Effectiveness of ultrasound-guided cannulation of AVF on infiltration rates: A single center quality improvement study

2021 ◽  
pp. 112972982110342
Author(s):  
Vandana Dua Niyyar ◽  
Kunal Buch ◽  
Forest Rawls ◽  
Rodella Broxton
Keyword(s):  
Quality Improvement ◽  
The United States ◽  
Quality Improvement Initiative ◽  
Hemodialysis Access ◽  
Ultrasound Guided ◽  
Ultrasound Exposure ◽  
Infiltration Rates ◽  
The Impact ◽  
And Training ◽  
Dialysis Staff

Though ultrasonography is increasingly used throughout the spectrum of hemodialysis access, its role in outpatient dialysis units in the United States has been limited so far. This may, in part, be due to limited ultrasound exposure, knowledge and training of dialysis staff. We implemented a quality improvement initiative in our dialysis units to expand the use of ultrasound by our frontline dialysis staff to prospectively evaluate newly placed AVF and guide cannulation. This manuscript describes our experience and the impact of our protocol on infiltration rates in our outpatient HD units.

Ultrasound-based simulation for cannulation in outpatient hemodialysis units: An educational protocol

2019 ◽  
pp. 112972981989153 ◽  
Author(s):  
Vandana Dua Niyyar
Keyword(s):  
United States ◽  
Point Of Care ◽  
The United States ◽  
Hemodialysis Access ◽  
Ultrasound Guided ◽  
Ultrasound Exposure ◽  
Hands On ◽  
Diagnostic Capabilities ◽  
And Training ◽  
Dialysis Staff

Portable ultrasounds are often referred to as the “new stethoscope.” Their portability and affordability have led to improved diagnostic capabilities at the point of care in virtually every field of medicine, and hemodialysis access is no exception. However, though ultrasonography is increasingly used throughout the spectrum of hemodialysis access, its role in outpatient dialysis units in the United States has been limited so far. This may, in part, be due to limited ultrasound exposure, knowledge, and training of dialysis staff. This article details an educational protocol including hands-on simulation for training dialysis technicians and nurses in ultrasound-guided cannulation techniques.

Abstract 388: Quality Improvement in the Outpatient Setting: Observations from the PINNACLE Registry® 2009 Q4-2013 Q1

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Katie Kehoe ◽  
Sherry Shultz ◽  
Fran Fiocchi ◽  
Qiong Li ◽  
Thomas Shields ◽  
...  
Keyword(s):  
South Carolina ◽  
Quality Improvement ◽  
Office Visit ◽  
The United States ◽  
Outpatient Setting ◽  
Quality Improvement Initiative ◽  
The South ◽  
Improvement Program ◽  
Heart Center ◽  
Over Time

Title: Quality Improvement in the Outpatient Setting: Observations from the PINNACLE Registry® 2009 Q4-2013 Q1 Authors: Katie Kehoe BSN, MS 1 ; Sherry Shultz RN, BSN, CIO 2 ; Fran Fiocchi MPH 1 ; Qiong Li PhD 1 ; Thomas Shields 1 ; Charlie Devlin MD FACC, FACP, FASNC 2 ; Nathan T Glusenkamp, MA 1 ; J. Brendan Mullen 1 ; Angelo Ponirakis, PhD 1 ; 1 American College of Cardiology, Washington, DC 2 South Carolina Heart Center, Columbia SC Background: The PINNACLE Registry® at the American College of Cardiology is the first outpatient practice-based quality improvement program in the United States. Begun as a pilot program in 2007, the registry systematically collects and reports on adherence to clinical guidelines in the care of patients with coronary artery disease, hypertension, atrial fibrillation and heart failure. Over time, these reports offer a unique opportunity for Quality Improvement (QI) in the outpatient setting. The current study aimed to assess the effect of QI in the outpatient setting using PINNACLE Registry data. Methods: The South Carolina Heart Center is a cardiovascular practice in Columbia, South Carolina. There are 19 providers, 5 office locations and NextGen EMR. The practice’s Quality Committee and Board meet monthly to review PINNACLE reports and identify areas for QI. This Clinical Quality Improvement Initiative began 10 years ago and consists of physicians, nurses, administrators, medical assistants, a medical record analyst and information systems staff. During this review, providers’ data was not blinded to others. QI Interventions implemented included physician and staff education, improving documentation during the office visit, addition of necessary fields to capture missing data and routine planned internal audits. Between October 1, 2009 and March 31, 2013 a total of 161,873 patient encounters were submitted to the registry. A two-tailed z test was performed to assess the significance in percentage changes between 2009 to 2013. Results: The following table showed significant percentage changes in six performance measures indicating interventions implemented by the practice demonstrate significant quality improvement over time from 2009-2013. Conclusions: Utilizing their PINNACLE Registry reports, the South Carolina Heart Center identified several areas for QI. Implementing multiple interventions, this practice was able to significantly improve their PINNACLE Reports and the quality of care provided.

Improving the Timely Delivery of Antihypertensive Medication for Severe Perinatal Hypertension in Pregnancy and Postpartum

2021 ◽  
Author(s):  
Patrick Schneider ◽  
Patricia Ann Lee King ◽  
Lauren Keenan-Devlin ◽  
Ann E.B. Borders
Keyword(s):  
Quality Improvement ◽  
Postpartum Period ◽  
Care Team ◽  
Quality Improvement Initiative ◽  
Elevated Blood ◽  
Statistical Process ◽  
Pregnancy And Postpartum ◽  
Blood Pressures ◽  
The Impact ◽  
Timely Delivery

Objective Sustained blood pressures ≥160/110 during pregnancy and the postpartum period require timely antihypertensive therapy. Hospital-level experiences outlining the efforts to improve timely delivery of care within 60 minutes have not been described. The objective of this analysis was to assess changes in care practices of an inpatient obstetrical health care team following the implementation of a quality improvement initiative for severe perinatal hypertension during pregnancy and the postpartum period. Study Design In January 2016, NorthShore University HealthSystem Evanston Hospital launched a quality improvement initiative focusing on perinatal hypertension, as part of a larger, statewide quality initiative via the Illinois Perinatal Quality Collaborative. We performed a retrospective cohort study of all pregnant and postpartum patients with sustained severely elevated blood pressure (two severely elevated blood pressures ≤15 minutes apart) with baseline data from 2015 and data collected during the project from 2016 through 2017. Changes in clinical practice and outcomes were compared before and after the start of the project. Statistical process control charts were used to demonstrate process-behavior changes over time. Results Comparing the baseline to the last quarter of 2017, there was a significant increase in the administration of medication within 60 minutes for severe perinatal hypertension (p <0.001). Implementation of a protocol for event-specific debriefing for each severe perinatal hypertension episode was associated with increased odds of the care team administering medication within 60 minutes of the diagnosis of severe perinatal hypertension (adjusted odds ratio 3.20, 95% confidence interval 1.73–5.91, p < 0.01). Conclusion Implementation of a quality improvement initiative for perinatal hypertension associated with pregnancy and postpartum improved the delivery of appropriate and timely therapy for severely elevated blood pressures and demonstrated the impact of interdisciplinary communication in the process. Key Points

Use of a Structured Panel Process to Define Quality Metrics for Antimicrobial Stewardship Programs

2012 ◽  
Vol 33 (5) ◽  
pp. 500-506 ◽  
Author(s):  
Andrew M. Morris ◽  
Stacey Brener ◽  
Linda Dresser ◽  
Nick Daneman ◽  
Timothy H. Dellit ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antimicrobial Stewardship ◽  
Bloodstream Infections ◽  
The United States ◽  
Community Acquired Pneumonia ◽  
Public Reporting ◽  
Modified Delphi ◽  
Number Of Patients ◽  
Days Of Therapy ◽  
The Impact

Introduction.Antimicrobial stewardship programs are being implemented in health care to reduce inappropriate antimicrobial use, adverse events, Clostridium difficile infection, and antimicrobial resistance. There is no standardized approach to evaluate the impact of these programs.Objective.To use a structured panel process to define quality improvement metrics for evaluating antimicrobial stewardship programs in hospital settings that also have the potential to be used as part of public reporting efforts.Design.A multiphase modified Delphi technique.Setting.Paper-based survey supplemented with a 1-day consensus meeting.Participants.A 10-member expert panel from Canada and the United States was assembled to evaluate indicators for relevance, effectiveness, and the potential to aid quality improvement efforts.Results.There were a total of 5 final metrics selected by the panel: (1) days of therapy per 1000 patient-days; (2) number of patients with specific organisms that are drug resistant; (3) mortality related to antimicrobial-resistant organisms; (4) conservable days of therapy among patients with community-acquired pneumonia (CAP), skin and soft-tissue infections (SSTI), or sepsis and bloodstream infections (BSI); and (5) unplanned hospital readmission within 30 days after discharge from the hospital in which the most responsible diagnosis was one of CAP, SSTI, sepsis or BSI. The first and second indicators were also identified as useful for accountability purposes, such as public reporting.Conclusion.We have successfully identified 2 measures for public reporting purposes and 5 measures that can be used internally in healthcare settings as quality indicators. These indicators can be implemented across diverse healthcare systems to enable ongoing evaluation of antimicrobial stewardship programs and complement efforts for improved patient safety.

Reporting Catheter-Associated Urinary Tract Infections: Denominator Matters

2011 ◽  
Vol 32 (7) ◽  
pp. 635-640 ◽  
Author(s):  
Marc-Oliver Wright ◽  
Maureen Kharasch ◽  
Jennifer L. Beaumont ◽  
Lance R. Peterson ◽  
Ari Robicsek
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Quality Improvement Initiative ◽  
Infection Rates ◽  
Improvement Program ◽  
Nursing Unit ◽  
Accepted Practice ◽  
Device Associated Infection ◽  
Tract Infections ◽  
The Impact

Objective.To evaluate two different methods of measuring catheter-associated urinary tract infection (CAUTI) rates in the setting of a quality improvement initiative aimed at reducing device utilization.Design, Setting, and Patients.Comparison of CAUTI measurements in the context of a before-after trial of acute care adult admissions to a multicentered healthcare system.Methods.CAUTIs were identified with an automated surveillance system, and device-days were measured through an electronic health record. Traditional surveillance measures of CAUTI rates per 1,000 device-days (R1) were compared with CAUTI rates per 10,000 patient-days (R2) before (T1) and after (T2) an intervention aimed at reducing catheter utilization.Results.The device-utilization ratio declined from 0.36 to 0.28 between T1 and T2 (P< .001), while infection rates were significantly lower when measured by R2 (28.2 vs 23.2, P = .02). When measured by R1, however, infection rates trended upward by 6% (7.79 vs. 8.28, P = .47), and at the nursing unit level, reduction in device utilization was significantly associated with increases in infection rate.Conclusions.The widely accepted practice of using device-days as a method of risk adjustment to calculate device-associated infection rates may mask the impact of a successful quality improvement program and reward programs not actively engaged in reducing device usage.

scholarly journals A Lean Quality Improvement Initiative to Enhance Tobacco Use Treatment in a Cancer Hospital

2020 ◽  
Vol 17 (6) ◽  
pp. 2165 ◽  
Author(s):  
Colleen Meyer ◽  
Sara Mitra ◽  
Ellen Ruebush ◽  
Laurel Sisler ◽  
Kyle Wang ◽  
...  
Keyword(s):  
North Carolina ◽  
Quality Improvement ◽  
Tobacco Use ◽  
Treatment Effectiveness ◽  
Cancer Recurrence ◽  
Improve Patient Care ◽  
The United States ◽  
Quality Improvement Initiative ◽  
The North ◽  
Cancer Hospital

Sustained tobacco use after cancer diagnosis decreases treatment effectiveness while increasing treatment side effects, primary cancer recurrence, and the occurrence of secondary cancers. Delivering tobacco use treatment to fewer patients due to inefficient workflow represents missed opportunities to deliver life-saving care. In 2017, the National Cancer Institute initiated the Cancer Cessation Initiative (C3I) to push new tobacco cessation resources into cancer centers across the United States. This grant allowed the University of North Carolina Tobacco Treatment Program (UNC TTP) to dramatically expand tobacco use treatment (TUT) services to patients at the North Carolina Cancer Hospital (NCCH). With this push, the team saw an opportunity to utilize Lean Six Sigma, a set of quality improvement (QI) tools, to streamline their processes and uncover the root causes of program inefficiencies. A 12-month QI project using the Lean A3 problem-solving tool was implemented to examine the team’s workflow. The study team mapped out the processes and, as a result, developed multiple “experiments” to test within the NCCH to address workflow efficiency and clinical reach. Outcome measures from the baseline to follow-up included: (1) the number of new patient referrals per month, and (2) the number of counseling sessions delivered per month. From the baseline to final state, the team’s referrals increased from a mean of 10 to 24 per month, and counseling sessions increased from a mean of 74 to 84 per month. This project provided a deeper understanding of how workflow inefficiencies can be eliminated in the clinical setting, how technology can be harnessed to increase reach, and finally, that soliciting and using feedback from NCCH leadership can remove barriers and improve patient care.

scholarly journals Doctor Who? A Quality Improvement Project to Assess and Improve Patients' Knowledge of Their Inpatient Physicians

2016 ◽  
Vol 8 (2) ◽  
pp. 197-201 ◽  
Author(s):  
Kathleen Broderick-Forsgren ◽  
Wynn G Hunter ◽  
Ryan D Schulteis ◽  
Wen-Wei Liu ◽  
Joel C Boggan ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Audit And Feedback ◽  
Quality Improvement Initiative ◽  
Clinical Learning Environment ◽  
Improvement Project ◽  
Business Card ◽  
Quality Patient Care ◽  
White Board ◽  
White Boards ◽  
The Impact

ABSTRACT  Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program.Background  This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools—business cards and white boards—to improve provider identification.Objective  This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians. The before phase began in July 2013. From September 2013 to May 2014, physicians received education on business card and white board use.Methods  We surveyed 378 patients. Our intervention improved white board utilization (72.2% postintervention versus 54.5% preintervention, P &lt; .01) and slightly improved business card use (44.4% versus 33.7%, P = .07), but did not improve physician recognition. Only 20.3% (14 of 69) of patients could name their physician without use of the business card or white board. Data from all study phases showed the use of both tools improved patients' ability to name physicians (OR = 1.72 and OR = 2.12, respectively; OR = 3.68 for both; P &lt; .05 for all), but had no effect on photograph recognition.Results  Our educational intervention improved white board use, but did not result in improved patient ability to recognize physicians. Pooled data of business cards and white boards, alone or combined, improved name recognition, suggesting better use of these tools may increase identification. Future initiatives should target other barriers to usage of these types of tools.Conclusions

scholarly journals 2069

2017 ◽  
Vol 1 (S1) ◽  
pp. 43-44
Author(s):  
Carlton Hornung ◽  
Carolyn Thomas Jones ◽  
Terri Hinkley ◽  
Vicki Ellingrod ◽  
Nancy Calvin-Naylor
Keyword(s):  
Clinical Research ◽  
Data Management ◽  
Core Competencies ◽  
Safety Data ◽  
The United States ◽  
Education And Training ◽  
Development Ethics ◽  
The Impact ◽  
And Training ◽  
Research Professionals

OBJECTIVES/SPECIFIC AIMS: Clinical research in the 21st century will require a well-trained workforce to insure that research protocols yield valid and reliable results. Several organizations have developed lists of core competencies for clinical trial coordinators, administrators, monitors, data management/informaticians, regulatory affairs personnel, and others. While the Clinical Research Appraisal Inventory assesses the self-confidence of physician scientists to be clinical investigators, no such index exists to assess the competence of clinical research professionals who coordinate, monitor, and administer clinical trials. We developed the Competency Index for Clinical Research Professionals (CICRP) as a general index of competency (ie, GCPs) as well as sub-scales to assess competency in the specific domains of Medicines Development; Ethics and Participant Safety; Data Management; and Research Methods. METHODS/STUDY POPULATION: We analyzed data collected by the Joint Task Force on the Harmonization of Core Competencies from a survey of research professionals working in the United States and Canada. Respondents reported how competent they believed themselves to be on 51 clinical research core competencies. Factor analyzes identified 20 core competencies that defined a Competency Index for Clinical Research Professionals—General (CICRP-General, ie, GCPs) and 4 subindices that define specialized research functions: Medicines Development; Ethics and Participant Safety; Data Management; and Research Concepts. RESULTS/ANTICIPATED RESULTS: Factor analysis identified 20 core competencies that defined a Competency Index for Clinical Research Professionals—General (CICRP-General, ie, GCPs) and 4 subindices that define specialized research functions: Medicines Development; Ethics and Participant Safety; Data Management; and Research Concepts. DISCUSSION/SIGNIFICANCE OF IMPACT: These indices can be used to gage an individual’s readiness to perform general as well as more advanced research functions; to assess the education and training needs of research workers; and to evaluate the impact of education and training programs on the competency of research coordinators, monitors, and other clinical research team members.

scholarly journals Quality improvement initiative to reduce adverse effects associated with parenteral nutrition overfeeding

2018 ◽  
Vol 10 (1) ◽  
pp. 67-71 ◽  
Author(s):  
Andrew J Franck
Keyword(s):  
Quality Improvement ◽  
Amino Acid ◽  
Parenteral Nutrition ◽  
Outcome Measures ◽  
Liver Dysfunction ◽  
Bloodstream Infections ◽  
Quality Improvement Initiative ◽  
Refeeding Syndrome ◽  
The Mean ◽  
The Impact

ObjectiveParenteral nutrition (PN) overfeeding is a potential risk factor in the development of infections and other complications including hyperglycaemia, refeeding syndrome and liver dysfunction. This study was conducted to evaluate the impact of a quality improvement initiative to reduce PN overfeeding.DesignRetrospective cohort study of a quality improvement initiative.SettingA health system comprised of two US Department of Veterans Affairs medical centres.PatientsPatients receiving PN.InterventionsMethods to reduce overfeeding included the use of standardised PN products with lower dextrose to amino acid ratios, reduced use of intravenous lipid emulsion (ILE), and use of adjusted body weights or guideline-recommended predictive equations for energy requirements.Main outcome measuresThe primary outcome measures were the doses of kilocalories, amino acids and ILE in each cohort. The proportions of patients developing complications before and after the intervention were evaluated.ResultsThe mean maximum total daily kilocalorie dose was 30.2 kcal/kg/day in the preintervention group (n=86) vs 23.4 kcal/kg/day in the postintervention group (n=62) (p<0.001). More patients in the postintervention group received reduced ILE during the first week of PN therapy compared with the preintervention group (p<0.001). The mean maximum total daily amino acid dose in each group was not significantly different. Significantly fewer cases of central line-associated bloodstream infections, hyperglycaemia and liver dysfunction were observed in the postintervention group.ConclusionsA quality improvement initiative to reduce PN overfeeding was effective in reducing kilocalorie and ILE doses while maintaining similar amino acid doses. Observed complications were reduced following the intervention.

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