Managing Access by Generating Improvements in Cannulation: A national quality improvement project

2020 ◽  
pp. 112972982093933
Author(s):  
Catherine Ann Fielding ◽  
Scott William Oliver ◽  
Alison Swain ◽  
Alayne Gagen ◽  
Sarah Kattenhorn ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Best Practice ◽  
Quality Improvement Project ◽  
Practical Implementation ◽  
Improvement Project ◽  
The United Kingdom ◽  
National Quality ◽  
Arteriovenous Access ◽  
Structure Improvement ◽  
Improvement Method

Cannulation is essential for haemodialysis with arteriovenous access, but also damages the arteriovenous access making it prone to failure, is associated with complications and affects patients’ experiences of haemodialysis. Managing Access by Generating Improvements in Cannulation is a national UK quality improvement project, designed to improve cannulation practice in the United Kingdom, ensuring it reflects current needling recommendations. It uses a simple quality improvement method, the Model for Improvement, to structure improvement to cannulation practice. It assists units in the practical implementation of the British Renal Society and Vascular Access Society of Britain and Ireland needling recommendations, ensuring actual cannulation practice reflects what is defined as best practice in cannulation. An eLearning package and awareness materials have been developed, to assist units in changing their cannulation practice. The Kidney Quality Improvement Partnership provides a structure for Managing Access by Generating Improvements in Cannulation that promotes development and dissemination. It is hoped that Managing Access by Generating Improvements in Cannulation will raise an understanding about the cannulation of arteriovenous access and change behaviours and beliefs around correct cannulation practice, to ensure longevity of this lifeline.

Abstract 267: A Single-page Best Practice Algorithm Reduces Stroke Risk and Improves Arrhythmia Management Decisions in Patients With Acute Atrial Fibrillation: A Quality Improvement Project

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Edd Maclean ◽  
Shreena Patel ◽  
Olaminposi Joseph ◽  
Daniella de Block Golding ◽  
Samantha Maden ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Quality Improvement ◽  
Best Practice ◽  
Stroke Risk ◽  
International Standards ◽  
Quality Improvement Project ◽  
Management Decisions ◽  
Improvement Project ◽  
Management Algorithm ◽  
Arrhythmia Management

Objectives: In response to a serious incident involving an atrial fibrillation (AF) associated stroke, a quality improvement project was established to examine and abrogate unnecessary thromboembolic risk in patients presenting with acute AF to London’s North Middlesex University Hospital (NMUH). Methods: The presenting complaint was examined for 2,105 consecutive medical admissions to identify 100 patients (4.7%) with acute AF. For each patient, 36 indices and performance indicators were collected and analysed against international standards and the collective best practice of the local Cardiology team. Deficiencies were identified throughout the inpatient experience, including documentation, risk stratification, anticoagulation and arrhythmia management decisions. With cross-specialty collaboration, a single-page AF management algorithm was subsequently established using sequential PDSA methodology, and following its introduction a further 100 consecutive patients with acute AF were analysed prospectively. Results: Algorithm implementation significantly reduced the proportion of patients exposed to unnecessary stroke risk (30% -> 4%, p<0.0001); improved identification and documentation of thromboembolic potential (50% -> 88%, p<0.0001), reduced incorrect drug decisions (12% -> 2%, p=0.01), reduced contraindicated rhythm control (8% -> 0%, p=0.007), and increased direct oral anticoagulant (DOAC) prescribing (38% -> 86%, p<0.0001) over warfarin. There was a trend towards reduced mean inpatient stay (4.7 -> 3.5 days, p=0.11). Conclusions: Using established quality improvement methodology and cost-neutral multi-disciplinary expertise, this novel management algorithm has significantly improved the quality and safety of care for patients with acute AF at NMUH. Prospective analysis of long-term adverse outcomes is now required to establish morbidity or mortality benefit.

Abstract 34: Kentucky Stroke Encounter Quality Improvement Project Statewide Collaboration to Improve Alteplase Utilization, Decrease Door to Needle Times, and Impact Outcomes: A 10 Year Review

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kari D Moore ◽  
Lynn Hundley ◽  
Polly Hunt ◽  
Bill Singletary ◽  
Allison Merritt ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Best Practices ◽  
Best Practice ◽  
Systems Of Care ◽  
Quality Improvement Project ◽  
Complication Rates ◽  
Improvement Project ◽  
Face To Face ◽  
Data Tracking ◽  
Stroke Systems Of Care

Background: Evidence shows systems change interventions improve care and outcomes for stroke patients. Geopolitical boundaries have been a barrier to improving regional systems of care. Despite efforts nationally, regionally, and locally alteplase use for ischemic stroke has remained low and door to needle (DTN) times exceeded 60 minutes. Kentucky created the Stroke Encounter Quality Improvement Project (SEQIP) in 2009 to share best practices and improve stroke systems of care across the Commonwealth. Purpose: The aim was to utilize and share best practice models among 23 SEQIP hospitals in KY to improve tPA utilization, decrease DTN times, and improve outcomes. Methods: Hospitals implemented a statewide quality improvement plan focused on identifying barriers, removing barriers, and implementing best practice strategies regarding thrombolytic therapy. Accountability was achieved with ongoing GWTG data tracking, teleconferences, and face to face meetings from January 2009 through December 2018 sharing strategies and solutions for best practice. Results: SEQIP’s participating hospitals achieved significant improvement in thrombolytic administration over 10 years. The percent of all AIS patients receiving tPA increased from 4.61% in 2009 to 8.80% in 2018 (OR=2.0, p <0.0001). Alteplase use in eligible patients arriving by 2 hours and treated by 3 hours improved from 59.6% to 88.5% (OR=5.2, p <0.0001). Alteplase use in eligible patients arriving by 3.5 hours to 4.5 hours increased from 24.9% to 55.1% (OR=5.0, p <0.0001). Median DTN times decreased from 74 minutes to 49 minutes (p<0.0001). Complication rates of symptomatic hemorrhage were consistent with NINDS data and < 6% from 2009-2018. The tPA in-hospital mortality rate in 2009 was 11.7% and by 2018, decreased to 3.6% (p=0.00016). In 2009, 28.4% of tPA patients were discharged home and by 2018, that had increased to 47.9% (p <0.00001). In 2009, 32.1% of tPA patients were able to walk independently at d/c and by 2018 had increased to 43.6% (p = 0.00359). Conclusions: Geopolitical boundaries can be overcome and collaboration can be sustained among competing hospitals through sharing of best practices to safely increase utilization of tPA in eligible patients, decrease DTN times, and improve outcomes.

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