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Zheng W, Zheng J, Wang C, Pan C, Zhang J, Liu R, Bian Y, Ma J, Cheng K, Xu F, Chen Y. The development history, current state, challenges, and future directions of the BASIC-OHCA registry in China: A narrative review. Resusc Plus 2024; 18:100588. [PMID: 38439934 PMCID: PMC10909623 DOI: 10.1016/j.resplu.2024.100588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Out-of-hospital cardiac arrest is a major public health problem worldwide due to its high burden and poor outcomes. Despite progress in treatment, patient outcomes remain unsatisfactory, particularly in low-resource settings. The establishment of a registry is the first step towards gaining a comprehensive understanding of prevailing local conditions and identifying potential opportunities for improving patient survival. Here, we provide a narrative review of the BASeline Investigation of Out-of-hospital Cardiac Arrest (BASIC-OHCA), the first national OHCA registry in China, to introduce its development history, current state, challenges and future directions. We aim to enhance cross-cultural understanding by providing insights from China, while also serving as a reference for the implementation of large-scale registries in low-resource settings.
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Affiliation(s)
| | | | - Chunyi Wang
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, and The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health, and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Chang Pan
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, and The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health, and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Jianbo Zhang
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, and The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health, and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Rugang Liu
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, and The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health, and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Yuan Bian
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, and The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health, and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Jingjing Ma
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, and The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health, and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Kai Cheng
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, and The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health, and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Feng Xu
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, and The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health, and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Yuguo Chen
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, and The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health, and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - On behalf of the BASIC-OHCA Coordinators and Investigators
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, and The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health, and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
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Merriman C, Freeth D. SIN-BARRSS - Developing a mnemonic to support nurses' participation in interprofessional ward rounds in intensive care: An appreciative inquiry for quality improvement. Intensive Crit Care Nurs 2024; 81:103609. [PMID: 38155052 DOI: 10.1016/j.iccn.2023.103609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVES To develop and pilot a mnemonic to increase the willingness and ability of bedside nurses to contribute to patient reviews in the daily interprofessional ward round. RESEARCH METHODOLOGY/DESIGN Appreciative inquiry quality improvement study, using ethnographic observations and appreciative inquiry discussions, augmented by quantitative data collection of basic facts. SETTING Large (44 beds) critical care unit in the United Kingdom. MAIN OUTCOME MEASURES Interprofessional development and acceptance of mnemonic; successful preparation for pilot; use and usability of mnemonic; improvements in bedside nurses' contributions to ward round discussions (frequency and focus). RESULT/FINDINGS Interprofessional development of a usable and useful mnemonic was successful, pilot implementation showed promising levels of take up and acceptance. Compared to before the quality improvement project bedside nurses were more willing and able to participate in ward round discussions, did so more often, and used the mnemonic script with insight and flexibility. CONCLUSIONS The implementation of a mnemonic supported bedside nurses' contributions to the ward round. This could provide a framework for introducing similar programmes to other intensive care units. Appreciative inquiry methodology could be replicated in other settings to aid the improvement of interprofessional ward rounds, or to address other quality improvement priorities. IMPLICATIONS FOR CLINICAL PRACTICE A mnemonic can provide a structure which supports bedside nurses' contributions in ways that make good use of bedside nurses' professional expertise and most up to date knowledge of patients' clinical state. Furthermore, a well-designed mnemonic can be used flexibly and provides an outline script that supports less experienced and less confident nurses to make well-focused and well received contributions to rapid interprofessional discussions. In turn, this can increase these nurses' confidence and capability. More experienced and confident nurses, and ward round leaders, can use the same mnemonic flexibly as an aide memoir that guards against missing information and insights that could affect the quality and safety of patient care.
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Affiliation(s)
- Clair Merriman
- London and Queen Mary University of London, Oxford Brookes University, United Kingdom.
| | - Della Freeth
- London and Queen Mary University of London, The Science Council, United Kingdom
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Morgan M, Aubry RE, Kilbride K. Improving the clinical monitoring of extrapyramidal symptoms: a local quality improvement project. Ir J Med Sci 2024; 193:875-880. [PMID: 37805958 DOI: 10.1007/s11845-023-03539-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Extrapyramidal symptoms (EPS) can cause significant morbidity and impact negatively on patients' quality of life. Clinical guidelines provide recommendations regarding screening frequency and the use of structured tools to ensure adequate monitoring of EPS. Despite this, the literature indicates that the documentation and monitoring of EPS remain suboptimal. AIMS To devise an intervention that would lead to the improvement in the documentation and hence monitoring of EPS. METHODS An initial paper chart survey was conducted to assess the current extent of documentation and monitoring of EPS carried out in patient files of three distinct settings in our Mental Health Service (MHS): inpatient, rehabilitation, and assertive outreach. An intervention aimed at improving practice was subsequently designed and implemented. This involved adoption by the MHS of a new EPS monitoring tool and delivery of an educational session regarding its use. The extent of documentation and monitoring of EPS was re-surveyed post-intervention. RESULTS Initially, only 14.8% of inpatient records contained evidence of EPS documentation while no evidence at all was found across the other two MHS settings. Following the intervention, there was evidence of guideline concordant EPS monitoring using a structured tool in the clinical records of 75% of inpatients, 79.6% in the rehabilitation setting, and 18% in the assertive outreach programme. CONCLUSION Documentation of EPS monitoring improved significantly across several settings affiliated with a Dublin North City MHS following the systematic adoption of the Extrapyramidal Symptom Scale (EPSS) and clinician education regarding its use.
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Affiliation(s)
- Micheal Morgan
- South Louth CAMHS, St. Mary's Hospital Campus, Dublin Road, Drogheda, Co. Louth, Ireland.
| | | | - Kevin Kilbride
- Program for the Homeless MHS, Usher's Island Day Hospital, Dublin 8, Ireland
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Maha R, Alison J, Michael S, Manvydas V. Triple assessment breast clinics: The value of clinical core biopsies. Ir J Med Sci 2024; 193:565-570. [PMID: 37550600 PMCID: PMC10961266 DOI: 10.1007/s11845-023-03445-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/23/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Triple Assessment Breast Clinics are designed for rapid diagnosis of symptomatic patients. When there is no concordance between clinical and radiological assessment, clinicians perform clinical core biopsies. In patients with a clinically suspicious examination (S4, S5) and normal imaging, clinically guided core biopsy should be performed as per NCCP guidelines. However, substantial research does not exist on the diagnostic value or use of clinical core biopsies in non-suspicious palpable (S3) lesions and practices differ in each health system. AIMS The aim of this research was to assess the diagnostic value of clinical core biopsies in nonsuspicious, probably benign palpable breast lesions (S3) where image guided cores were not indicated (R1/R2). METHODS The cohort consisted of patients undergoing clinical core biopsies at a Symptomatic Breast Unit from January 2014 to 2019. Data regarding patient demographics, outcome of triple-assessment and incidence of malignancy were obtained from a prospectively maintained database and results were analysed using Minitab 2018. RESULTS Three hundred and sixty patients had a clinical core biopsy performed in this period. Clinical examination scores for these patients were S1/S2 (66), S3 (277), S4 (15), and S5 (2). Radiology Scores were R1/R2 (355) and R3(5). Two patients with clinical score S3 (0.6%) were diagnosed with breast cancer due to their clinical cores. Both patients had normal mass imaging. There was no association between uncertain palpable breast lesions (S3), and atypia or malignancy on biopsy results when breast imaging was normal (P = 0.43, χ2 test). CONCLUSION Despite clinical core biopsies being used in triple assessment, there is no certainty in their value except that there is high clinical suspicion. Imaging modalities are constantly improving and are already well established. When the patient is assigned a clinical score of S3 and has normal radiology, a clinical core biopsy is not required in most cases.
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Affiliation(s)
| | - Johnston Alison
- Donegal Clinical Research Academy, Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland
- Department of Breast Surgery, Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland
| | - Sugrue Michael
- Donegal Clinical Research Academy, Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland
- Department of Breast Surgery, Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland
| | - Varzgalis Manvydas
- Department of Breast Surgery, Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland.
- University Of Galway, Galway, Ireland.
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Bolger LA, O'Riordan N, Allen C. A rapid improvement event: progesterone prescribing in prevention of miscarriage. BMJ Open Qual 2024; 13:e002517. [PMID: 38531628 DOI: 10.1136/bmjoq-2023-002517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/02/2024] [Indexed: 03/28/2024] Open
Abstract
A rapid improvement event (RIE) is a standard operational excellence technique that uses team-based problem solving to improve processes. In this study, a RIE was undertaken to improve progesterone prescribing rates for those with a history of miscarriage experiencing vaginal bleeding in early pregnancy. This was on the basis of a recent change in guidelines regarding prescribing in these instances. NICE guidelines changed in November 2021 after Cochrane meta-analysis and the PRISM (Progesterone in Spontaneous Miscarriage) randomised control trial demonstrated a higher incidence of live births in those prescribed vaginal micronised progesterone for threatened miscarriage, when compared with those not prescribed it.A RIE involves a team approach and a standard sequence of events allowing analysis and improvement of a process. Analysis in the form of audit revealed a low progesterone prescribing rate for eligible patients in our unit. Dissection of this problem into its elements revealed a low level of staff knowledge regarding the change in guidelines and a lack of confidence in prescription of progesterone. A plan of actionable events to improve prescribing rates was devised. The updated guidance and local recommendations on appropriate micronised progesterone formulations were presented at hospital Grand Rounds with multidisciplinary attendance. Infographics were displayed in areas visible to stakeholders within the hospital and on the hospital's social media pages. The validity of these educational measures to improve the process was reaudited after 3 months.Progesterone prescribing improved by 48%. Those comfortable with prescribing as per the new guidelines improved from 43% to 78%. A RIE proved to be an effective and efficient approach to collaboration, decision-making and action.
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Affiliation(s)
- Lucy Anne Bolger
- Obstetrics & Gynaecology, National Maternity Hospital, Dublin, Ireland
| | - Nicola O'Riordan
- Obstetrics & Gynaecology, National Maternity Hospital, Dublin, Ireland
| | - Cathy Allen
- Obstetrics & Gynaecology, National Maternity Hospital, Dublin, Ireland
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Bateman N. Effective use of interdisciplinary approaches in healthcare quality: drawing on operations and visual management. BMJ Qual Saf 2024; 33:216-219. [PMID: 38448220 DOI: 10.1136/bmjqs-2023-016947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Nicola Bateman
- ULSB, University of Leicester, Leicester, Leicestershire, UK
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Brown A, La J, Keri MI, Hillis C, Razack S, Korah N, Karpinski J, Frank JR, Wong B, Goldman J. In EPAs we trust, is quality and safety a must? A cross-specialty analysis of entrustable professional activity guides. Med Teach 2024:1-9. [PMID: 38527417 DOI: 10.1080/0142159x.2024.2323177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/21/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE The inclusion of quality improvement (QI) and patient safety (PS) into CanMEDS reflects an expectation that graduating physicians are competent in these areas upon training completion. To ensure that Canadian postgraduate specialty training achieves this, the translation of QI/PS competencies into training standards as part of the implementation of competency-based medical education requires special attention. METHODS We conducted a cross-specialty, multi-method analysis to examine how QI/PS was incorporated into the EPA Guides across 11 postgraduate specialties in Canada. RESULTS We identify cross-specialty variability in how QI/PS is incorporated, positioned, and emphasized in EPAs and milestones. QI/PS was primarily referenced alongside clinical activities rather than as a sole competency or discrete activity. Patterns were characterized in how QI/PS became incorporated into milestones through repetition and customization. QI/PS was also decoupled, conceptualized, and emphasized differently across specialties. CONCLUSIONS Variability in the inclusion of QI/PS in EPAs and milestones has important implications considering the visibility and influence of EPA Guides in practice. As specialties revisit and revise EPA Guides, there is a need to balance the standardization of foundational QI/PS concepts to foster shared understanding while simultaneously ensuring context-sensitive applications across specialties. Beyond QI/PS, this study illuminates the challenges and opportunities that lie in bridging theoretical frameworks with practical implementation in medical education, prompting broader consideration of how intrinsic roles and emergent areas are effectively incorporated into competency-based medical education.
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Affiliation(s)
- Allison Brown
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Julie La
- Graduate Program in Health Quality, Queen's University, Kingston, Canada
- Department of Surgery, Queen's University, Kingston, Canada
| | | | - Chris Hillis
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Saleem Razack
- Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - Nadine Korah
- Faculty of Medicine, McGill University, Montreal, Canada
| | | | - Jason R Frank
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Brian Wong
- Centre for Quality Improvement and Patient Safety, Toronto, Canada
- Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
| | - Joanne Goldman
- Centre for Quality Improvement and Patient Safety, Toronto, Canada
- Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
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Moyal-Smith R, Etheridge JC, Turley N, Lim SR, Sonnay Y, Payne S, Smid-Nanninga H, Kothari R, Berry W, Havens J, Brindle ME. CheckPOINT: a simple tool to measure Surgical Safety Checklist implementation fidelity. BMJ Qual Saf 2024; 33:223-231. [PMID: 37734956 DOI: 10.1136/bmjqs-2023-016030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/02/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION The WHO Surgical Safety Checklist (SSC) is a communication tool that improves teamwork and patient outcomes. SSC effectiveness is dependent on implementation fidelity. Administrative audits fail to capture most aspects of SSC implementation fidelity (ie, team communication and engagement). Existing research tools assess behaviours during checklist performance, but were not designed for routine quality assurance and improvement. We aimed to create a simple tool to assess SSC implementation fidelity, and to test its reliability using video simulations, and usability in clinical practice. METHODS The Checklist Performance Observation for Improvement (CheckPOINT) tool underwent two rounds of face validity testing with surgical safety experts, clinicians and quality improvement specialists. Four categories were developed: checklist adherence, communication effectiveness, attitude and engagement. We created a 90 min training programme, and four trained raters independently scored 37 video simulations using the tool. We calculated intraclass correlation coefficients (ICC) to assess inter-rater reliability (ICC>0.75 indicating excellent reliability). We then trained two observers, who tested the tool in the operating room. We interviewed the observers to determine tool usability. RESULTS The CheckPOINT tool had excellent inter-rater reliability across SSC phases. The ICC was 0.83 (95% CI 0.67 to 0.98) for the sign-in, 0.77 (95% CI 0.63 to 0.92) for the time-out and 0.79 (95% CI 0.59 to 0.99) for the sign-out. During field testing, observers reported CheckPOINT was easy to use. In 98 operating room observations, the total median (IQR) score was 25 (23-28), checklist adherence was 7 (6-7), communication effectiveness was 6 (6-7), attitude was 6 (6-7) and engagement was 6 (5-7). CONCLUSIONS CheckPOINT is a simple and reliable tool to assess SSC implementation fidelity and identify areas of focus for improvement efforts. Although CheckPOINT would benefit from further testing, it offers a low-resource alternative to existing research tools and captures elements of adherence and team behaviours.
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Affiliation(s)
- Rachel Moyal-Smith
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - James C Etheridge
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nathan Turley
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shu Rong Lim
- Health Services Research Department, Singapore General Hospital, Singapore
| | - Yves Sonnay
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sarah Payne
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Rishabh Kothari
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - William Berry
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joaquim Havens
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mary E Brindle
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Gillespie BM, Ziemba JB. Lost in translation: does measuring 'adherence' to the Surgical Safety Checklist indicate true implementation fidelity? BMJ Qual Saf 2024; 33:209-211. [PMID: 38191563 DOI: 10.1136/bmjqs-2023-016617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Brigid M Gillespie
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland & School of Nursing & Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Justin Bradley Ziemba
- Department of Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Tsao LR, Wen S, Lamar RC, Irani RA, Otani IM. Promoting Prenatal Penicillin Allergy Evaluations: A Multi-Year Process Improvement Study. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00168-6. [PMID: 38521341 DOI: 10.1016/j.anai.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/03/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Lulu R Tsao
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine.
| | - Shan Wen
- UCSF Department of Medicine, Division of Hospital Medicine and Data Core.
| | - Robyn C Lamar
- UCSF Department of Obstetrics, Gynecology, and Reproductive Sciences.
| | - Roxanna A Irani
- UCSF Department of Obstetrics, Gynecology, and Reproductive Sciences.
| | - Iris M Otani
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine.
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Jiang JJ, Link K, Mellgard G, Silvestri F, Qian D, Chennareddy S, Tran M, Goldstein Y, Frid G, Band I, Saali A, Thomas DC, Jasti H, Meah YS. Evaluation of patient health outcomes of a student-run free clinic in East Harlem. BMC Med Educ 2024; 24:323. [PMID: 38515122 PMCID: PMC10958952 DOI: 10.1186/s12909-024-05070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/18/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Most United States medical schools have affiliated student-run free clinics, but the quality of services provided in such contexts compared to national metrics is unknown. This study determines whether a student-run, attending-supervised free clinic servicing a low-income and minority race patient population in New York City can meet national metrics of care. METHODS Through chart review from January 1, 2020 to December 31, 2020, patient outcomes and service utilization in the Healthcare Effectiveness Data and Information Set were examined and compared to national rates of patients using Medicaid HMO or Medicare. Patients are ≥ 21 years of age, residents of East Harlem, and ineligible for health insurance because of legal residency requirements. The majority identify as Hispanic and speak Spanish as their primary language. All patients who were seen in the clinic during the 2020 calendar year were included. The primary study outcome is the number of Healthcare Effectiveness Data and Information Set measures in which patients, seen in a student-run free clinic, meet or exceed national comparisons. RESULTS The healthcare outcomes of 238 patients, mean age 47.8 years and 54.6% female, were examined in 18 Healthcare Effectiveness Data and Information Set measures. The student-run free clinic met or exceeded national metrics in 16 out of 18 categories. CONCLUSIONS The student-run free clinic met or exceeded the national standard of care according to national metrics. Evidence-based priorities have been clarified for future improvement. Other student-run free clinics should similarly evaluate the quality of their services.
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Affiliation(s)
- Joy J Jiang
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 18th Floor Room 18-16, New York, NY, 10029, USA.
| | - Katie Link
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 18th Floor Room 18-16, New York, NY, 10029, USA
| | - George Mellgard
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 18th Floor Room 18-16, New York, NY, 10029, USA
| | - Francesca Silvestri
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 18th Floor Room 18-16, New York, NY, 10029, USA
| | - Daniel Qian
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 18th Floor Room 18-16, New York, NY, 10029, USA
| | - Susmita Chennareddy
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 18th Floor Room 18-16, New York, NY, 10029, USA
| | - Michelle Tran
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 18th Floor Room 18-16, New York, NY, 10029, USA
| | - Yoni Goldstein
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 18th Floor Room 18-16, New York, NY, 10029, USA
| | - Gabriela Frid
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 18th Floor Room 18-16, New York, NY, 10029, USA
| | - Isabelle Band
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 18th Floor Room 18-16, New York, NY, 10029, USA
| | - Alexandra Saali
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 18th Floor Room 18-16, New York, NY, 10029, USA
| | - David C Thomas
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 18th Floor Room 18-16, New York, NY, 10029, USA
| | - Harish Jasti
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 18th Floor Room 18-16, New York, NY, 10029, USA
| | - Yasmin S Meah
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 18th Floor Room 18-16, New York, NY, 10029, USA
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Li P, Kang T, Carrillo-Argueta S, Kassapidis V, Grohman R, Martinez MJ, Sartori DJ, Hayes R, Jervis R, Moussa M. Bridging the gap: a resident-led transitional care clinic to improve post hospital care in a safety-net academic community hospital. BMJ Open Qual 2024; 13:e002289. [PMID: 38508663 PMCID: PMC10953301 DOI: 10.1136/bmjoq-2023-002289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/11/2024] [Indexed: 03/22/2024] Open
Abstract
The transitional period between hospital discharge and primary care follow-up is a vulnerable time for patients that can result in adverse health outcomes and preventable hospital readmissions. This is especially true for patients of safety-net hospitals (SNHs) who often struggle to secure primary care access when leaving the hospital due to social, economic and cultural barriers. In this study, we describe a resident-led postdischarge clinic that serves patients discharged from NYU Langone Hospital-Brooklyn, an urban safety-net academic hospital. In our multivariable analysis, there was no statistical difference in the readmission rate between those who completed the transitional care management and those who did not (OR 1.32 (0.75-2.36), p=0.336), but there was a statistically significant increase in primary care provider (PCP) engagement (OR 0.53 (0.45-0.62), p<0.001). Overall, this study describes a postdischarge clinic model embedded in a resident clinic in an urban SNH that is associated with increased PCP engagement, but no reduction in 30-day hospital readmissions.
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Affiliation(s)
- Patrick Li
- Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Tiffany Kang
- NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | | | - Vickie Kassapidis
- Pulmonary and Critical Care Medicine, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Rebecca Grohman
- Allergy and Immunology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Daniel J Sartori
- Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Rachael Hayes
- Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
- The Family Health Centers at NYU Langone, Brooklyn, NY, USA
| | - Ramiro Jervis
- Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Marwa Moussa
- Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra University, Staten Island, NY, USA
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13
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Norsa L, Morotti F, Mantegazza C, Meroni M, Deganello Saccomani M, Banzato C, Parma B, Franchino G, Di Nardo G, Sansotta N, Orizio P, Dabizzi E, Fava GR, Chiaro A, Pellegrino M, Fornaroli F, Pizzol A, Strisciuglio C, Pacenza C, Ruggiero C, Russo G, Oliva S. Mobile Health technology in pediatric esophagogastroduodenoscopy quality indicators assessment: results from a national program of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition. Gastrointest Endosc 2024:S0016-5107(24)00180-9. [PMID: 38513921 DOI: 10.1016/j.gie.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND AIMS Upper endoscopy procedures (UEP, esophagogastroduodenoscopy [EGDS] and retrograde endoscopic retrograde cholangiography [ERCP]) are an established standard of care in pediatric gastroenterology. The Pediatric endoscopy quality improvement network (PEnQuIN) recently published its pediatric-specific endoscopy quality guidelines. This study, initiated by the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP), aims to evaluate the adherence of Italian Pediatric Endoscopy Centers to these established quality standards. METHODS Conducted between April 2019 and March 2021, this nationwide study utilized a smartphone app-based approach. Data encompassing pediatric endoscopy facilities, patient profiles, endoscopy indications, 17 procedure-related PEnQuIN indicators, and a GHAA-9m patient satisfaction questionnaire were systematically collected. RESULTS A comprehensive analysis of 3582 procedures from 24 PECs revealed that 2654 (76%) were UEP. The majority of centers (75%) involved more than one operator, with 9 PEC incorporating adult endoscopists, responsible for 5% of UEPs. Overall, adherence to quality standards was good; however, areas of improvement include sub-optimal reporting of sedation details, adherence to disease-specific guidelines, and patient satisfaction questionnaire completeness (56%). The complication rate aligned with literature standards (1%), and patient satisfaction was generally high. A noteworthy observation was a 30% decrease monthly reporting rate and a shift in disease-specific patterns following the COVID-19 outbreak. CONCLUSIONS Pediatric UEP practices in Italy adhere well to established quality standards. Emphasizing the adoption of disease-specific guidelines is crucial for optimizing resources, enhancing diagnostic accuracy, and minimizing unnecessary procedures. Prioritizing patient satisfaction is important for immediate enhancements in practice as well as for future research endeavors.
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Affiliation(s)
- Lorenzo Norsa
- Pediatric Hepatology Gastrosenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; Deparment of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy.
| | - Francesco Morotti
- Division of Pediatrics, Department of Health Sciences, Università degli Studi del Piemonte Orientale, Novara, Italy; Neonatology and Neonatal Intensive Care Unit, Spedali Civili Children's Hospital, Brescia, Italy
| | - Cecilia Mantegazza
- Deparment of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Milena Meroni
- Department of Pediatric Surgery, Vittore Buzzi Children's Hospital, Milan, Italy
| | | | - Claudia Banzato
- Department of Pediatrics, Woman's & Child's University Hospital of Verona, Italy
| | - Barbara Parma
- Department of Pediatric, Mariani Foundation Center for Fragile Child. ASST-Lariana, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Giulia Franchino
- Department of Pediatric, Mariani Foundation Center for Fragile Child. ASST-Lariana, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Giovanni Di Nardo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Naire Sansotta
- Pediatric Hepatology Gastrosenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Orizio
- Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia, Italy
| | - Emanuele Dabizzi
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
| | - Giorgio Raffaele Fava
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Chiaro
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Fabiola Fornaroli
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio Pizzol
- Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child, General and Specialistic Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Caterina Pacenza
- Department of Pediatrics, San Giovanni di Dio Hospital, Crotone, Italy
| | - Cosimo Ruggiero
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
| | - Giusy Russo
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
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MacRae CB, Grieco KC, Solomon IH. Diagnostic yield of postmortem brain examination following premortem brain biopsy for neoplastic and nonneoplastic disease. J Neuropathol Exp Neurol 2024:nlae025. [PMID: 38501995 DOI: 10.1093/jnen/nlae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
Medical autopsies have decreased in frequency due in part to advances in radiological techniques and increased availability of molecular and other ancillary testing. However, premortem diagnosis of CNS disease remains challenging; while ∼90% of brain tumor biopsies are diagnostic, only 20%-70% of biopsies for presumed nonneoplastic disease result in a specific diagnosis. The added benefits of performing an autopsy following surgical brain biopsy are not well defined. A retrospective analysis was performed of patients who underwent brain biopsy and autopsy at Brigham and Women's Hospital from 2003 to 2022. A total of 135 cases were identified, including 95 (70%) patients with primary CNS neoplasms, 16 (12%) with metastatic tumors, and 24 (18%) with nonneoplastic neurological disease. Diagnostic concordance between biopsy and autopsy diagnosis was excellent both for primary CNS neoplasms (98%) and metastatic tumors (94%). Conversely, patients with nonneoplastic disease received definitive premortem diagnoses in 7/24 (29%) cases. Five (21%) additional patients received conclusive diagnoses following autopsy; 8 (33%) received a more specific differential diagnosis compared to the biopsy. Overall, autopsy confirmed premortem diagnoses or provided new diagnostic information in 131/135 (97%) cases, highlighting the value in performing postmortem brain examination in patients with both neoplastic and nonneoplastic diseases.
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Affiliation(s)
- Cassie B MacRae
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kristina C Grieco
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Isaac H Solomon
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Peña-López Y, Slocker-Barrio M, de-Carlos-Vicente JC, Serrano-Megías M, Jordán-García I, Rello J. Outcomes associated with ventilator-associated events (VAE), respiratory infections (VARI), pneumonia (VAP) and tracheobronchitis (VAT) in ventilated pediatric ICU patients: A multicentre prospective cohort study. Intensive Crit Care Nurs 2024; 83:103664. [PMID: 38513567 DOI: 10.1016/j.iccn.2024.103664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/19/2024] [Accepted: 02/25/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES An objective categorization of respiratory infections based on outcomes is an unmet clinical need. Ventilator-associated pneumonia and tracheobronchitis remain used in clinical practice, whereas ventilator-associated events (VAE) are limited to surveillance purposes. RESEARCH METHODOLOGY/DESIGN This was a secondary analysis from a multicentre observational prospective cohort study. VAE were defined as a sustained increase in minimum Oxygen inspired fraction (FiO2) and/or Positive end-expiratory pressures (PEEP) of ≥ 0.2/2 cm H2O respectively, or an increase of 0.15 FiO2 + 1 cm H20 positive end-expiratory pressures for ≥ 1 calendar-day. SETTING 15 Paediatric Intensive Care Units. MAIN OUTCOME MEASURES Mechanical ventilation duration, intensive care and hospital length of stay; (LOS) and mortality. RESULTS A cohort of 391 ventilated children with an age (median, [Interquartile Ranges]) of 1 year[0.2-5.3] and 7 days[5-10] of mechanical ventilation were included. Intensive care and hospital stays were 11 [7-19] and 21 [14-39] days, respectively. Mortality was 5.9 %. Fifty-eight ventilator-associated respiratory infections were documented among 57 patients: Seventeen (29.3 %) qualified as ventilator-associated pneumonia (VAP) and 41 (70.7 %) as ventilator-associated tracheobronchitis (VAT). Eight pneumonias and 16 tracheobronchitis (47 % vs 39 %,P = 0.571) required positive end-expiratory pressure or oxygen increases consistent with ventilator-associated criteria. Pneumonias did not significantly impact on outcomes when compared to tracheobronchitis. In contrast, infections (pneumonia or tracheobronchitis) following VAEs criteria were associated with > 6, 8 and 15 extra-days of ventilation (16 vs 9.5, P = 0.001), intensive care stay (23.5 vs 15; P = 0.004) and hospital stay (39 vs 24; P = 0.015), respectively. CONCLUSION When assessing ventilated children with respiratory infections, VAE apparently is associated with higher ventilator-dependency and LOS compared with pneumonia or tracheobronchitis. IMPLICATIONS FOR PRACTICE Incorporating the modification of ventilatory settings for further categorization of the respiratory infections may facilitate therapeutic management among ventilated patients.
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Affiliation(s)
- Yolanda Peña-López
- Microbiome Research Laboratory, Immunology Department, University of Texas Southwestern Medical Center, Dallas, 75390 TX, United States; Pediatric Intensive Care Department, Vall d' Hebron University Hospital, Vall d' Hebron Research Institute, Passeig de la Vall d' Hebron 119-129, 08035 Barcelona, Spain; Global Health eCore, Vall d' Hebron Institute of Research, Passeig de la Vall d' Hebron 129, AMI-14 08035 Barcelona, Spain.
| | - María Slocker-Barrio
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital and Gregorio Marañón Biomedical Research Institute, 28009 Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/0011, Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | | | - Marta Serrano-Megías
- Greenlife Research Group, Health Science, University of San Jorge, Zaragoza, Spain.
| | - Iolanda Jordán-García
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu and Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain; Consortium of Biomedical Research Network for Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
| | - Jordi Rello
- Global Health eCore, Vall d' Hebron Institute of Research, Passeig de la Vall d' Hebron 129, AMI-14 08035 Barcelona, Spain.
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Ahmad SZ, Ivers N, Zenlea I, Parsons JA, Shah BR, Mukerji G, Punthakee Z, Shulman R. An assessment of adaptation and fidelity in the implementation of an audit and feedback-based intervention to improve transition to adult type 1 diabetes care in Ontario, Canada. Implement Sci Commun 2024; 5:25. [PMID: 38500183 PMCID: PMC10946155 DOI: 10.1186/s43058-024-00563-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/03/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The fit between an intervention and its local context may affect its implementation and effectiveness. Researchers have stated that both fidelity (the degree to which an intervention is delivered, enacted, and received as intended) and adaptation to the local context are necessary for high-quality implementation. This study describes the implementation of an audit and feedback (AF)-based intervention to improve transition to type 1 diabetes adult care, at five sites, in terms of adaptation and fidelity. METHODS An audit and feedback (AF)-based intervention for healthcare teams to improve transition to adult care for patients with type 1 diabetes was studied at five pediatric sites. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to document the adaptations made during the study. Fidelity was determined on three different levels: delivery, enactment, and receipt. RESULTS Fidelity of delivery, receipt, and enactment were preserved during the implementation of the intervention. Of the five sites, three changed their chosen quality improvement initiative, however, within the parameters of the study protocol; therefore, fidelity was preserved while still enabling participants to adapt accordingly. CONCLUSIONS We describe implementing a multi-center AF-based intervention across five sites in Ontario to improve the transition from pediatric to adult diabetes care for youth with type 1 diabetes. This intervention adopted a balanced approach considering both adaptation and fidelity to foster a community of practice to facilitate implementing quality improvement initiatives for improving transition to adult diabetes care. This approach may be adapted for improving transition care for youth with other chronic conditions and to other complex AF-based interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.
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Affiliation(s)
- Syed Zain Ahmad
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- SickKids Research Institute, Toronto, Canada
| | - Noah Ivers
- Women's College Institute for Health System Solutions and Virtual Care, Toronto, Canada
- Department of Family Medicine, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | - Janet A Parsons
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Baiju R Shah
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Canada
- ICES, Toronto, Canada
| | - Geetha Mukerji
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
| | - Zubin Punthakee
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Rayzel Shulman
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- SickKids Research Institute, Toronto, Canada.
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Canada.
- Department of Pediatrics, University of Toronto, Toronto, Canada.
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17
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Behrendt CA, Heckenkamp J, Bergsträßer A, Billing A, Böckler D, Bücker A, Cotta L, Donas KP, Grözinger G, Heidecke CD, Hinterseher I, Horn S, Kaltwasser A, Kiefer A, Kirnich-Müller C, Kock L, Kölbel T, Czerny M, Kralewski C, Kurz S, Larena-Avellaneda A, Mutlak H, Oberhuber A, Oikonomou K, Pfeiffer M, Pfister K, Reeps C, Schäfer A, Schmitz-Rixen T, Steinbauer M, Steinbauer C, Strupp D, Stolecki D, Trenner M, Veit C, Verhoeven E, Waydhas C, Weber CF, Adili F. [Recommendations for the specialist further training of nursing personnel on intensive care units in the treatment of abdominal aortic aneurysms: results of a modified Delphi procedure with experts]. Chirurgie (Heidelb) 2024:10.1007/s00104-024-02066-1. [PMID: 38498123 DOI: 10.1007/s00104-024-02066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION The medical development in the previous 15 years and the changes in treatment reality of the comprehensive elective treatment of abdominal aortic aneurysms necessitate a re-evaluation of the quality assurance guidelines of the Federal Joint Committee in Germany (QBAA-RL). In the current version this requires a specialist further training quota for nursing personnel in intensive care wards of 50%. The quota was determined in 2008 based on expert opinions, although a direct empirical evidence base for this does not exist. METHODS Representatives from the fields of patient representation, physicians, nursing personnel and other relevant interface areas were invited to participate in a modified Delphi procedure. Following a comprehensive narrative literature search, a survey and focus group discussions with national and international experts, a total of three anonymized online-based voting rounds were carried out for which previously determined key statements were assessed with a 4‑point Likert scale (totally disagree up to totally agree). In addition, the expert panel had also defined a recommendation for a minimum quota for the specialist training of nursing personnel on intensive care wards in the treatment of abdominal aortic aneurysms, whereby an a priori agreement of 80% of the participants was defined as the consensus limit. RESULTS Overall, 37 experts participated in the discussions and three successive voting rounds (participation rate 89%). The panel confirmed the necessity of a re-evaluation of the guideline recommendations and recommended the introduction of a shift-related minimum quota of 30% of the full-time equivalent of nursing personnel on intensive care wards and the introduction of structured promotional programs for long-term elevation of the quota. CONCLUSION In this national Delphi procedure with medical and nursing experts as well as representatives of patients, the fundamental benefits and needs of professional specialist qualifications in the field of intensive care medicine were confirmed. The corresponding minimum quota for specialist further training of intensive care nursing personnel should generally apply without limitations to specific groups. The expert panel stipulates a shift-related minimum quota for intensive care nursing personnel with specialist training of 30% of the nursing personnel on intensive care wards and the obligatory introduction of structured and transparent promotion programs for the long-term enhancement.
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Affiliation(s)
- Christian-Alexander Behrendt
- Deutsches Institut für Gefäßmedizinische Gesundheitsforschung gGmbH, Berlin, Deutschland.
- Abt. für Allgemeine und Endovaskuläre Gefäßchirurgie, Asklepios Klinik Wandsbek, Asklepios Medical School, Alphonsstr. 14, 22043, Hamburg, Deutschland.
| | | | | | - Arend Billing
- Kommission Krankenhausökonomie, Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin e. V., Berlin, Deutschland
| | - Dittmar Böckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Arno Bücker
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Livia Cotta
- Deutsches Institut für Gefäßmedizinische Gesundheitsforschung gGmbH, Berlin, Deutschland
| | - Konstantinos P Donas
- Rhein Main Vascular Center, Klinik für vaskuläre und endovaskuläre Chirurgie, Asklepios Kliniken Langen, Paulinen Wiesbaden und Seligenstadt, Langen, Deutschland
| | - Gerd Grözinger
- Abt. für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Claus-Dieter Heidecke
- Institut für Qualität und Transparenz im Gesundheitswesen (IQTIG), Berlin, Deutschland
| | - Irene Hinterseher
- Klinik für Gefäßchirurgie, Universitätsklinikum Ruppin-Brandenburg, Medizinische Hochschule Brandenburg, Neuruppin, Deutschland
| | - Silvio Horn
- Gefäßchirurgie, Alexianer St. Josefs Krankenhaus Potsdam, Potsdam, Deutschland
| | - Arnold Kaltwasser
- Sektion Pflegeforschung und Pflegequalität, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e. V., Berlin, Deutschland
| | - Andrea Kiefer
- Deutscher Berufsverband für Pflegeberufe (DBfK) Bundesverband e. V., Berlin, Deutschland
| | | | - Lars Kock
- Klinik für Gefäßchirurgie, Immanuel Albertinen Diakonie, Hamburg, Deutschland
| | - Tilo Kölbel
- Klinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Martin Czerny
- Abteilung für Herz- und Gefäßchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
- Medizinische Fakultät, Albert Ludwigs Universität Freiburg, Freiburg, Deutschland
| | - Christian Kralewski
- Kompetenz-Centrum Qualitätssicherung (KCQ), Medizinischer Dienst Baden-Württemberg, Tübingen, Deutschland
| | - Stephan Kurz
- Klinik für Herz‑, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum der Charité (DHZC), Berlin, Deutschland
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Axel Larena-Avellaneda
- Abteilung für Gefäß- und endovaskuläre Chirurgie, Asklepios Klinik Altona, Asklepios Medical School, Hamburg, Deutschland
| | - Haitham Mutlak
- Klinik für Anästhesiologie, Intensiv- und Schmerzmedizin, SANA Klinikum Offenbach, Offenbach, Deutschland
| | - Alexander Oberhuber
- Klinik für Vaskuläre und Endovaskuläre Chirurgie, Uniklinik Münster, Münster, Deutschland
| | - Kyriakos Oikonomou
- Abteilung für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Manfred Pfeiffer
- Interessenvertretung Patienten-&-Versicherte, Sörgenloch, Deutschland
| | - Karin Pfister
- Universitäres Gefäßzentrum Ostbayern, Abteilung für Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Christian Reeps
- Bereich Gefäß- und Endovaskuläre Chirurgie, Uniklinikum Dresden, Dresden, Deutschland
| | - Andreas Schäfer
- Deutsche Gesellschaft für Pflegewissenschaft e. V., Duisburg, Deutschland
| | | | - Markus Steinbauer
- Klinik für Gefäßchirurgie, Gefäßzentrum, Barmherzige Brüder Regensburg, Regensburg, Deutschland
| | - Claudia Steinbauer
- Katholische Akademie für Berufe im Gesundheits- und Sozialwesen, Regensburg, Deutschland
| | - Daniel Strupp
- Intensivpflege, Asklepios Klinik Wandsbek, Hamburg, Deutschland
| | - Dietmar Stolecki
- Deutsche Gesellschaft für Fachkrankenpflege und Funktionsdienste e. V., Berlin, Deutschland
| | | | | | - Eric Verhoeven
- Klinikum Nürnberg und Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - Christian Waydhas
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e. V., Berlin, Deutschland
- Klinik Für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Christian F Weber
- Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, Asklepios Klinik Wandsbek, Hamburg, Deutschland
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Frankfurt, Frankfurt am Main, Deutschland
| | - Farzin Adili
- Klinik für Gefäßmedizin, Gefäßchirurgie und Endovaskuläre Chirurgie, Klinikum Darmstadt, Darmstadt, Deutschland
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18
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Xing X, Qu H, Wang L, Hao X, Zhong Y, Jing F. Enhancing Drug Management, Cost Savings, and Staff Satisfaction in Anesthesiology: A Quality Improvement Project in a Chinese Tertiary Hospital. Adv Ther 2024:10.1007/s12325-024-02814-z. [PMID: 38494541 DOI: 10.1007/s12325-024-02814-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION In alignment with China's national directive for improved drug management in anesthesiology, the Affiliated Hospital of Qingdao University initiated a quality improvement project, aiming to tackle the prevailing challenges of inefficiencies in drug administration, escalating drug costs, and the notable communication gap between pharmacists and anesthesiologists. METHODS We employed a Plan-Do-Study-Act methodology to establish a pharmacy team and execute a multidimensional pharmaceutical intervention. The interventions included the formulation of standard procedures, guidelines and regulations, assistance from an information system (including automatic dispensing cabinets and prospective prescription review system), communication feedback (via WeChat groups), and education for anesthesiology staff. The intervention spanned from April to September 2023, focusing on optimizing medication management, achieving cost savings, and enhancing the satisfaction of anesthesia team members, with an additional observation from October to December 2023. RESULTS Following the interventions, improvements were observed in drug management practices. These enhancements included increased compliance with accounting procedures, more rigorous registration of controlled substances, and more effective disposal of liquid residues. There was no adverse events related to high-alert medications or look-alike drug usage errors. The introduction of automatic dispensing cabinets and a prospective prescription review system markedly improved work efficiency. The utilization of a WeChat group facilitated effective communication about unreasonable prescriptions and drug-related issues. Among the 29,061 patients who underwent surgery both before and after the interventions, significant reductions were observed both in the drug proportion and the per capita drug costs (P = 0.03, P = 0.014, respectively). The per capita drug cost decreased by 20.82%, from ¥723.43 to ¥572.78, consistently remaining below ¥600 throughout the 9-month observation period. The per capita cost of monitoring drugs including dezocine, butorphanol, haemocoagulase agkistrodon, penehyclidine, and ulinastatin experienced a significant reduction (P < 0.05). Additionally, in the satisfaction questionnaires returned, a remarkable 94.44% of anesthesiology staff expressed high satisfaction with the comprehensive pharmaceutical interventions. CONCLUSION The quality improvement project has yielded remarkable positive outcomes, serving as a model worthy of reference and replication in similar healthcare settings.
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Affiliation(s)
- Xiaomin Xing
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | - Haijun Qu
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | - Longyuan Wang
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | - Xiaojia Hao
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | - Yalan Zhong
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | - Fanbo Jing
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China.
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Rosvall A, Axelsson M, Toth E, Kumlien C, Gershater MA. Development and content validity testing of a colonoscopy-specific patient-reported experience measure: the Patient Experience Colonoscopy Scale (PECS). J Patient Rep Outcomes 2024; 8:32. [PMID: 38498225 PMCID: PMC10948700 DOI: 10.1186/s41687-024-00710-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/05/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND In endoscopic care, favourable patient experiences before, during and after a colonoscopy are essential for the patient's willingness to repeat the procedure. To ensure that significant experiences are measured, patients should be involved in creating the measurement instruments. Thus, the aim of the present study was to develop a colonoscopy-specific PREM by (1) operationalising patient experiences before, during and after a colonoscopy procedure and (2) evaluating its content validity. METHODS The colonoscopy-specific PREM was developed in two stages: (1) operationalisation with item generation and (2) content validity testing. A previously developed conceptual model, based on a systematic literature review that illustrates patients' (n = 245) experiences of undergoing a colonoscopy, formed the theoretical basis. To assess the degree to which the PREM reflected patients' experiences before, during and after a colonoscopy procedure, content validity was tested-through face validity with healthcare professionals (n = 4) and cognitive interviews with patients (n = 14) having experienced a colonoscopy. Content validity index (CVI) was calculated to investigate the relevance of the items. RESULTS The Patient Experience Colonoscopy Scale (PECS) is a colonoscopy-specific PREM consisting of five different constructs: health motivation, discomfort, information, a caring relationship and understanding. Each construct was defined and generated into a pool of items (n = 77). After face-validity assessment with healthcare professionals, a draft 52-item version of the PECS was ready for content validity testing by the patients. During cognitive interviews the patients contributed valuable insights that led to rewording and removal of items. Results from the CVI suggest that the PECS and its content are relevant (I-CVI range 0.5-1, S-CVI/Ave = 0.86). The final PECS consists of 30 items representing a colonoscopy-specific PREM. CONCLUSION The PECS is a new 30-item PREM instrument designed for adult elective colonoscopy patients after they have undergone the procedure. Each item in the PECS derives from a conceptual model based on a systematic literature review. Patients and healthcare professionals were involved in developing the PECS, which measures colonoscopy-specific patient experiences before, during and after the procedure. The content validity testing positively contributed to the development of the PECS. Psychometric properties need to be evaluated further.
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Affiliation(s)
- Annica Rosvall
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Lund, Sweden
| | - Christine Kumlien
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Department of Cardio-Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
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20
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Hengartner AC, Elsamadicy AA, Jonnalagadda A, Craft S, Sherman JJZ, Reeves BC, Fernandez T, Hobbs J, Koo AB, DiLuna M, Tuason DA. Impact of a quality improvement initiative and monthly multidisciplinary meetings on outcomes after posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform 2024:10.1007/s43390-024-00859-2. [PMID: 38493442 DOI: 10.1007/s43390-024-00859-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Several studies have demonstrated the benefits of enhanced recovery after surgery (ERAS) protocols for patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal instrumented fusion (PSIF). However, there are relatively few studies investigating the effect of regular multidisciplinary team meetings on level selection, surgical performance parameters, and patient outcomes after PSIF for AIS. The aim of this study was to assess changes in intra- and postoperative outcomes following multidisciplinary team meeting implementation for patients undergoing PSIF for AIS. METHODS The medical records of 96 adolescents (10 to 18 years old) diagnosed with AIS and undergoing PSIF at a major academic institution from 2017 to 2022 were retrospectively reviewed. A quality improvement (QI) initiative was implemented in February 2020, including institution of monthly multidisciplinary conferences focusing on preoperative indications, level selection, postoperative review of surgical performance parameters for previous cases, and discussion and optimization of postoperative ambulation and pain control protocols. Patients were placed into "Pre-QI" (treated pre-February 2020) and "Post-QI" (treated post-February 2020) cohorts. Patient demographics, comorbidities, deformity characteristics, intraoperative variables, ambulation status, postoperative complications, length of stay (LOS), and unplanned readmission rates were assessed. RESULTS Of the 96 study patients, 44 (45.8%) were in the Pre-QI cohort, and 52 (54.2%) were in the Post-QI cohort. Mean major curve was not significantly different between the two cohorts (Pre-QI: 58.0 ± 7.3° vs Post-QI: 57.9 ± 14.5°, p = 0.169). The Pre-QI cohort had a greater mean minor curve degree (Pre-QI: 42.7 ± 11.8° vs Post-QI: 36.8 ± 12.4, p = 0.008). The Pre-QI cohort had significantly greater mean spinal levels fused (Pre-QI: 11.7 ± 1.7 vs Post-QI: 10.4 ± 2.6, p = 0.009), significantly greater mean estimated blood loss (Pre-QI: 1063.6 ± 631.5 ml vs. Post-QI: 415.8 ± 189.9 ml, p < 0.001), significantly greater mean operative time normalized to levels fused (Pre-QI: 0.6 ± 0.1 h/level fused vs Post-QI: 0.4 ± 0.1 h/level fused, p < 0.001), and a significantly greater proportion of patients with intraoperative drain placement (Pre-QI: 93.2% vs Post-QI: 5.8%, p < 0.001). The Post-QI cohort had significantly shorter time to postoperative ambulation (Pre-QI: 2.1 ± 0.9 days vs Post-QI: 1.3 ± 0.5 days, p < 0.001). A significantly greater proportion of patients in the Pre-QI cohort developed any postoperative complication (Pre-QI: 72.7% vs Post-QI: 34.6%, p < 0.001), and mean LOS was significantly greater among Pre-QI patients (Pre-QI: 4.5 ± 1.1 days vs Post-QI: 3.2 ± 0.8 days, p < 0.001). Discharge disposition (p = 0.758) and 30-day unplanned readmissions (p = 0.207) were similar between the cohorts. CONCLUSIONS Our findings suggest that monthly multidisciplinary pediatric spine team meetings may improve patient care. Further studies exploring the incorporation of QI implementation with frequent multidisciplinary team meetings into existing ERAS protocols are merited.
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Affiliation(s)
- Astrid C Hengartner
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Anshu Jonnalagadda
- Department of Orthopedics, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Samuel Craft
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Josiah J Z Sherman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Tiana Fernandez
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Joshua Hobbs
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Michael DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Dominick A Tuason
- Department of Orthopedics, Yale University School of Medicine, New Haven, CT, 06520, USA.
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Salluh JIF, Amado F, Pilcher D, Hashmi M. The relevance and sustainability of registry-embedded research for critical care. J Crit Care 2024; 82:154765. [PMID: 38492521 DOI: 10.1016/j.jcrc.2024.154765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Jorge I F Salluh
- D'OR Institute for Research and Education, Rio de Janeiro, Brazil; Post-Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Filipe Amado
- D'OR Institute for Research and Education, Rio de Janeiro, Brazil.
| | - David Pilcher
- Department of Intensive Care, Alfred Health, Commercial Road, Prahran, VIC 3004, Australia; The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, High Street, Prahran, VIC 3004, Australia
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Haysom A, Loveday WH, Ratneswaran K, Nerantzis G, Hakim N, Dineva D, Richards A. Improving availability and accuracy of the junior doctors' on-call handover through digitalisation. BMJ Open Qual 2024; 13:e002615. [PMID: 38485114 PMCID: PMC10941170 DOI: 10.1136/bmjoq-2023-002615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
Clinical handovers from out-of-hours activity are essential for relaying information about events such as new admissions, outstanding or complete investigations, physical health reviews, ward jobs and risk. This information enables the day team to effectively prioritise and follow-up any necessary tasks.Junior doctors at a hospital site in the London Borough of Newham were aware that the existing handover system, constituted of a word document circulated via email, was lacking robustness and that the handover was not sent out reliably on a daily basis.Quality improvement (QI) methods including process mapping, PDSA ('Plan, Do, Study, Act') cycles, driver diagrams and run charts were used to understand the issue, create a more robust process and measure the improvements made, all supported by regular QI project meetings. The change ideas included moving from an informal Microsoft (MS) Word document, which was emailed out, to an Excel spreadsheet stored centrally on MS Teams. Column headers were added for admissions, ward jobs, seclusion reviews, matters relating to mental health law and Accident and Emergency (A&E) assessments, as well as defined columns for outstanding jobs and standard tasks that need to be completed for all admissions. Responsibility for circulating the handover list was given to the incoming day duty doctor if the night doctor was too busy, with admin support to chase the circulation of the handover. Results were studied for the following 18 months.The percentage of handovers being appropriately sent out increased from a median of 80% to 100% during the project period, and the availability of handover data where the data were visible to doctors on MS Teams but had not been sent out also increased from a median of 80% to 100%. The system was deemed safe, effective and easy to use, and has already been replicated at neighbouring hospitals.
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Affiliation(s)
| | | | | | | | - Nahid Hakim
- East London NHS Foundation Trust, London, UK
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Lahnaoui O, Houmada A, Benkabbou A, Ghannam A, Al Ahmadi B, Belkhadir Z, Mohsine R, Souadka A, Majbar MA. Enhancing patient safety: a system-based analysis of morbidity and mortality conferences in managing postoperative bleeding following gastric and pancreatic cancer surgery. BMJ Open Qual 2024; 13:e002657. [PMID: 38485113 PMCID: PMC10941144 DOI: 10.1136/bmjoq-2023-002657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
Morbidity and mortality conferences (MMCs) have evolved beyond their traditional educational role to become instrumental in enhancing patient safety. System-based MMCs offer a unique perspective on patient safety by dissecting systemic factors contributing to adverse events. This paper reviews the impact of MMC in managing postoperative bleeding after gastric and pancreatic cancer surgery, within the constraints of limited resources. The study conducted at the National Institute of Oncology in Rabat, Morocco, analysed 18 MMC of haemorrhage following gastric and pancreatic surgeries and allowed to identify two patterns of cumulative factors contributing to adverse events. The first one relates to organisational issues and the second to postoperative management. Fifteen recommendations of improvement emerged from MMC addressing elements of these patterns with an implementation rate of 53.3%.
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Affiliation(s)
- Oumayma Lahnaoui
- National Institute of Oncology - Surgical Oncology Department, Mohammed V University in Rabat, Rabat, Morocco
| | - Amina Houmada
- National Institute of Oncology - Surgical Oncology Department, Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- National Institute of Oncology - Surgical Oncology Department, Mohammed V University in Rabat, Rabat, Morocco
| | - Abdelillah Ghannam
- National Institute of Oncology - Intensive Care Department, Mohammed V University in Rabat, Rabat, Morocco
| | - Brahim Al Ahmadi
- National Institute of Oncology - Intensive Care Department, Mohammed V Souissi University, Rabat, Morocco
| | - Zakaria Belkhadir
- National Institute of Oncology - Intensive Care Department, Mohammed V University in Rabat, Rabat, Morocco
| | - Raouf Mohsine
- National Institute of Oncology - Surgical Oncology Department, Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Souadka
- National Institute of Oncology - Surgical Oncology Department, Mohammed V University in Rabat, Rabat, Morocco
| | - Mohammed Anass Majbar
- National Institute of Oncology - Surgical Oncology Department, Mohammed V University in Rabat, Rabat, Morocco
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Iroz CB, Ramaswamy R, Bhutta ZA, Barach P. Quality improvement in public-private partnerships in low- and middle-income countries: a systematic review. BMC Health Serv Res 2024; 24:332. [PMID: 38481226 PMCID: PMC10935959 DOI: 10.1186/s12913-024-10802-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Public-private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs. METHODS We searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. The study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed in detail by a second author. RESULTS We identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We identified five key themes for successful QI projects in LMICs: 1) leadership support and alignment with overarching priorities, 2) local ownership and engagement of frontline teams, 3) shared authentic learning across teams, 4) resilience in managing external challenges, and 5) robust data and data visualization to track progress. We found great heterogeneity in QI tools, study designs, participants, and outcome measures. Most studies had diffuse aims and poor descriptions of the intervention components and their follow-up. Few papers formally reported on actual deployment of private-sector capital, and either provided insufficient information or did not follow the formal PPP model, which involves capital investment for a explicit return on investment. Few studies discussed the response to their findings and the organizational willingness to change. CONCLUSIONS Many of the same factors that impact the success of QI in healthcare in high-income countries are relevant for PPP in LMICs. Vague descriptions of the structure and financial arrangements of the PPPs, and the roles of public and private entities made it difficult to draw meaningful conclusions about the impacts of the organizational governance on the outcomes of QI programs in LMICs. While we found many articles in the published literature on PPP-funded QI partnerships in LMICs, there is a dire need for research that more clearly describes the intervention details, implementation challenges, contextual factors, leadership and organizational structures. These details are needed to better align incentives to support the kinds of collaboration needed for guiding accountability in advancing global health. More ownership and power needs to be shifted to local leaders and researchers to improve research equity and sustainability.
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Affiliation(s)
- Cassandra B Iroz
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Rohit Ramaswamy
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Institute for Global Health & Development, The Aga Khan University, South Central Asia, East Africa, UK
| | - Paul Barach
- Thomas Jefferson University, Philadelphia, PA, USA
- Imperial College, London, UK
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Raidah F, Ghisi GLM, Anchique CV, Soomro NN, Candelaria D, Grace SL. Promoting cardiac rehabilitation program quality in low-resource settings: Needs assessment and evaluation of the International Council of Cardiovascular Prevention and Rehabilitation's registry quality improvement supports. Int J Cardiol 2024:131962. [PMID: 38484802 DOI: 10.1016/j.ijcard.2024.131962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/29/2024] [Accepted: 03/10/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Cardiac rehabilitation (CR) registries have the potential to support quality improvement (QImp). This study investigated the QImp needs of International CR Registry-participating programs and their evaluation of its' supports. METHODS ICRR offers comparative outcome dashboards and QImp sessions, among other features. In this qualitative study, ICRR data stewards from the 17 active on-boarded CR programs were invited to a focus group held in November 2023 via Teams; stewards not sufficiently-proficient in English were invited to provide written input. Deductive-thematic analysis using NVIVO was undertaken by 2 researchers; member-checking ensued. RESULTS Nine participated, and four provided input, from eight countries. Three themes emerged; saturation was achieved. First, QImp facilitators included training, institutional requirements, dedicated staff, resources in academic centres and ICRR features. Second, QImp barriers included staffing issues, the global nature of the ICRR, and structural challenges in low-resource settings. Finally, ICRR supports for QImp included didactic webinars, hearing from other programs, 1-1 support offered and assessing minimum Certification standards. CONCLUSION ICRR-participating programs are satisfied with QImp supports but encounter challenges, including related to language, staffing and other resources. CR registries should be leveraged and optimized to support CR programs to assess and improve their care quality.
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Affiliation(s)
- Fabbiha Raidah
- Faculty of Health, York University, 4700 Keele St, Toronto M3J 1P3, ON, Canada
| | - Gabriela L M Ghisi
- Faculty of Health, York University, 4700 Keele St, Toronto M3J 1P3, ON, Canada; KITE Research Institute- Toronto Rehabilitation Institute, University Health Network, 550 University Ave, Toronto M5G 2A2, Canada
| | - Claudia V Anchique
- The Cardiology Service, Mediagnostica Tecmedi, Cra. 16 #14-68, Centro-Sur, Duitama, Boyacá, Colombia
| | - Nabila N Soomro
- Department of Physical Medicine and Rehabilitation, Sindh Institute of Physical Medicine and Rehabilitation (SIPMR), Chand Bibi Rd, Near Mujahid Masjid, Deli Colony Ranchore Lane, Karachi, Karachi City, Sindh 74200, Pakistan
| | - Dion Candelaria
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Western Ave, Camperdown, NSW 2050, Australia
| | - Sherry L Grace
- Faculty of Health, York University, 4700 Keele St, Toronto M3J 1P3, ON, Canada; KITE Research Institute- Toronto Rehabilitation Institute, University Health Network, 550 University Ave, Toronto M5G 2A2, Canada.
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McIver R, Erdogan M, Parker R, Evans A, Green R, Gomez D, Johnston T. Effect of trauma quality improvement initiatives on outcomes and costs at community hospitals: A scoping review. Injury 2024:111492. [PMID: 38531721 DOI: 10.1016/j.injury.2024.111492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Due to complex geography and resource constraints, trauma patients are often initially transported to community or rural facilities rather than a larger Level I or II trauma center. The objective of this scoping review was to synthesize evidence on interventions that improved the quality of trauma care and/or reduced healthcare costs at non-Level I or II facilities. METHODS A scoping review was performed to identify studies implementing a Quality Improvement (QI) initiative at a non-major trauma center (i.e., non-Level I or II trauma center [or equivalent]). We searched 3 electronic databases (MEDLINE, Embase, CINAHL) and the grey literature (relevant networks, organizations/associations). Methodological quality was evaluated using NIH and JBI study quality assessment tools. Studies were included if they evaluated the effect of implementing a trauma care QI initiative on one or more of the following: 1) trauma outcomes (mortality, morbidity); 2) system outcomes (e.g., length of stay [LOS], transfer times, provider factors); 3) provider knowledge or perception; or 4) healthcare costs. Pediatric trauma, pre-hospital and tele-trauma specific studies were excluded. RESULTS Of 1046 data sources screened, 36 were included for full review (29 journal articles, 7 abstracts/posters without full text). Educational initiatives including the Rural Trauma Team Development Course and the Advanced Trauma Life Support course were the most common QI interventions investigated. Study outcomes included process metrics such as transfer time to tertiary care and hospital LOS, along with measures of provider perception and knowledge. Improvement in mortality was reported in a single study evaluating the impact of establishing a dedicated trauma service at a community hospital. CONCLUSIONS Our review captured a broad spectrum of trauma QI projects implemented at non-major trauma centers. Educational interventions did result in process outcome improvements and high rates of self-reported improvements in trauma care. Given the heterogeneous capabilities of community and rural hospitals, there is no panacea for trauma QI at these facilities. Future research should focus on patient outcomes like mortality and morbidity, and locally relevant initiatives.
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Affiliation(s)
- Reba McIver
- Dalhousie University, School of Medicine, Halifax, NS, Canada.
| | - Mete Erdogan
- Nova Scotia Health Trauma Program, Halifax, NS, Canada
| | - Robin Parker
- Dalhousie University Libraries, Halifax, NS, Canada
| | - Allyson Evans
- Dalhousie University, School of Medicine, Halifax, NS, Canada
| | - Robert Green
- Nova Scotia Health Trauma Program, Halifax, NS, Canada; Dalhousie University, Faculty of Medicine, Department of Emergency Medicine, Halifax, NS, Canada; Dalhousie University, Faculty of Medicine, Department of Critical Care, Halifax, NS, Canada
| | - David Gomez
- Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Tyler Johnston
- Dalhousie University, Faculty of Medicine, Department of Emergency Medicine, Halifax, NS, Canada
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Chon HK, Kim KH, Song TJ, Ahn DW, Lee ES, Lee YN, Lee YS, Jeon TJ, Park CH, Cho KB, Lee DW, Park JS, Yoon SB, Chung KH, Lee J, Choi M. Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea. Gut Liver 2024:gnl230427. [PMID: 38462478 DOI: 10.5009/gnl230427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/22/2023] [Indexed: 03/12/2024] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that requires significant experiences and skills and has various procedure-related complications, some of which can be severe and even result in the death of patients. Expanding ERCP availability has the advantage of increasing accessibility for patients. However, ERCP poses a substantial risk if performed without proper quality management. ERCP quality management is essential for both ensuring safe and successful procedures and meeting the social demands for enhanced healthcare competitiveness and quality assurance. To address these concerns, the Korean Pancreatobiliary Association established a task force to develop ERCP quality indicators (QIs) tailored to the Korean medical environment. Key questions for five pre-procedure, three intra-procedure, and four post-procedure measures were formulated based on a literature search related to ERCP QIs and a comprehensive clinical review conducted by experts. The statements and recommendations regarding each QI item were selected through peer review. The developed ERCP QIs were reviewed by external experts based on the latest available evidence at the time of development. These domestically tailored ERCP QIs are expected to contribute considerably to improving ERCP quality in Korea.
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Affiliation(s)
- Hyung Ku Chon
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea
- Institute of Wonkwang Medical Science, Iksan, Korea
| | - Ki-Hyun Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Tae Jun Song
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Won Ahn
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eaum Seok Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yun Nah Lee
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Yoon Suk Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Tae Joo Jeon
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Chang Hwan Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kwang Bum Cho
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Wook Lee
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin-Seok Park
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Seung Bae Yoon
- Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang Hyun Chung
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
| | - Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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Bayisa G, Gonfaa L, Badasa K, Dugasa N, Abebe M, Deressa H, Teshoma Regassa M, Takele A, Tilahun T. Improving medical record completeness at Wallaga University Referral Hospital: a multidimensional quality improvement project. BMJ Open Qual 2024; 13:e002665. [PMID: 38458759 DOI: 10.1136/bmjoq-2023-002665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/31/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Appropriately documented medical records enhance coordination, patient outcomes and clinical research. OBJECTIVE The aim of this project was to improve Wallaga University Referral Hospital's (WURH) medical record completeness rate from 53% to 80% from 1 January 2023 to 31 August 2023. METHODS A hospital-based interventional study was conducted at WURH. The Plan-Do-Study-Act cycle was used to test change ideas. A fishbone diagram and a driver diagram were used to identify root causes and address them. Key interventions consisted of supportive supervision, developing and distributing standardised formats, orientation for staff, establishing a chart audit team and assigning data owners. RESULT On the completion of the project, the overall implementation of inpatient medical record completeness increased from 53% to 82%. This improvement varies from department-to-department. It increased from 51% to 79%, 53% to 79%, 46% to 81% and 64% to 91% in the departments of internal medicine, paediatrics, obstetrics and gynaecology and surgery, respectively. The project brought improvements in the completeness of physician notes (84% to 100%), physician order sheet (54% to 84%), nursing care plan (26% to 69%), admission sheet (76% to 98%), discharge summary (94% to 98%), progress note (38% to 91%), medication administration (80% to 100%), appropriate attachment of documents (78% to 93%) and documentation of vital signs (50% to 100%). CONCLUSION AND RECOMMENDATION The rate of medical record completeness was significantly improved in the study area. This was achieved through the application of multidimensional change ideas related to health professionals, supplies, health management information systems and leadership. However, in some of the parameters, the national targets were not met. Therefore, we recommend providing regular technical updates, conducting frequent chart audits and providing supportive supervision for the enhancement of medical record completeness. It is also advisable for the hospital management to work on its sustainability.
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Affiliation(s)
- Gedefa Bayisa
- Quality Assurance, Nursing and Midwifery, Wallaga University Referral Hospital, Nekemte, Ethiopia
| | - Lammii Gonfaa
- Department of Obstetrics and Gynecology, Wollega University Institute of Health Sciences, Nekemte, Ethiopia
| | - Ketema Badasa
- Quality Assurance, Nursing and Midwifery, Wallaga University Referral Hospital, Nekemte, Ethiopia
| | - Nemomsa Dugasa
- Quality Assurance, Nursing and Midwifery, Wallaga University Referral Hospital, Nekemte, Ethiopia
| | - Mulugeta Abebe
- Quality Assurance, Nursing and Midwifery, Wallaga University Referral Hospital, Nekemte, Ethiopia
| | - Habtamu Deressa
- Inpatient Nursing Service, Wallaga University Referral Hospital, Nekemte, Ethiopia
| | | | - Amsalu Takele
- Department of Surgery, Wollega University Institute of Health Sciences, Nekemte, Ethiopia
| | - Temesgen Tilahun
- Department of Obstetrics and Gynecology, Wollega University Institute of Health Sciences, Nekemte, Ethiopia
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Portegijs S, van Beek APA, van Tuyl LHD, Wagner C. Implementing a new living concept for persons with dementia in long-term care: evaluation of a quality improvement process. BMC Health Serv Res 2024; 24:306. [PMID: 38454437 PMCID: PMC10921681 DOI: 10.1186/s12913-024-10765-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Improving quality of nursing home care for residents is a constant focus of stakeholders involved within quality improvement projects. Though, achieving change in long-term care is challenging. Process evaluations provide insight into the nature, exposure and experiences of stakeholders and influencing mechanisms for implementation. The aim of this study is to gain insight into the process and facilitating and hindering mechanisms of implementing a quality improvement project that seeks to create a dementia-friendly community with a nursing home at its core. METHODS For the process evaluation we planned a case study design with an ethnographic approach. Various research methods were used: qualitative observations, focus groups, interviews and questionnaires for various stakeholders and document review. Data collection and analyses in this study is based on the Consolidated Framework for Implementation Research. RESULTS Four main lessons were learned. Firstly, nursing staff are crucial to achieve more freedom for residents. Secondly, high-impact changes in daily care need strong and sustainable focus from the care organisation. Thirdly, dementia-friendly societies should be deployed from multiple actors, which entails long-term collaborations with external stakeholders. Fourthly, the transition to a dementia-friendly society requires meeting spaces for and a focus on both residents and people from the community. Consequently, local residents are shifting from external to internal stakeholders, extending beyond the regular involvement of informal carers and volunteers within the nursing home. CONCLUSIONS Nursing homes are part of the local community and provide opportunities to collaborate on a dementia-friendly society. However, the change that is required (promoting freedom, residents' autonomy and the redesign of care processes) is complex and influenced by various mechanisms. Understanding these mechanisms can benefit other care organisations that strive to implement a similar initiative.
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Affiliation(s)
- Suzanne Portegijs
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3513 CR, Utrecht, The Netherlands.
- Viva! Zorggroep, Care Organisation, Parlevinkerstraat 23, 1951 AR, Velsen-Noord, The Netherlands.
| | | | | | - Cordula Wagner
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3513 CR, Utrecht, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute (APH), Amsterdam UMC, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Mohankumar K, Rossman AH, Yong R, Thao A, Sheridan K, Roth EB. Opioid prescription usage and disposal after provider education and SMS-based parent education. J Pediatr Urol 2024:S1477-5131(24)00147-5. [PMID: 38514285 DOI: 10.1016/j.jpurol.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Adequate pain control after outpatient pediatric urologic surgery is important for both providers and caregivers; however, opioid pain medications are often prescribed in excess of utilization. The resultant excess opioid medication has potential to be diverted or misused. While families are instructed to dispose of leftover opioids, a significant proportion may not dispose of leftover medication. We performed a quality improvement (QI) initiative within a tertiary academic care center to examine opioid excess, opioid disposal, and whether a two-component QI intervention of provider education and family education via automated SMS messages on opioid disposal could improve excess opioid prescribing and leftover opioid disposal. MATERIALS AND METHODS Prospective parent surveys were performed on a baseline cohort of 73 patients undergoing outpatient pediatric urologic surgery between July 27 and September 4, 2020. Based on baseline data, a two-component quality improvement initiative was implemented. The first component was non-binding surgeon education regarding opioid prescribing versus opioid utilization. The second component was initiation of automated SMS messages to families after surgery with information on expected postoperative course and hyperlinked instructions for opioid disposal with GPS search for opioid disposal sites nearby. We then repeated the survey for a second cohort of patients between September 14 and October 29, 2021, including additional questions regarding SMS message utility. RESULTS Of 73 patients in the baseline group, 46% were prescribed opioids (Summary Table). Of patients prescribed opioids, a median of 3 doses were used and 96% had leftover opioid medication. Seventeen percent of parents in the baseline group disposed of unused opioids prior to survey completion (1-4 weeks postop). After the intervention, 19 of 74 (26%) patients were prescribed opioids. In the group that received opioids, a median of 2 doses were used and 63% reported disposing of opioids. Ninety-six percent of parents reported satisfaction with SMS messages. DISCUSSION Many competing priorities exist for surgical providers and parents of children undergoing outpatient pediatric urologic surgery. A passive program that delivers just-in-time information in the postoperative period has high utility for both parents and providers. CONCLUSIONS Automated SMS messages and provider education about opioid utilization are associated with decreased excess opioid after outpatient pediatric urologic surgery and improved opioid disposal rates by parents. These interventions are easily implemented without significant manpower and should be considered by organizations interested in decreasing excess community opioids after outpatient pediatric urologic surgery.
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Affiliation(s)
| | | | | | | | - Katie Sheridan
- Medical College of Wisconsin, Department of Urology, USA
| | - Elizabeth B Roth
- Medical College of Wisconsin, Department of Urology, USA; Children's Wisconsin, USA.
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Guerra-Londono CE, Dexter F, Mitchell JD, Forrest PB, Penning DH. Effect of a non-reactive absorbent with or without environmentally oriented electronic feedback on anesthesia provider's fresh gas flow rates: A greening initiative. J Clin Anesth 2024; 95:111441. [PMID: 38452428 DOI: 10.1016/j.jclinane.2024.111441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/29/2023] [Accepted: 03/03/2024] [Indexed: 03/09/2024]
Abstract
STUDY OBJECTIVE To examine the effects of a non-reactive carbon dioxide absorbent (AMSORB® Plus) versus a traditional carbon dioxide absorbent (Medisorb™) on the FGF used by anesthesia providers and an electronic educational feedback intervention using Carestation™ Insights (GE HealthCare) on provider-specific change in FGF. DESIGN Prospective, single-center cohort study set in a greening initiative. SETTING Operating room. PARTICIPANTS 157 anesthesia providers (i.e., anesthesiology trainees, certified registered nurse anesthetists, and solo anesthesiologists). INTERVENTIONS Intervention #1 was the introduction of AMSORB® Plus into 8 Aisys CS2, Carestation™ Insights-enabled anesthesia machines (GE HealthCare) at the study site. At the end of week 6, anesthesia providers were educated and given an environmentally oriented electronic feedback strategy for the next 12 weeks of the study (Intervention #2) using Carestation™ Insights data. MEASUREMENTS The dual primary outcomes were the difference in average daily FGF during maintenance anesthesia between machines assigned to AMSORB® Plus versus Medisorb™ and the provider-specific change in average fresh gas flows after 12 weeks of feedback and education compared to the historical data. MAIN RESULTS Over the 18-week period, there were 1577 inhaled anesthetics performed in the 8 operating rooms (528 for intervention 1, 1049 for intervention 2). There were 1001 provider days using Aisys CS2 machines and 7452 provider days of historical data from the preceding year. Overall, AMSORB® Plus was not associated with significantly less FGF (mean - 80 ml/min, 97.5% confidence interval - 206 to 46, P = .15). The environmentally oriented electronic feedback intervention was not associated with a significant decrease in provider-specific mean FGF (-112 ml/min, 97.5% confidence interval - 244 to 21, P = .059). CONCLUSIONS This study showed that introducing a non-reactive absorbent did not significantly alter FGF. Using environmentally oriented electronic feedback relying on data analytics did not result in significantly reduced provider-specific FGF.
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Affiliation(s)
- Carlos E Guerra-Londono
- Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health, Detroit, MI, USA.
| | - Franklin Dexter
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA
| | - John D Mitchell
- Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health, Detroit, MI, USA
| | - Patrick B Forrest
- Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health, Detroit, MI, USA
| | - Donald H Penning
- Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health, Detroit, MI, USA
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Beleigoli A, Foote J, Gebremichael LG, Bulamu NB, Astley C, Keech W, Tavella R, Gulyani A, Nesbitt K, Pinero de Plaza MA, Ramos JS, Ludlow M, Nicholls SJ, Chew DP, Beltrame J, Clark RA. Clinical Effectiveness and Utilisation of Cardiac Rehabilitation After Hospital Discharge: Data Linkage Analysis of 84,064 Eligible Discharged Patients (2016-2021). Heart Lung Circ 2024:S1443-9506(24)00048-9. [PMID: 38443278 DOI: 10.1016/j.hlc.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/12/2023] [Accepted: 01/11/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Despite the highest levels of evidence on cardiac rehabilitation (CR) effectiveness, its translation into practice is compromised by low participation. AIM This study aimed to investigate CR utilisation and effectiveness in South Australia. METHODS This retrospective cohort study used data linkage of clinical and administrative databases from 2016 to 2021 to assess the association between CR utilisation (no CR received, commenced without completing, or completed) and the composite primary outcome (mortality/cardiovascular re-admissions within 12 months after discharge). Cox survival models were adjusted for sociodemographic and clinical data and applied to a population balanced by inverse probability weighting. Associations with non-completion were assessed by logistic regression. RESULTS Among 84,064 eligible participants, 74,189 did not receive CR, with 26,833 of the 84,064 (31.9%) participants referred. Of these, 9,875 (36.8%) commenced CR, and 7,681 of the 9,875 (77.8%) completed CR. Median waiting time from discharge to commencement was 40 days (interquartile range, 23-79 days). Female sex (odds ratio [OR] 1.12; 95% CI 1.01-1.24; p=0.024), depression (OR 1.17; 95% CI 1.05-1.30; p=0.002), and waiting time >28 days (OR 1.15; 95% CI 1.05-1.26; p=0.005) were associated with higher odds of non-completion, whereas enrolment in a telehealth program (OR 0.35; 95% CI 0.31-0.40; p<0.001) was associated with lower odds of non-completion. Completing CR (hazard ratio [HR] 0.62; 95% CI 0.58-0.66; p<0.001) was associated with a lower risk of 12-month mortality/cardiovascular re-admissions. Commencing without completing was also associated with decreased risk (HR 0.81; 95% CI 0.73-0.90; p<0.001), but the effect was lower than for those completing CR (p<0.001). CONCLUSIONS Cardiac rehabilitation (CR) attendance is associated with lower all-cause mortality/cardiovascular re-admissions, with CR completion leading to additional benefits. Quality improvement initiatives should include promoting referral, women's participation, access to telehealth, and reduction of waiting times to increase completion.
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Affiliation(s)
- Alline Beleigoli
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
| | - Jonathon Foote
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Lemlem G Gebremichael
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Norma B Bulamu
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Carolyn Astley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Wendy Keech
- Health Translation SA, Adelaide, SA, Australia
| | - Rosanna Tavella
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Aarti Gulyani
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Katie Nesbitt
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | | | - Joyce S Ramos
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Marie Ludlow
- National Heart Foundation of Australia, Adelaide, SA, Australia
| | | | - Derek P Chew
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| | - John Beltrame
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Robyn A Clark
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA, Australia
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Panganiban JMS, Loreche AM, De Mesa RYH, Camiling-Alfonso R, Fabian NMC, Dans LF, Galingana CLT, Lopez JFE, Casile RU, Aquino MRN, Rey MP, Sanchez JT, Javelosa MAU, Tan-Lim CSC, Marfori JRA, Paterno RP, Dans AL. Promoting equitable and patient-centred care: an analysis of patient satisfaction in urban, rural and remote primary care sites in the Philippines. BMJ Open Qual 2024; 13:e002483. [PMID: 38448041 PMCID: PMC10916135 DOI: 10.1136/bmjoq-2023-002483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/28/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES This study measured changes in patient satisfaction levels before and after the introduction of primary care system strengthening interventions in urban, rural, and remote sites in the Philippines. METHODS A previously validated 16-item questionnaire was distributed to 200 patients per site before implementation of interventions and to a different set of 200 patients 1 year after implementation. We compared the percentage change in highly satisfied patients per site before and after implementing interventions using a two-proportion Z-test. RESULTS The urban site had a significant increase in patient satisfaction in 13 survey items, which corresponded to the domains of healthcare availability, service efficiency, technical competency and health communication. The rural site had a significant increase in six survey items, which corresponded to the domains of service efficiency, environment, location, health communication and handling. The remote site had a decrease in patient satisfaction in 10 survey items, with a significant increase in only 4 items under the domains of healthcare availability and handling. CONCLUSION Our findings support the 'inverse equity hypothesis', where well-resourced urban communities quickly adopt complex health interventions while rural and remote settings experience delays in effectively meeting patient needs and system demands. Extended intervention periods and targeted strategies may be necessary to impact patient satisfaction in underserved areas considerably.
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Affiliation(s)
| | - Arianna Maever Loreche
- National Clinical Trials and Translation Center, University of the Philippines Manila, Manila, Philippines
| | - Regine Ynez H De Mesa
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
| | - Romelei Camiling-Alfonso
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
| | - Noleen Marie C Fabian
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
- University of the East Ramon Magsaysay Memorial Medical Center Inc, Quezon City, Philippines
| | - Leonila F Dans
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
- Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Cara Lois T Galingana
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
| | - Johanna Faye E Lopez
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
| | - Ray U Casile
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
| | - Maria Rhodora N Aquino
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
| | - Mia P Rey
- Department of Accounting and Finance, Cesar E.A. Virata School of Business, University of the Philippines Diliman, Quezon City, Philippines
| | - Josephine T Sanchez
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
| | - Mark Anthony U Javelosa
- Department of Clinical Epidemiology, University of the Philippines Manila, Manila, Philippines
| | | | - Jose Rafael A Marfori
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
- Department of Clinical Epidemiology, University of the Philippines Manila, Manila, Philippines
| | - Ramon Pedro Paterno
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
| | - Antonio L Dans
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
- National Institutes of Health, University of the Philippines Manila, Manila, Philippines
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Yousefi Nooraie R, Qin Q, Wagg A, Berta W, Estabrooks C. Building a communication and support network among quality improvement teams in nursing homes: a longitudinal study of the SCOPE trial. Implement Sci Commun 2024; 5:19. [PMID: 38438921 PMCID: PMC10913450 DOI: 10.1186/s43058-024-00559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND We applied a longitudinal network analysis approach to assess the formation of knowledge sharing and collaboration networks among care aide-led quality improvement (QI) teams in Canadian nursing homes participating in the Safer Care for Older Persons (in residential) Environments (SCOPE) trial which aimed to support unregulated front-line staff to lead unit-based quality improvement (QI) teams in nursing homes. We hypothesized that SCOPE's communicative and participatory nature would provide opportunities for peer support, knowledge sharing, and collaboration building among teams. METHODS Fourteen QI teams in Alberta (AB) and seventeen QI teams in British Columbia (BC) participated in the study. Communications across nursing homes occurred through a series of 4 collaborative Learning Congresses (training sessions) over a 1-year period. The senior leaders of QI teams participated in two online network surveys about the communication/collaboration between teams in their province, 1 month after the first, and 6 months later, after the fourth Learning Congress. We developed communication and collaboration network maps pertaining to three time points: before SCOPE, at 2 months, and at 9 months. RESULTS Over time, teams made significantly more new connections and strengthened existing ones, within and across regions. Geographic proximity and co-membership in organizational chains were important predictors of connectivity before and during SCOPE. Teams whose members were well connected at baseline disproportionately improved connectivity over time. On the other hand, teams that did not have prior opportunities to connect appeared to use SCOPE to build new ties. CONCLUSIONS Our findings suggest the importance of network-altering activities to the formation of collaboration networks among QI teams across nursing homes. Active strategies could be used to better connect less connected teams and facilitate collaboration among geographically proximate teams. These findings may inform the development of interventions to leverage existing networks and provide new networking opportunities to develop and sustain organizational improvements.
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Affiliation(s)
- Reza Yousefi Nooraie
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA.
| | - Qiuyuan Qin
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Adrian Wagg
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Whitney Berta
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Zhou S, Zhang Y, Dong X, Ma J, Li N, Shi H, Smith SC, Jin Y, Xu M, Xiang D, Zheng ZJ, Huo Y. Regional variations in management and outcomes of patients with acute coronary syndrome in China: Evidence from the National Chest Pain Center Program. Sci Bull (Beijing) 2024:S2095-9273(24)00154-3. [PMID: 38519397 DOI: 10.1016/j.scib.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/25/2023] [Accepted: 12/19/2023] [Indexed: 03/24/2024]
Abstract
Regional variations in acute coronary syndrome (ACS) management and outcomes have been an enormous public health issue. However, studies have yet to explore how to reduce the variations. The National Chest Pain Center Program (NCPCP) is the first nationwide, hospital-based, comprehensive, continuous quality improvement program for improving the quality of care in patients with ACS in China. We evaluated the association of NCPCP and regional variations in ACS healthcare using generalized linear mixed models and interaction analysis. Patients in the Western region had longer onset-to-first medical contact (FMC) time and time stay in non-percutaneous coronary intervention (PCI) hospitals, lower rates of PCI for ST-elevation myocardial infarction (STEMI) patients, and higher rates of medication usage. Patients in Central regions had relatively lower in-hospital mortality and in-hospital heart failure rates. Differences in the door-to-balloon time (DtoB) and in-hospital mortality between Western and Eastern regions were less after accreditation (β = -8.82, 95% confidence interval (CI) -14.61 to -3.03; OR = 0.79, 95%CI 0.70 to 0.91). Similar results were found in differences in DtoB time, primary PCI rate for STEMI between Central and Eastern regions. The differences in PCI for higher-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients among different regions had been smaller. Additionally, the differences in medication use between Eastern and Western regions were higher after accreditation. Regional variations remained high in this large cohort of patients with ACS from hospitals participating in the NCPCP in China. More comprehensive interventions and hospital internal system optimizations are needed to further reduce regional variations in the management and outcomes of patients with ACS.
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Affiliation(s)
- Shuduo Zhou
- Department of Global Health, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing100871, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing 100034, China
| | - Xuejie Dong
- Department of Global Health, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing100871, China
| | - Junxiong Ma
- Department of Global Health, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing100871, China
| | - Na Li
- Department of Global Health, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing100871, China
| | - Hong Shi
- Chinese Medical Association, Beijing 100052, China
| | - Sidney C Smith
- Division of Cardiovascular Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina 27599-3140, USA
| | - Yinzi Jin
- Department of Global Health, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing100871, China
| | - Ming Xu
- Department of Global Health, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing100871, China
| | - Dingcheng Xiang
- Department of Cardiology, General Hospital of Southern Theater Command of PLA, Guangzhou 510010, China.
| | - Zhi-Jie Zheng
- Department of Global Health, Peking University School of Public Health, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing100871, China.
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing 100034, China.
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Ebm C, Del Pozo C, Barbarello A, Poli G, Brusa S. Unleashing excellence: using a project management approach to effectively implement a simulation curriculum to improve residents' preparedness. BMC Med Educ 2024; 24:234. [PMID: 38438940 PMCID: PMC10913544 DOI: 10.1186/s12909-024-05166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/12/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Integrating innovative, simulation-based training programs into medical curricula frequently encounters familiar challenges, including scepticism, limited faculty time, and financial constraints. Recognized for its success in business projects, the Harvard Project Management Theory emerges as a promising approach to optimizing the implementation process and achieving sustainable success. This study endeavours to elucidate the application of project management theory in our implementation process and assess its impact on the clinical preparedness of novice residents. METHODS The research utilized a structured four-phase implementation strategy-Planning, Build-up, Execution, and Closing-to develop a simulation-based education curriculum. Incorporating project management tools like project charters and risk management tools played a crucial role in facilitating the effective implementation of standardized processes and improved clinical outcomes. Essential components of this innovative management approach encompass stakeholder engagement, milestone definition, and the alignment of institutional policies and processes. RESULTS A collective of 395 residents actively engaged in eight monthly simulation-based events, reflecting an average participation rate of 39 residents per lecture (± 19). A noteworthy enhancement was observed in the average rating for knowledge gain, with a significant improvement from 5.9/10 to 8.8/10 (p = 0.0001). Participants highlighted the program's considerable impact on future clinical practice (4.7/5) and teamwork (4.8/5) as particularly valuable aspects. The introduction of a novel organizational structure received favourable feedback from faculty members, with a notable rating of 4.8/5 for predictive time planning. Qualitative insights from the evaluation highlighted the significance of targeted incentive schemes in optimizing the implementation process. CONCLUSION This project underscores the constructive influence of project management principles in designing simulation-based curricula, explicitly focusing on stakeholder engagement, faculty motivation, and data utilization. Adopting the Harvard Project Management Approach emerges as a catalyst for heightened success in curriculum design, contributing to enhanced emergency preparedness among novice residents. The positive outcomes observed in this study provide valuable insights for future implementations, offering a foundation for refining and optimizing medical education programs to meet the evolving needs of learners and stakeholders alike.
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Affiliation(s)
- Claudia Ebm
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
| | - Carolina Del Pozo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Giovani Poli
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefania Brusa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Ali J, Thompson M, Mackenzie C. Assessing the frequency and types of errors involved in the use of a modified intravenous N-acetylcysteine protocol for acetaminophen overdose. CAN J EMERG MED 2024; 26:174-178. [PMID: 38340270 DOI: 10.1007/s43678-023-00641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/27/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Acetaminophen overdose is a leading cause of acute liver failure in developing countries. N-acetylcysteine (NAC) is a highly effective antidote for acetaminophen hepatotoxicity, typically initiated in the emergency department. Due to a known high rate of errors with the standard three-bag IV NAC protocol, in 2019, the Ontario Poison Center changed to a modified 3% IV NAC one-bag protocol. This study was undertaken to determine the frequency and types of errors associated with the use of this protocol. METHODS Data were gathered via chart review of Ontario Poison Centre electronic medical record cases identified as receiving IV NAC for acetaminophen overdose between August 1 and September 30, 2022. 218 total charts were identified, and 188 were deemed eligible based on inclusion and exclusion criteria. RESULTS Errors were identified in 25% of charts, consisting of dosing errors in 11.7%, stopping errors in 9.0%, initiation errors in 3.7%, and interruptions in therapy in 3.2%. Dosing errors were the most common type of error (44.4%), with overdoses occurring three times more than underdoses. Errors were identified at 39% of geographic locations in the charts reviewed, with similar frequency in Ontario, Manitoba, and Nunavut. Clinical outcomes were similar in charts with and without errors. INTERPRETATION The rate of errors identified with this 3% IV NAC one-bag protocol is lower than reported for the standard three-bag protocol, but remains high due to dosing errors. Previously reported issues with prolonged interruptions in therapy with the standard three-bag protocol were low with the current 3% one-bag protocol. Although severe outcomes are rare, IV NAC overdose can be fatal. Identifying local factors in emergency departments that can contribute to administration errors (i.e., dose calculation, pump programming issues) can enhance the safety of this important antidote.
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Affiliation(s)
- J Ali
- Department of Medicine, Western University, London, ON, Canada
| | - M Thompson
- Ontario Poison Centre, Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada
- Division of Emergency Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Connie Mackenzie
- Ontario Poison Centre, Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada.
- Divisions of Clinical Pharmacology and Toxicology/Respirology, Western University, London, ON, Canada.
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Kozelka EE, Acquilano SC, Al-Abdulmunem M, Guarino S, Elwyn G, Drake RE, Carpenter-Song E. Digital Mental Health and Its Discontents: Assumptions About Technology That Create Barriers to Equitable Access. Psychiatr Serv 2024; 75:299-302. [PMID: 38050440 DOI: 10.1176/appi.ps.20230238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Despite the potential of digital mental health interventions to aid recovery for people with serious mental illness, access to these digital tools remains a key barrier. In this column, the authors discuss three key assumptions that shape the integration of digital mental health tools into community health settings: clinical context, digital literacy, and financial burden. Clinical contexts have shifted with the increased use of telehealth, altering intervention environments; access to a mobile device is not the same as digital literacy; and digital mental health care is not necessarily affordable. Context-centered study design through ethnography will facilitate transfer of digital resources to real-world settings.
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Affiliation(s)
- Ellen E Kozelka
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Stephanie C Acquilano
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Monirah Al-Abdulmunem
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Sue Guarino
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Glyn Elwyn
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Robert E Drake
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Elizabeth Carpenter-Song
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
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Rioles N, March C, Muñoz CE, Ilkowitz J, Ohmer A, Wolf RM. Stakeholder Engagement in Type 1 Diabetes Research, Quality Improvement, and Clinical Care. Endocrinol Metab Clin North Am 2024; 53:165-182. [PMID: 38272594 DOI: 10.1016/j.ecl.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
The integration of stakeholder engagement (SE) in research, quality improvement (QI), and clinical care has gained significant traction. Type 1 diabetes is a chronic disease that requires complex daily management and care from a multidisciplinary team across the lifespan. Inclusion of key stakeholder voices, including patients, caregivers, health care providers and community advocates, in the research process and implementation of clinical care is critical to ensure representation of perspectives that match the values and goals of the patient population. This review describes the current framework for SE and its application to research, QI, and clinical care across the lifespan.
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Affiliation(s)
| | - Christine March
- Division of Pediatric Endocrinology and Diabetes, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Cynthia E Muñoz
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeniece Ilkowitz
- Pediatric Diabetes Center, NYU Langone Health, New York, NY, USA
| | - Amy Ohmer
- International Children's Advisory Network, Atlanta, GA, USA
| | - Risa M Wolf
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Quigley DD, Elliott MN, Slaughter ME, Lerner C, Hays RD. Narrative comments about pediatric inpatient experiences yield substantial information beyond answers to closed-ended CAHPS survey questions. J Pediatr Nurs 2024:S0882-5963(24)00059-9. [PMID: 38431461 DOI: 10.1016/j.pedn.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/01/2024] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Adults' comments on patient experience surveys explain variation in provider ratings, with negative comments providing more actionable information than positive comments. We investigate if narrative comments on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey of inpatient pediatric care (Child HCAHPS) account for global perceptions of the hospital beyond that explained by reports about specific aspects of care. METHODS We analyzed 545 comments from 927 Child HCAHPS surveys completed by parents and guardians of hospitalized children with at least a 24-h hospital stay from July 2017 to December 2020 at an urban children's hospital. Comments were coded for valence (positive/negative/mixed) and actionability and used to predict Overall Hospital Rating and Willingness to Recommend the Hospital along with Child HCAHPS composite scores. RESULTS Comments were provided more often by White and more educated respondents. Negative comments and greater actionability of comments were significantly associated with Child HCAHPS global rating measures, controlling for responses to closed-ended questions, and child and respondent characteristics. Each explained an additional 8% of the variance in respondents' overall hospital ratings and an additional 5% in their willingness to recommend the hospital. CONCLUSIONS Child HCAHPS narrative comment data provide significant additional information about what is important to parents and guardians during inpatient pediatric care beyond closed-ended composites. PRACTICE IMPLICATIONS Quality improvement efforts should include a review of narrative comments alongside closed-ended responses to help identify ways to improve inpatient care experiences. To promote health equity, comments should be encouraged for racial-and-ethnic minority patients and those with less educational attainment.
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Affiliation(s)
- Denise D Quigley
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States of America.
| | - Marc N Elliott
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States of America.
| | - Mary E Slaughter
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States of America.
| | - Carlos Lerner
- UCLA David Geffen School of Medicine, Department of Medicine, 1100 Glendon Avenue, Los Angeles, CA 90024-1736, United States of America; UCLA Mattel Children's Hospital, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America.
| | - Ron D Hays
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States of America; UCLA David Geffen School of Medicine, Department of Medicine, 1100 Glendon Avenue, Los Angeles, CA 90024-1736, United States of America.
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Hrymak C, Lim R, Trivedi S, Alvarez A, Purdy E, Belisle S, Thull-Freedman J, Leeies M, Lang E, Chartier LB. An Exploration of the Interplay Between Well-being and Quality and Safety. CAN J EMERG MED 2024; 26:148-155. [PMID: 38421518 DOI: 10.1007/s43678-024-00653-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/11/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Quality improvement and patient safety (QIPS) and clinician well-being work are interconnected and impact each other. Well-being is of increased importance in the current state of workforce shortages and high levels of burnout. The Canadian Association of Emergency Physicians (CAEP) Academic Symposium sought to understand the interplay between QIPS and clinician well-being and to provide practical recommendations to clinicians and institutions on ensuring that clinician well-being is integrated into QIPS efforts. METHODS A team of emergency physicians with expertise in well-being and QIPS performed a literature review, drafted goals and recommendations, and presented at the CAEP Academic Symposium in 2023 for feedback. Goals and recommendations were then further refined. RESULTS Three goals and recommendations were developed as follows: QIPS leaders and practitioners must (1) understand the potential intersection of well-being and QIPS, (2) consider a well-being lens for all QIPS work, and (3) incorporate QIPS methodology in efforts to improve clinician well-being. CONCLUSION QIPS and clinician well-being are often closely linked. By incorporating these recommendations, QIPS strategies can enhance clinician well-being.
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Affiliation(s)
- Carmen Hrymak
- Department of Emergency Medicine and Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada.
| | - Rodrick Lim
- Departments of Paediatrics and Medicine, Western University, London, ON, Canada
| | - Sachin Trivedi
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Al'ai Alvarez
- Department of Emergency Medicine, Stanford University, Stanford, CA, USA
| | - Eve Purdy
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Sheena Belisle
- Departments of Paediatrics and Medicine, Western University, London, ON, Canada
| | - Jennifer Thull-Freedman
- Departments of Pediatrics and Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine and Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Lucas B Chartier
- Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada
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van der Wees PJ, Balog EJ, Irrgang JJ, Zeleznik H, McDonald PL, Harwood KJ. Using feedback on patient health outcomes to improve orthopaedic physical therapist practice: a quality improvement study. BMJ Open Qual 2024; 13:e002338. [PMID: 38429061 PMCID: PMC10910658 DOI: 10.1136/bmjoq-2023-002338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 02/14/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE Measuring health outcomes plays an important role in patient-centred healthcare. When aggregated across patients, outcomes can provide data for quality improvement (QI). However, most physical therapists are not familiar with QI methods based on patient outcomes. This mixed-methods study aimed to develop and evaluate a QI programme in outpatient physical therapy care based on routinely collected health outcomes of patients with low-back pain and neck pain. METHODS The QI programme was conducted by three teams of 5-6 physical therapists from outpatient settings. Plan-do-study-act cycles were used based on team-selected goals. Monthly feedback reports of process and outcomes of care, including pre-post treatment changes in Oswestry Disability Index (ODI) and Neck Disability Index (NDI), guided the QI efforts. Primary outcomes were pre-QI and post-QI changes in knowledge and attitudes towards outcome measures through a survey, and administered and self-reported compliance with using the ODI and NDI. Semistructured interviews and a focus group were conducted to evaluate the perceived value of the programme. RESULTS Post-QI, the survey showed improvements in two items related to the role of patients and implementation of outcome measures. Registered pre-QI and post-QI completion rates were high at intake (ODI:91% pre, 88% post; NDI:75% pre, 84% post), while completion rates at discharge improved post-QI (ODI:14% pre, 66% post; NDI: 32% pre, 50% post). Perceived benefits of the QI programme included clinician and institutional accountability to processes and strategies aimed at continuous improvement in patient care. An important facilitator for programme participation was autonomy in project selection and development, while a main barrier was the time required to set up the QI project. CONCLUSION A QI programme based on the feedback of routinely collected health outcomes of patients with low back pain and neck pain was feasible and well accepted by three pilot teams of physical therapists.
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Affiliation(s)
- Philip J van der Wees
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Science Department IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Emily J Balog
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Department of Rehabilitation and Movement Sciences, Rutgers University, New Brunswick, New Jersey, USA
| | - James J Irrgang
- Clinical Rehab Services, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA
| | - Hallie Zeleznik
- Clinical Rehab Services, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Paige L McDonald
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Kenneth J Harwood
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Marymount University College of Health and Education, Arlington, Virginia, USA
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Searl J, Genoa K, Fritz A, Kearney A, Pandian V, Brenner MJ, Doyle P. Perceptions and practices of people with a total laryngectomy during COVID-19 pandemic: A mixed methods analysis. Am J Otolaryngol 2024; 45:104126. [PMID: 38039911 PMCID: PMC10939873 DOI: 10.1016/j.amjoto.2023.104126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE People with a total laryngectomy (PTL) confront safety threats related to altered airway anatomy and risk of adverse events is amplified during healthcare crises, as exemplified by COVID-19 pandemic. Understanding these challenges, how they are navigated by PTL, and what resources can be deployed to alleviate risk can improve interprofessional care by speech-language pathologists (SLPs), otolaryngologists, and other professionals. MATERIALS AND METHODS An online survey was disseminated to PTL in the United States during the COVID-19 pandemic, querying participants about safety concerns and sources of information accessed to address care. Descriptive statistics and Chi-square were used to analyze information sources consumed by tracheoesophageal, esophageal, and electrolaryngeal speakers. Content analysis was completed to identify themes and quantify responses by subtheme. RESULTS Among 173 respondent PTL, tracheoesophageal speakers preferentially sought otolaryngologist input, whereas esophageal and electrolaryngeal speakers more often chose SLPs (p < .01). Overall, tracheoesophageal speakers had more SLP or otolaryngologist contact. Many PTL reported stringent handwashing, neck cleaning, and hygienic risk mitigation strategies. Six themes emerged in content analysis involving risk of infection/transmission, heightened vigilance, changes to alaryngeal communication, modified tracheostoma coverage, diagnostic testing, and risk from comorbid conditions. Limited provider contact suggested pandemic barriers to healthcare access. CONCLUSIONS PTL have a range of laryngectomy-specific needs and concerns, and type of alaryngeal communication was associated with source of information sought. Collaborations among healthcare professionals need to be optimized to improve patient navigation and overall access to specialized care.
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Affiliation(s)
- Jeff Searl
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA.
| | - Kathryn Genoa
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA.
| | - Alyssa Fritz
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA.
| | - Ann Kearney
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| | - Vinciya Pandian
- Center for Immersive Learning and Digital Innovation, Johns Hopkins School of Nursing, Baltimore, MD, USA.; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA; Global Tracheostomy Collaborative, Raleigh, NC, USA.
| | - Michael J Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA; Global Tracheostomy Collaborative, Raleigh, NC, USA.
| | - Philip Doyle
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Rosi-Schumacher M, Sharma J, Clausen S, Favre N, Powers K, Carr M. Post-tonsillectomy bleeding rate decreases with limitation in maximum post-operative ibuprofen dosage: A quality improvement study. Am J Otolaryngol 2024; 45:104197. [PMID: 38113775 DOI: 10.1016/j.amjoto.2023.104197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE The objective of this study is to investigate the effect of a reduction in the prescribed post-operative ibuprofen dosage on frequency of post-tonsillectomy bleeding. METHODS A quality improvement study was conducted at a single tertiary care pediatric hospital with patients weighing >40 kg undergoing tonsillectomy. The intervention was limiting the post-operative ibuprofen dosage to a maximum of 400 mg per dose. Data was collected on all patients returning to the hospital with bleeding after tonsillectomy. The primary outcome was the rate of post-tonsillectomy bleeding. Statistical analysis was conducted using nonparametric comparisons and a run chart. RESULTS A total of 199 tonsillectomy patients >40 kg were included in the study. There were 119 (59.8 %) females and 80 (40.2 %) males total. The pre-intervention group had a total of 56 patients while the post-intervention group had a total of 143 patients. There was no statistical difference in age, weight, or sex between the pre- and post-intervention groups (p > .05). The post-tonsillectomy hemorrhage rate was 11/56 (19.6 %) before the intervention, and 11/143 (7.7 %) after the intervention (p = .016). Children who experienced a bleeding event were significantly older (mean 15.9 years, 95 % CI 14.5-17.3) than those who did not (13.5 years, 95 % CI 12.9-14.1; p = .011). The run chart revealed that the intervention resulted in a nonrandom decrease in rate of post-tonsillectomy bleeding. CONCLUSIONS Post-tonsillectomy bleeding rate decreased with a ceiling post-operative ibuprofen dose of 400 mg/dose in this quality improvement study. Further research is warranted.
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Affiliation(s)
- Mattie Rosi-Schumacher
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14209, United States of America
| | - Jyoti Sharma
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14209, United States of America
| | - Sean Clausen
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14209, United States of America
| | - Nicole Favre
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14209, United States of America
| | - Kristina Powers
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14209, United States of America
| | - Michele Carr
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14209, United States of America.
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Lu Y, Yu W, Zhang J, Li R. Advancements in hospice and palliative care in China: A five-year review. Asia Pac J Oncol Nurs 2024; 11:100385. [PMID: 38486860 PMCID: PMC10937227 DOI: 10.1016/j.apjon.2024.100385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 03/17/2024] Open
Abstract
In response to the challenges posed by an aging population, an increasing cancer incidence, and the growing demand for hospice care services, China has actively promoted the development of hospice and palliative care, achieving significant progress in the past five years. This article provides a retrospective analysis of the efforts and accomplishments in the field of hospice and palliative care in China, focusing on government policy support, quality standards and regulations, drug management, health provider training, and public education. Additionally, the study explores the current issues and challenges in the field.
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Affiliation(s)
- Yuhan Lu
- Department of Nursing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)&Peking University Cancer Hospital & Institute, Beijing, China
| | - Wenhua Yu
- Department of Nursing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)&Peking University Cancer Hospital & Institute, Beijing, China
| | - Jie Zhang
- Department of Breast Cancer Prevention and Treatment Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)&Peking University Cancer Hospital & Institute, Beijing, China
| | - Ran Li
- Department of Pharmacy, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)&Peking University Cancer Hospital & Institute, Beijing, China
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Pirzadeh M, Lagina M, Wood C, Valley T, Ramnath N, Arenberg D, Deng JC. Barriers to Timely Lung Cancer Care in Early Stage Non-Small Cell Lung Cancer and Impact on Patient Outcomes. Clin Lung Cancer 2024; 25:135-143. [PMID: 37981476 PMCID: PMC10922667 DOI: 10.1016/j.cllc.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/04/2023] [Accepted: 10/28/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Optimal time to treatment for early-stage lung cancer is uncertain. We examined causes of delays in care for Veterans who presented with early-stage non-small cell lung cancer (NSCLC) and whether workup time was associated with increased upstaging or all-cause mortality. METHODS We performed a retrospective analysis of Veterans referred to our facility with radiographic stage I or II NSCLC between January 2013 to December 2017, with follow-up through October 2021. Patient demographics, tumor characteristics, time intervals of care, and reasons for delays were collected. Guideline concordance (GC) was defined as treatment within 14 weeks of abnormal image. Multivariable analyses were performed to determine association between delays in care, survival, and upstaging. RESULTS Data from 203 Veterans were analyzed. Median time between abnormal imaging to treatment was 17.7 weeks (IQR 12.7-26.6). Only 33% of Veterans received GC care. Most common patient-related delays were: intercurrent hospitalization/comorbidity (23%), no-shows (16%) and inability to reach Veteran (17%). Most common system-related delay: lack of scheduling availability (25%). Delays associated with upstaging: transportation issues, request for coordination of appointments, and unforeseen appointment changes. Rates of upstaging did not differ between GC and discordant groups (P = .6). GC care was not an independent predictor of mortality. Post-hoc, treatment within 8 weeks was associated with lower rates of upstaging (P = .05). CONCLUSION Although GC care did not impact survival or upstaging for early-stage NSCLC, shorter timeframes may be beneficial. Modifiable delays in care exist which may be addressed at an institutional level to improve timeliness of care.
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Affiliation(s)
- Mina Pirzadeh
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.
| | - Madeline Lagina
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Cameron Wood
- Division of Hematology and Oncology, Duke University, Durham, NC
| | - Thomas Valley
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Nithya Ramnath
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Douglas Arenberg
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Jane C Deng
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
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Ejaredar M, Ruzycki SM, Glazer TS, Trudeau P, Jim B, Nelson G, Cameron A. Implementation of a surgical site infection prevention bundle in gynecologic oncology patients: An enhanced recovery after surgery initiative. Gynecol Oncol 2024; 185:173-179. [PMID: 38430815 DOI: 10.1016/j.ygyno.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/10/2024] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To evaluate the clinical outcomes pre- and post-implementation of an evidence-informed surgical site infection prevention bundle (SSIPB) in gynecologic oncology patients within an Enhanced Recovery After Surgery (ERAS) care pathway. METHODS Patients undergoing laparotomy for a gynecologic oncology surgery between January-June 2017 (pre-SSIPB) and between January 2018-December 2020 (post-SSIPB) were compared using t-tests and chi-square. Patient characteristics, surgical factors, and ERAS process measures and outcomes were abstracted from the ERAS® Interactive Audit System (EIAS). The primary outcomes were incidence of surgical site infections (SSI) during post-operative hospital admission and at 30-days post-surgery. Secondary outcomes included total postoperative infections, length of stay, and any surgical complications. Multivariate models were used to adjust for potential confounding factors. RESULTS Patient and surgical characteristics were similar in the pre- and post-implementation periods. Evaluation of implementation suggested that preoperative and intraoperative components of the intervention were most consistently used. Infectious complications within 30 days of surgery decreased from 42.1% to 24.4% after implementation of the SSIPB (p < 0.001), including reductions in wound infections (17.0% to 10.8%, p = 0.02), urinary tract infections (UTI) (12.7% to 4.5%, p < 0.001), and intra-abdominal abscesses (5.4% to 2.5%, p = 0.05). These reductions were associated with a decrease in median length of stay from 3 to 2 days (p = 0.001). In multivariate analysis, these SSI reductions remained statistically significant after adjustment for potential confounders. CONCLUSION Implementation of SSIPB was associated with a reduction in SSIs and infectious complications, as well as a shorter length of stay in gynecologic oncology patients.
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Affiliation(s)
- Maede Ejaredar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shannon M Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tali Sara Glazer
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pat Trudeau
- Surgery Strategic Clinical Network TM, Alberta Health Services, Edmonton, Alberta, Canada
| | - Brent Jim
- Department of Oncology & Department of Obstetrics and Gynecology, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Gregg Nelson
- Department of Oncology and Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anna Cameron
- Department of Oncology and Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Ebekozien O, Mungmode A, Hardison H, Rapaport R. Improving Outcomes for People with Type 1 Diabetes Through Collaboration: Summary of Type 1 Diabetes Exchange Quality Improvement Collaborative Studies. Endocrinol Metab Clin North Am 2024; 53:1-16. [PMID: 38272589 DOI: 10.1016/j.ecl.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Type 1 diabetes (T1D) management has evolved over the last decade. Innovations and groundbreaking research have paved the way for improved outcomes for people with T1D. One of the major T1D focused research network that has supported real-world research studies in the United States is the T1D Exchange Quality Improvement Collaborative (T1DX-QI) Network.T1DX-QI is a large multicenter network of 55 T1D clinics that uses quality improvement, health equity framework, and population health principles to improve outcomes for people with T1D. This article summarizes insights from T1DX-QI clinical and population health improvement studies.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, MA, USA; University of Mississippi School of Population Health, Jackson, MS, USA.
| | | | | | - Robert Rapaport
- Department of Pediatrics at Icahn School of Medicine; Mount Sinai Kravis Children's Hospital, New York, NY, USA
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Schootman M, Li C, Ying J, Orcutt ST, Laryea J. Maximizing Readmission Reduction in Colon Cancer Patients. J Surg Res 2024; 295:587-596. [PMID: 38096772 PMCID: PMC10922981 DOI: 10.1016/j.jss.2023.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/09/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Multiple studies have identified risk factors for readmission in colon cancer patients. We need to determine which risk factors, when modified, produce the greatest decrease in readmission for patients so that limited resources can be used most effectively by implementing targeted evidence-based performance improvements. We determined the potential impact of various modifiable risk factors on reducing 30-d readmission in colon cancer patients. METHODS We used a cohort design with the 2012-2020 American College of Surgeons' National Surgical Quality Improvement Program data to track colon cancer patients for 30 d following surgery. Colon cancer patients who received colectomies and were discharged alive were included. Readmission (to the same or another hospital) for any reason within 30 d of the resection was the outcome measure. Modifiable risk factors were the use of minimally invasive surgery (MIS) versus open colectomy, mechanical bowel preparation, preoperative antibiotic use, functional status, smoking, complications (deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke, infections, anastomotic leakage, prolonged postoperative ileus, extensive blood loss, and sepsis), serum albumin, and hematocrit. RESULTS 111,691 patients with colon cancer were included in the analysis. About half of the patients were male, most were aged 75 or older, and were discharged home. Overall, 11,138 patients (10.0%) were readmitted within 30 d of surgery. In adjusted analysis, the reduction in readmission would be largest by preventing both prolonged ileus and by switching open colectomies to MIS (28.0% relative reduction) followed by preventing anastomotic leaks (6.2% relative reduction). Improving other modifiable risk factors would have a more limited impact. CONCLUSIONS The focus of readmission reduction should be on preventing prolonged ileus, increasing the use of MIS, and preventing anastomotic leaks.
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Affiliation(s)
- Mario Schootman
- Division of Community Health and Research, Department of Internal Medicine, College of Medicine, The University of Arkansas for Medical Sciences, Springdale, Arkansas; Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Chenghui Li
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jun Ying
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Biostatistics, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sonia T Orcutt
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Division of Surgical Oncology, Department of Surgery, College of Medicine, The University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jonathan Laryea
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Division of Colorectal Surgery, Department of Surgery, College of Medicine, The University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Merz LE, Huang GX, Mehta GD, Lynch DM, Maliborski N, Besz K, Wickner P, Cutler C, Castells M. Development of a Pipeline for Removing Allergy Labels in Patients Undergoing Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2024; 30:322.e1-322.e10. [PMID: 38134971 DOI: 10.1016/j.jtct.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
Penicillin allergy is reported by 10% to 20 % of patients, but when evaluated only 1% to 2% may have a true allergy. Patients undergoing hematopoietic stem cell transplantation (HSCT) have a high likelihood of requiring beta-lactam antibiotics due to increased infection risk, which can be limited by a penicillin allergy label. When a penicillin allergy is recorded, alternatives are needed, including more expensive broader-spectrum antibiotics, with increases in drug-resistant bacteria, longer hospital stays, higher expenditures, and increases in nosocomial infections, such as Clostridium difficile colitis. This group of patients already undergoes extensive pretreatment testing and would especially benefit from allergy delabeling. This study aimed to develop a self-sustaining, low-cost pipeline between an HSCT clinic and an allergy clinic to identify and successfully delabel low-risk patients who endorse an allergy to penicillin, amoxicillin, amoxicillin-clavulanate, piperacillin-tazobactam, or ampicillin before admission to the hospital. We developed a survey to triage allergy risk, identified key stakeholders in building the pipeline, and underwent 4 plan, do, study, act (PDSA) cycles. Changes were made in each of the PDSA cycles to minimize cost and uncompensated provider time, as well as to increase patient retention throughout the pipeline by increasing appointment availability and decreasing reliance on patients to independently progress through the pathway. Of the 410 patients with planned HSCT who were screened over 11 months, 89 (21.7%) were listed as having a penicillin and/or beta lactam allergy. All but 1 (66 of 67; 98.5%) of the participants completed the survey accurately when confirmed by an allergist, and the survey was 100% accurate in predicting delabeling success in low-risk patients. Of eligible patients, 43.8% (n = 39) were successfully delabeled before their transplant date, and 97.4% of these (n = 38) have undergone HSCT to date. This pipeline is maintained by approximately 5 hours of work per week (1 hour of allergy physician time, 4 hours of nurse and/or clinical coordinator time), with no other direct costs. There is an estimated direct savings of at least $1914.93 per patient delabeled. We successfully designed and implemented a pipeline between the HSCT clinic and the allergy clinic as a quality improvement initiative to identify and address high rates of reported beta-lactam allergies. We identified and addressed patient-based factors, logistical, temporal, and financial barriers that impacted patient retention and sustainability. This model is expected to yield significant and sustained cost savings for the healthcare system as well as to improve patient outcomes, and this hypothesis is currently undergoing formal analysis. We anticipate that this model can be used to create a similar pipeline in other healthcare systems for HSCT recipients, as well as patients in other clinical settings, such as oncology and chimeric antigen receptor T cell therapy.
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Affiliation(s)
- Lauren E Merz
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - George X Huang
- Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Geneva D Mehta
- Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Donna-Marie Lynch
- Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Natalia Maliborski
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kylie Besz
- Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paige Wickner
- Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Corey Cutler
- Division of Transplantation and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mariana Castells
- Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts.
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