scholarly journals Increasing Perioperative Risk Scoring in Emergency Laparotomy: A Surgical Trainee-Led Nationwide Quality Improvement Programme

2021 ◽  
Author(s):  
Deirdre M Nally ◽  
Peter E Lonergan ◽  
Emer P O Connell ◽  
Deborah McNamara
Keyword(s):  
Quality Improvement ◽  
Care Delivery ◽  
Perioperative Risk ◽  
Emergency Laparotomy ◽  
High Morbidity ◽  
Surgical Trainee ◽  
Implementation Framework ◽  
Implementation Phase ◽  
Full Implementation ◽  
Risk Scoring

Abstract Background: Emergency laparotomy is associated with high morbidity and mortality. The early identification of high-risk patients allows for the provision of timely perioperative care and appropriate resource allocation. The aim of this study was to develop a nationwide surgical trainee-led quality improvement (QI) programme to increase the use of perioperative risk scoring in emergency laparotomy.Methods: The programme was structured using the active implementation framework in 15 state-funded Irish hospitals to guide the staged implementation of perioperative risk scoring. The primary outcome was a documented preoperative risk score for patients undergoing an emergency laparotomy at each site.Results: The percentage of patients undergoing emergency laparotomy who received perioperative risk scoring increased from 0-11% during the exploratory phase to 35-100% during the full implementation phase. This change was consistently maintained throughout the full implementation phase of the programme.Conclusions: A trainee-led QI programme increased the use of perioperative risk assessment in patients undergoing emergency laparotomy, suggesting that such an approach may be feasible for improving patient outcomes and care delivery performance.

The Institute for Healthcare Improvement–NeuroPoint Alliance collaboration to decrease length of stay and readmission after lumbar spine fusion: using national registries to design quality improvement protocols

2020 ◽  
Vol 33 (6) ◽  
pp. 812-821
Author(s):  
Scott L. Zuckerman ◽  
Clinton J. Devin ◽  
Vincent Rossi ◽  
Silky Chotai ◽  
E. Hunter Dyer ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Discharge Planning ◽  
Lumbar Fusion ◽  
Nonparametric Tests ◽  
Learning System ◽  
Design Quality ◽  
Implementation Phase ◽  
Healthcare Improvement ◽  
The Impact

OBJECTIVENational databases collect large amounts of clinical information, yet application of these data can be challenging. The authors present the NeuroPoint Alliance and Institute for Healthcare Improvement (NPA-IHI) program as a novel attempt to create a quality improvement (QI) tool informed through registry data to improve the quality of care delivered. Reducing the length of stay (LOS) and readmission after elective lumbar fusion was chosen as the pilot module.METHODSThe NPA-IHI program prospectively enrolled patients undergoing elective 1- to 3-level lumbar fusions across 8 institutions. A three-pronged approach was taken that included the following phases: 1) Research Phase, 2) Development Phase, and 3) Implementation Phase. Primary outcomes were LOS and readmission. From January to June 2017, a learning system was created utilizing monthly conference calls, weekly data submission, and continuous refinement of the proposed QI tool. Nonparametric tests were used to assess the impact of the QI intervention.RESULTSThe novel QI tool included the following three areas of intervention: 1) preoperative discharge assessment (location, date, and instructions), 2) inpatient changes (LOS rounding checklist, daily huddle, and pain assessments), and 3) postdischarge calls (pain, primary care follow-up, and satisfaction). A total of 209 patients were enrolled, and the most common procedure was a posterior laminectomy/fusion (60.2%). Seven patients (3.3%) were readmitted during the study period. Preoperative discharge planning was completed for 129 patients (61.7%). A shorter median LOS was seen in those with a known preoperative discharge date (67 vs 80 hours, p = 0.018) and clear discharge instructions (71 vs 81 hours, p = 0.030). Patients with a known preoperative discharge plan also reported significantly increased satisfaction (8.0 vs 7.0, p = 0.028), and patients with increased discharge readiness (scale 0–10) also reported higher satisfaction (r = 0.474, p < 0.001). Those receiving postdischarge calls (76%) had a significantly shorter LOS than those without postdischarge calls (75 vs 99 hours, p = 0.020), although no significant relationship was seen between postdischarge calls and readmission (p = 0.342).CONCLUSIONSThe NPA-IHI program showed that preoperative discharge planning and postdischarge calls have the potential to reduce LOS and improve satisfaction after elective lumbar fusion. It is our hope that neurosurgical providers can recognize how registries can be used to both develop and implement a QI tool and appreciate the importance of QI implementation as a separate process from data collection/analysis.

scholarly journals Interim Evaluation of the Tier 1 Program (Secondary 1 Curriculum) of the Project P.A.T.H.S.: First Year of the Full Implementation Phase

2008 ◽  
Vol 8 ◽  
pp. 47-60 ◽  
Author(s):  
Daniel T. L. Shek ◽  
Hing Keung Ma ◽  
Rachel C. F. Sun
Keyword(s):  
Implementation Process ◽  
First Year ◽  
Perceived Benefits ◽  
Implementation Quality ◽  
Implementation Phase ◽  
Telephone Interviews ◽  
Full Implementation ◽  
Tier 1 ◽  
Negative Comments

To understand the implementation quality of the Tier 1 Program (Secondary 1 Curriculum) of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) in the full implementation phase, 100 schools were randomly selected to participate in personal and/or telephone interviews regarding the quality of the implementation process of the Tier 1 Program. In the interviews, the participants described the responses of the students to the program, the perceived benefits of the program, the perceived good aspects of the program, and the areas requiring improvement, difficulties encountered in the implementation process, and perceived attributes of the worker-support scheme (“Co-Walker Scheme”). Results showed that most workers perceived that the students had positive responses to the program and the program was beneficial to the students. They also identified several good aspects in the program, although negative comments on the program design and difficulties in the implementation process were also recorded. Roughly half of the respondents had positive comments on the “Co-Walker Scheme”. In sum, the respondents generally regarded the program as beneficial to the students and they were satisfied with the Tier 1 Program (Secondary 1 Curriculum) in the full implementation phase, although some implementation difficulties were also expressed.

Assessing early unplanned reoperations in neurosurgery: opportunities for quality improvement

2015 ◽  
Vol 123 (1) ◽  
pp. 198-205 ◽  
Author(s):  
Nancy McLaughlin ◽  
Peng Jin ◽  
Neil A. Martin
Keyword(s):  
Quality Improvement ◽  
Quality Indicator ◽  
Outpatient Surgery ◽  
Care Delivery ◽  
Average Length ◽  
Medical Center ◽  
Postoperative Bleeding ◽  
Time Interval ◽  
Neurosurgical Procedures ◽  
Neurosurgical Department

OBJECT Review of morbidities and mortality has been the primary method used to assess surgical quality by physicians, hospitals, and oversight agencies. The incidence of reoperation has been proposed as a candidate quality indicator for surgical care. The authors report a comprehensive assessment of reoperations within a neurosurgical department and discuss how such data can be integrated into quality improvement initiatives to optimize value of care delivery. METHODS All neurosurgical procedures performed in the main operating room or the outpatient surgery center at the Ronald Reagan UCLA Medical Center and UCLA Santa Monica Medical Center from July 2008 to December 2012 were considered for this study. Interventional radiology and stereotactic radiosurgery procedures were excluded. Early reoperations within 7 days of the index surgery were reviewed and their preventability status was evaluated. RESULTS The incidence of early unplanned reoperation was 2.6% (occurring after 183 of 6912 procedures). More than half of the patients who underwent early unplanned reoperation initially had surgery for shunt-related conditions (34.4%) or intracranial tumor (23.5%). Shunt failure was the most common indication for early unplanned reoperation (34.4%), followed by postoperative bleeding (20.8%) and postoperative elevated intracranial pressure (9.8%). The average time interval (± SD) between the index surgery and reoperation was 3.0 ± 1.9 days. The average length of stay following reoperation was 12.1 ± 14.4 days. CONCLUSIONS This study enabled an in-depth assessment of reoperations within an academic neurosurgical practice and identification of strategic opportunities for department-wide quality improvement initiatives. The authors provide a nuanced discussion regarding the use of absolute reoperations as a quality indicator for neurosurgical patient populations.

Surgical Trainee Supervision During Non-Trauma Emergency Laparotomy in Rwanda and South Africa

2021 ◽  
Author(s):  
Linda Pohl ◽  
Megan Naidoo ◽  
Jennifer Rickard ◽  
Egide Abahuje ◽  
Nazmie Kariem ◽  
...  
Keyword(s):  
South Africa ◽  
Emergency Laparotomy ◽  
Surgical Trainee

scholarly journals Standardising Care in the ICU: A Protocol for a Scoping Review of Tools used to Improve Care Delivery

2020 ◽  
Author(s):  
laura Allum ◽  
Chloe Apps ◽  
Nicholas Hart ◽  
Natalie Pattison ◽  
Bronwen Connolly ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Care Delivery ◽  
Cochrane Library ◽  
Future Research ◽  
Care Plans ◽  
Icu Stay ◽  
Structured Care ◽  
High Dependency ◽  
Prolonged Icu Stay

Abstract Background: Increasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families, and cost to health systems. Quality improvement tools such as checklists concisely articulate best practices with the aim of improving quality and safety, however these tools have not been designed for the specific needs of patients with prolonged ICU stay. The primary objective of this review will be to determine the characteristics including format and content of multicomponent tools designed to standardise or improve ICU care. Secondary objectives are to describe the outcomes reported in these tools, the type of patients and settings studied, and to understand how these tools were developed and implemented in clinical practice. Methods: We will search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO, Web of Science, OpenGrey, NHS evidence and Trial Registries from January 2000 onwards. We will include primary research studies (e.g. experimental, quasi-experimental, observational, and qualitative studies) recruiting more than 10 adult participants admitted to ICUs, high dependency units and weaning centres regardless of length of stay, describing quality improvement tools such as structured care plans or checklists designed to standardize more than one aspect of care delivery. We will extract data on study and patient characteristics, tool design and implementation strategies and measured outcomes. Two reviewers will independently screen citations for eligible studies and perform data extraction. Data will be synthesised with descriptive statistics; we will use a narrative synthesis to describe review findings. Discussion: The findings will be used to guide development of tools for use with prolonged ICU stay patients. Our group will use experience-based co-design methods to identify the most important actionable processes of care to include in quality improvement tools these patients. Such tools are needed to standardise practice and thereby improve quality of care. Illustrating the development and implementation methods used for such tools will help to guide translation of similar tools into ICU clinical practice and future research.Systematic Review Registration: This protocol is registered on the Open Science Framework, https://osf.io/, DOI 10.17605/OSF.IO/Z8MRE

EP.FRI.857 Audit and quality improvement project; data entry into the NELA database from Royal Stoke university hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nandu Nair ◽  
Vasileios Kalatzis ◽  
Madhavi Gudipati ◽  
Anne Gaunt ◽  
Vishnu Machineni
Keyword(s):  
Quality Improvement ◽  
Data Entry ◽  
Quality Improvement Project ◽  
University Hospital ◽  
Emergency Laparotomy ◽  
Data Set ◽  
Improvement Project ◽  
Hospital Database ◽  
Case Ascertainment ◽  
Project Data

Abstract Aims During the period December-2018 to November-2019 a total of 84 cases were entered on the NELA website, corresponding to HES data suggesting 392 laparotomies. This suggests a possible case acquisition of 21% prompting us to look at our data acquisition in detail. Methods Interrogation of the NELA data from January–March 2020 was done from NELA website and hospital records. Results Analysis revealed that during this period 45 patients had laparotomy recorded whereas hospital database recorded 68 laparotomies. Of the 45 cases entered on the NELA database, only 1 patient had a complete data set entered.  22 cases had 87% data entry and 22 cases had &lt;50% of the data fields completed. Firstly, we were not capturing all patients who underwent an emergency laparotomy and secondly our data entry for the patients we did report was incomplete.  This led us to engage in a quality improvement project with following measures - Conclusions We re-assessed the case ascertainment and completeness of data collection in the period April 2020 – June 2020 and case ascertainment rate increased to 54% and all the entries were complete and locked.

Quality of Care: Performance Measurement and Quality Improvement in Clinical Practice

2017 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Financial Incentives ◽  
Clinical Performance ◽  
Care Delivery ◽  
The United States ◽  
Technological Advancement

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement. This chapter contains 56 references.

Quality of Care: Performance Measurement and Quality Improvement in Clinical Practice

2015 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Financial Incentives ◽  
Clinical Performance ◽  
Care Delivery ◽  
The United States ◽  
Technological Advancement

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement. This chapter contains 56 references.

Timely Family Feedback to Guide Family Engagement in the Intensive Care Unit

2020 ◽  
Vol 40 (6) ◽  
pp. 42-51
Author(s):  
Natalie S. McAndrew ◽  
Laura Mark ◽  
Mary Butler
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Patient Care ◽  
Care Delivery ◽  
Family Engagement ◽  
Family Satisfaction ◽  
Family Experience ◽  
Improvement Project ◽  
The Family

Background Organizations motivated to provide high-quality care in the intensive care unit are exploring strategies to engage families in patient care. Such initiatives are based on emerging evidence that family engagement improves quality and safety of care. Objective To gather family feedback to guide future nurse-led quality improvement efforts to engage families in the intensive care unit setting. Methods The Critical Care Family Satisfaction Survey, which consists of 20 items rated from 1 (very dissatisfied) to 5 (very satisfied), was paired with open-ended questions and administered to families during the intensive care unit stay from March through December 2017. Content analysis was used to identify themes regarding the family experience. Results Responses were collected from 178 family members. The mean (SD) score on the survey was 4.65 (0.33). Five themes emerged regarding the delivery of family care in the intensive care unit: family interactions with the interdisciplinary team, information sharing and effective communication, family navigation of the intensive care unit environment, family engagement in the intensive care unit, and quality of patient care. Conclusions This quality improvement project provided foundational information to guide family engagement efforts in the intensive care unit. Real-time solicitation of feedback is essential to improving the family experience and guiding family-centered care delivery in this practice environment.

scholarly journals A Neonatal Intensive Care Unit’s Experience with Implementing an In-Situ Simulation and Debriefing Patient Safety Program in the Setting of a Quality Improvement Collaborative

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 202
Author(s):  
Mary Eckels ◽  
Terry Zeilinger ◽  
Henry C. Lee ◽  
Janine Bergin ◽  
Louis P. Halamek ◽  
...  
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care ◽  
Quality Care ◽  
Neonatal Resuscitation ◽  
Healthcare Team ◽  
In Situ Simulation ◽  
Implementation Phase

Extensive neonatal resuscitation is a high acuity, low-frequency event accounting for approximately 1% of births. Neonatal resuscitation requires an interprofessional healthcare team to communicate and carry out tasks efficiently and effectively in a high adrenaline state. Implementing a neonatal patient safety simulation and debriefing program can help teams improve the behavioral, cognitive, and technical skills necessary to reduce morbidity and mortality. In Simulating Success, a 15-month quality improvement (QI) project, the Center for Advanced Pediatric and Perinatal Education (CAPE) and California Perinatal Quality Care Collaborative (CPQCC) provided outreach and training on neonatal simulation and debriefing fundamentals to individual teams, including community hospital settings, and assisted in implementing a sustainable program at each site. The primary Aim was to conduct two simulations a month, with a goal of 80% neonatal intensive care unit (NICU) staff participation in two simulations during the implementation phase. While the primary Aim was not achieved, in-situ simulations led to the identification of latent safety threats and improvement in system processes. This paper describes one unit’s QI collaborative experience implementing an in-situ neonatal simulation and debriefing program.

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