scholarly journals Use of Electronic Health Records to Develop and Implement a Silent Best Practice Alert Notification System for Patient Recruitment in Clinical Research: Quality Improvement Initiative (Preprint)

2018 ◽  
Author(s):  
Connor Devoe ◽  
Harriett Gabbidon ◽  
Nina Schussler ◽  
Lauren Cortese ◽  
Emily Caplan ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Research ◽  
Best Practice ◽  
Screening Method ◽  
Research Quality ◽  
Quality Improvement Initiative ◽  
Screening Methods ◽  
Participant Recruitment ◽  
Use Of Resources ◽  
Best Practice Alert

BACKGROUND Participant recruitment, especially for frail, elderly, hospitalized patients, remains one of the greatest challenges for many research groups. Traditional recruitment methods such as chart reviews are often inefficient, low-yielding, time consuming, and expensive. Best Practice Alert (BPA) systems have previously been used to improve clinical care and inform provider decision making, but the system has not been widely used in the setting of clinical research. OBJECTIVE The primary objective of this quality-improvement initiative was to develop, implement, and refine a silent Best Practice Alert (sBPA) system that could maximize recruitment efficiency. METHODS The captured duration of the screening sessions for both methods combined with the allotted research coordinator hours in the Emerald-COPD (chronic obstructive pulmonary disease) study budget enabled research coordinators to estimate the cost-efficiency. RESULTS Prior to implementation, the sBPA system underwent three primary stages of development. Ultimately, the final iteration produced a system that provided similar results as the manual Epic Reporting Workbench method of screening. A total of 559 potential participants who met the basic prescreen criteria were identified through the two screening methods. Of those, 418 potential participants were identified by both methods simultaneously, 99 were identified only by the Epic Reporting Workbench Method, and 42 were identified only by the sBPA method. Of those identified by the Epic Reporting Workbench, only 12 (of 99, 12.12%) were considered eligible. Of those identified by the sBPA method, 30 (of 42, 71.43%) were considered eligible. Using a side-by-side comparison of the sBPA and the traditional Epic Reporting Workbench method of screening, the sBPA screening method was shown to be approximately four times faster than our previous screening method and estimated a projected 442.5 hours saved over the duration of the study. Additionally, since implementation, the sBPA system identified the equivalent of three additional potential participants per week. CONCLUSIONS Automation of the recruitment process allowed us to identify potential participants in real time and find more potential participants who meet basic eligibility criteria. sBPA screening is a considerably faster method that allows for more efficient use of resources. This innovative and instrumental functionality can be modified to the needs of other research studies aiming to use the electronic medical records system for participant recruitment.

scholarly journals Partners eCare Research Core for Clinical Research: Pilot to Build and Test Silent Best Practice Alert Notifications for Recruiting Inpatient Study Participants

Iproceedings ◽  
2017 ◽  
Vol 3 (1) ◽  
pp. e16
Author(s):  
Emily Caplan ◽  
Nina Schussler ◽  
Harriett Gabbidon ◽  
Lauren Cortese ◽  
Erick Maclean ◽  
...  
Keyword(s):  
Clinical Research ◽  
Best Practice ◽  
Best Practice Alert ◽  
Study Participants

scholarly journals GETTING TO YES . . . I WILL RESPOND: CHALLENGES AND SUCCESSES SURVEYING AGING SERVICES PROVIDERS TO PRODUCE QUALITY DATA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S582-S582
Author(s):  
Lauren Harris-Kojetin
Keyword(s):  
Quality Improvement ◽  
Assisted Living ◽  
Academic Research ◽  
Response Rates ◽  
Lessons Learned ◽  
Research Network ◽  
Research Quality ◽  
Quality Data ◽  
Quality Improvement Initiative ◽  
Aging Services

Abstract Voluntary surveys of aging services providers are important data sources for research, quality improvement, and program evaluation efforts to inform evidence-based decision making. Ideally, provider surveys—a type of establishment survey—offer valuable information on providers and services users. However, decreasing survey response rates in recent years raise data quality concerns. This symposium highlights challenges leading to lower response rates (e.g., time constraints, skepticism, confidentiality concerns, getting to the correct respondent); specific data collection techniques tested, what did and did not work, and lessons learned. Although the surveys focus on long-term services and supports (LTSS) providers (e.g., assisted living) and services users (e.g., residents), the session is generalizable to other establishment surveys. Presenters bring extensive survey experience and diverse organizational perspectives—academic research center, national provider association, federal statistical agency, and research contractor. Over the years, the presenters have used their research network to share challenges and lessons learned with each other, which addresses the GSA conference theme, “Strength in Age: Harnessing the Power of Networks.” The first presentation describes test results of a state survey protocol to obtain sampled resident information from assisted living providers. The second presentation examines approaches to increase provider participation in a quality improvement initiative. The third presentation discusses efforts to address response challenges in an on-going national survey of providers in two LTSS sectors. The session allows time for and facilitates interaction with audience members to share their insights and lessons learned.

scholarly journals Optimal Screening Methods to Detect Cardiac Disorders in Athletes: An Evidence-Based Review

2017 ◽  
Vol 52 (12) ◽  
pp. 1168-1170 ◽  
Author(s):  
Zachary K. Winkelmann ◽  
Ashley K. Crossway
Keyword(s):  
False Positive ◽  
Best Practice ◽  
Meta Analysis ◽  
False Positive Rate ◽  
Screening Method ◽  
Heart Association ◽  
Screening Methods ◽  
Likelihood Ratios ◽  
Positive Rate ◽  
Cardiac Disorders

Reference/Citation:  Harmon KG, Zigman M, Drezner JA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. J Electrocardiol. 2015;48(3):329–338. Clinical Question:  Which screening method should be considered best practice to detect potentially lethal cardiac disorders during the preparticipation physical examination (PE) of athletes? Data Sources:  The authors completed a comprehensive literature search of MEDLINE, CINAHL, Cochrane Library, Embase, Physiotherapy Evidence Database (PEDro), and SPORTDiscus from January 1996 to November 2014. The following key words were used individually and in combination: ECG, athlete, screening, pre-participation, history, and physical. A manual review of reference lists and key journals was performed to identify additional studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this review. Study Selection:  Studies selected for this analysis involved (1) outcomes of cardiovascular screening in athletes using the history, PE, and electrocardiogram (ECG); (2) history questions and PE based on the American Heart Association recommendations and guidelines; and (3) ECGs interpreted following modern standards. The exclusion criteria were (1) articles not in English, (2) conference abstracts, and (3) clinical commentary articles. Study quality was assessed on a 7-point scale for risk of bias; a score of 7 indicated the highest quality. Articles with potential bias were excluded. Data Extraction:  Data included number and sex of participants, number of true- and false-positives and negatives, type of ECG criteria used, number of cardiac abnormalities, and specific cardiac conditions. The sensitivity, specificity, false-positive rate, and positive predictive value of each screening tool were calculated and summarized using a bivariate random-effects meta-analysis model. Main Results:  Fifteen articles reporting on 47 137 athletes were fully reviewed. The overall quality of the 15 articles ranged from 5 to 7 on the 7-item assessment scale (ie, participant selection criteria, representative sample, prospective data with at least 1 positive finding, modern ECG criteria used for screening, cardiovascular screening history and PE per American Heart Association guidelines, individual test outcomes reported, and abnormal screening findings evaluated by appropriate diagnostic testing). The athletes (66% males and 34% females) were ethnically and racially diverse, were from several countries, and ranged in age from 5 to 39 years. The sensitivity and specificity of the screening methods were, respectively, ECG, 94% and 93%; history, 20% and 94%; and PE, 9% and 97%. The overall false-positive rate for ECG (6%) was less than that for history (8%) or PE (10%). The positive likelihood ratios of each screening method were 14.8 for ECG, 3.22 for history, and 2.93 for PE. The negative likelihood ratios were 0.055 for ECG, 0.85 for history, and 0.93 for PE. A total of 160 potentially lethal cardiovascular conditions were detected, for a rate of 0.3%, or 1 in 294 patients. The most common conditions were Wolff-Parkinson-White syndrome (n = 67, 42%), long QT syndrome (n = 18, 11%), hypertrophic cardiomyopathy (n = 18, 11%), dilated cardiomyopathy (n = 11, 7%), coronary artery disease or myocardial ischemia (n = 9, 6%), and arrhythmogenic right ventricular cardiomyopathy (n = 4, 3%). Conclusions:  The most effective strategy to screen athletes for cardiovascular disease was ECG. This test was 5 times more sensitive than history and 10 times more sensitive than PE, and it had a higher positive likelihood ratio, lower negative likelihood ratio, and lower false-positive rate than history or PE. The 12-lead ECG interpreted using modern criteria should be considered the best practice in screening athletes for cardiovascular disease, and the use of history and PE alone as screening tools should be reevaluated.

scholarly journals MON-117 Reducing Unnecessary Repeat Vitamin D Testing at a Large Ambulatory Hospital: A Quality Improvement Initiative

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Olexandra Koshkina ◽  
Miranda Boggild ◽  
Felicia Tai ◽  
Geetha Mukerji
Keyword(s):  
Vitamin D ◽  
Quality Improvement ◽  
Best Practice ◽  
Quality Improvement Initiative ◽  
College Hospital ◽  
Improvement Project ◽  
Repeat Testing ◽  
Hydroxyvitamin D ◽  
Practice Advisory ◽  
25 Hydroxyvitamin D

Abstract Background: With the increasing interest in the importance and potential benefits of vitamin D, there has been a significant rise in unnecessary vitamin D testing. The aim of the project was to reduce unnecessary repeat vitamin D testing at Women’s College Hospital by 50% by May 30th 2020. Methods: The Model for Improvement framework was used in the design of the quality improvement project to reduce unnecessary repeat vitamin D testing. Problem characterization was conducted to design the intervention to address root causes and iterative Plan-do-Study-Act cycles were used to develop an intervention that incorporated a best practice advisory (BPA). The primary outcome measure was unnecessary vitamin D testing. Unnecessary repeat testing was defined as: repeat 25-hydroxyvitamin D testing within 3 months or repeat 25-hydroxyvitamin D testing after a normal result (>75 mmol/L) in the preceding 12 months. Secondary outcomes which included BPAs generated, as well as the number of BPAs that resulted in no test being ordered were tracked. Paper-based orders were also tracked as a balancing measure. Results: It was identified that 12.7% of vitamin D testing (n= 289/2276) between July 2017 and July 2018 was related to unnecessary repeat testing. Following our cause and effect analysis and problem characterization, it was noted that providers ordered repeat vitamin D testing due to being unaware of prior normal results, as well as due to a knowledge gap of current testing recommendations. If the 25-hydroxyvitamin D order was identified as unnecessary at the time of order entry, a BPA was generated at the point of care. The BPA was implemented on February 4th, 2019. As of August 31st, 2019 based on the analysis of the number of BPAs generated and the number of tests not ordered as a result, there has been a 26% reduction in the number of inappropriate repeat vitamin D orders. Conclusions: Based on the preliminary data, a best practice advisory alert for vitamin D testing can be an appropriate QI intervention to reduce unnecessary vitamin D testing. Ongoing data analysis will be conducted to assess the long-term impact and sustainability of this intervention. Next steps include consideration of implementation of force function to reduce inappropriate repeat vitamin D testing.

scholarly journals MP11: A quality improvement initiative to decrease the rate of solitary blood cultures in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S68-S69
Author(s):  
J. Choi ◽  
S. Ensafi ◽  
L.B. Chartier ◽  
O. Van Praet
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Control Charts ◽  
Best Practice ◽  
Blood Cultures ◽  
Quality Improvement Initiative ◽  
Relative Reduction ◽  
Education Intervention ◽  
Statistical Process ◽  
Forcing Function

Introduction: Best practice guidelines recommend that at least two sets of blood cultures be sent when blood cultures are required. However, high rates of solitary blood cultures are still common in the emergency department. The aim of this study was to evaluate the efficacy of different quality improvement initiatives aimed at reducing the rate of solitary blood cultures being sent to the lab on patients ultimately discharged from our emergency department. Methods: This was a multi-centre, multi-phase, prospective study evaluating a comprehensive education-based intervention and a second intervention that combined a computerized forcing function along with a brief education-based intervention. The results were analyzed using segmented regression analysis, as well as statistical process control charts. Results: The baseline rate of solitary sets of blood cultures was 41.1%. The education intervention reduced this rate to 30.3%. The introduction of a forcing function with a brief educational intervention further reduced the rate to 11.6%. This represents an absolute reduction of 29.5% from baseline (relative reduction of 71.8%). According to segmental regression analyses, the education intervention alone did not produce a statistically significant change when factoring possible background time-related trends (P=0.071). However, the forcing function produced a statistically significant improvement (P < 0.0005), which was maintained for 6 months. Conclusion: The combination of a brief education-based intervention and a computerized forcing function was more effective than education alone in reducing solitary blood culture collection in our emergency department in this time series study. Forcing functions can be a powerful tool in modifying behaviours and processes in the clinical setting.

Abstract 267: Improving Inpatient Stroke Care by Implementing Stroke Units Across Health Systems Using an Improvement Collaborative Approach

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Noreen Kamal ◽  
Pamela Aikman ◽  
Philip Teal ◽  
Michael Suddes ◽  
Todd Collier ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Stroke Unit ◽  
Best Practice ◽  
Interdisciplinary Team ◽  
Stroke Care ◽  
Quality Improvement Initiative ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Learning Session ◽  
Stroke Units

Background: Stroke units, defined as a geographic location where stroke patients are cared for by an interdisciplinary team, hold the strongest evidence in reduced mortality and disability for stroke patients. However, according to the 2011 Canadian Stroke Network’s National Stroke Audit, only 23% of stroke patients in Canada were admitted to a Stroke Unit with the Canadian province of British Columbia (BC) lagging at only 4%. The objective of this quality improvement initiative was to increase the number of stroke units and to improve existing stroke units; additionally, we aimed to improve adherence to best practice acute stroke care. Methods: Using the Institute for Healthcare Improvement’s Breakthrough Series Collaborative methodology, a stroke unit Improvement Collaborative was run from January 2013 to December 2013 by Stroke Services BC, a program of the Provincial Health Services Authority in BC. Faculty members were recruited from BC and the Calgary Stroke Program in the province of Alberta. The collaborative had 4 Learning Sessions, a closing workshop, and bi-weekly webinars. Teams followed a structured 7-step framework: understanding current volumes; securing space; establishing the team; ensuring clinical best practice; creating processes for team communication; ensuring patient engagement; and establishing quality improvement mechanisms. Pre and post self-reports of care were collected through electronic polling at Learning Session 2 in February 2013 (pre, n=78) and at the Closing Celebration in December 2013 (post, n=66) using a 4-point Likert scale. There were 20 questions based on best practice. Results: Eleven teams enrolled representing 17 hospitals in BC and a hospital in Saskatoon in the province of Saskatchewan. Teams were either working at the hospital or health region level. There were a total of 75 new stroke beds created in BC, and 12 beds recommended for Saskatoon. Furthermore, the results from the e-voting on best practice showed statistically significant improvement in the following areas: admission to a stroke unit (p=0.005); assessment by an interdisciplinary team within 48 hours of admission (p=0.002); use of standardized valid tools (p=0.002); swallowing screen within 24 hours (p<0.001); core interprofessional team on the stroke unit (p<0.001); care to prevent secondary complication (p<0.001); management of serum lipid levels (p=0.017); patient education (p<0.001); and team education (p=0.02). Conclusions: This inter-provincial Quality Improvement Collaborative was successful in implementing and improving stroke units, and in improving best practice care of inpatient stroke patients. Critical success factors include the engagement of faculty from high-performing centers even if they exist outside the jurisdiction where improvement is sought, and the use of the 7-step framework for implementing stroke units.

scholarly journals Quality improvement initiative increases total paracentesis and early paracentesis rates in hospitalised cirrhotics with ascites

2019 ◽  
Vol 11 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Arun Jesudian ◽  
Luis Barraza ◽  
Peter Steel ◽  
Nicole Shen ◽  
Yecheskel Schneider ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Best Practice ◽  
Tertiary Care ◽  
Quality Improvement Initiative ◽  
Care Hospital ◽  
Care Providers ◽  
Bacterial Peritonitis ◽  
Major Metropolitan Area ◽  
Hospitalised Patients ◽  
Before And After

ObjectiveEarly paracentesis (EP) for rapid diagnosis of spontaneous bacterial peritonitis is considered best practice in the care of admitted patients with cirrhosis and ascites, but inpatient paracentesis is frequently not performed or delayed. We developed a quality improvement (QI) initiative aimed at increasing the proportion of admitted patients with cirrhosis who undergo paracentesis and EP.Design Pre–post study of a QI initiative.Setting A tertiary care hospital in a major metropolitan area.Patients Hospitalised patients with cirrhosis and ascites.InterventionsWe targeted care providers in the emergency department (ED) by raising awareness of the importance of EP, developing criteria to identify patients at highest risk of SBP who were prioritised for EP by ED providers and restructuring the ED environment to enable timely paracentesis.Results76 patients meeting inclusion criteria were admitted during the postintervention 9-month study period. Of these, 91% (69/76) underwent paracentesis during admission versus 71 % (77/109) preintervention (p=0.001). 81% (56/69) underwent EP within 12 hours of presentation or after a predefined acceptable reason for delay versus 48% (37/77) preintervention (p=0.001). There were no significant differences in in-hospital mortality or length of stay before and after intervention.ConclusionA multidisciplinary QI intervention targeting care in the ED successfully increased the proportion of patients with cirrhosis and ascites undergoing diagnostic paracentesis during admission and EP within 12 hours of presentation.

scholarly journals Publish or Perish

2021 ◽  
Vol 12 (5) ◽  
Author(s):  
Beth Faiman, PhD, MSN, APRN-BC, AOCN®, FAAN
Keyword(s):  
Quality Improvement ◽  
Clinical Research ◽  
Relevant Information ◽  
Research Quality ◽  
First Year ◽  
Publish Or Perish ◽  
The Past ◽  
Do So

In the past 10 years, APs have become more engaged in clinical research and publishing articles of interest for their peers. In fact, in 2019, there was a 24% increase in the number of submissions to JADPRO compared with the first year the journal was launched, in 2010. Advanced practitioners are well positioned to design and conduct clinical research, quality improvement projects, and to update peers on relevant information; however, many lack the time and resources to do so (Lambert & Housden, 2017). Advancing the science is an inherent desire for many APs, but knowing where to start and having strategies for writing can be overwhelming. For clinical APs, the importance of writing is becoming more important.

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