scholarly journals HIV retesting in pregnant women in South Africa: Outcomes of a quality improvement project targeting health systems’ weaknesses

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Lauren M. Golden ◽  
Lee Fairlie ◽  
Freda Might ◽  
Stina Mojela ◽  
Dorothy Motsamai ◽  
...  
Keyword(s):  
South Africa ◽  
Quality Improvement ◽  
Health Systems ◽  
Process Analysis ◽  
Patient Flow ◽  
Hiv Infections ◽  
Quality Improvement Project ◽  
Care Process ◽  
Improvement Project ◽  
North West

Introduction: South Africa is moving towards achieving elimination of mother-to-child transmission (eMTCT) but gaps remain in eMTCT programmes. Documenting successful outcomes of health systems interventions to address these gaps could encourage similar initiatives in the future.Methods: We describe the effectiveness of a Quality Improvement Project (QIP) to improve HIV retesting rates during pregnancy among women who had previously tested negative by redesigning the clinic process. Eight poorly-performing clinics were selected and compared with eight better-performing control clinics in a subdistrict in North West Province. Over nine months, root cause analysis and testing of change ideas using Plan-Do-Study-Act cycles were used to identify and refine interventions. Analysis of patient flow showed that women were referred for retesting following their nurse-driven antenatal visits, and many left without retesting as this would have further prolonged their visit. Processes were redesigned and standardised, where a counsellor was charged with retesting patients before antenatal consults. Staff were mentored on data collection and interpretation process. Quality improvement nurse advisors monitored indicators bi-weekly and adjusted interventions accordingly.Results: Retesting in intervention clinics rose from 36% in the three months pre-intervention to full coverage at month nine. At the end of the study, retesting in intervention clinics was 20% higher than in controls. Retesting also increased in the subdistrict overall.Conclusion: Service coverage and overall impact of HIV programmes can be raised through care-process analysis that optimises patient flow, supported by targeted QI interventions. These QI methodologies may be effective elsewhere for identifying new HIV infections in pregnant/breastfeeding women, and possibly in other services.

scholarly journals Implementation of the ‘TAKE STOCK’ Hot Debrief Tool in the ED: a quality improvement project

2021 ◽  
pp. emermed-2019-208830
Author(s):  
Max Sugarman ◽  
Blair Graham ◽  
Sarah Langston ◽  
Pam Nelmes ◽  
John Matthews
Keyword(s):  
Quality Improvement ◽  
Well Being ◽  
Learning Opportunities ◽  
Quality Improvement Project ◽  
Care Staff ◽  
Staff Perceptions ◽  
Improvement Project ◽  
North West ◽  
Stakeholder Consultation ◽  
Pdsa Cycle

Hot debriefing (HoD) describes a structured team-based discussion which may be initiated following a significant event. Benefits may include improved teamwork, staff well-being and identification of learning opportunities. Existing literature indicates that while staff value HoD following significant events, it is infrequently undertaken in practice. Internationally, several frameworks for HoD have been developed, although none are widely adopted for use in the ED. A quality improvement project was conducted to introduce HoD into a single UK ED in North West England, between January and March 2019. Following stakeholder consultation, the 9-item ‘TAKE STOCK’ tool was developed. Implementation of the tool increased the number of HoD (0—2.2 HoD episodes/week). Findings from the first plan-do-study-act (PDSA) cycle are presented, which revealed the key strengths and limitations of this model. Staff perceptions of the tool were evaluated using a self-administered short questionnaire designed by the authors. Satisfaction with TAKE STOCK was assessed using 10-point numerical scales. Across respondents (n−15), average satisfaction scores exceeded 9 out of 10 concerning patient care, staff self-care, decision-making, education, teamwork and identification of equipment issues. Implementation of HoD into the ED is feasible and viewed as beneficial by staff. Implementation toolkits for TAKE STOCK have been requested by 42 additional UK hospitals and ambulance trusts, demonstrating significant interest in its use. Research is now required to formally validate HoD frameworks for use in the ED, and assess whether HoD results in sustained improvements to staff and patient outcomes.

The Effect of Education on Chlorhexidine Use in the NICU

2017 ◽  
Vol 36 (5) ◽  
pp. 294-305 ◽  
Author(s):  
Janet Delong Pettit ◽  
Elizabeth Li Sharpe
Keyword(s):  
Quality Improvement ◽  
Education Program ◽  
Clinical Care ◽  
Central Line ◽  
Quality Improvement Project ◽  
Care Process ◽  
Improvement Project ◽  
Percent Correct ◽  
Central Line Insertion ◽  
Quasi Experimental

AbstractBackground: Neonates are at greater risk for central line–associated bloodstream infection (CLABSI) because of prolonged vascular access for nutrition and medications. Skin antisepsis using chlorhexidine gluconate (CHG), particularly the formulation with alcohol (CHG/alcohol), during central line insertion and maintenance activities is a key clinical care process associated with CLABSI reduction. One area of ongoing confusion for many clinicians is whether to adhere to the manufacturer’s recommendations that CHG remain on the skin following the procedure to promote persistent microbicidal effects or to foster product removal in hopes of preventing skin-related complications.Purpose: Determine the effect of a targeted education program on the knowledge and attitudes of nurses who place peripherally inserted central catheters in the NICU regarding the use and removal of CHG antiseptic.Methods: A quasi-experimental presurvey/postsurvey quality improvement project (QI project) recruited participants from the electronic mailing list of a national neonatal nursing organization.Results: There was a statistically significant deficiency in knowledge or misinformation related to the use of CHG/alcohol on the presurvey assessment. Eight questions reflecting knowledge consistent with most recent evidence were answered correctly only 11.4–25.7 percent of the time, all of which were considered statistically significant. Following completion of the education program, a nearly 100 percent correct response rate on all but three postsurvey questions resulted.Conclusions: This quality improvement project demonstrated success in the ability to change knowledge surrounding the removal of CHG/alcohol from the skin of babies in the NICU following completion of a targeted education program and the effectiveness of targeted web-based educational programs.

scholarly journals From Trauma Quality Improvement Project to the Geriatric Trauma Institute: Developing an Innovative Care Model for the Coming Storm

2014 ◽  
Vol 3 (3) ◽  
pp. 105-108
Author(s):  
Connie M DeLa'O ◽  
Aurelio Rodriguez ◽  
Justin Boer ◽  
Thomas Simunich ◽  
Russell Dumire
Keyword(s):  
Quality Improvement ◽  
Trauma Care ◽  
Formative Evaluation ◽  
Transitional Care ◽  
Quality Improvement Project ◽  
Geriatric Trauma ◽  
Care Process ◽  
Care Model ◽  
Improvement Project ◽  
Trauma Service

ABSTRACT Background The US geriatric population is projected to steadily increase to approximately 20% by 2030, thereby significantly increasing the burden to trauma services. This study sought to transform the geriatric trauma care model into one more effective, efficient, financially sustainable, and capable of absorbing the anticipated increased demand. Study design The goals were to improve the geriatric trauma care process—for patient and hospital, detail its evolution, and provide a formative evaluation of the result. A multidisciplinary team, internal and external to the hospital, was assembled including clinical, administrative, and technical staff. Over 18 months, application of Lean Six Sigma tools/concepts produced a novel care model, the Geriatric Trauma Institute (GTI). Retrospectively, formative evaluation was accomplished by comparing pre-GTI data time-matched with that from the first 8 months post-GTI initiation. Results The GTI has achieved 100% involvement of institution orthopedists with 100% of geriatric trauma admissions being converted to the GTI. Eight months post-GTI, geriatric trauma service admissions increased 26.6%, while non-trauma admissions decreased 78.2%. Out-transfers declined by 28.2%. Patients dispositioned to home increased 26.1% alongside decreases to rehabilitation (47.2%), skilled nursing, and transitional care facilities. Conclusion Geriatric trauma institute success is evidenced by the quantifiable benefits to patient and hospital. During development, new work processes, tools, and staff training helped boost the utilization of the trauma service regarding geriatric trauma care via the novel multidisciplinary approach. The GTI has demonstrated sustained quality improvement in geriatric trauma care maintained through the trauma service performance improvement initiative. How to cite this article DeLa'O CM, Rodriguez A, Boer J, Simunich T, Dumire R. From Trauma Quality Improvement Project to the Geriatric Trauma Institute: Developing an Innovative Care Model for the Coming Storm. Panam J Trauma Crit Care Emerg Surg 2014;3(3):105-108.

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