reduction in ED patient attendance. Most street homeless persons were put up in temporary hotels in the government funded scheme ‘Everybody In’, lockdown meant the hidden homeless should stay indoors, and a ban on court evictions has been extended until 23 August 2020.Nonetheless, work to improve quality of care continued with a new pathway for safe discharge of homeless patients with suspected COVID-19. Planning ahead for post pandemic times has brought about a new standard operating procedure, which will ensure sustainability of the QIP.

Analysis of Plastic Surgery Consultations in a High-Volume Paediatric Emergency Department: A Quality Improvement Initiative

2020 ◽  
pp. 229255032096965
Author(s):  
Kathrin Neuhaus ◽  
Emily S. Ho ◽  
Nelson Low ◽  
Christopher R. Forrest
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
High Volume ◽  
Patient Characteristics ◽  
Quality Improvement Initiative ◽  
Education Intervention ◽  
Intervention Period ◽  
Post Intervention ◽  
Ed Overcrowding

Introduction: Consult services influence emergency department (ED) workflow. Prolonged ED length of stay (LOS) correlates with ED overcrowding and as a consequence decreased quality of care and satisfaction of health team professionals. To improve management of paediatric ED patients requiring plastic and reconstructive surgery (PRS) expertise, current processes were analyzed. Methods: Patient characteristics and metrics of PRS consultations in our paediatric ED were collected over a 3-month period. Data analysis was followed by feedback education intervention to ED and PRS staff. Data collection was then resumed and results were compared to the pre-intervention period. Results: One hundred ninety-eight PRS consultations were reviewed, mean patient age was 6.3 years. Most common (52%) diagnoses were burns and hand trauma; 81% of PRS referrals were deemed appropriate; 25% of PRS consults were requested after hour with no differences in patient characteristics compared to regular hours; 60% of consultations involved interventions in the ED. Time between ED registration and PRS consultation request (116.5 minutes), quality of procedural sedation (52% rated inadequate), and overall ED LOS (289.2 minutes) were identified as main areas of concern and addressed during feedback education intervention. Emergency department LOS and quality of sedation did not improve in the post-intervention period. Conclusion: The study provides detailed insights in the characteristics of PRS consultation in the paediatric ED population. Despite high referral appropriateness and education feedback intervention, significant inefficiencies were identified that call for further collaborative efforts to optimize quality of care for paediatric ED patients and improve satisfaction of involved healthcare professionals.

scholarly journals Assurance of Myeloid Growth Factor Administration in an Infusion Center: Pilot Quality Improvement Initiative

2017 ◽  
Vol 13 (12) ◽  
pp. e1040-e1045 ◽  
Author(s):  
Pamela Maree Ramirez ◽  
Barry Peterson ◽  
Christine Holtshopple ◽  
Kristina Borja ◽  
Vincent Torres ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Six Sigma ◽  
Hospital Costs ◽  
Safety Net ◽  
Primary Objective ◽  
Lean Six Sigma ◽  
Quality Improvement Initiative ◽  
Six Sigma Methodology

Purpose: Four incident reports involving missed doses of myeloid growth factors (MGFs) triggered the need for an outcome-driven initiative. From March 1, 2015, to February 29, 2016, at University of California Irvine Health Chao Infusion Center, 116 of 3,300 MGF doses were missed (3.52%), including pegfilgrastim, filgrastim, and sargramostim. We hypothesized that with the application of Lean Six Sigma methodology, we would achieve our primary objective of reducing the number of missed MGF doses to < 0.5%. Methods: This quality improvement initiative was conducted at Chao Infusion Center as part of a Lean Six Sigma Green Belt Certification Program. Therefore, Lean Six Sigma principles and tools were used throughout each phase of the project. Retrospective and prospective medical record reviews and data analyses were performed to evaluate the extent of the identified problem and impact of the process changes. Improvements included systems applications, practice changes, process modifications, and safety-net procedures. Results: Preintervention, 24 missed doses (20.7%) required patient supportive care measures, resulting in increased hospital costs and decreased quality of care. Postintervention, from June 8, 2016, to August 7, 2016, zero of 489 MGF doses were missed after 2 months of intervention ( P < .001). Chao Infusion Center reduced missed doses from 3.52% to 0%, reaching the goal of < 0.5%. Conclusion: The establishment of simplified and standardized processes with safety checks for error prevention increased quality of care. Lean Six Sigma methodology can be applied by other institutions to produce positive outcomes and implement similar practice changes.

scholarly journals P037: The Ontario Emergency Department Return Visit Quality Program: a provincial initiative to promote continuous quality improvement

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S90
Author(s):  
L.B. Chartier ◽  
O. Ostrow ◽  
I. Yuen ◽  
S. Kutty ◽  
B. Davis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Continuous Quality Improvement ◽  
High Volume ◽  
Return Visit ◽  
Continuous Quality ◽  
Quality Program ◽  
Ed Visits

Introduction: Analyzing the charts of patients who have a return visit to an emergency department (ED) requiring hospital admission (termed ‘RV’) is an efficient way to identify adverse events (AEs). Investigating these AEs can inform efforts to improve the quality of care provided. The ED RV Quality Program (RVQP) is a new initiative supported by Ontario’s Ministry of Health and Long-Term Care and managed by Health Quality Ontario. It aims to promote a culture of continuous quality improvement through routine audit/investigation of RVs. Methods: The provincial program is mandatory for high-volume EDs and requires auditing of some 72-hour RVs and all 7-day RVs involving ‘sentinel diagnoses’ (subarachnoid hemorrhage [SAH], acute myocardial infarction [AMI], or pediatric sepsis [PS]). A standardized audit template is followed that includes assessment of the type/severity and underlying causes of AEs, and potential actions for improvement. Results: 73 high-volume EDs and 16 smaller EDs (collectively receiving 90% of all ED visits in Ontario) are participating in the program. Nine months’ data have been released to date, comprising 33,956 RVs (1.05% of 3,235,751 ED visits). Of these, 233 RVs (0.69%) were for a sentinel diagnosis (SAH=11, AMI=191, PS=31). The most common presenting complaint on the index visit was abdominal pain (18%). The most common discharge diagnosis following RV admission was acute appendicitis (3.8%). Conclusion: The ED RVQP aims to improve the quality of care provided in Ontario’s EDs by requiring hospitals to conduct audits of RVs and plan actions for improvement when quality gaps are identified. Participating hospitals have completed hundreds of audits to date.

scholarly journals Efficacy and safety of Si-Jun-Zi-Tang-based therapies for functional (non-ulcer) dyspepsia: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yaping Wang ◽  
Bin Liu ◽  
Xiuqiong Fu ◽  
Tiejun Tong ◽  
Zhiling Yu
Keyword(s):  
Relapse Rate ◽  
Large Scale ◽  
Primary Outcome ◽  
Response Rate ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Efficacy And Safety ◽  
History Of ◽  
Non Ulcer Dyspepsia

Abstract Background The traditional Chinese medicine formula Si-Jun-Zi-Tang (SJZT) has a long history of application in the treatment of functional dyspepsia (non-ulcer dyspepsia, FD)-like symptoms. SJZT-based therapies have been claimed to be beneficial in managing FD. This study aimed to assess the efficacy and safety of SJZT-based therapies in treating FD by meta-analysis. Methods Systematic searches for RCTs were conducted in seven databases (up to February 2019) without language restrictions. Data were analyzed using Cochrane RevMan software version 5.3.0 and Stata software version 13.1, and reported as relative risk (RR) or odds ratio (OR) with 95% confidence intervals (CIs). The primary outcome was response rate and the secondary outcomes were gastric emptying, quality of life, adverse effects and relapse rate. The quality of evidence was evaluated according to criteria from the Cochrane risk of bias. Results A total of 341 potentially relevant publications were identified, and 12 RCTs were eligible for inclusion. For the response rate, there was a statically significant benefit in favor of SJZT-based therapies (RR = 1.23; 95% CI 1.17 to 1.30). However, the benefit was limited to modified SJZT (MSJZT). The relapse rate of FD patients received SJZT-based therapies was lower than that of patients who received conventional medicines (OR = 0.23; 95% CI 0.10 to 0.51). No SJZT-based therapies-related adverse effect was reported. Conclusion SJZT-based prescriptions may be effective in treating FD and no serious side-effects were identified, but the effect on response rate appeared to be limited to MSJZT. The results should be interpreted with caution as all the included studies were considered at a high risk of bias. Standardized, large-scale and strictly designed RCTs are needed to further validate the benefits of SJZT-based therapies for FD management. Trial registration Systematic review registration: [PROSPERO registration: CRD42019139136].

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