Developing a Quantitative Staffing to Workload Tool in an Ambulatory Setting

Ambulatory staffing to workload based on visit volume in an outpatient setting is an elusive formula, and the literature describing such processes is limited. One health system tasked a multidisciplinary team with developing an ambulatory staffing to workload tool to meet the needs of staff, management, and leadership. The resultant tool includes an automated dashboard for determining staffing needs on the basis of quantified workload, prospective modeling, and historical dashboards to demonstrate actual staffing (full-time equivalents) to workload (outpatient volumes) compared with budget.

Pseudomonas infection reduction in the ICU: a successful multidisciplinary quality improvement project

Pseudomonas aeruginosa infection causes high morbidity and mortality, especially in immunocompromised patients. Pseudomonas can develop multidrug resistance. As a result, it can cause serious outbreaks in hospital and intensive care unit (ICU) settings, increasing both length of stay and costs. In the second quarter of 2020, in a community hospital's 15-bed ICU, the P. aeruginosa-positive sputum culture rate was unacceptably high, with a trend of increasing prevalence over the previous 3 quarters. We performed a multidisciplinary quality improvement (QI) initiative to decrease the P. aeruginosa-positive rate in our ICU. We used the Define, Measure, Analyze, Improve, and Control model of Lean Six Sigma for our QI initiative to decrease the P. aeruginosa-positive sputum culture rate by 50% over the following year without affecting the baseline environmental services cleaning time. A Plan-Do-Study-Act approach was used for key interventions, which included use of sterile water for nasogastric and orogastric tubes, adherence to procedure for inline tubing and canister exchanges, replacement of faucet aerators, addition of hopper covers, and periodic water testing. We analyzed and compared positive sputum culture rates quarterly from pre-intervention to post-intervention. The initial P. aeruginosa-positive culture rate of 10.98 infections per 1,000 patient-days in a baseline sample of 820 patients decreased to 3.44 and 2.72 per 1,000 patient-days in the following 2 post-intervention measurements. Environmental services cleaning time remained stable at 34 minutes. Multiple steps involving all stakeholders were implemented to maintain this progress. A combination of multidisciplinary efforts and QI methods was able to prevent a possible ICU P. aeruginosa outbreak.

Guidelines for lumbar spine radiography in acute low back pain: effect of implementation in an accident and emergency department

Guidelines for lumbar spine radiography were agreed by consultation between staff in the radiology, accident and emergency and neurosurgical departments of a large teaching hospital. Study of 322 consecutive patients over an eight month period showed that the proportion of patients referred for radiography was reduced from 48.4% to 27.2% following introduction of the guidelines (p = 0.0002). Successful use of such guidelines requires cooperation between clinical and radiological staff and frequent review of performance.

A temporal profile of changes in myocardial copper after isoproterenol induced cardiac necrosis

The changes in myocardial copper were studied over a period of five days after producing myocardial necrosis in albino rats by subcutaneous injection of isoproterenol. Two different doses of isoproterenol (85 mg/kg & 42.5 mg/kg) were used to study the effect of variation in the extent of myocardial damage on the behaviour of myocardial copper. It was interesting to note that there was mainly an increase in myocardial copper with the lower dose of isoproterenol whereas there was mainly a fall in myocardial copper with the higher dose of isoproterenol. It has been hypothesized that this difference in behaviour of myocardial copper with respect to the different doses of isoproterenol is related to the extent of the myocardial tissue which escapes injury. Confirmation of myocardial necrosis was done by ECG, enzymes (SGOT, SGPT & LDH) and histology. Estimation of myocardial copper was done by atomic absorption spectrophotometry (Perkin Elmer 303).

A temporal profile of myocardial zinc changes after isoproterenol induced cardiac necrosis

Changes in myocardial zinc level was followed up over a period of 5 days after producing myocardial necrosis in albino rats by subcutaneous injection of isoproterenol, 85 mg/kg body weight. Myocardial necrosis was confirmed by ECG (Lead II), histology and serum enzyme studies (SGOT, SGPT and LDH). A decrease in myocardial zinc level was observed on all the five days. The possible mechanism and the therapeutic implications of these changes are discussed.