quality improvement intervention
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Author(s):  
Vanessa McFadden ◽  
Sarah Corey Bauer ◽  
Kelsey Porada ◽  
Sonia Mehta ◽  
Michelle L. Pickett

OBJECTIVES: Hospitals are an important nontraditional setting in which to address adolescent reproductive health. However, opportunities for intervention are frequently missed, especially for boys and patients hospitalized for noningestion complaints. Our global aim was to increase delivery of reproductive health care to adolescents hospitalized through our children’s hospital Pediatric Hospital Medicine service. METHODS: We performed 2 quality improvement intervention cycles: (1) provider education and monthly reminder e-mails and (2) an automated electronic health record (EHR) adolescent history and physical note template with social history prompts while discontinuing reminder e-mails. The primary outcome measure was sexual history documentation (SHD). Secondary measures were sexually transmitted infection (STI) testing and contraception provision. Statistical process control charts were used to analyze effectiveness of interventions. RESULTS: From July 2018 through June 2019, 528 Primary Hospital Medicine encounters were included in this study and compared with published baseline data on 150 encounters. Control charts revealed a special cause increase in SHD from 60% to 82% overall, along with 37% to 73% for boys and 57% to 80% for noningestion hospitalizations. Increased SHD correlated with cycle 1 and was maintained through cycle 2. Percent STI testing significantly increased but did not shift or trend toward special cause variation. Contraception provision, length of stay, and patient relations consultations were not affected. CONCLUSIONS: The interventions were successful in increasing SHD, including among boys and noningestion hospitalizations. The EHR enhancement maintained these increases after reminder emails were discontinued. Future interventions should specifically address STI testing and provision of contraception.


2021 ◽  
pp. 089801012110655
Author(s):  
Emily Marsh ◽  
Donna Millette ◽  
Alison Wolfe

Purpose: This study analyzed the efficacy of Post-Ease, a custom essential oil aromatherapy blend, in decreasing postoperative nausea and vomiting (PONV) and the need for antiemetic drugs in an orthopaedic surgical population. Study Design: This is retrospective cohort study, utilizing electronic health record data pre- and post-implementation of a nurse-driven quality improvement intervention. Methods: The study examined the impact of an inhaled custom blend of essential oils containing lavender, peppermint, ginger and lemon to assist in decreasing PONV and reduce the use of antiemetic medications. Data on the use of antiemetic drugs in pre- and post-intervention periods were analyzed. Findings: Nurses provided the Post-Ease blend 384 times in 2020 to patients as an option before proceeding, if necessary, to antiemetic drugs. The intervention group demonstrated a statistically significant reduction in the number of unique surgical patients’ need for antiemetics as treatment (22%; p = .05). Similarly, the total doses of antiemetics administered was significantly reduced (21%; p ≤ .05) during the study period. Conclusion: This study supports the use of aromatherapy to reduce PONV and minimize antiemetic use in an orthopaedic population.


2021 ◽  
pp. bmjqs-2021-014014
Author(s):  
Clare Rock ◽  
Rebecca Perlmutter ◽  
David Blythe ◽  
Jacqueline Bork ◽  
Kimberly Claeys ◽  
...  

To evaluate changes in Clostridioides difficile incidence rates for Maryland hospitals that participated in the Statewide Prevention and Reduction of C. difficile (SPARC) collaborative. Pre-post, difference-in-difference analysis of non-randomised intervention using four quarters of preintervention and six quarters of postintervention National Healthcare Safety Network data for SPARC hospitals (April 2017 to March 2020) and 10 quarters for control hospitals (October 2017 to March 2020). Mixed-effects negative binomial models were used to assess changes over time. Process evaluation using hospital intervention implementation plans, assessments and interviews with staff at eight SPARC hospitals. Maryland, USA. All Maryland acute care hospitals; 12 intervention and 36 control hospitals. Participation in SPARC, a public health–academic collaborative made available to Maryland hospitals, with staggered enrolment between June 2018 and August 2019. Hospitals with higher C. difficile rates were recruited via email and phone. SPARC included assessments, feedback reports and ongoing technical assistance. Primary outcomes were C. difficile incidence rate measured as the quarterly number of C. difficile infections per 10 000 patient-days (outcome measure) and SPARC intervention hospitals’ experiences participating in the collaborative (process measures). SPARC invited 13 hospitals to participate in the intervention, with 92% (n=12) participating. The 36 hospitals that did not participate served as control hospitals. SPARC hospitals were associated with 45% greater C. difficile reduction as compared with control hospitals (incidence rate ratio=0.55, 95% CI 0.35 to 0.88, p=0.012). Key SPARC activities, including access to trusted external experts, technical assistance, multidisciplinary collaboration, an accountability structure, peer-to-peer learning opportunities and educational resources, were associated with hospitals reporting positive experiences with SPARC. SPARC intervention hospitals experienced 45% greater reduction in C. difficile rates than control hospitals. A public health–academic collaborative might help reduce C. difficile and other hospital-acquired infections in individual hospitals and at state or regional levels.


Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Ziad Nehme ◽  
Jocasta Ball ◽  
Melanie Villani ◽  
Michael Stephenson ◽  
Tony Walker ◽  
...  

Introduction: Some emergency medical services (EMS) have shown increases in survival from out-of-hospital cardiac arrest (OHCA) following the implementation of a high-performance cardiopulmonary resuscitation (CPR) protocol. Despite this, little is known about the effect of high-performance CPR on OHCA witnessed by EMS personnel. Methods: We performed a retrospective cohort study of adult, EMS-witnessed OHCA patients of medical etiology from a population-based registry in Victoria, Australia. Patients treated after the introduction of a high-performance CPR protocol and training program between February 2019 and January 2020 were compared to historical controls between January 2015 and January 2019. The effect of the intervention on survival to hospital discharge was examined using logistic regression models adjusted for temporal and arrest factors. Results: A total of 1,561 and 420 EMS-witnessed OHCA patients were treated in the control and intervention periods, respectively. Baseline characteristics were similar across control and intervention periods, including the median age of cases (69 vs. 69 years, p=0.97), male sex (65.2% vs. 60.5%, p=0.08) and initial shockable arrests (33.7% vs. 29.3%, p=0.09). Resuscitation interventions were similar across groups, except for the use of mechanical CPR which declined during the intervention period (17.0% vs. 10.7%, p<0.001). Unadjusted survival to hospital discharge was similar across control and intervention periods for the overall population (29.4% vs. 32.1%, p=0.27), but significantly higher during the intervention period for initial shockable arrests (66.6% vs. 76.9%, p=0.03). After adjustment for confounders, cases in the intervention period were associated with a 43% increase (adjusted odds ratio [AOR] 1.43; 95% CI: 1.05, 1.94; p=0.02) in the risk-adjusted odds of survival to hospital discharge or a 79% increase (AOR 1.79, 95% CI: 1.09, 2.95; p=0.02) for initial shockable arrests. Conclusions: The implementation of a high-performance CPR quality improvement intervention was associated with significant improvement in survival from EMS witnessed OHCA. Efforts to monitor and improve CPR performance could yield further improvements in patient outcomes.


2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Joseph Mendlovic ◽  
Todd Zalut ◽  
Gabriel Munter ◽  
Ofer Merin ◽  
Amos M. Yinnon ◽  
...  

Abstract Background and aim Since 2014, the annual number of patients entering our emergency department (ED) has increased significantly. These were primarily Internal Medicine (IM) patients, and of these, 25–30% were admitted. The present governmental policy presents a deterrent to adding IM beds for these patients, and Emergency and IM departments cope with ever-increasing number of IM patients. We describe a quality improvement intervention to increase outflow of IM patients from the ED to the IM departments. Methods We conducted a quality improvement intervention at the Shaare Zedek Medical Center from 2014 to 2018. The first stage consisted of an effort to increase morning discharges from the IM departments. The second stage consisted of establishing a process to increase the number of admissions to the IM departments from the ED. Results Implementation of the first stage led to an increased morning discharge rate from a baseline of 2–4 to 18%. The second stage led to an immediate mean (± SD) morning transfer of 35 ± 7 patients to the medical departments (8–12 per department), providing significant relief for the ED. However, the additional workload for the IM departments’ medical and nursing staff led to a rapid decrease in morning discharges, returning to pre-intervention rates. Throughout the period of the new throughput intervention, morning admissions increased from 30 to > 70%, and were sustained. The number of patients in each department increased from 36 to 38 to a new steady state of 42–44, included constant hallway housing, and often midday peaks of 48–50 patients. Mean length of stay did not change. IM physician and nurse dissatisfaction led to increased number of patients being admitted during the evening and night hours and fewer during the morning. Conclusion We describe a quality improvement intervention to improve outflow of medical patients from the ED in the morning hours. The new ED practices had mixed effects. They led to less ED crowding in the morning hours but increased dissatisfaction among the IM department medical and nursing staff due to an increased number of admissions in a limited number of hours. The present governmental reimbursement policy needs to address hospital overcrowding as it relates to limited community healthcare beds and an aging population.


2021 ◽  
Author(s):  
Joshua Sapadin ◽  
Linelle Campbell ◽  
Komal Bajaj ◽  
Joshua Moskovitz

Abstract Background: Low back pain is a common emergency department (ED) complaint that does not always necessitate imaging. Unnecessary imaging drives medical overuse with potential to harm patients. Quality improvement (QI) interventions have shown to be an effective solution. The purpose of this QI intervention was to increase the percentage of appropriately ordered radiographs for low back pain while reducing the absolute number. Methods: A multi-component intervention led by a clinician champion including staff education, patient education, electronic medical record modification, audit and peer-feedback, and clinical decision support tools was implemented at an urban public hospital Emergency Department. In addition to the total number ordered, Choosing Wisely and American College of Radiology recommendations were used to assess appropriateness of all ED thoracic and lumbar conventional radiographs by chart review over eight months. Results: The percent of appropriately ordered radiographs increased from 5.8% to 53.9% and the monthly number of radiographs ordered decreased from 86 to 47 over the eight-month initiative. There were no compensatory increases in thoracic or lumbar computed tomography (CT) scans during this time frameConclusion: A multi-component QI intervention led by a clinician champion is an effective way to reduce the overutilization of thoracic and lumbar radiographs in an urban public hospital emergency department.


2021 ◽  
Author(s):  
Charlotte Hespe ◽  
Edwina Brown ◽  
Lucie Rychetnik

Abstract BackgroundQuality-improvement collaborative (QIC) initiatives aim to reduce gaps in clinical care provided in the healthcare system. This study provides a qualitative evaluation of a QIC project (QPulse) in Australian general practice focused on improving cardiovascular disease (CVD) assessment and management. MethodsThis qualitative-methods study explored implementing a QIC project by a Primary Health Network (PHN) in 34 general practices. Qualitative analyses examined in-depth interviews with participants and stakeholders focusing on barriers and enablers to implementation in our health system. They were analysed thematically using the Complex Systems Improvement framework (CSI), focusing on strategy, culture, structure, workforce, and technology.ResultsDespite strategic engagement with QPulse objectives across the health system, implementation barriers associated with this program were considerable for both PHN and the general practices. Adoption of the QIC process was reliant on engaged leadership, practice culture, systems for clear communication, tailored education and regular clinical audit and review. Practice ownership, culture and governance, rather than practice size and location, were related to successful implementation. Financial incentives for both the PHN and general practice were identified as prerequisites for systematised quality improvement (QI) projects in the future, along with individualised support and education provided to each practice. Technology was both an enabler and a barrier, and the PHN was seen as key to assisting the successful adoption of the available tools. ConclusionsImplementation of QI programs remains a potential tool for achieving better health outcomes in General Practice. However, enablers such as individualised education and support provided via a meso-level organisation, financial incentives, and IT tools and support are crucial if the full potential of QI programs are to be realised in the Australian healthcare setting. Trial registrationACTRN12615000108516, UTN U1111-1163-7995.


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