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Matthews A, Hilbig A. Introduction to quality improvement: From corridor conversation to system change. Emerg Med Australas 2023; 35:862-863. [PMID: 37633835 DOI: 10.1111/1742-6723.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Alexander Matthews
- Emergency Department, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Adelene Hilbig
- Emergency Department, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
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Davison G, Ruddell J, Trouton M, McDonald R, Kennedy B, O'Neill V, McCann J, Bartholome B, Steen H, Shields MD, Mullen S. Reducing oral steroid intolerability and drug costs for acute wheezers: A retrospective evaluation of a clinical management algorithm in a Pediatric Emergency Department. Pediatr Pulmonol 2023; 58:1012-1021. [PMID: 36598127 DOI: 10.1002/ppul.26286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 11/23/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023]
Abstract
PROJECT AIM To retrospectively evaluate a clinical management algorithm for acute wheezers in a UK Pediatric Emergency Department (PED). OVERVIEW AND RATIONALE Acute wheezing attacks are a leading cause of PED attendances and inpatient admissions. Prednisolone, a routine treatment, is intolerable in almost one-third of children, requiring repeated dosing, which may prolong length of stay (LOS). To address this problem, we: (1) developed an acute management algorithm (concise, single-sided flow-chart, instructing immediate management); (2) modified the OCS regime from prednisolone (1 mg/kg, 3-day course) to dexamethasone (600 then 300 mcg/kg); (3) and disseminated guidance regionally. Written information-handouts, e-mails, and posters-were followed-up with verbal reinforcement. We implemented the algorithm in 2017 and revised it further in 2018. EVALUATION In 2019, we retrospectively collected data on 100 acute wheeze attendances (those requiring OCS, aged 2-14), between October and December in 2016, 2017, and 2018 (n = 300), and assessed outcomes. RESULTS Over a 48-month period, we reduced OCS intolerability by 67.2% and OCS drug costs by 85.8% (saving £41,470.14), while not significantly influencing the other outcomes. CONCLUSIONS Reduced intolerability and substantial cost savings can be achieved by implementing a structured acute pediatric wheeze algorithm and modifying the OCS to single-dose dexamethasone (300 mcg/kg).
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Affiliation(s)
- Gail Davison
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland, UK.,Children's Emergency Department, (primary institution), Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK
| | - Josh Ruddell
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Michelle Trouton
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Roisin McDonald
- Children's Emergency Department, (primary institution), Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK
| | - Ben Kennedy
- Children's Emergency Department, (primary institution), Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK
| | - Vikki O'Neill
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Joseph McCann
- Pharmacy Department, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK
| | - Brigitte Bartholome
- Children's Emergency Department, (primary institution), Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK
| | - Heather Steen
- Respiratory Department, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK
| | - Mike D Shields
- Respiratory Department, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK.,Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Stephen Mullen
- Children's Emergency Department, (primary institution), Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK
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Graham B, Smith JE, Nelmes P, Squire R, Latour JM. Initial Development of a Patient-Reported Experience Measure for Older Adults Attending the Emergency Department: Part II-Focus Groups with Professional Caregivers. Healthcare (Basel) 2023; 11:healthcare11050714. [PMID: 36900719 PMCID: PMC10001184 DOI: 10.3390/healthcare11050714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
A wide range of healthcare professionals provide care for patients in the emergency department (ED). This study forms part of a wider exploration of the determinants of patient experience for older adults in the ED, to assist the development of a new patient-reported experience measure (PREM). Inter-professional focus groups aimed to build on findings from earlier interviews with patients conducted in the ED, by exploring professional perspectives on caring for older people in this setting. A total of thirty-seven clinicians, comprising nurses, physicians and support staff, participated in seven focus groups across three EDs in the United Kingdom (UK). The findings reinforced that meeting patients' communication, care, waiting, physical, and environmental needs are all central to the delivery of an optimal experience. Meeting older patients' basic needs, such as access to hydration and toileting, is a priority often shared by all ED team members, irrespective of their professional role or seniority. However, due to issues including ED crowding, a gap exists between the desirable and actual standards of care delivered to older adults. This may contrast with the experience of other vulnerable ED user groups such as children, where the provision of separate facilities and bespoke services is commonplace. Therefore, in addition to providing original insights into professional perspectives of delivering care to older adults in the ED, this study demonstrates that the delivery of suboptimal care to older adults may be a significant source of moral distress for ED staff. Findings from this study, earlier interviews, and the literature will be triangulated to formulate a comprehensive list of candidate items for inclusion in a newly developed PREM, for patients aged 65 years and older.
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Affiliation(s)
- Blair Graham
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
- Department of Emergency Medicine, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK
- Correspondence:
| | - Jason E. Smith
- Department of Emergency Medicine, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK
| | - Pam Nelmes
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Rosalyn Squire
- Department of Emergency Medicine, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK
| | - Jos M. Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth 6102, Australia
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Dunn M, Savoie K, Erdem G, Dykes MW, Buckingham D, Spencer S, Besner G, Kenney B. Quality improvement methodology can reduce hospitalisation for abscess management. Emerg Med J 2022; 39:emermed-2021-211466. [PMID: 35017188 DOI: 10.1136/emermed-2021-211466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 11/26/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Abscesses 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. METHODS A 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. RESULTS Admissions 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%. CONCLUSION We 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.
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Affiliation(s)
- Michael Dunn
- Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
- Pediatric Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Kate Savoie
- Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
- Pediatric Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Guliz Erdem
- Pediatric Infectious Disease, Nationwide Children's Hospital, Columbus, Ohio, USA
- Pediatric Infectious Disease, The Ohio State University, Columbus, Ohio, USA
| | - Michael W Dykes
- Department of Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Don Buckingham
- Department of Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sandra Spencer
- Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
- Pediatric Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Gail Besner
- Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
- Pediatric Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Brian Kenney
- Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
- Pediatric Surgery, The Ohio State University, Columbus, Ohio, USA
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A practical guide to publishing a quality improvement paper. J Perinatol 2021; 41:1454-1458. [PMID: 33398057 DOI: 10.1038/s41372-020-00902-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/05/2020] [Accepted: 12/01/2020] [Indexed: 01/30/2023]
Abstract
Quality improvement (QI) is a relatively new and evolving field as it applies to healthcare. Hence, publishing a QI paper may present certain challenges as QI differs from standard types of scientific research. Some considerations in writing are inherent to all types of manuscripts submitted for publication, whereas others are unique to QI papers. This paper, the final in a series of eight papers related to QI in the neonatal setting, describes the best practices for writing and publishing QI manuscripts. Common pitfalls to avoid are also highlighted.
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Body R. Declining Emergency Medicine publications from the UK: the glass is half empty and may be leaking. Emerg Med J 2020; 37:323. [PMID: 32332057 DOI: 10.1136/emermed-2020-209650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Richard Body
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK .,Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
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