Getting It Right First Time: the reports

2021 ◽  
Vol 17 (6) ◽  
pp. 247-252
Author(s):  
Sue Thomas
Keyword(s):  
Quality Improvement ◽  
Service Delivery ◽  
Acute Care ◽  
Patient Outcomes ◽  
Future Directions ◽  
Subject Areas ◽  
First Time ◽  
Improve Patient

Originally launched in 2015, the Getting It Right First Time (GIRFT) programme has become a leading authority for quality improvement in the NHS. In September 2021, the programme published an impressive series of reviews in no fewer than 18 subject areas, neurology being one of these. While earlier GIRFT reports tended to focus on acute care, the new reports have a much wider scope and scan a whole pathway approach for unwarranted variations in practice and what needs to happen to improve patient outcomes. In Part 1, Sue Thomas explores what GIRFT says about the organisation of neurological services and recommendations for service delivery, while Part 2 will explore parallel services, commissioning and future directions.

scholarly journals Immunotherapy in gastroesophageal cancers: Current state and future directions

2020 ◽  
pp. 107815522096353
Author(s):  
Hira Shaikh ◽  
Amir Kamran ◽  
Dulabh K Monga
Keyword(s):  
Patient Outcomes ◽  
Molecular Targeted Therapy ◽  
Treatment Options ◽  
Cell Cycle Checkpoints ◽  
Future Directions ◽  
Alternative Strategies ◽  
Current State ◽  
Dismal Prognosis ◽  
The World ◽  
Improve Patient

While gastroesophageal (GE) cancers are one of the most common cancers worldwide, unfortunately, the mortality remains high. Commonly used treatment options include surgical resection, chemotherapy, radiotherapy, and molecular targeted therapy, which improve survival only minimally; thus, affirming the dire need for exploring alternative strategies to improve patient outcomes. Immunotherapy, which has revolutionized the world of oncology, has somewhat lagged behind in GE malignancies. Tumor-associated microenvironment and regulatory T cells, alongside cell cycle checkpoints, have been proposed by various studies as the mediators of carcinogenesis in GE cancers. Thus, inhibition of each of these could serve as a possible target of treatment. While the approval of pembrolizumab has provided some hope, it is not enough to override the dismal prognosis that this disease confers. Herein, we discuss the prospects of immunotherapy in this variety of cancer.

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 135 The Impact of an Early Mobilisation Initiative Evidence from an Acute Care Setting

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Aileen Horgan ◽  
Michelle Carr ◽  
Aileen Murphy
Keyword(s):  
Acute Care ◽  
Patient Outcomes ◽  
Care Setting ◽  
Functional Decline ◽  
Length Of Hospital Stay ◽  
Hospital Length Of Stay ◽  
Acute Care Setting ◽  
Early Mobilisation ◽  
The Impact ◽  
Improve Patient

Abstract Background Unnecessary bed rest results in a loss of mobility and an increased length of hospital stay. Despite mobilising regularly being acknowledged as an important preventative measure for deconditioning, inpatient functional decline continues to pose a significant challenge in hospital settings. Hospital-based mobility initiatives offer the potential to address issues of functional decline, improve patient outcomes and hospital length of stay. The aim of this research is to examine the impact of an early mobilisation initiative called “End PJ Paralysis”. Methods The research design comprises of three elements: (i) an examination of a period that promoted mobility to all patients on one acute unit (ii) an analysis of the reported number of falls during the study period and (iii) an exploration of perceptions and attitudes of nurses, nurse managers, and patients involved with the initiative. Results Our study demonstrates that following a 10-week promotion of the initiative from April 17th-June 26th 2018 in an acute care setting in south of Ireland, an increase of 15% of patients were mobilising and a decrease in the number of reported falls. In addition, staff participation was found to increase and self-reported patient satisfaction improved. Factors identified as influencing the impact of the initiative included patient and staff behavior, nurse management leadership, and effective communication. Conclusion The study provides evidence to suggest that early mobilisation initiatives can prevent deconditioning and improve patient outcomes. Each day a patient spends in hospital should contribute towards their recovery and discharge and mobilising patients while in hospital has a profound impact on their functional status.

Effects of a transsphenoidal surgery quality improvement program on patient outcomes and hospital financial performance

2021 ◽  
pp. 1-10
Author(s):  
Christina E. Sarris ◽  
Scott T. Brigeman ◽  
Estelle Doris ◽  
Maggie Bobrowitz ◽  
Thomas Rowe ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Financial Performance ◽  
Patient Care ◽  
Patient Outcomes ◽  
Transsphenoidal Surgery ◽  
Pituitary Surgery ◽  
Care Pathways ◽  
Improvement Program ◽  
Hospital Financial Performance ◽  
Improve Patient

OBJECTIVE A comprehensive quality improvement (QI) program aimed at all aspects of patient care after pituitary surgery was initiated at a single center. This initiative was guided by standard quality principles to improve patient outcomes and optimize healthcare value. The programmatic goal was to discharge most elective patients within 1 day after surgery, improve patient safety, and limit unplanned readmissions. The program is described, and its effect on patient outcomes and hospital financial performance over a 5-year period are investigated. METHODS Details of the patient care pathway are presented. Foundational elements of the QI program include evidence-based care pathways (e.g., for hyponatremia and pain), an in-house research program designed to fortify care pathways, patient education, expectation setting, multidisciplinary team care, standard order sets, high-touch postdischarge care, outcomes auditing, and a patient navigator, among other elements. Length of stay (LOS), outcome variability, 30-day unplanned readmissions, and hospital financial performance were identified as surrogate endpoints for healthcare value for the surgical epoch. To assess the effect of these protocols, all patients undergoing elective transsphenoidal surgery for pituitary tumors and Rathke’s cleft cysts between January 2015 and December 2019 were reviewed. RESULTS A total of 609 adult patients who underwent elective surgery by experienced pituitary surgeons were identified. Patient demographics, comorbidities, and payer mix did not change significantly over the study period (p ≥ 0.10). The mean LOS was significantly shorter in 2019 versus 2015 (1.6 ± 1.0 vs 2.9 ± 2.2 midnights, p < 0.001). The percentage of patients discharged after 1 midnight was significantly higher in 2019 versus 2015 (75.4% vs 15.6%, p < 0.001). The 30-day unplanned hospital readmission rate decreased to 2.8% in 2019 from 8.3% in 2015. Per-patient hospital profit increased 71.3% ($10,613 ± $19,321 in 2015; $18,180 ± $21,930 in 2019), and the contribution margin increased 42.3% ($18,925 ± $19,236 in 2015; $26,939 ± $22,057 in 2019), while costs increased by only 3.4% ($18,829 ± $6611 in 2015; $19,469 ± $4291 in 2019). CONCLUSIONS After implementation of a comprehensive pituitary surgery QI program, patient outcomes significantly improved, outcome variability decreased, and hospital financial performance was enhanced. Future studies designed to evaluate disease remission, patient satisfaction, and how the surgeon learning curve may synergize with other quality efforts may provide additional context.

scholarly journals Developing and implementing an action-oriented staff survey: Queensland Health and the 'Better Workplaces' initiative

2009 ◽  
Vol 33 (3) ◽  
pp. 365 ◽  
Author(s):  
Ceri Jury ◽  
M Anthony Machin ◽  
Jan Phillips ◽  
Hong Eng Goh ◽  
Shaney Olsen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Service ◽  
Patient Outcomes ◽  
Local Level ◽  
Workplace Culture ◽  
Action Plans ◽  
Opinion Survey ◽  
Queensland Health ◽  
Improve Patient

QUEENSLAND HEALTH IMPLEMENTED the ?Better Workplaces? staff opinion survey (the survey) in May 2006. The initiative stands as the largest single staff survey ever conducted in Queensland, and one of the largest in Australia. This case study outlines the process of this project, the outcomes to date and some of the pitfalls and successes along the way. Logistically it involved 37 health service districts and 10 corporate areas spread across the state. The survey process incorporated four survey periods over two years. The aim of the survey was: to improve workplace culture at the local level and across the organisation as a whole. Workplace culture is defined by Cole as ?The collection of unwritten rules, codes of behaviour and norms by which people operate, how we do things around here?1 Queensland Health proposed to improve its workplace culture by listening to staff and developing and driving targeted action plans following the survey with each district and division to create a climate of trust, respect, and innovation among staff which will ultimately improve patient outcomes. ?. . . The creation of a culture that is free of blame and encourages an open examination of error and failure is a key feature of services dedicated to quality improvement and to learning.?

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