Abstract WP266: EMS/Hospital Combined Education Decreased Primary Stroke Center Bypass

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jason P Stopyra ◽  
Myron Waddell ◽  
Emily B Parks
Keyword(s):  
North Carolina ◽  
Quality Improvement ◽  
Service Area ◽  
Education Intervention ◽  
Post Intervention ◽  
Intervention Phase ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
The Impact

Introduction: Historically, community hospitals have had few options for meaningful treatment of patients presenting with acute stroke. As expertise grows in the administration of thrombolytics, primary stroke centers (PSC) fulfill an important role in the reduction of morbidity and mortality related to stroke. It is important for the PSC to partner with Emergency Medical Services (EMS) to change historical perceptions of the quality of PSC care. Education may improve teamwork and increase awareness of the PSC, thereby increasing their utilization in EMS disposition decisions. Objective: The objective of this study is to report the impact of an education intervention on PSC bypass decisions. Methods: The electronic patient care record database from a North Carolina county EMS system was queried as a quality improvement analysis from January 1, 2012 to February 28, 2016. This included 19 months prior to the education intervention, the year during the education intervention, and 19 months after the education intervention. All primary patient transports with Stroke/CVA, or suspected TIA as the primary or secondary impression were included. Interfacility transports were excluded. The recorded call location was determined to either be inside or outside the PSC service area. The hospital the patient was transported to was also recorded. Results: During the pre-intervention phase 222 patients were identified, 48 of which originated in the PSC service area. Of those 48 patients, 16 bypassed the PSC (33.3%). In the post-intervention phase, 94 of 269 total patients were in PSC service area. Only 12 bypasses occurred (12.8%) which is a reduction of 61.7% in PSC bypass compared to the pre-intervention phase. Conclusion: The period following a combined hospital/EMS educational intervention showed significant reduction in PSC bypass.

scholarly journals A case study: Applying quality improvement methods to reduce pre-operative length of stay in a resource-constrained setting in Rwanda

2015 ◽  
Vol 5 (1) ◽  
pp. 41 ◽  
Author(s):  
Ssebuufu Robinson ◽  
Victor Pawelzik ◽  
Abraham Megentta ◽  
Oswald Benimana ◽  
Damascene Mazimpaka ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Problem Solving ◽  
Length Of Stay ◽  
Work Group ◽  
Surgical Patients ◽  
P Value ◽  
Post Intervention ◽  
Quality Of Surgery ◽  
The Impact

Objective: While several studies have focused on improving the quality of surgery, less attention has been paid to reducing pre-operative delays in care. We undertook a hospital quality improvement (QI) effort to reduce pre-operative delays in a teaching hospital in Rwanda. Without a coordinated admission schedule, many surgical patients arriving at the hospital for admissions were turned away because of unavailable beds. For those admitted for surgery, the pre-operative waits were long.Methods: A pre- and post-intervention study was conducted to examine the impact of a QI effort on two metrics: 1) pre-operative length-of-stay (LOS) for elective surgical patients, and 2) the number of elective surgical patients who were turned away on the scheduled admission date. Intervention: A multi-disciplinary work group utilized a Strategic Problem Solving Approach and implemented a centralized patient wait list and new schedule process utilizing the existing resources available at the hospital.Results: The percentage of elective surgical patients with a pre-operative LOS of more than two days was significantly lower in the post-intervention compared with the pre-intervention period (80% versus 26.8%, p-value < .001). The percentage of scheduled patients who were turned away due unavailable inpatient beds significantly decreased from 63.4% to 5.3%, p-value < .001.Conclusions: By following a methodical strategic problem solving approach, the pre-operative LOS was reduced, elective surgical patients turned away due to unavailable beds was decreased at very low financial cost.

scholarly journals Engaging community pharmacists in quality improvement (QI): a qualitative case study of a partnership between a Higher Education Institute and Local Pharmaceutical Committees

2021 ◽  
Vol 10 (1) ◽  
pp. e001047
Author(s):  
Asam Latif ◽  
Nargis Gulzar ◽  
Fiona Lowe ◽  
Theo Ansong ◽  
Sejal Gohil
Keyword(s):  
Quality Improvement ◽  
Focus Groups ◽  
Qualitative Methodology ◽  
Positive Impact ◽  
Community Pharmacists ◽  
Educational Institute ◽  
Collaboration And Communication ◽  
Improve Service Quality ◽  
The Impact

BackgroundQuality improvement (QI) involves the use of systematic tools and methods to improve the quality of care and outcomes for patients. However, awareness and application of QI among healthcare professionals is poor and new strategies are needed to engage them in this area.ObjectivesThis study describes an innovative collaboration between one Higher Educational Institute (HEI) and Local Pharmaceutical Committees (LPCs) to develop a postgraduate QI module aimed to upskill community pharmacists in QI methods. The study explores pharmacist engagement with the learning and investigates the impact on their practice.MethodsDetails of the HEI–LPCs collaboration and communication with pharmacist were recorded. Focus groups were held with community pharmacists who enrolled onto the module to explore their motivation for undertaking the learning, how their knowledge of QI had changed and how they applied this learning in practice. A constructivist qualitative methodology was used to analyse the data.ResultsThe study found that a HEI–LPC partnership was feasible in developing and delivering the QI module. Fifteen pharmacists enrolled and following its completion, eight took part in one of two focus groups. Pharmacists reported a desire to extend and acquire new skills. The HEI–LPC partnership signalled a vote of confidence that gave pharmacists reassurance to sign up for the training. Some found returning to academia challenging and reported a lack of time and organisational support. Despite this, pharmacists demonstrated an enhanced understanding of QI, were more analytical in their day-to-day problem-solving and viewed the learning as having a positive impact on their team’s organisational culture with potential to improve service quality for patients.ConclusionsWith the increased adoption of new pharmacist’s roles and recent changes to governance associated with the COVID-19 pandemic, a HEI–LPC collaborative approach could upskill pharmacists and help them acquire skills to accommodate new working practices.

scholarly journals Applying quality improvement principles to improve accident and emergency department overcrowding and flow in Rwanda: a case study

2015 ◽  
Vol 4 (5) ◽  
pp. 47 ◽  
Author(s):  
Jean Claude Byiringiro ◽  
Rex Wong ◽  
Caroline Davis ◽  
Jeffery Williams ◽  
Joseph Becker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Success Factors ◽  
Low Cost ◽  
Post Intervention ◽  
Triage System ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
Accident And Emergency Department ◽  
The Impact

Few case studies exist related to hospital accident and emergency department (A&E) quality improvement efforts in lowerresourced settings. We sought to report the impact of quality improvement principles applied to A&E overcrowding and flow in the largest referral and teaching hospital in Rwanda. A pre- and post-intervention study was conducted. A linked set of strategies included reallocating room space based on patient/visitor demand and flow, redirecting traffic, establishing a patient triage system and installing white boards to facilitate communication. Two months post-implementation, the average number of patients boarding in the A&E hallways significantly decreased from 28 (pre-intervention) to zero (post-intervention), p < .001. Foot traffic per dayshift hour significantly decreased from 221 people to 160 people (28%, p < .001), and non-A&E related foot traffic decreased from 81.4% to 36.3% (45% decrease, p < .001). One hundred percent of the A&E patients have been formally triaged since the implementation of the newly established triage system. Our project used quality improvement principles to reduce the number of patients boarding in the hallways and to decrease unnecessary foot traffic in the A&E department with little investment from the hospital. Key success factors included a collaborative multidisciplinary project team, strong internal champions, data-driven analysis, evidence-based interventions, senior leadership support, and rapid application of initial implementation learnings. Results to date show the application of quality improvement principles can help hospitals in resource-limited settings improve quality of care at relatively low cost.

scholarly journals The impact of a teacher-based positive education intervention on student wellbeing literacy

2021 ◽  
Vol 2 (1) ◽  
pp. 22-43
Author(s):  
Lea Waters ◽  
Matthew Charles Higgins
Keyword(s):  
Mental Health ◽  
Education Intervention ◽  
Positive Education ◽  
Post Intervention ◽  
Emotional Management ◽  
Strength Based ◽  
Before And After ◽  
Education Interventions ◽  
Written Descriptions ◽  
The Impact

Over the past decade, research has consistently found that positive education interventions have a beneficial effect on mental health outcomes for students, such as improvements in life satisfaction and reduction of anxiety. While it is encouraging to see these changes in student mental health, the research has not yet adequately explored whether positive education interventions change a student’s understanding of wellbeing itself. Wellbeing literacy is a new construct within the field of positive education and is defined as the ability to understand the concept and language of wellbeing. This study examines whether student language and understanding of wellbeing changes following an intervention that trains teachers in the core principles of positive education. Students across grades five, six and seven (ages 11–13; n = 231) from three Australian schools provided brief written descriptions of their understanding of wellbeing before and after their teachers undertook an eight-month positive education intervention. Thematic analysis was used as the methodological tool to analyze student language and understanding of wellbeing. Inferential frequency-based statistical analyses were used to compare the pre-intervention and post-intervention responses. The results revealed that student understanding of wellbeing evolved in four key ways to become more: (1) detailed; (2) strength based; (3) expanded/multidimensional; and (4) relational. Post-intervention understanding of wellbeing was significantly more likely to include aspects of emotional management, strengths, coping, mindfulness and self-kindness. Implications, limitations and future directions are discussed.

scholarly journals Improving quality and assessment of referrals to the Enfield Crisis Resolution and Home Treatment Team (ECRHTT)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S202-S202
Author(s):  
Margarita Kousteni ◽  
John Cousins ◽  
Ajay Mansingh ◽  
Maja Elia ◽  
Yumnah Ras ◽  
...  
Keyword(s):  
Home Treatment ◽  
Absolute Difference ◽  
List Type ◽  
Treatment Team ◽  
Crisis Resolution ◽  
Post Intervention ◽  
Improvement Project ◽  
Consultant Psychiatrist ◽  
The Impact

AimsTriaging referrals to crisis resolution and home treatment teams is a significant undertaking requiring experienced and dedicated staff. We observed that the volume of inappropriate referrals to ECRHTT was high, and that staff processing these often felt inexperienced or lacking in confidence to discharge them back to the referrers and signpost them to appropriate services.The aims of this quality improvement project (QIP) were: a)to reduce the number of inappropriate referrals received by the teamb)to reduce the number of inappropriate referrals accepted by the teamThis would significantly improve access and flow to the service and facilitate better patient care.MethodA pilot study was first completed of the quality (appropriateness/ inappropriateness) and source of all referrals to ECRHTT in January 2019 (n = 177).Subsequently, the consultant psychiatrist for ECRHTT based himself within the assessment team. He was able to closely monitor the referrals, at the same time as providing medical input to patients at their first point of contact. To evaluate the impact of this intervention, the percentage of inappropriate referrals accepted pre- and post-change was compared by re-auditing all referrals received in February 2019 (n = 175).Further interventions were instigated to improve referral quality. These included continuation of psychiatric medical input to the assessment team, teaching sessions for GPs and the crisis telephone service, and weekly meetings with psychiatric liaison and community mental health teams (CMHTs). Change was measured by reassessing the quality of all referrals made to ECRHTT in February 2020 (n = 215).Result46.9% of inappropriate referrals to ECRHTT were accepted in January 2019 compared to 16.9% in February 2019 following the addition of medical input to the assessment team. The absolute difference was 30% (95% CI: 14%–44%, p < 0.001).71% of referrals from GPs were inappropriate in January 2019 compared to 36% in February 2020 post-intervention (difference 35%, 95% CI: 8.84%–55.4%, p < 0.05). Inappropriate referrals from CMHTs decreased from 55.5% to 12% (difference 43.5%, 95% CI: 9.5%–70.3%, p < 0.05). Overall, the percentage of inappropriate referrals fell from 38% to 27.4%, a difference of 10.6% (95% CI: 1.3%–19.8%, p < 0.05). The percentage of inappropriate referrals from liaison teams did not change significantly.ConclusionThis piece of work shows that better engagement with referral sources significantly improved the quality of referrals made to ECRHTT. Interventions included medical input at the point of referral, teaching sessions for general practitioners as well as ongoing liaison with referring teams.

scholarly journals The impact of music on health-related quality of life, as quantified by the SF-36: A systematic review and meta-analysis

2021 ◽  
Author(s):  
J. Matt McCrary ◽  
Eckart Altenmuller ◽  
Clara Kretschmer ◽  
Daniel S. Scholz
Keyword(s):  
Standard Treatment ◽  
Meta Analysis ◽  
Music Listening ◽  
Health Related Quality ◽  
Post Intervention ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related ◽  
The Impact

Background/Objectives: Increasing evidence supports the ability of music to broadly promote wellbeing and health-related quality of life (HRQOL). However, the magnitude of music effects on HRQOL is still unclear, particularly relative to established interventions, limiting inclusion of music interventions in health policy and care. The SF-36 is the most widely used instrument to evaluate HRQOL, with broad validity in evaluating the effects of a range of interventions. This study aims to synthesize and contextualize the impact of music interventions on HRQOL, as assessed by the SF-36. Methods: MEDLINE; EMBASE; Web of Science; PsycINFO, clinicaltrials.gov, and ICTRP databases were searched on 30 July 2021. Randomized and single-group studies of music interventions which reported SF-36 data at pre- and post-intervention timepoints were included. Observational studies were excluded. The quality and certainty of evidence provided by included articles and meta-analysis results was appraised using GRADE. Inverse variance random effects meta-analyses quantified changes in SF-36 mental and physical component summary scores (respectively, MCS and PCS) pre- to post-intervention and vs. common control groups. Results: Analyses included 764 participants from 25 studies. Music interventions (music listening, 10 studies; music therapy, 7 studies; singing, 7 studies; gospel music, 1 study) significantly improved MCS (Mean difference (MD) [95% confidence interval]=3.0 [1.4, 4.6]; p<.001) and PCS (MD=1.0 [0.1, 2.0; p<.04) scores. In a subgroup (8 studies; music group, N=254; control, N=257) addition of music to standard treatment for a range of conditions significantly improved MCS scores vs. standard treatment alone (MD=3.7 [0.4, 7.1; p<.03). Effects did not vary between music listening, therapy and singing intervention types or doses (p>.12); no evidence of small study or publication biases was present in any analysis (p>.31). Music impact on MCS scores meets SF-36 minimum important difference thresholds (MD>/=3) and is within the range of established interventions. Conclusions: This study provides Moderate quality evidence that music interventions can generally be used to provide clinically meaningful improvements in HRQOL. Further study is needed to determine optimal music interventions and doses for distinct clinical and public health scenarios. Funding: Alexander von Humboldt Foundation Registration: PROSPERO (ID: CRD42021276204)

scholarly journals Impact of low vision services on the quality of life of low vision patients in Ghana

2016 ◽  
Vol 75 (1) ◽  
Author(s):  
Godwin O. Ovenseri-Ogbomo ◽  
Harriette Osafo-Agyei ◽  
Ralph E.U. Akpalaba ◽  
James Addy ◽  
Elizabeth O. Ovenseri
Keyword(s):  
Quality Of Life ◽  
Visual Acuity ◽  
Positive Impact ◽  
Low Vision ◽  
Care Quality ◽  
Eastern Region ◽  
Post Intervention ◽  
Low Vision Clinic ◽  
The Impact

Patients’ perspectives on the impact of clinical interventions have been recognised as critical elements in patient care. Quality-of-life instruments are designed to measure these perspectives. We used the National Eye Institute’s 25-item Visual Function Questionnaire (NEI VFQ) to measure the impact of optical low vision devices on the quality of life of 22 low vision patients who obtained and were using low vision devices from a secondary low vision clinic in the Eastern Region, Ghana. The study employed a pre- and post-intervention technique. We found statistically significant improvements in measured visual acuity and NEI VFQ scores in 8 of the 10 domains evaluated. We conclude that optical low vision devices have a positive impact on the quality of life of low vision patients in Ghana.Keywords: low vision; quality of life; visual acuity; visual impairment; Ghana

The impact of an education intervention on the approach of hospital staff to patients with dementia in a Danish general hospital setting: An explanatory sequential mixed-methods study

2021 ◽  
pp. 205715852110229
Author(s):  
Annemarie Toubøl ◽  
Lene Moestrup ◽  
Katja Thomsen ◽  
Jesper Ryg ◽  
Dennis Lund Hansen ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Data Collection ◽  
General Hospital ◽  
Hospital Staff ◽  
Education Intervention ◽  
Post Intervention ◽  
Sequential Mixed Methods ◽  
Number Of Patients ◽  
The Impact ◽  
Dementia Education

The number of patients with dementia admitted to hospitals is increasing. However, the care and treatment of these patients tends to be suboptimal. A response to this is a widespread implementation of educational initiatives. Nevertheless, the effect of such initiatives is questioned. The aim of this study was to investigate the impact of a dementia education intervention by examining the self-reported outcomes of general hospital staff and exploring the staff’s experiences of these outcomes. An explanatory sequential mixed-methods design framed the study method. The quantitative data collection included repeated questionnaires: pre-intervention ( n = 849), one month post-intervention ( n = 618), and five months post-intervention ( n = 468) followed by a qualitative data collection using interviews ( n = 16). The GRAMMS guideline was followed. The integration of the quantitative and qualitative results suggests that the impact of the education intervention can be ascribed to the interdisciplinary focus, which facilitated a comprehensive commitment to creating careful solutions for patients with dementia. A prioritization of person over task seems to be assisted by an improved interdisciplinary cooperation initiated by the inclusion of all employed staff at the hospital in a dementia education intervention.

scholarly journals Impact of a Pharmacist-Driven Protocol to Improve Drug Allergy Documentation at a University Hospital

2013 ◽  
Vol 48 (4) ◽  
pp. 302-307 ◽  
Author(s):  
Christopher Burrell ◽  
Candy Tsourounis ◽  
David Quan ◽  
Vicki Jue ◽  
Eunice Tam ◽  
...  
Keyword(s):  
Drug Allergy ◽  
Age Groups ◽  
Substantial Improvement ◽  
University Hospital ◽  
Order Entry ◽  
Post Intervention ◽  
Pediatric Services ◽  
Physician Order Entry ◽  
The Impact

Background An internal evaluation of the inpatient pharmacy order entry database ( WORx) at a university hospital revealed that the nature of the reaction was documented for only 47% of patients with reported drug allergies/intolerance. Insufficient documentation of drug allergy/intolerance may result in administration of drugs that should not be prescribed. Similarly, valuable agents that should be used may not be prescribed due to an unnecessary fear of adverse drug reaction. More complete description of drug allergy/intolerance may result in more correct prescribing of medications. Objective Evaluate the impact of a pharmacist-driven protocol on the quality of drug allergy/intolerance documentation. Methods Four pre-intervention evaluations were conducted every 2 weeks documenting the completeness of drug allergy/intolerance information in the pharmacy order entry database. One week following the implementation of a pharmacist-driven protocol intended to improve the completeness of drug allergy/intolerance information, a series of 4 postintervention evaluations was repeated. Proportional analysis of pre- and postinterventional data was performed to evaluate the effectiveness of the intervention. Results A total of 1,686 allergies from 2,174 patients were reviewed pre and post intervention. The frequency of complete drug allergy/intolerance documentation pre intervention was 52% to 62%. Following implementation of the hospitalwide, pharmacist-driven protocol, this rate increased to 60% to 76%. Pediatric services demonstrated the most substantial improvement, increasing from 53% to 79% to 67% to 93%. Blank reaction fields decreased by 10% in both age groups. Conclusion A pharmacy-driven initiative intended to improve the completeness of drug allergy/intolerance documentation was associated with modest success. Other mechanisms, including electronic health record systems with computerized physician order entry and decision support, are needed to improve the completeness of drug allergy/intolerance information.

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