scholarly journals Improving facilitation of ECT treatment for patients in an acute medical hospital

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S42-S42
Author(s):  
Vatsala Mishra ◽  
Chun Chiang Sin Fai Lam ◽  
Marilia Calcia ◽  
Isabel McMullen
Keyword(s):  
Patient Safety ◽  
Clinical Outcomes ◽  
Psychiatric Patients ◽  
Severe Depression ◽  
Liaison Psychiatry ◽  
Improvement Project ◽  
Initial Intervention ◽  
Delayed Recovery ◽  
Medical Teams ◽  
Operational Aspects

AimsA Quality Improvement Project aiming to streamline facilitation of electroconvulsive therapy (ECT) treatment for psychiatric patients at a general acute hospital and reduce cancellation rates via the use of a checklist.ECT treatment is an essential aspect of psychiatric care for patients with severe depression or treatment-resistant psychosis. Facilitation of ECT treatment is an uncommon task for liaison psychiatry and the medical and nursing teams responsible for patients’ medical care. Between August-October 2019, this liaison psychiatry team had 3 patients undergoing ECT treatment a total of 13 times, with treatment being cancelled on 4 occasions. After engagement with stakeholders from the acute medical teams, the liaison team and the ECT suite team, key areas requiring intervention were identified to help reduce the rates of cancellation. Areas identified included a lack of ownership on the logistic and operational aspects of ECT amongst staff, a lack of knowledge of what the process involved and a lack of confidence in managing said patients. Difficulties in communication between teams and accurate documentation may contribute to errors and cancellation of ECT sessions, which in turn would delay treatment and impact on patient safety and clinical outcomes.MethodThe first author, a Foundation Year 1 doctor, developed a 10-point checklist to be referred to when arranging ECT for patients, to ensure errors were not made which could lead to missed treatment and delayed recovery. The tasks and responsibilities of each key member of the team were clearly identified. This checklist was included in all ECT patients’ files and teaching was provided to staff involved. Feedback was obtained from staff involved regarding the clarity of information and their confidence in managing such cases.ResultIn the month following initial intervention the liaison psychiatry team organised 12 ECT sessions. The checklist was pasted into notes the day before each ECT session and 0 sessions were missed for avoidable reasons. Feedback from staff showed all teams felt more confident co-ordinating ECT treatment as a result of the checklist.ConclusionCreating a 10-point checklist for the facilitation of ECT treatment in patients at a medical hospital was beneficial in reducing avoidable errors from 16% to 0%. The liaison psychiatrists, medical doctors, and nurses involved reported greater confidence in managing patients undergoing ECT and described the checklist as enhancing the feeling of teamwork and communication within the multi-disciplinary team, and felt it had improved patient safety and clinical outcomes.

scholarly journals OR and ICU teams ‘running in parallel’ at the end of cardiothoracic surgery improves perceptions of handoff safety

2021 ◽  
Vol 10 (1) ◽  
pp. e001001
Author(s):  
Safraz Hamid ◽  
Frederic Joyce ◽  
Aaliya Burza ◽  
Billy Yang ◽  
Alexander Le ◽  
...  
Keyword(s):  
Patient Safety ◽  
Cardiac Surgery ◽  
Safety Culture ◽  
Positive Response ◽  
Improve Patient Safety ◽  
Health Care Research ◽  
Response Rates ◽  
Patient Safety Culture ◽  
Improvement Project ◽  
Surgery Patient

The transfer of a cardiac surgery patient from the operating room (OR) to the intensive care unit (ICU) is both a challenging process and a critical period for outcomes. Information transferred between these two teams—known as the ‘handoff’—has been a focus of efforts to improve patient safety. At our institution, staff have poor perceptions of handoff safety, as measured by low positive response rates to questions found in the Agency for Health Care Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPS). In this quality improvement project, we developed a novel handoff protocol after cardiac surgery where we invited the ICU nurse and intensivist into the OR to receive a face-to-face handoff from the circulating nurse, observe the final 30 min of the case, and participate in the end-of-case debrief discussions. Our aim was to increase the positive response rates to handoff safety questions to meet or surpass the reported AHRQ national averages. We used plan, do, study, act cycles over the course of 123 surgical cases to test how our handoff protocol was leading to changes in perceptions of safety. After a 10-month period, we achieved our aim for four out of the five HSOPS questions assessing safety of handoff. Our results suggest that having an ICU team ‘run in parallel’ with the cardiac surgical team positively impacts safety culture.

Incidence and Association of Patient Safety Indicator 9 (Perioperative hemorrhage or hematoma) and clinical outcomes in Cardio-thoracic surgery hospital, Ain Shams University, Egypt

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mahi M Al-Tehewy ◽  
Sara E. M Abd AlRazak ◽  
Maha M Wahdan ◽  
Tamer S. F Hikal
Keyword(s):  
Patient Safety ◽  
Incidence Rate ◽  
Clinical Outcomes ◽  
Improve Patient Safety ◽  
Cardiothoracic Surgery ◽  
Patient Safety Indicators ◽  
Risk Of Death ◽  
Safety Indicator ◽  
Perioperative Hemorrhage

Abstract Background Patient Safety Indicators (PSIs) were developed as a tool for hospitals to identify potentially preventable complications and improve patient safety performance. Aim the study aimed to measure the association between the AHRQ patient safety indicator PSI9 (Perioperative hemorrhage or hematoma) and the clinical outcome including death, readmission within 30 days and length of stay at the cardiothoracic surgery hospital Ain Shams University. Methods exploratory prospective cohort study was conducted to follow up patients from admission till 1 month after discharge at the cardiothoracic surgery hospital who fulfills the inclusion criteria. Data were collected for 330 patients through basic information sheet and follow-up sheet. Results the incidence rate of PSI9 was 49.54 per 1000 discharges. Demographic data was not significantly associated with increased incidence of PSI9. The risk of development of PSI9 was significantly higher in patients admitted directly to ICU [relative risk (RR) =5.6]. The risk of death and readmission was higher in cases developed PSI9 than the cases without PSI9 [RR = 2.40 (0.60-9.55) and 2.43 (0.636 - 9.48) respectively]. Conclusion high incidence rate of PSI9 and the incidence is higher in male gender and 60 years old and more patients. Those patients developed PSI9 were at high risk for readmission and death. Recommendations the hospital administration should consider strategies and policies to decrease the rate of PSI9 and subsequent unfavorable clinical outcomes.

Depression impact on the sexual desire

2011 ◽  
Vol 26 (S2) ◽  
pp. 1549-1549
Author(s):  
M. Lourenço ◽  
L.P. Azevedo ◽  
J.L. Gouveia
Keyword(s):  
Sexual Desire ◽  
Depressive Symptomatology ◽  
Psychiatric Patients ◽  
Severe Depression ◽  
List Type ◽  
Sexual Performance ◽  
Average Value ◽  
Treatment Of Depression ◽  
The One ◽  
The Relationship

IntroductionDepression as a pathology and the side effects of pharmacology therapy have been pointed proven to be as responsible for the lack of sexual desire. Among the drugs used in the treatment of depression, anti-depressives are the ones mostly connected to sexual dysfunction.Aims /objectivesTo study the relationship between depression and its impact on the sexual desire in psychiatric patients.MethodsThe chosen sample is composed of 89 subjects, 73 females and 16 males, with ages ranging from 21 to 70 years, who present with depressive symptomatology (mild to moderate symptomatology (MMS) and severe symptomatology (SS).To each patient 3 instruments were applied: 1)Questionnaire used to collect demographic and clinical data from the sample;2)Instrument of estimation of the depression degree (BDI - Beck Depression Inventory);3)Instrument of valuation of the sexual desire (SDS - Sexual Desire Scale).ResultsDepression average value obtained with BDI was 25.58 (SD = 11.86). The majority was satisfied with their marital relationship (72.7% and 52.9%, respectively), and the group with most sexual damaged (actual sexual performance regarding sexual desire) being the one with severe depression (54.5% versus 82.4%, respectively). Regarding total SDS value, the group with MMD present with higher levels of sexual desire (M = 54.93; DP = 14.56) than the group with SD (M = 41.82; DP = 11.86).ConclusionsThis study presents an exploratory character and the obtained results revealed that depressive symptomatology severity is directly related with sexual desire, by saying the higher the depression's severity is the lower sexual desire will be.

The Clinical Nurse Specialist Role and its Relevance to Vascular Access: A Canadian Perspective

2021 ◽  
Vol 26 (3) ◽  
pp. 25-30
Author(s):  
Andrea Raynak ◽  
Brianne Wood
Keyword(s):  
Quality Improvement ◽  
Clinical Outcomes ◽  
Vascular Access ◽  
Organizational Outcomes ◽  
Clinical Nurse Specialist ◽  
Nurse Specialist ◽  
Care Hospital ◽  
Improvement Project ◽  
Clinical Nurse ◽  
The Impact

Highlights Abstract Purpose: The purpose of this quality improvement study was to examine the impact of a Vascular Access Clinical Nurse Specialist (VA-CNS) on patient and organizational outcomes. Description of the Project/Program: The VA-CNS role was created and implemented at an acute care hospital in Thunder Bay, Ontario, Canada. The VA-CNS collected data on clinical activities and interventions performed from April 1 to March 29, 2019. The dataset and its associated qualitative clinical outcomes were analyzed using deductive content analysis. Furthermore, a cost analysis was performed by the hospital accountant on these clinical outcomes. Outcome: Over a 1-year period, there were 547 patients protected from an unwarranted peripherally inserted central catheter (PICC) insertion among 302 patient consultations for the VA-CNS. A total of 322 ultrasound-guided peripheral intravenous catheters were inserted and 45 PICC insertions completed at the bedside. The cost associated with the 547 patients not receiving a PICC line result in an estimated savings of $113,301. The VA-CNS role demonstrated a positive payback of $417,525 to the organization. Conclusion: The results of this quality improvement project have demonstrated the positive impacts of the VACNS on patient and organizational outcomes. This role may be of benefit and worth its adoption for other health systems with similar patient populations.

scholarly journals Ward round template: enhancing patient safety on ward rounds

2018 ◽  
Vol 7 (2) ◽  
pp. e000170 ◽  
Author(s):  
Niall Gilliland ◽  
Natalie Catherwood ◽  
Shaouyn Chen ◽  
Peter Browne ◽  
Jacob Wilson ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Antibiotic Stewardship ◽  
Ward Round ◽  
Early Warning Score ◽  
Improvement Project ◽  
Inpatient Ward ◽  
Improve Compliance ◽  
Safety Parameters ◽  
Ward Rounds

Introduction and aimsConcerns had been raised at clinical governance regarding the safety of our inpatient ward rounds with particular reference to: documentation of clinical observations and National Early Warning Score (NEWS), compliance with Trust guidance for venous thromboembolism (VTE) risk assessment, antibiotic stewardship, palliative care and treatment escalation plans (TEP). This quality improvement project was conceived to ensure these parameters were considered and documented during the ward round, thereby improving patient care and safety. These parameters were based on Trust patient safety guidance and CQUIN targets.MethodThe quality improvement technique of plan–do–study–act (PDSA) was used in this project. We retrospectively reviewed ward round entries to record baseline measurements, based on the above described parameters, prior to making any changes. Following this, the change applied was the introduction of a ward round template to include the highlighted important baseline parameters. Monthly PDSA cycles are performed, and baseline measurements are re-examined, then relevant changes were made to the ward round template.Summary of resultsDocumentation of baseline measurements was poor prior to introduction of the ward round template; this improved significantly following introduction of a standardised ward round template. Following three cycles, documentation of VTE risk assessments increased from 14% to 92%. Antibiotic stewardship documentation went from 0% to 100%. Use of the TEP form went from 29% to 78%.ConclusionsFollowing introduction of the ward round template, compliance improved significantly in all safety parameters. Important safety measures being discussed on ward rounds will lead to enhanced patient safety and will improve compliance to Trust guidance and comissioning for quality and innovation (CQUIN) targets. Ongoing change implementation will focus on improving compliance with usage of the template on all urology ward rounds.

scholarly journals Longitudinal, multidisciplinary, resident-driven intervention to increase immunisation rates for Medicaid, low-income and uninsured patients

2020 ◽  
Vol 9 (4) ◽  
pp. e000986
Author(s):  
Cynthia Cantu ◽  
Kristopher Koch ◽  
Ramon S Cancino
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Primary Care Practice ◽  
Care Practice ◽  
Waiting Room ◽  
Improvement Project ◽  
Vaccination Rates ◽  
Initial Intervention ◽  
Risk Patients ◽  
Academic Primary Care

IntroductionMore payers are closely linking reimbursement to high-value care outcomes such as immunisation rates. Despite this, there remain high rates of pneumonia and influenza-related hospitalisations generating hospital expenditures as high as $11 000 per hospitalisation. Vaccinating the public is an integral part of preventing poor health and utilisation outcomes and is particularly relevant to high-risk patients. As part of a multidisciplinary effort between family and internal medicine residency programmes, our goal was to improve vaccination rates to an average of 76% of eligible Medicaid, low-income and uninsured (MLIU) patients at an academic primary care practice.MethodsThe quality improvement project was completed over 3 months by three primary care resident groups. The setting was a suburban academic primary care practice and eligible patients were 18 years of age or older. Our aim was to increase immunisation rates of pneumococcal, influenza, varicella, herpes zoster virus and tetanus and diphtheria vaccination. There were 1690 patients eligible for the vaccination composite metric. Data were derived from the electronic health record and administrative data.InterventionsCohort 1 developed an initial intervention that consisted of a vaccine questionnaire for patients to complete while in the waiting room. Cohort 2 modified questionnaire after reviewing results from initial intervention. Cohort 3 recommended elimination of questionnaire and implementation of a bundled intervention approach.ResultsThere were minimal improvements in patient immunisation rates after using a patient-directed paper questionnaire. After implementation of multiple interventions via an improvement bundle, there were improvements in immunisation rates which were sustained and the result of special cause variation.ConclusionA key to improving immunisation rates for MLIU patients in this clinic was developing relationships with faculty and staff stakeholders. We received feedback from all the medical staff and then applied it to the interventions and made an impact in the average of vaccinations.

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