scholarly journals Dynamic Triaging Using Quality Improvement (QI) Methodology to Prevent the Admission of Asymptomatic COVID Positive Obstetric Patients

2020 ◽  
pp. 016327872097103
Author(s):  
Manju Puri ◽  
Swati Agrawal ◽  
Anuradha Singh ◽  
Lata Singh ◽  
Kiran Aggarwal ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Tertiary Hospital ◽  
New Delhi ◽  
Test Results ◽  
Effective Strategies ◽  
Testing Strategies ◽  
Action Team ◽  
Care Workers ◽  
Green Zone ◽  
Spread Of Infection

A single undiagnosed COVID-19 positive patient admitted in the green zone has the potential to infect many Health Care Workers (HCWs) and other patients at any given time with resultant spread of infection and reduction in the available workforce. Despite the existing triaging strategy at the Obstetric unit of a tertiary hospital in New Delhi, where all COVID-19 suspects obstetric patients were tested and admitted in orange zone and non-suspects in green zone, asymptomatic COVID-19 positive patients were found admitted in the green zone. This was the trigger to undertake a quality improvement (QI) initiative to prevent the admission of asymptomatic COVID-19 positive patients in green zones. The QI project aimed at reducing the admission of COVID-19 positive patients in the green zone of the unit from 20% to 10% in 4 weeks’ time starting 13/6/2020 by means of dynamic triaging. A COVID-19 action team was made and after an initial analysis of the problem multiple Plan-Do-Study-Act (PDSA) cycles were run to test the change ideas. The main change ideas were revised testing strategies and creating gray Zones for patients awaiting COVID-19 test results. The admission of unsuspected COVID-19 positive cases in the green zone of the unit reduced from 20% to 0% during the stipulated period. There was a significant reduction in the number of HCWs, posted in the green zone, being quarantined or test positive for COVID-19 infection as well. The authors conclude that Quality Improvement methods have the potential to develop effective strategies to prevent spread of the deadly Corona virus.

Importance of the universal precautions among health care personnel and its impact against Covid-19 spread - A survey

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 675-684
Author(s):  
Preethi Shankar ◽  
Abilasha R ◽  
Preetha S
Keyword(s):  
Health Care ◽  
Statistical Analysis ◽  
Health Care Workers ◽  
Medical Personnel ◽  
Health Care Personnel ◽  
Universal Precaution ◽  
Universal Precautions ◽  
Care Workers ◽  
Standard Set ◽  
Spread Of Infection

Universal precautions are a vital standard set of rules applied to be followed by patients and doctors while carrying out any clinical procedure, but especially in patients with blood-borne diseases or infections. It is carried out to prevent the spread of infection from one person to another. Universal precautions are of great significance to medical personnel, where they expose themselves to numerous infectious diseases. The research aimed to assess and improve knowledge about universal precautions among health care personnel to reduce the rate of harmful exposure and infections among them. A questionnaire comprising 20 questions was created and circulated among 100 health care workers through the online platform "Google forms". The results were collected and analysed. Statistical analysis was performed using SPSS. It was evident that many people were not aware of the seriousness of universal precautions. Fortunately, many medical personals followed and were aware of universal precaution to an extent. Universal precaution should be followed religiously and judiciously to prevent the spread of deadly diseases.

scholarly journals Predicting mortality in adults with suspected infection in a Rwandan hospital: an evaluation of the adapted MEWS, qSOFA and UVA scores

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e040361
Author(s):  
Amanda Klinger ◽  
Ariel Mueller ◽  
Tori Sutherland ◽  
Christophe Mpirimbanyi ◽  
Elie Nziyomaze ◽  
...  
Keyword(s):  
Decision Making ◽  
Quality Improvement ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Tertiary Hospital ◽  
Early Warning Score ◽  
Receiver Operating Curve ◽  
Predictive Capacity ◽  
Suspected Infection ◽  
Significant Difference

RationaleMortality prediction scores are increasingly being evaluated in low and middle income countries (LMICs) for research comparisons, quality improvement and clinical decision-making. The modified early warning score (MEWS), quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and Universal Vital Assessment (UVA) score use variables that are feasible to obtain, and have demonstrated potential to predict mortality in LMIC cohorts.ObjectiveTo determine the predictive capacity of adapted MEWS, qSOFA and UVA in a Rwandan hospital.Design, setting, participants and outcome measuresWe prospectively collected data on all adult patients admitted to a tertiary hospital in Rwanda with suspected infection over 7 months. We calculated an adapted MEWS, qSOFA and UVA score for each participant. The predictive capacity of each score was assessed including sensitivity, specificity, positive and negative predictive value, OR, area under the receiver operating curve (AUROC) and performance by underlying risk quartile.ResultsWe screened 19 178 patient days, and enrolled 647 unique patients. Median age was 35 years, and in-hospital mortality was 18.1%. The proportion of data missing for each variable ranged from 0% to 11.7%. The sensitivities and specificities of the scores were: adapted MEWS >4, 50.4% and 74.9%, respectively; qSOFA >2, 24.8% and 90.4%, respectively; and UVA >4, 28.2% and 91.1%, respectively. The scores as continuous variables demonstrated the following AUROCs: adapted MEWS 0.69 (95% CI 0.64 to 0.74), qSOFA 0.65 (95% CI 0.60 to 0.70), and UVA 0.71 (95% CI 0.66 to 0.76); there was no statistically significant difference between the discriminative capacities of the scores.ConclusionThree scores demonstrated a modest ability to predict mortality in a prospective study of inpatients with suspected infection at a Rwandan tertiary hospital. Careful consideration must be given to their adequacy before using them in research comparisons, quality improvement or clinical decision-making.

Gaps in Diabetic Ketoacidosis Management at a Tertiary Hospital: Need for Quality Improvement

2017 ◽  
Vol 41 (5) ◽  
pp. S53
Author(s):  
Angela Assal ◽  
Bikrampal Sidhu ◽  
Christine Ibrahim ◽  
Vithika Sivabalasundaram ◽  
Ilana Halperin ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Diabetic Ketoacidosis ◽  
Tertiary Hospital

scholarly journals 227 Multiple Outbreak Of SARS-COVID-19 In Surgical Wards at The Tertiary Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B B Karki ◽  
S Mohammad ◽  
W Chung ◽  
A Eltweri ◽  
T Sauodi ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Test Results ◽  
Social Distancing ◽  
Staff Members ◽  
Preventative Measures ◽  
Laboratory Capacity ◽  
Risk Areas ◽  
Communal Areas ◽  
Initial Source ◽  
Source Number

Abstract Background Since the second surge of SARS-COVID-19 on 18th of September, additional several measures were introduced, and pathways created in order to execute safe surgical practices and protect both patients and staff from SARS-COVID-19. Despite these measures, there have been reported cases of outbreaks in various parts of UK amongst patients and clinical staff. Method Three outbreaks in the past 6 weeks (10, September 2020 to 21, October 2020) were reported in our surgical wards and we compiled the timing, initial source, number of affected individuals and immediate management steps taken. Results Following the first outbreak on wards, 28-day surveillance helped us understand responsible variants. Several staff members were found walking out of hospital, in groups once they had removed their PPEs. Communal lunching with inadequate social distancing, attending work with symptoms (albeit atypical for COVID), sharing cars to/from work or not wearing PPE correctly were highlighted in the subsequent investigations. The reduction in number of affected individuals during the last two incidents reflected a degree of efficacy of the implemented preventative measures, which were reviewed again following the subsequent incidents. Conclusions In the present climate, a robust and prompt response to outbreaks is required. Continual iteration with regards to the need for PPE, adequate social distancing and avoiding over-crowding in communal areas is paramount to reduce the probability of ward outbreaks and inter-professional transmission. Asymptomatic staff testing, particularly in high-risk areas could also be considered but would require adequate laboratory capacity and rapid turnaround of test results.

scholarly journals Impact of COVID-19 on healthcare workers at a cancer care centre

2021 ◽  
Author(s):  
Atika Dogra ◽  
Anuj Parkash ◽  
Anurag Mehta ◽  
Meenu Bhatia
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Front Line ◽  
Care Workers ◽  
Front Line Workers ◽  
Severity Of The Disease ◽  
Novel Coronavirus ◽  
Spread Of Infection ◽  
The Impact

ABSTRACTBackgroundThe services of front-line health care workers (HCWs) have been paramount in the management of novel coronavirus disease 2019 (COVID-19). Health care professionals have been at high occupational risk of getting disease and even dying of the disease, however; they have been the subject of very limited studies in terms of COVID-19. The objectives of this study are to examine the incidence and the impact of COVID-19 infection among HCWs in terms of recovery, productivity, quality of life (QOL) and post-COVID complications.Materials and MethodsThis was a retrospective, questionnaire based study including demographic details, workplace characteristics, symptoms, source/ spread of infection, details of recovery and the consequences of COVID-19 comprising impaired productivity/ QOL, post-COVID-19 complications and others. The data were analyzed by using IBM SPSS software (Version 23, SPSS Inc., Chicago, IL, USA).Results and ConclusionsOut of a total of 1482 employees, 18.3% (271) were laboratory confirmed to have contracted novel contagion during the study period of 5 months. The median age at diagnosis was 29 (range, 21-62) years. Front-line workers and female workers were the most infected personnel with COVID-19. Flu-like symptoms were the most frequently experienced symptoms. The median time for recovery was 20 (range, 2-150) days. The relationship between pre-existing comorbidities and age was highly significant. The QOL and productivity were associated with pre-existing comorbidities, severity of the disease, time for recovery and post-COVID syndrome. More than a half (51.8%) of all HCWs had suffered from post-COVID complications. There was no fatality reported due to COVID-19. The post-COVID complications were related to pre-existing comorbidities, severity of disease, time for recovery and status of recovery. Further research to explore the consequences of COVID-19 is warranted. The general public needs to be aware of symptoms and management of the post-COVID syndrome.

Spread of NDM-producing Klebsiella pneumoniae in a tertiary Greek hospital

2021 ◽  
Author(s):  
Κonstantina Kontopoulou ◽  
Georgios Meletis ◽  
Styliani Pappa ◽  
Sofia Zotou ◽  
Katerina Tsioka ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Rapd Analysis ◽  
Random Amplified Polymorphic Dna ◽  
Hospital Setting ◽  
Tertiary Hospital ◽  
Whole Genome Sequence ◽  
Health Concern ◽  
Resistant Bacteria ◽  
New Delhi ◽  
Whole Genome

AbstractBacterial carbapenem resistance, especially when mediated by transferable carbapenemases, is of important public health concern. An increased number of metallo-β-lactamase (MBL)-producing Klebsiella pneumoniae strains isolated in a tertiary hospital in Thessaloniki, Greece, called for further genetic investigation.The study included 29 non-repetitive carbapenem resistant K. pneumoniae isolates phenotypically characterized as MBL-producers collected in a tertiary hospital in Greece. The isolates were screened for the detection of carbapenemase genes (K. pneumoniae carbapenemase (blaKPC), Verona-integron-encoded MBL-1 (blaVIM-1), imipenemase (blaIMP), oxacillinase-48 (blaOXA-48) and New Delhi MBL (blaNDM)). The genetic relationship of the isolates was determined by Random Amplified Polymorphic DNA (RAPD) analysis. The whole genome sequences (WGS) from two NDM-positive K. pneumoniae isolates were further characterized.The presence of New Delhi MBL (blaNDM) gene was confirmed in all K. pneumoniae isolates, while blaKPC and blaVIM-1 genes were co-detected in one and two isolates, respectively. The RAPD analysis showed that the isolates were clustered into two groups. The whole genome sequence analysis of two K. pneumoniae isolates revealed that they belonged to the sequence type 11, they carried the blaNDM-1 gene, and exhibited differences in the number and type of the plasmids and the resistant genes.All MBL-producing K. pneumoniae isolates of the study harbored a blaNDM gene, while WGS analysis revealed genetic diversity in resistance genes. Continuous surveillance is needed to detect the emergence of new clones in a hospital setting, while application of antimicrobial stewardship is the only way to reduce the spread of multi-resistant bacteria.

scholarly journals Resident-led organizational initiatives to reduce burnout and improve wellness

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sundus Mari ◽  
Rachel Meyen ◽  
Bo Kim
Keyword(s):  
Quality Improvement ◽  
Residency Training Program ◽  
Well Being ◽  
Control Group ◽  
Preventative Care ◽  
Quality Improvement Effort ◽  
Action Team ◽  
Resident Wellness ◽  
Resident Burnout ◽  
Continuous Feedback

Abstract Background Professional burnout among medical trainees has been identified as a national concern in need of attention. A significant challenge for residency programs is designing and implementing effective strategies to promote resident wellness and reduce burnout. Emerging evidence highlights the importance of developing organizational changes targeting physician burnout. Methods To address this critical need, Harvard South Shore (HSS) Psychiatry Residency Training Program aimed to assess burnout among residents, identify areas for wellness-related growth, and implement strategies for organizational change to reduce burnout and increase wellness. We aligned closely to the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines to systematically approach planning, conducting, and evaluating this quality improvement effort. We developed a wellness action team and assessed burnout using the Copenhagen Burnout Inventory (CBI). We also conducted a survey to investigate high opportunity areas for wellness-related growth and using this data we designed and implemented four organizational initiatives to (i) improve residents’ on-call experience, (ii) increase social activities, (iii) support preventative care, and (iv) promote wellness education. We then re-assessed burnout 1 year after implementation and performed two-sample t-tests to compare CBI scores. We additionally gathered and analyzed feedback from residents on the implemented organizational initiatives’ relevance to wellness and their well-being. Results There was an overall clinically meaningful reduction in burnout averaged among all residents that participated. Participants indicated that fitness-oriented activities were most likely to lead to change in wellness habits. Conclusion Our implemented wellness program was resident-led and involved continuous feedback from both residents and leadership. Given that there may be multiple factors that affect resident burnout, future studies involving a control group could help reveal whether our intervention contributed to the change in burnout scores we observed.

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