Anticancer therapy within the last 30 days of life: Results of an audit and re-audit cycle from a regional cancer center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18260-e18260
Author(s):  
Mike Nguyen ◽  
Alysson Wann ◽  
Babak Tamjid ◽  
Arvind Sahu ◽  
Javier Torres
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Retrospective Review ◽  
Medical Records ◽  
Quality Improvement Intervention ◽  
Separate Analysis ◽  
Number Of Patients ◽  
Audit Period ◽  
Improvement Intervention

e18260 Background: The therapeutic landscape in medical oncology continues to expand significantly. Newer therapies, especially immunotherapy, offer the hope of profound and durable responses with more tolerable side effect profiles. Integrating this information into the decision making process is challenging for patients and oncologists. Systemic anticancer treatment within the last thirty days of life is a key quality of care indicator and is one parameter used in the assessment of aggressiveness of care. Methods: A retrospective review of medical records of all patients previously treated at Goulburn Valley Health oncology department who died between 1 January 2015 and 30 June 2018 was conducted. Information collected related to patient demographics, diagnosis, treatment, and hospital care within the last 30 days of life. These results were presented to a hospital meeting and a quality improvement intervention program instituted. A second retrospective review of medical records of all patients who died between 1 July 2018 and 31 December 2018 was conducted in order to measure the effect of this intervention. Results: The initial audit period comprised 440 patients. 120 patients (27%) received treatment within the last 30 days of life. The re-audit period comprised 75 patients. 19 patients (25%) received treatment within the last 30 days of life. Treatment rates of chemotherapy reduced after the intervention in contrast to treatment rates of immunotherapy which increased. A separate analysis calculated the rate of mortality within 30 days of chemotherapy from the total number of patients who received chemotherapy was initially 8% and 2% in the re-audit period. Treatment within the last 30 days of life was associated with higher use of aggressive care such as emergency department presentation, hospitalisation, ICU admission and late hospice referral. Palliative care referral rates improved after the intervention. Conclusions: This audit demonstrated that a quality improvement intervention can impact quality of care indicators with reductions in the use of chemotherapy within the last 30 days of life. However, immunotherapy use increased which may be explained by increased access and perceived better tolerability.

scholarly journals Improving Documentation of Distress in Veteran Patients for Hematology/Oncology Clinics

2019 ◽  
Vol 15 (5) ◽  
pp. e475-e479
Author(s):  
Samantha Bodner ◽  
Arpan Patel ◽  
Priya K. Gopalan
Keyword(s):  
Quality Improvement ◽  
Medical Records ◽  
Medical Center ◽  
Quality Improvement Intervention ◽  
Pdsa Cycle ◽  
Patients Experience ◽  
Cancer Network ◽  
Improvement Intervention

The purpose of this quality improvement study was to improve physician documentation of distress in medical records of hematology/oncology veteran patients at the Malcolm Randall Veteran Affairs (VA) Medical Center hematology/oncology fellows’ clinic in Gainesville, Florida. Before this intervention, the VA hematology/oncology fellows were not documenting patient distress in medical records. The quality improvement intervention was executed through the use of Plan-Do-Study-Act (PDSA) cycles with an ultimate goal of 50% documentation rate. Physician charts were audited to investigate official documentation of distress in patient charts. Physician documentation of distress was 14% in the first PDSA cycle, 21% in the second PDSA cycle, and 36% in the third PDSA cycle. Additional data on distress in hematology/oncology veteran patients were collected using the National Comprehensive Cancer Network Distress Thermometer and Problem List for Patients. Analysis of findings indicated that 42% of 88 patients experienced distress. Findings also suggest that hematology/oncology veteran patients experience specific sources of distress, notably fatigue and pain. These patients have presumably undergone unique experiences that can result in distress that providers should follow-up with in medical charts. Although this intervention has proven challenging to fully implement, standardizing patient distress in patient medical records has the potential to improve the quality of care provided by hematology/oncology physicians.

Door-to-balloon time and mortality in patients with ST-elevation myocardial infarction undergoing primary angioplasty

2020 ◽  
Author(s):  
Basheer Karkabi ◽  
Gal Meir ◽  
Barak Zafrir ◽  
Ronen Jaffe ◽  
Salim Adawi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Quality Improvement ◽  
St Elevation Myocardial Infarction ◽  
Quality Improvement Intervention ◽  
Entire Cohort ◽  
Number Of Patients ◽  
Before And After ◽  
St Elevation ◽  
Door To Balloon ◽  
Improvement Intervention

Abstract Aims The evidence are not conclusive that a small incremental increase in door-to-balloon (D2B) time leads to a significant increase in death of ST-elevation myocardial infarction (STEMI) patients. In a previous study, we described a quality improvement intervention that reduced D2B time in 333 patients with STEMI. The aim of the current study was to compare mortality rates of the patients, before and after the intervention. Methods and results We examined the survival of 133 consecutive patients with STEMI treated prior to an intervention to decrease D2B time and 200 treated after the intervention. The mortality rate was the same before and after the quality intervention. The median D2B time for the entire cohort was 55 min. The number of patients with D2B time >55 min prior to the intervention was 82/133 (61%) and after the intervention 74/200 (37%) P < 0.00001. Thirty-day mortality among the patients with D2B time ≤55 min was 5/178 (2.8%) and among those with D2B time >55 min was 15/155 (9.7%), P < 0.008. The hazard ratio for 30-day mortality when the D2B time was >55 min was 3.7 (1.3–10.4). Conclusion Mortality and non-fatal complications did not differ significantly between STEMI patients before and after a quality improvement intervention. However, the number of patients treated within 55 min from arrival was significantly higher after the intervention; and coronary intervention within this time was associated with a lower death rate.

scholarly journals An Evaluation of Virginia Gold: A Medicaid Program to Improve Nursing Facility Quality of Care

2014 ◽  
Author(s):  
Gerald Craver ◽  
Amy Burkett ◽  
Karen Kimsey
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Facility Management ◽  
Care Quality ◽  
Quality Improvement Intervention ◽  
Nursing Facilities ◽  
Nursing Assistant ◽  
Improvement Program ◽  
Nursing Facility

A qualitative case study design employing focus groups was used to evaluate certified nursing assistant (CNA) (n = 26) and resident (n = 30) perceptions of the Virginia Gold Quality Improvement Program, a Medicaid funded 2-year quality improvement intervention piloted in five nursing facilities. As part of the program, the nursing facilities implemented quality improvement projects to develop supportive work environments in an effort to reduce CNA turnover and improve quality of care. Overall, the focus group participants viewed Virginia Gold positively and reported that CNA turnover decreased, while care quality improved during the program. These findings are supported by a previous Virginia Gold evaluation as well as by the results from a quantitative analysis of nursing facility CNA turnover and quality of care data and interviews with selected nursing facility management staff (n = 7) 1-year following the program’s culmination. A key finding from the management interviews is that the quality improvement projects became self-sustaining over time allowing all five nursing facilities to continue the projects without state funding.

scholarly journals Did a quality improvement intervention improve quality of maternal health care? Implementation evaluation from a cluster-randomized controlled study

2019 ◽  
Vol 32 (1) ◽  
pp. 54-63 ◽  
Author(s):  
Elysia Larson ◽  
Godfrey M Mbaruku ◽  
Jessica Cohen ◽  
Margaret E Kruk
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Quality Improvement Intervention ◽  
Implementation Evaluation ◽  
Randomized Controlled ◽  
Cluster Randomized ◽  
Improvement Intervention

Abstract Objective To test the success of a maternal healthcare quality improvement intervention in actually improving quality. Design Cluster-randomized controlled study with implementation evaluation; we randomized 12 primary care facilities to receive a quality improvement intervention, while 12 facilities served as controls. Setting Four districts in rural Tanzania. Participants Health facilities (24), providers (70 at baseline; 119 at endline) and patients (784 at baseline; 886 at endline). Interventions In-service training, mentorship and supportive supervision and infrastructure support. Main outcome measures We measured fidelity with indictors of quality and compared quality between intervention and control facilities using difference-in-differences analysis. Results Quality of care was low at baseline: the average provider knowledge test score was 46.1% (range: 0–75%) and only 47.9% of women were very satisfied with delivery care. The intervention was associated with an increase in newborn counseling (β: 0.74, 95% CI: 0.13, 1.35) but no evidence of change across 17 additional indicators of quality. On average, facilities reached 39% implementation. Comparing facilities with the highest implementation of the intervention to control facilities again showed improvement on only one of the 18 quality indicators. Conclusions A multi-faceted quality improvement intervention resulted in no meaningful improvement in quality. Evidence suggests this is due to both failure to sustain a high-level of implementation and failure in theory: quality improvement interventions targeted at the clinic-level in primary care clinics with weak starting quality, including poor infrastructure and low provider competence, may not be effective.

scholarly journals Mixed effect of increasing outflow of medical patients from an emergency department

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Joseph Mendlovic ◽  
Todd Zalut ◽  
Gabriel Munter ◽  
Ofer Merin ◽  
Amos M. Yinnon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Nursing Staff ◽  
Quality Improvement Intervention ◽  
Annual Number ◽  
Medical Patients ◽  
Mixed Effect ◽  
Second Stage ◽  
Number Of Patients ◽  
Improvement Intervention

Abstract Background and aim Since 2014, the annual number of patients entering our emergency department (ED) has increased significantly. These were primarily Internal Medicine (IM) patients, and of these, 25–30% were admitted. The present governmental policy presents a deterrent to adding IM beds for these patients, and Emergency and IM departments cope with ever-increasing number of IM patients. We describe a quality improvement intervention to increase outflow of IM patients from the ED to the IM departments. Methods We conducted a quality improvement intervention at the Shaare Zedek Medical Center from 2014 to 2018. The first stage consisted of an effort to increase morning discharges from the IM departments. The second stage consisted of establishing a process to increase the number of admissions to the IM departments from the ED. Results Implementation of the first stage led to an increased morning discharge rate from a baseline of 2–4 to 18%. The second stage led to an immediate mean (± SD) morning transfer of 35 ± 7 patients to the medical departments (8–12 per department), providing significant relief for the ED. However, the additional workload for the IM departments’ medical and nursing staff led to a rapid decrease in morning discharges, returning to pre-intervention rates. Throughout the period of the new throughput intervention, morning admissions increased from 30 to > 70%, and were sustained. The number of patients in each department increased from 36 to 38 to a new steady state of 42–44, included constant hallway housing, and often midday peaks of 48–50 patients. Mean length of stay did not change. IM physician and nurse dissatisfaction led to increased number of patients being admitted during the evening and night hours and fewer during the morning. Conclusion We describe a quality improvement intervention to improve outflow of medical patients from the ED in the morning hours. The new ED practices had mixed effects. They led to less ED crowding in the morning hours but increased dissatisfaction among the IM department medical and nursing staff due to an increased number of admissions in a limited number of hours. The present governmental reimbursement policy needs to address hospital overcrowding as it relates to limited community healthcare beds and an aging population.

The ENT emergency clinic: does senior input matter?

2012 ◽  
Vol 127 (1) ◽  
pp. 15-19 ◽  
Author(s):  
A Mirza ◽  
L McClelland ◽  
M Daniel ◽  
N Jones
Keyword(s):  
Quality Of Care ◽  
Discharge Rate ◽  
Surrogate Marker ◽  
Operating Theatre ◽  
Number Of Children ◽  
Discharge Rates ◽  
Time Period ◽  
Number Of Patients

AbstractBackground:Many ENT conditions can be treated in the emergency clinic on an ambulatory basis. Our clinic traditionally had been run by foundation year two and specialty trainee doctors (period one). However, with perceived increasing inexperience, a dedicated registrar was assigned to support the clinic (period two). This study compared admission and discharge rates for periods one and two to assess if greater registrar input affected discharge rate; an increase in discharge rate was used as a surrogate marker of efficiency.Method:Data was collected prospectively for patients seen in the ENT emergency clinic between 1 August 2009 and 31 July 2011. Time period one included data from patients seen between 1 August 2009 and 31 July 2010, and time period two included data collected between 1 August 2010 and 31 July 2011.Results:The introduction of greater registrar support increased the number of patients that were discharged, and led to a reduction in the number of children requiring the operating theatre.Conclusion:The findings, which were determined using clinic outcomes as markers of the quality of care, highlighted the benefits of increasing senior input within the ENT emergency clinic.

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