control charts
Recently Published Documents


TOTAL DOCUMENTS

3234
(FIVE YEARS 719)

H-INDEX

73
(FIVE YEARS 8)

Author(s):  
Robert J. Clifford ◽  
Donna Newhart ◽  
Maryrose R. Laguio-Vila ◽  
Jennifer L. Gutowski ◽  
Melissa Z. Bronstein ◽  
...  

Abstract Objective: To quantitatively evaluate relationships between infection preventionists (IPs) staffing levels, nursing hours, and rates of 10 types of healthcare-associated infections (HAIs). Design and setting: An ambidirectional observation in a 528-bed teaching hospital. Patients: All inpatients from July 1, 2012, to February 1, 2021. Methods: Standardized US National Health Safety Network (NHSN) definitions were used for HAIs. Staffing levels were measured in full-time equivalents (FTE) for IPs and total monthly hours worked for nurses. A time-trend analysis using control charts, t tests, Poisson tests, and regression analysis was performed using Minitab and R computing programs on rates and standardized infection ratios (SIRs) of 10 types of HAIs. An additional analysis was performed on 3 stratifications: critically low (2–3 FTE), below recommended IP levels (4–6 FTE), and at recommended IP levels (7–8 FTE). Results: The observation covered 1.6 million patient days of surveillance. IP staffing levels fluctuated from ≤2 IP FTE (critically low) to 7–8 IP FTE (recommended levels). Periods of highest catheter-associated urinary tract infection SIRs, hospital-onset Clostridioides difficile and carbapenem-resistant Enterobacteriaceae infection rates, along with 4 of 5 types of surgical site SIRs coincided with the periods of lowest IP staffing levels and the absence of certified IPs and a healthcare epidemiologist. Central-line–associated bloodstream infections increased amid lower nursing levels despite the increased presence of an IP and a hospital epidemiologist. Conclusions: Of 10 HAIs, 8 had highest incidences during periods of lowest IP staffing and experience. Some HAI rates varied inversely with levels of IP staffing and experience and others appeared to be more influenced by nursing levels or other confounders.


PEDIATRICS ◽  
2022 ◽  
Author(s):  
Olivia Ostrow ◽  
Deena Savlov ◽  
Susan E. Richardson ◽  
Jeremy N. Friedman

BACKGROUND AND OBJECTIVES: Viral respiratory infections are common in children, and practice guidelines do not recommend routine testing for typical viral illnesses. Despite results often not impacting care, nasopharyngeal swabs for viral testing are frequently performed and are an uncomfortable procedure. The aim of this initiative was to decrease unnecessary respiratory viral testing (RVT) in the emergency department (ED) and the pediatric medicine wards (PMWs) by 50% and 25%, respectively, over 36 months. METHODS: An expert panel reviewed published guidelines and appropriate evidence to formulate an RVT pathway using plan-do-study-act cycles. A multifaceted improvement strategy was developed that included implementing 2 newer, more effective tests when testing was deemed necessary; electronic order modifications with force functions; audit and feedback; and education. By using statistical process control charts, the outcomes analyzed were the percentage of RVT ordered in the ED and the rate of RVT ordered on the PMWs. Balancing measures included return visits leading to admission and inpatient viral nosocomial outbreaks. RESULTS: The RVT rate decreased from a mean of 3.0% to 0.5% of ED visits and from 44.3 to 30.1 per 1000 patient days on the PMWs and was sustained throughout the study. Even when accounting for the new rapid influenza test available in the ED, a 50% decrease in overall ED RVT was still achieved without any significant impact on return visits leading to admission or inpatient nosocomial infections. CONCLUSIONS: Through implementation of a standardized, electronically integrated RVT pathway, a decrease in unnecessary RVT was successfully achieved. Audit and feedback, reminders, and biannual education all supported long-term sustainability of this initiative.


Symmetry ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 159
Author(s):  
Xuelong Hu ◽  
Suying Zhang ◽  
Guan Sun ◽  
Jianlan Zhong ◽  
Shu Wu

Much research has been conducted on two-sided Exponentially Weighted Moving Average (EWMA) control charts, while less work has been devoted to the one-sided EWMA charts. Traditional one-sided EWMA charts involve resetting the EWMA statistic to the target whenever it falls below or above the target, or truncating the observations above or below the target and further applying the EWMA statistic to the truncated samples. In order to further improve the performance of traditional one-sided EWMA mean (X¯) charts, this paper studies the performance of the Modified One-sided EWMA (MOEWMA) X¯ charts to monitor a normally distributed process. The Monte-Carlo simulation method is used to obtain the zero- and steady-state Run Length (RL) properties of the proposed control charts. Through extensive simulations and comparisons with other charts, it is shown that the proposed MOEWMA X¯ charts compare favorably with some existing competing charts. Moreover, by attaching the variable sampling intervals (VSI) feature to the MOEWMA X¯ charts, it is shown that the VSI MOEWMA charts outperform the corresponding charts without the VSI feature. Finally, a real data example from manufacturing process shows the implementation of the proposed one-sided charts.


2022 ◽  
pp. emermed-2021-211466
Author(s):  
Michael Dunn ◽  
Kate Savoie ◽  
Guliz Erdem ◽  
Michael W Dykes ◽  
Don Buckingham ◽  
...  

BackgroundAbscesses are a common reason for ED visits. While many are drained in the ED, some require drainage in the operating room (OR). We observed that a higher percentage of patients at our institution in Columbus, Ohio, were admitted to the hospital with abscesses for incision and drainage (I&D) in the OR than other institutions, including paediatric institutions. Our aim was to decrease hospitalisations for abscess management.MethodsA multidisciplinary team convened to decrease hospitalisation for patients with abscesses and completed multiple ‘Plan-Do-Study-Act’ cycles, including increasing I&Ds performed in the ED. Other interventions included implementation of a clinical pathway, training of procedure technicians (PT), updating the electronic medical record (EMR), credentialing advanced practice nurses in sedation and individual follow-up with providers for admitted patients. Data were analysed using statistical process control charts. Gross average charges were assessed.ResultsAdmissions for I&D decreased from 26.3% to 13.7%. Abscess drainage in the ED improved from 79.3% to 96.5%. Mean length of stay decreased from 19.5 to 11.5 hours for all patients. Patients sedated increased from 3.3% to 18.2%. The number of repeat I&Ds within 30 days decreased from 4.3% to 1.7%.ConclusionWe decreased hospitalisations for abscess I&D by using quality improvement methodology. The most influential intervention was an initiative to increase I&Ds performed in the ED. Additional interventions included expanded training of PTs, implementation of a clinical pathway, updating the EMR, improving interdepartmental communication and increasing sedation providers.


Symmetry ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 122
Author(s):  
Anam Iqbal ◽  
Tahir Mahmood ◽  
Zulfiqar Ali ◽  
Muhammad Riaz

Innovations in technology assist the manufacturing processes in producing high-quality products and, hence, become a greater challenge for quality engineers. Control charts are frequently used to examine production operations and maintain product quality. The traditional charting structures rely on a response variable and do not incorporate any auxiliary data. To resolve this issue, one popular approach is to design charts based on a linear regression model, usually when the response variable shows a symmetric pattern (i.e., normality). The present work intends to propose new generalized linear model (GLM)-based homogeneously weighted moving average (HWMA) and double homogeneously weighted moving average (DHWMA) charting schemes to monitor count processes employing the deviance residuals (DRs) and standardized residuals (SRs) of the Poisson regression model. The symmetric limits of HWMA and DHWMA structures are derived, as SR and DR statistics showed a symmetric pattern. The performance of proposed and established methods (i.e., EWMA charts) is assessed by using run-length characteristics. The results revealed that SR-based schemes have relatively better performance as compared to DR-based schemes. In particular, the proposed SR-DHWMA chart outperforms the other two, namely SR-EWMA and SR-HWMA charts, in detecting shifts. To illustrate the practical features of the study’s proposal, a real application connected to the additive manufacturing process is offered.


2022 ◽  
Author(s):  
P.B. Dao

Abstract. The cointegration method has recently attracted a growing interest from scientists and engineers as a promising tool for the development of wind turbine condition monitoring systems. This paper presents a short review of cointegration-based techniques developed for condition monitoring and fault detection of wind turbines. In all reported applications, cointegration residuals are used in control charts for condition monitoring and early failure detection. This is known as the residual-based control chart approach. Vibration signals and SCADA data are typically used with cointegration in these applications. This is due to the fact that vibration-based condition monitoring is one of the most common and effective techniques (used for wind turbines); and the use of SCADA data for condition monitoring and fault detection of wind turbines has become more and more popular in recent years.


2022 ◽  
Vol 16 (2) ◽  
pp. 1
Author(s):  
SALIH OSMAN Duffuaa ◽  
Ahmed M. Ghaithan ◽  
Ahmed M. Attia

2022 ◽  
Vol 13 ◽  
pp. 215013192110626
Author(s):  
John Meurer ◽  
Robert Rohloff ◽  
Lisa Rein ◽  
Ilya Kanter ◽  
Nayanika Kotagiri ◽  
...  

Introduction and Objectives: A pediatric group with 25 clinics and 150 providers used multifaceted approaches to implement workflow processes and an electronic health record (EHR) flowsheet to improve child developmental screening. The key outcome was developmental screening done for every patient during 3 periods between ages 8 and 36 months. Identification of developmental concerns was the secondary study outcome. Screening rates and referrals were hypothesized to be optimized for children regardless of demographic backgrounds. Methods: During preventive visits, developmental screens targeted patients in age groups 8 to 12, 13 to 24, and 25 to 36 months. EHRs were analyzed for screening documentation, results, and referrals by patient demographics. Fifteen pediatric professionals were interviewed about their qualitative experiences. Quality improvement interventions included appointing clinic champions, training staff about the screening process and responsibilities, using a standardized tool, employing plan-do-study-act cycles, posting EHR prompts, providing financial incentives, and monitoring screening rates using control charts. Results: Within 25 months, screening rates improved from 60% to >95% within the 3 preventive visit age groups for a total of more than 30 000 children. Professionals valued the team process improvements. Children enrolled in Medicaid, black children, and those living in lower income zip codes had lower screening rates than privately insured, white children, and those living in higher income areas. Ages and Stages Questionnaire 3rd edition results were significantly different by gender, race/ethnicity, insurance, and income categories across all groups. Referral rates varied by race/ethnicity and zip code of residence. Conclusions: This project resulted in an effective and efficient process to improve child developmental screening that was valued by pediatric professionals. Analyses of patient demographics revealed disparities in services for the most vulnerable families. Ongoing quality improvement, health services research, and advocacy offer hope to improve health equity.


10.6036/10115 ◽  
2022 ◽  
Vol 97 (1) ◽  
pp. 71-78
Author(s):  
Li-Pang Chen ◽  
Syamsiyatul Muzayyanah ◽  
SU-FEN YANG ◽  
Bin Wang ◽  
Ting-An Jiang ◽  
...  

Control charts are effective tools for detecting out-of-control conditions of process parameters in manufacturing and service industries. The development of distribution-free control charts is important in statistical process control when the process quality variable follows an unknown or a non-normal distribution. This research thus proposes to use a distribution-free technology to establish a new control region based on the exponentially weighted moving average median statistic and exponentially weighted moving average interquartile range statistic for simultaneously monitoring the process location and dispersion and further sets up a corresponding new control chart. We compute the out-of-control average run length to evaluate out-of-control detection performance of the proposed control region and also compare the proposed control region with some existing location and dispersion control charts. Results show that our proposed chart always exhibits superior detection performance when the shifts in process location and/or dispersion are small or moderate. The new control region is thus recommended. Keywords: control chart, distribution-free, dispersion and location, EWMA, kernel control region, kernel density estimation.


Sign in / Sign up

Export Citation Format

Share Document