Procedural Sedation in Minor Procedure Rooms for Pediatric Myringotomy and Tympanostomy: A Quality Improvement Initiative

2021 ◽  
pp. 019459982110110
Author(s):  
Catherine F. Roy ◽  
Sena Turkdogan ◽  
Lily H. P. Nguyen ◽  
Jeffrey Yeung
Keyword(s):  
Quality Improvement ◽  
Wait Time ◽  
Procedural Sedation ◽  
Wait Times ◽  
Healthy Children ◽  
Tympanostomy Tube ◽  
Tube Insertion ◽  
Improvement Project ◽  
A Minor ◽  
Minor Procedure

Objective Lengthy wait times for elective surgery is a widespread health care system conundrum that may increase patient distress and jeopardize health outcomes. The primary aim of this quality improvement project was to reduce the surgical wait time in patients undergoing tympanostomy tube insertion. Methods As of January 2018, our tertiary care institution implemented a novel protocol whereby healthy children may undergo tympanostomy tube insertion in a minor procedure room under ketamine sedation administered by pediatric emergency physicians to address lack of both physical and anesthesia staffing resources. A retrospective study of all children undergoing elective tympanostomy tube insertion was conducted between September 1, 2017, and May 8, 2019, to assess wait time to surgery, as well as anesthesia-related and surgical complications. Results Procedural sedation in minor procedure rooms effectively decreased surgical wait times by 53 days (from 134 to 81 days, P < .001) at 16 months postimplementation. This new protocol was found to be safe and effective for healthy children, with no major surgical or anesthesia-related complications noted in 113 patients having undergone the procedure in the novel setting. Discussion Although conscious sedation by emergency physicians has been well studied across a variety of surgical procedures, its novel use in pediatric tympanostomy tube insertion requires careful patient selection to enhance accessibility while maintaining anesthetic safety. Implications for Practice This quality improvement project describes a novel combination of processes, using a minor procedure room space and ketamine-based procedural sedation to address surgical wait times in pediatric patients undergoing tympanostomy tube insertion.

Improving Wait Times for Elective Chemotherapy Through Pre-Preparation: A Quality-Improvement Project at the National University Cancer Institute of Singapore

2015 ◽  
Vol 11 (1) ◽  
pp. e89-e94 ◽  
Author(s):  
Thomas I Peng Soh ◽  
Yi Siew Tan ◽  
Zarinah Hairom ◽  
Mariana Ibrahim ◽  
Yao Yao ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Project ◽  
Wait Times ◽  
Improvement Project ◽  
National University

Pre-preparation of chemotherapy, together with effective telephone triaging, is an effective way to reduce chemotherapy wait times.

Barriers to receipt of novel oral oncolytics: A single-institution quality improvement investigation

2019 ◽  
Vol 26 (2) ◽  
pp. 279-285
Author(s):  
Ann A Wang ◽  
Christopher Tapia ◽  
Yasin Bhanji ◽  
Christopher Campbell ◽  
Daniel Larsen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Care Center ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Wait Times ◽  
Prescription Data ◽  
Electronic Prescription ◽  
Improvement Project ◽  
Pharmacy Claims ◽  
Oral Oncolytics

Introduction Novel oral oncolytic agents have become the standard of care and first-line therapies for many malignancies. However, issues impacting access to these drugs are not well explored. As part of a quality improvement project in a large tertiary academic institution, we aim to identify potential barriers that delay treatment for patients who are prescribed novel oral oncolytics. Methods This was a retrospective review of adults who were newly prescribed a novel oral oncolytic for Food and Drug Administration-approved indications at a single tertiary care center. Patients were identified via electronic prescription data (e-Scribe). Demographics, insurance information, and prescription dates were extracted from the electronic medical record and pharmacy claims data. Statistical analyses were performed to determine whether time-to-receipt was associated with insurance category, pharmacy transfers, cost assistance, and drug prescribed. Results Of the 270 successfully filled prescriptions, the mean time-to-receipt was 7.3 ± 10.3 days (range: 0–109 days). Patients with Medicare experienced longer time-to-receipt (9.1 ± 13.1 days) compared to patients with commercial insurance (4.4 ± 3.3). Uninsured patients experienced the longest time-to-receipt (15.7 ± 7.8 days) overall. Pharmacy transfers and cost assistance programs were also significantly associated with longer time-to-receipt. Ten prescriptions remained unfilled 90 days after the study period and were considered abandoned. Conclusion Insurance has a significant effect on the time-to-receipt of newly prescribed novel oral oncolytics. Pharmacy transfers and applying for cost assistance are also associated with longer wait times for patients. Our retrospective analysis identifies areas of improvement for future interventions to reduce wait times for patients receiving novel oral oncolytics.

Triage of Rheumatology Referrals Facilitates Wait Time Benchmarks

2016 ◽  
Vol 43 (11) ◽  
pp. 2064-2067 ◽  
Author(s):  
Chandra Farrer ◽  
Liza Abraham ◽  
Dana Jerome ◽  
Jacqueline Hochman ◽  
Natasha Gakhal
Keyword(s):  
Quality Improvement ◽  
Connective Tissue ◽  
Patient Outcomes ◽  
Inflammatory Arthritis ◽  
Wait Time ◽  
Wait Times ◽  
Referral Letter ◽  
Advanced Practice ◽  
Priority Ranking ◽  
Improve Patient

Objective.In 2014 the Canadian Rheumatology Association published wait time benchmarks for inflammatory arthritis (IA) and connective tissue disease (CTD) to improve patient outcomes. This study’s aim was to determine whether centralized triage and the introduction of quality improvement initiatives would facilitate achievement of wait time benchmarks.Methods.Referrals from September to November 2012 were retrospectively triaged by an advanced practice physiotherapist (APP) and compared to referrals triaged by an APP from January to March 2014. Each referral was assigned a priority ranking and categorized into one of 2 groups: suspected IA/CTD, or suspected non-IA/CTD. Time to initial consult and time to notification from receipt of referral were assessed.Results.A total of 558 (n = 227 and n = 331 from 2012 and 2014, respectively) referrals were evaluated with 35 exclusions. In 2012, there were 96 (42.5%) suspected IA/CTD and 124 (54.9%) suspected non-IA/CTD patients at the time of the initial consult. Mean wait times in 2012 for patients suspected to have IA was 33.8 days, 95% CI 27.8–39.8, compared to 37.3 days, 95% CI 32.9–41.7 in suspected non-IA patients. In 2014, there were 131 patients (43%) with suspected IA based on information in the referral letter. Mean wait times in 2014 for patients suspected to have IA was 15.5 days, 95% CI 13.85–17.15, compared to 52.2 days, 95% CI 46.3–58.1 for suspected non-IA patients. Time to notification of appointment improved from 17 days to 4.37 days.Conclusion.Centralized triage of rheumatology referrals and quality improvement initiatives are effective in improving wait times for priority patients as determined by paper referral.

scholarly journals A telephone assessment and advice service within an ED Physiotherapy clinic: A single-site quality improvement cohort study

2021 ◽  
Author(s):  
Marie Kelly ◽  
Anna Higgins ◽  
Adrian Murphy ◽  
Karen McCreesh
Keyword(s):  
Cohort Study ◽  
Quality Improvement ◽  
Usual Care ◽  
Wait Time ◽  
Single Site ◽  
Site Quality ◽  
Attendance Rates ◽  
Improvement Project ◽  
Face To Face ◽  
Advice Service

Abstract BackgroundIn response to issues with timely access and high non-attendance rates for Emergency Department (ED) physiotherapy, a telephone assessment and advice service was evaluated as part of a quality improvement project. This telehealth option requires minimal resources, with the added benefit of allowing the healthcare professional streamline care. A primary aim was to investigate whether this service model can reduce wait times and non-attendance rates, compared to usual care. A secondary aim was to evaluate service user acceptability.MethodsThis was a single-site quality improvement cohort study that compares data on wait time to first physiotherapy contact, non-attendance rates and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, X, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on wait time and non-attendance rates was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study.ResultsThose that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3 – 8 days) compared to those that opted for usual care (median 35 days; 19 – 39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction.ConclusionA telephone assessment and advice service may be useful in minimising delays for advice for those referred to ED Physiotherapy for musculoskeleltal problems. This telehealth option appears to be broadly acceptable and since it can be introduced rapidly, it may be helpful in triaging referrals and minimising face-to-face consultations, in line with COVID-19 recommendations. However, a large scale randomised controlled trial is warranted to confirm these findings.

scholarly journals Improving the wait time to admission by reducing bed rejections

2019 ◽  
Vol 8 (3) ◽  
pp. e000710
Author(s):  
Yuzeng Shen ◽  
Lin Hui Lee
Keyword(s):  
Quality Improvement ◽  
Wait Time ◽  
Wait Times ◽  
Quality Improvement Effort ◽  
Average Wait Time ◽  
Bed Management ◽  
Ward Level ◽  
Resultant Increase ◽  
Admissions Process ◽  
Improvement Effort

Congestion at the emergency department (ED) is associated with increased wait times, morbidity and mortality. We have identified prolonged wait time to admission as a significant contributor to ED congestion. One of the main contributors to prolonged wait time to admission was due to rejections by ward staff for the beds allocated to newly admitted patients by the Bed Management Unit (BMU). We have identified this as a systemic issue and through this quality improvement effort, seek to reduce the incidence of bed rejections for all admitted patients by 50% from 9% to 4.5% within 6 months. We used PDSA (Plan, Do, Study, Act) cycles to implement a series of interventions, such as updating legacy categorisation of wards, instituting a ‘no rejects’ policy and performing ward level audits. Compared with baseline, there was reduction in rejected BMU allocation requests from 9% to 5% (p<0.01). The monthly percentage of patients with at least one rejection dropped from an average of 7% to 4% (p<0.01). With reduction in the number of rejections, the average wait time to the final request acknowledged by the ward for all admission sources decreased from 2 hours 19 min to 1 hour (p<0.01), thereby allowing the overall wait time to admission to decrease by 68 min, from 5 hours 13 min to 4 hours 5 min. Improvements in the absolute duration and variance of wait times were sustained. Although the team’s initial impetus was to improve ED wait times, this hospital-wide effort improved wait times across all admission sources. There has been a resultant increase in ownership of the admissions process by both nursing and BMU staff. With the conclusion of this effort, we are looking to further reduce the wait time to admission by optimising the current bed allocation logic through another quality improvement effort.

The next generation of quality improvement at MSK: Turning chemotherapy process delays into chemo express.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18230-e18230
Author(s):  
Jennifer Tota ◽  
Kathleen Levine ◽  
Jeanine Gordon ◽  
Abigail Baldwin ◽  
Jodi Wald ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Patient Experience ◽  
Wait Time ◽  
Wait Times ◽  
Pilot Program ◽  
Treatment Results ◽  
Average Wait Time ◽  
Major Bottleneck ◽  
Work Done

e18230 Background: Chemotherapy wait times can dramatically affect patient experience. MSK’s largest outpatient facility has 76 infusion spaces and 250-300 daily visits. A retrospective review of the facility’s infusion area wait times suggested that the lab (where all patients go to get their vitals and blood drawn) was a major bottleneck leading to process delays in infusion. Methods: We conducted a pilot program using a multi-pronged approach. Our goal was to decrease wait time from 40 minutes to an average of 15 minutes. Our initiative was defined as follows: (1) to redefine lab parameters that are relevant for toxicity and to only consider drawing those necessary labs; additionally, we created guidelines for timing of the labs prior to infusion treatment, (2) to introduce a program known as “ChemoExpress” which offers patients the opportunity to get blood work done prior to the day of their infusion appointment. After the labs result, the outpatient RN calls the patient, assesses symptoms and “clears them” for treatment cueing the pharmacy to prepare and “premix” the drug on the day of treatment. Results: 150 patients have enrolled in ChemoExpress. Patient satisfaction was high based on patient satisfaction surveys (n = 20). Average wait time was 9 minutes (76% less) in ChemoExpress participants as compared to an average wait of 39 minutes for those who did not participate in ChemoExpress. Conclusions: Implementing a process that enables patients to have their bloodwork drawn prior to the day of treatment and drugs prepared in advance of their treatment appointment results in greater efficiency in the overall workflow. It also offers the patient a lower wait time and a more efficient and satisfying experience.

Protocol for stepped wedge cluster randomized trial to evaluate the effects of SurgeCon: A quality improvement emergency department surge management platform (Preprint)

2021 ◽  
Author(s):  
Hensley Mariathas ◽  
Shabnam Asghari ◽  
Oliver Hurley ◽  
Nahid Anaraki ◽  
Christina Young ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Health System ◽  
Wait Time ◽  
Cluster Randomized Trial ◽  
Wait Times ◽  
Hybrid Design ◽  
Stepped Wedge ◽  
Patient Reported ◽  
Cluster Randomized

BACKGROUND Despite many efforts, long wait time and overcrowding at Emergency Departments (EDs) have remained a significant health system issue in Canada. For several years, Canada has had one of the longest wait times among Organisation for Economic Co-operation and Development OECD countries. From the patient’s perspective, the challenge has been described as “patients wait in pain or discomfort for hours before being seen at EDs”. In this study, we propose an innovative quality-improvement intervention called SurgeCon that includes a protocol-driven software platform and several other initiatives to reduce wait times and improve the sustainability of health systems without significant workforce changes. We piloted SurgeCon at an ED in Carbonear, Newfoundland and Labrador (NL) and found there was a 32% reduction in ED wait time. OBJECTIVE Our primary objectives of the trial are to evaluate the effects of SurgeCon on ED performance based on length of stay (LOS), time to physician’s initial assessment (PIA), and the number of patients leaving the ED without being seen by a physician (LWBS), patient satisfaction and patient-reported experience with ED wait times. The ultimate goal of this study is to create better value care by reducing the per-patient cost of delivering ED services. METHODS This study will investigate the effects of SurgeCon on health system key performance outcomes and patient-reported experience and satisfaction. The study uses a comparative effectiveness-implementation hybrid design. This type of hybrid design has been recommended to help achieve rapid translational gains that can hasten the movement of interventions from research to practice to public health impact. In our hybrid design, we will use a pragmatic stepped wedge cluster randomized trial (SW-CRT) design that enrols four 24/7 on-site ED physician support (category A) hospitals into a 30-month trial. All clusters (hospitals) start with a baseline period of “usual care” and are randomized to determine the order and timing of transitioning to “intervention care” until all hospitals are exposed to the intervention condition for the remainder of the study. RESULTS Data collection for this study is ongoing. To date, 15 randomly selected patients have participated in telephone interviews concerning patient-reported experiences and patient satisfaction with ED wait times. CONCLUSIONS By evaluating the mechanisms behind the use of SurgeCon, we hope to be able to improve wait times and create better value ED care in this healthcare context. CLINICALTRIAL This study is registered in ClinicalTrials.gov NCT04789902

scholarly journals Improving Wait Time for Patients in a Pediatric Echocardiography Laboratory - a Quality Improvement Project

2018 ◽  
Vol 3 (3) ◽  
pp. e083 ◽  
Author(s):  
Anitha Parthiban ◽  
Ashley Warta ◽  
Jennifer A. Marshall ◽  
Kimberly J. Reid ◽  
Keith Mann ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Wait Time ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Echocardiography Laboratory ◽  
Pediatric Echocardiography

scholarly journals How does clinical space utilisation impact patient flow?

2019 ◽  
Vol 8 (3) ◽  
pp. e000542 ◽  
Author(s):  
Alexandra von Guionneau ◽  
Charlotte M Burford
Keyword(s):  
Quality Improvement ◽  
Waiting Time ◽  
Primary Outcome ◽  
Patient Flow ◽  
Waiting Times ◽  
Wait Time ◽  
Limiting Factor ◽  
Electronic Systems ◽  
Improvement Project ◽  
Medical Wards

BackgroundLong waiting times in accident and emergency (A&E) departments remain one of the largest barriers to the timely assessment of critically unwell patients. In order to reduce the burden on A&Es, some trusts have introduced ambulatory care areas (ACAs) which provide acute assessment for general practitioner referrals. However, ACAs are often based on already busy acute medical wards and the availability of clinical space for clerking patients means that these patients often face long waiting times too. A cheap and sustainable method to reducing waiting times is to evaluate current space utilisation with the view to making use of underutilised workspace. The aim of this quality improvement project was to improve accessibility to pre-existing clinical spaces, and in doing so, reduce waiting times in acute admissions.MethodsData were collected retrospectively from electronic systems and used to establish a baseline wait time from arrival to having blood taken (primary outcome). Quality improvement methods were used to identify potential implementations to reduce waiting time, by increasing access to clinical space, with serial measurements of the primary outcome being used to monitor change.ResultsData were collected over 54 consecutive days. The median wait time increased by 55 min during the project period. However, this difference in waiting time was not deemed significant between the three PDSA cycles (p=0.419, p=0.270 and p=0.350, Mann-Whitney U). Run chart analysis confirmed no significant changes occurred.ConclusionIn acute services, one limiting factor to seeing patients quickly is room availability. Quality improvement projects, such as this, should consider facilitating better use of available space and creating new clinical workspaces. This offers the possibility of reducing waiting times for both staff and patients alike. We recommend future projects focus efforts on integration of their interventions to generate significant improvements.

scholarly journals A telephone assessment and advice service within an ED physiotherapy clinic: a single-site quality improvement cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Marie Kelly ◽  
Anna Higgins ◽  
Adrian Murphy ◽  
Karen McCreesh
Keyword(s):  
Cohort Study ◽  
Quality Improvement ◽  
Usual Care ◽  
Wait Time ◽  
Single Site ◽  
Site Quality ◽  
Attendance Rates ◽  
Improvement Project ◽  
Face To Face ◽  
Advice Service

Abstract Background In response to issues with timely access and high non-attendance rates for Emergency Department (ED) physiotherapy, a telephone assessment and advice service was evaluated as part of a quality improvement project. This telehealth option requires minimal resources, with the added benefit of allowing the healthcare professional streamline care. A primary aim was to investigate whether this service model can reduce wait times and non-attendance rates, compared to usual care. A secondary aim was to evaluate service user acceptability. Methods This was a single-site quality improvement cohort study that compares data on wait time to first physiotherapy contact, non-attendance rates and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, XMercy University Hospital, Cork, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on wait time and non-attendance rates was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study. Results Those that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3–8 days) compared to those that opted for usual care (median 35 days; 19–39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction. Conclusion A telephone assessment and advice service may be useful in minimising delays for advice for those referred to ED Physiotherapy for musculoskeleltal problems. This telehealth option appears to be broadly acceptable and since it can be introduced rapidly, it may be helpful in triaging referrals and minimising face-to-face consultations, in line with COVID-19 recommendations. However, a large scale randomised controlled trial is warranted to confirm these findings.

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