scholarly journals Feedback Frequency in Competence by Design: A Quality Improvement Initiative

2020 ◽  
Vol 12 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Neil Arnstead ◽  
Paolo Campisi ◽  
Susan Glover Takahashi ◽  
Chris J. Hong ◽  
Florence Mok ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Head And Neck ◽  
Control Charts ◽  
Neck Surgery ◽  
Completion Rate ◽  
Head And Neck Surgery ◽  
Audit And Feedback ◽  
Quality Improvement Initiative ◽  
Statistical Process ◽  
Electronic Assessment

ABSTRACT Background Otolaryngology–head and neck surgery is in the first wave of residency training programs in Canada to adopt Competence by Design (CBD), a model of competency-based medical education. CBD is built on frequent, low-stakes assessments and requires an increase in the number of feedback interactions. The University of Toronto otolaryngology–head and neck surgery residents piloted the CBD model but were completing only 1 assessment every 4 weeks, which was insufficient to support CBD. Objective This project aimed to increase assessment completion to once per resident per week using quality improvement methodology. Methods Stakeholder engagement activities had residents and faculty characterize barriers to assessment completion. Brief electronic assessment forms were completed by faculty on residents' personal mobile devices in face-to-face encounters, and the number completed per resident was tracked for 10 months during the 2016–2017 pilot year. Response to the intervention was analyzed using statistical process control charts. Results The first bundled intervention—a rule set dictating which clinical instance should be assessed, combined with a weekly reminder implemented for 10 weeks—was unsuccessful in increasing the frequency of assessments. The second intervention was a leaderboard, designed on an audit-and-feedback system, which sent weekly comparison e-mails of each resident's completion rate to all residents and the program director. The leaderboard demonstrated significant improvement from baseline over 10 weeks, increasing the assessment completion rate from 0.22 to 2.87 assessments per resident per week. Conclusions A resident-designed audit-and-feedback leaderboard system improved the frequency of CBD assessment completion.

scholarly journals An audit and feedback system for effective quality improvement in head and neck surgery: Can we become better surgeons?

Cancer ◽  
2015 ◽  
Vol 121 (10) ◽  
pp. 1581-1587 ◽  
Author(s):  
Carol M. Lewis ◽  
Marcus M. Monroe ◽  
Dianna B. Roberts ◽  
Amy C. Hessel ◽  
Stephen Y. Lai ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Head And Neck ◽  
Feedback System ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Audit And Feedback

scholarly journals A Quality Improvement Initiative to Reduce Bronchopulmonary Dysplasia in a Level 4 NICU—Golden Hour Management of Respiratory Distress Syndrome in Preterm Newborns

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 301
Author(s):  
Andrew M. Dylag ◽  
Jamey Tulloch ◽  
Karen E. Paul ◽  
Jeffrey M. Meyers
Keyword(s):  
Quality Improvement ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Control Charts ◽  
Fluid Management ◽  
Delivery Room ◽  
Quality Improvement Initiative ◽  
Statistical Process ◽  
Golden Hour ◽  
Surfactant Administration

Background: Prevention of chronic lung disease (CLD) requires a multidisciplinary approach spanning from the delivery room to Neonatal Intensive Care Unit (NICU) discharge. In 2018, a quality improvement (QI) initiative commenced in a level 4 NICU with the goal of decreasing chronic lung disease rates below the Vermont Oxford Network (VON) average of 24%. Methods: Improvement strategies focused on addressing the primary drivers of ventilation strategies, surfactant administration, non-invasive ventilation, medication use, and nutrition/fluid management. The primary outcome was VON CLD, defined as need for mechanical ventilation and/or supplemental oxygen use at 36 weeks postmenstrual age. Statistical process control charts were used to display and analyze data over time. Results: The overall CLD rate decreased from 33.5 to 16.5% following several interventions, a 51% reduction that has been sustained for >18 months. Changes most attributable to this include implementation of the “golden hour” gestational age (GA) based delivery room protocol that encourages early surfactant administration and timely extubation. Fewer infants were intubated across all GA groups with the largest improvement among infants 26–27 weeks GA. Conclusions: Our efforts significantly decreased CLD through GA-based respiratory guidelines and a comprehensive, rigorous QI approach that can be applicable to other teams focused on improvement.

Patient Safety/Quality Improvement Primer, Part III: The Role of Simulation

2021 ◽  
pp. 019459982110133
Author(s):  
Ellen S. Deutsch ◽  
Sonya Malekzadeh ◽  
Cecelia E. Schmalbach
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Control Charts ◽  
Neck Surgery ◽  
Resident Training ◽  
Statistical Process ◽  
Ensure Patient Safety ◽  
Statistical Process Control Charts ◽  
The Individual ◽  
The Impact

Simulation training has taken a prominent role in otolaryngology–head and neck surgery (OTO-HNS) as a means to ensure patient safety and quality improvement (PS/QI). While it is often equated to resident training, this tool has value in lifelong learning and extends beyond the individual otolaryngologists to include simulation-based learning for teams and health systems processes. Part III of this PS/QI primer provides an overview of simulation in medicine and specific applications within the field of OTO-HNS. The impact of simulation on PS/QI will be presented in an evidence-based fashion to include the use of run and statistical process control charts to assess the impact of simulation-guided initiatives. Last, steps in developing a simulation program focused on PS/QI will be outlined with future opportunities for OTO-HNS simulation.

scholarly journals Effects of an external ventricular drain alert protocol on venticulostomy placement time in the emergency department

2021 ◽  
Vol 51 (5) ◽  
pp. E4
Author(s):  
Henry Chang ◽  
Michael A. Silva ◽  
Alexander Giner ◽  
Selina Ancheta ◽  
José G. Romano ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Control Charts ◽  
External Ventricular Drain ◽  
Improve Patient Care ◽  
Control Group ◽  
Quality Improvement Initiative ◽  
Alert System ◽  
Statistical Process ◽  
Healthcare Teams

OBJECTIVE Timely ventriculostomy placement is critical in the management of neurosurgical emergencies. Prompt external ventricular drain (EVD) placement has been shown to improve long-term patient outcomes and decrease the length of ICU and hospital stays. Successful and efficient EVD placement requires seamless coordination among multiple healthcare teams. In this study, the authors sought to identify factors favoring delayed ventriculostomy via a quality improvement initiative and to implement changes to expedite EVD placement. METHODS Through process mapping, root cause analysis, and interviews with staff, the authors identified the lack of a standardized mechanism for alerting necessary healthcare teams as a major contributor to delays in EVD placement. In December 2019, an EVD alert system was developed to automatically initiate an EVD placement protocol and to alert the neurosurgery department, pharmacy, core laboratory, and nursing staff to prepare for EVD placement. The time to EVD placement was tracked prospectively using time stamps in the electronic medical record. RESULTS A total of 20 patients who underwent EVD placement between December 2019 and April 2021, during the EVD alert protocol initiation, and 18 preprotocol control patients (January 2018 to December 2019) met study inclusion criteria and were included in the analysis. The mean time to EVD placement in the control group was 71.88 minutes compared with 50.3 minutes in the EVD alert group (two-tailed t-test, p = 0.025). The median time to EVD placement was 64 minutes in the control group compared with 52 minutes in the EVD alert group (rank-sum test, p = 0.0184). All patients from each cohort exhibited behavior typical of stable processes, with no violation of Shewhart rules and no special cause variations on statistical process control charts. CONCLUSIONS A quality improvement framework helped identify sources of delays to EVD placement in the emergency department. An automated EVD alert system was a simple intervention that significantly reduced the time to EVD placement in the emergency department and can be easily implemented at other institutions to improve patient care.

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.

Patient Safety and Quality Improvement in Otolaryngology–Head and Neck Surgery: A Systematic Review

2020 ◽  
Vol 131 (1) ◽  
pp. 33-40
Author(s):  
John D. Gettelfinger ◽  
P. Barrett Paulk ◽  
Cecelia E. Schmalbach
Keyword(s):  
Systematic Review ◽  
Patient Safety ◽  
Quality Improvement ◽  
Head And Neck ◽  
Neck Surgery ◽  
Head And Neck Surgery

scholarly journals Implementation of a Pharmacist-Led Antimicrobial Time-Out for Medical-Surgery Services in an Academic Pediatric Hospital

2021 ◽  
Vol 26 (3) ◽  
pp. 284-290
Author(s):  
Christopher R.T. Stang ◽  
Preeti Jaggi ◽  
Jessica Tansmore ◽  
Katelyn Parson ◽  
Kathryn E. Nuss ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Audit And Feedback ◽  
Quality Improvement Initiative ◽  
Pediatric Hospital ◽  
Pediatric Medicine ◽  
Statistical Process ◽  
Quality Improvement Team ◽  
Time Out ◽  
The Mean ◽  
Improvement Team

OBJECTIVE This report describes a quality improvement initiative to implement a pharmacist-led antimicrobial time-out (ATO) in a large, freestanding pediatric hospital. Our goal was to reach 90% ATO completion and documentation for eligible patients hospitalized on general pediatric medicine or surgery services. METHODS A multidisciplinary quality improvement team developed an ATO process and electronic documentation tool. Clinical pharmacists were responsible to initiate and document an ATO for pediatric medicine or surgery patients on or before the fifth calendar day of therapy. The quality improvement team educated pharmacists and physicians and provided ATO audit and feedback to the pharmacists. We used statistical process control methods to track monthly rates of ATO completion retrospectively from October 2017 through March 2018 and prospectively from April 2018 through April 2019. Additionally, we retrospectively evaluated the completion of 6 data elements in the ATO note over the final 12-month period of the study. RESULTS Among 647 eligible antimicrobial courses over the 19-month study period, the mean monthly documentation rate increased from 54.6% to 83.5% (p < 0.001). The mean ATO documentation rate increased from 32.8% to 74.2% (p < 0.001) for the pediatric medicine service and from 65.0% to 88.1% for the pediatric surgery service (p = 0.006). Among 302 notes assessed for completeness, 35.8% had all the required data fields completed. A tentative antimicrobial stop date was the data element completed least often (49.3%). CONCLUSIONS We implemented a pharmacist-led ATO, highlighting the role pharmacists play in antimicrobial stewardship. Additional efforts are needed to further increase ATO completion rates and to define treatment duration.

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