Key performance indicators to inform evaluation of wound care programmes for people with complex wounds: a protocol for systematic review

OBJECTIVE

The objective of the systematic review is to examine and summarise the available evidence in the literature of the use of key performance indicators (KPIs) to inform evaluation of wound care programmes and services for people with hard-to-heal (complex) wounds. The need for wound care is expected to grow with the continued ageing of the population and the resulting increased development of chronic conditions. This expected increase necessitates improvement of wound care programmes and services and their ability to deliver quality, evidence-based and cost-effective practice. The current literature lacks a systematic assessment of KPIs to inform evaluation of wound care services and programmes across various settings, and how the KPIs are used to improve the quality of wound care and achieve desired outcomes. This protocol sets out how the systemtic review will be undertaken.

METHOD

Primary studies will be screened from databases such as MEDLINE, CINAHL and Scopus, with unpublished studies and grey literature retrieved from Google Scholar and ProQuest Dissertations and Theses. The study titles and abstracts will be screened by two independent reviewers, using Covidence systematic review software to ensure they meet the inclusion criteria, who will then proceed with data extraction of the full-text using the standardised data extraction instrument. The reference lists of all studies selected for critical appraisal will be screened for additional publications. The two independent reviewers will critically appraise all studies undergoing full-text data extraction using the appropriate checklist from JBI SUMARI. At all stages, differences between reviewers will be resolved through discussion, with adjudication by a third, independent reviewer.

RESULTS

Data points will be analysed with descriptive statistics and grouped, based on programme characteristics and publication status. Grey literature and peer-reviewed publications will form separate analyses. To answer review questions, the data will be summarised in a narrative format. A meta-analysis is not planned. At the time of writing, this protocol has been implemented up to the preliminary literature search.

CONCLUSION

This review will address a current literature gap and systematically identify KPIs in wound care, allowing for programmes to evaluate their quality of care and improve their services in a methodical manner.

Conventional in vitro fertilisation rather than intracytoplasmic sperm injection when only one oocyte is retrieved: Time to overcome irrational fears

BACKGROUND

The use of intracytoplasmic sperm injection (ICSI) currently extends beyond male factor infertility, notably replacing conventional in vitro fertilisation (IVF) in scenarios like limited oocyte availability, where it is used as a precaution against complete fertilisation failure. While existing studies on the use of conventional IVF in such situations provide some reassurance, the available evidence is somewhat insufficient and ICSI is commonly used.

AIMS

To evaluate whether conventional IVF can be a feasible option when only one oocyte is retrieved.

MATERIALS AND METHODS

A retrospective study was performed to evaluate the fertilisation rate with conventional IVF in women retrieving only one oocyte and whose partner had normal semen. The study aimed at evaluating whether the fertilisation rate was aligned with the threshold indicated by recognized IVF laboratory performance indicators (Vienna Consensus). Clinical pregnancy and live birth rates were secondary outcomes.

RESULTS

Out of 304 cycles with a single oocyte inseminated with conventional IVF, 209 achieved normal fertilisation and 82 did not. Thirteen had no mature oocytes. The fertilisation rate was 69% (95% CI: 63-74%) and increased to 72% (95% CI: 66-77%) when immature oocytes were excluded. The fertilisation rate surpassed the minimum competency threshold of the Vienna Consensus (60%), even if below the benchmark value (75%). Clinical pregnancy and live birth rates per oocyte retrieval were 10% and 8%, respectively. Univariate and multivariate analyses failed to identify any predictive factor of fertilisation.

CONCLUSION

Conventional IVF with one oocyte met Vienna Consensus standards even if it fell short of higher benchmarks.

Data-Driven AI Models within a User-Defined Optimization Objective Function in Cement Production

This paper explores the energy-intensive cement industry, focusing on a plant in Greece and its mill and kiln unit. The data utilized include manipulated, non-manipulated, and uncontrolled variables. The non-manipulated variables are computed based on the machine learning (ML) models and selected by the minimum value of the normalized root mean square error (NRMSE) across nine (9) methods. In case the distribution of the data displayed in the user interface changes, the user should trigger the retrain of the AI models to ensure their accuracy and robustness. To form the objective function, the expert user should define the desired weight for each manipulated or non-manipulated variable through the user interface (UI), along with its corresponding constraints or target value. The user selects the variables involved in the objective function based on the optimization strategy, and the evaluation is based on the comparison of the optimized and the active value of the objective function. The differential evolution (DE) method optimizes the objective function that is formed by the linear combination of the selected variables. The results indicate that using DE improves the operation of both the cement mill and kiln, yielding a lower objective function value compared to the current values.

The pattern of emergency department length of stay in Saudi Arabia: an epidemiological Nationwide analyses of secondary surveillance data

Background

Emergency department length of stay is a vital performance indicator for quality and efficiency in healthcare. This research aimed to evaluate the length of stay patterns in emergency departments across Saudi Arabia and to identify predictors for extended stays. The study used secondary data from the Ministry of Health's Ada'a program.

Methods

Using a retrospective approach, the study examined data from the Ada'a program on emergency department length of stay from September 2019 to December 2021. These data covered 1,572,296 emergency department visits from all regions of Saudi Arabia. Variables analyzed included quality indicators, year of visit, shift time, hospital type, and data entry method. The analysis was conducted using multiple linear regression.

Results

The study found that the median length of stay was 61 min, with significant differences among related predictors. All associations were significant with a value of p of less than 0.001. Compared to 2019, the length of stay was notably shorter by 28.5% in 2020 and by 44.2% in 2021. Evening and night shifts had a shorter length of stay by 5.9 and 7.8%, respectively, compared to the morning shift. Length of stay was lower in winter, summer, and fall compared to spring. Patients in levels I and II of the Canadian Triage and Acuity Scales had longer stays than those in level III, with those in level I reaching an increase of 20.5% in length of stay. Clustered hospitals had a longer length of stay compared to the non-clustered ones. Pediatric hospitals had a 15.3% shorter stay compared to general hospitals. Hospitals with data entered automatically had a 14.0% longer length of stay than those entered manually. Patients admitted to the hospital had a considerably longer length of stay, which was 54.7% longer compared to non-admitted patients. Deceased patients had a 20.5% longer length of stay than patients discharged alive.

Conclusion

Data at the national level identified several predictors of prolonged emergency department length of stay in Saudi Arabia, including shift time, season, severity level, and hospital type. These results underline the necessity of continuous monitoring and improvement efforts in emergency departments, in line with policy initiatives aiming to enhance patient outcomes in Saudi Arabia.

Identifying and prioritizing the key performance indicators for hospital management dashboard at a national level: Viewpoint of hospital managers

Participation of main users in identifying key performance indicators (KPIs) for management dashboards contributes to their success. The aim of this study was to identify and prioritize the KPIs of hospital management dashboards from the viewpoint of hospital managers. This study was conducted on managers of public hospitals at a national level in Iran in 2020. Data were collected using a self-administrated questionnaire. The KPIs were classified into five categories, namely financial, operational, human resources, safety and quality of care, services provided to patients. A total of 234 hospital managers participated in this study. Totally, 25 KPIs were determined for the hospital management dashboard, including the patient falls rate, waiting time for patients in the emergency department, patient satisfaction, total hospital revenue, financial balance, bed occupancy rate, patients' discharge with own agreement, average length of stay, and personnel satisfaction. For designing hospital management dashboards, the domains of services provided to patients, safety and quality of care, financial resources, human resources, and operational are important from the hospital managers' viewpoint, respectively. The results of this study can be helpful for developers of business intelligence tools, such as hospital management dashboards, to visualize the most important indicators for managers.

Opposition Skill Efficiency During Professional Rugby Union Official Games Is Related to Horizontal Force-Production Capacities in Sprinting

PURPOSE

This study aimed to determine relationships between parameters of force-production capacity in sprinting and opposition skill efficiency in rugby union games according to position.

METHODS

The sprint force-velocity profile of 33 professional rugby union players divided into 2 subgroups (forwards and backs) was measured on a 30-m sprint. Skill efficiencies (in percentage) of offensive duels, tackles, and rucks were assessed using objective criteria during 12 consecutive competitive games. Pearson correlation was used to determine the relationships between parameters of horizontal force-production capacity in sprinting (maximum propulsive power, theoretical maximum force [F0], theoretical maximum velocity, maximum ratio of horizontal force [RFmax], and rate of decrease of this ratio of forces with increasing velocity) and skill efficiencies. Two multiple linear regression models were used to observe whether skill efficiencies could depend on determinants of horizontal force application in low- or high-velocity conditions. A first model including F0 and theoretical maximum velocity was used as a macroscopic analysis, while a second model including RFmax and rate of decrease of this ratio of forces with increasing velocity was used as microscopic analysis to determine the most significant determinants of skill efficiency.

RESULTS

All skill efficiencies were strongly correlated with maximum propulsive power in forwards and backs. In forwards, F0 and RFmax were the key predictors of dueling, rucking, and tackling efficiency. In backs, F0 was the main predictor of dueling and rucking efficiency, whereas RFmax was the key predictor of dueling and tackling efficiency. F0 and theoretical maximum velocity equivalently contributed to tackling performance.

CONCLUSIONS

In rugby union forward and back players, skill efficiency is correlated with maximum propulsive power and may be more explained by horizontal force-production capacity and mechanical effectiveness at lower velocities than at higher velocities.

Enhancing healthcare quality and outcomes for peritoneal dialysis patients in Thailand: An evaluation of key performance indicators and PDOPPS cohort representativeness

AIM

To assess whether the peritoneal dialysis (PD) centres included in the Peritoneal Dialysis Outcomes and Practise Patterns Study (PDOPPS) in Thailand are representative of other PD centres in the country, based on 8 key performance indicators (KPIs 1-8).

METHODS

A retrospective analysis was conducted comparing PD-related clinical outcomes between PD centres included in the PDOPPS (the PDOPPS group) and those not included (the non-PDOPPS group) from January 2018 to December 2019. Logistic regression analysis was used to identify predictors associated with achieving the target KPIs.

RESULTS

Of 181 PD centres, 22 (12%) were included in the PDOPPS. PD centres in the PDOPPS group were larger and tended to serve more PD patients than those in the non-PDOPPS group. However, the process and outcome KPIs (KPIs 1-8) were comparable between the 2 groups. Large hospitals (≥120 beds), providing care to ≥100 PD cases and having experience for >10 years were independent predictors of achieving the peritonitis rate target of <0.5 episodes/year. Most PD centres in Thailand showed weaknesses in off-target haemoglobin levels and culture-negative peritonitis rate.

CONCLUSIONS

The PD centres included in Thai PDOPPS were found to be representative of other PD centres in Thailand in terms of clinical outcomes. Thus, Thai PDOPPS findings may apply to the broader PD population in Thailand.

360 Health Analysis (H360)-A Comparison of Key Performance Indicators in Breast Cancer Management across Health Institution Settings in Portugal

BACKGROUND

The increased focus on quality indicators (QIs) and the use of clinical registries in real-world cancer studies have increased compliance with therapeutic standards and patient survival. The European Society of Breast Cancer Specialists (EUSOMA) established QIs to assess compliance with current standards in breast cancer care.

METHODS

This retrospective study is part of H360 Health Analysis and aims to describe compliance with EUSOMA QIs in breast cancer management in different hospital settings (public vs. private; general hospitals vs. oncology centers). A set of key performance indicators (KPIs) was selected based on EUSOMA and previously identified QIs. Secondary data were retrieved from patients' clinical records. Compliance with target KPIs in different disease stages was compared with minimum and target EUSOMA standards.

RESULTS

A total of 259 patient records were assessed. In stages I, II, and III, 18 KPIs met target EUSOMA standards, 5 met minimum standards, and 8 failed to meet minimum standards. Compliance with KPIs varied according to the type of hospital (particularly regarding diagnosis) and disease stage. Although small differences were found in KPI compliance among institutions, several statistical differences were found among treatment KPIs according to disease stage, particularly in stage III.

CONCLUSIONS

This study represents the first assessment of the quality of breast cancer care in different hospital settings in Portugal and shows that, although most QIs meet EUSOMA standards, there is room for improvement. Differences have been found across institutions, particularly between oncology centers and general hospitals, in diagnosis and compliance with KPIs among disease stages. Stage III showed the greatest variability in compliance with treatment KPIs, probably related to the lower specificity of the guidelines in this disease stage.

Key performance indicators used by dairy consultants during the evaluation of reproductive performance during routine visits

Dairy farms need thorough and efficient reproduction control. Consultants specialized in reproduction use key performance indicators (KPI) to monitor the reproductive performance of farms and must be able to decipher between the approach in a first visit and routine visits. A total of 49 consultants specialized in dairy reproduction from 21 countries responded to an online survey conducted to determine the most suitable parameters during routine visits every 2 to 4 weeks. The survey was comprised of 190 questions, 178 of them rated from 0 (irrelevant) to 10 (maximum importance) points. The questions were divided into five sections: (1) consultant and farm model, (2) general data of the farm, (3) cow reproduction, (4) postpartum and metabolic disease, and (5) heifer reproduction. The median, interquartile range, minimum and maximum values, and 95% confidence interval were determined for each question. Afterward, a multivariate analysis, using between-group linkage via Ward's hierarchical clustering was conducted to generate clusters of consultants according to their response pattern. Finally, a chi-square test was conducted to assess the association between years of experience of the consultant and farm size within the clusters generated in each section of the questionnaire. The majority of the consultants considered 34 parameters to be highly important (rated 8-10) to analyze during routine visits. The consultants used several KPI (in variable quantitative range) to evaluate any of the presented sections and considered that all the five sections are critical to control. They are aware of using KPI that reflect heat detection, fertility, and farming efficiency as well as KPI that can provide information on reproductive efficiency in the near future for cows, such as postpartum and metabolic diseases. However, parameters that are relatively old and ineffective, in terms of reproductive performance control, are still highly regarded by the majority of consultants in a routine-visit scenario. Farm size and years of experience of the consultant did not influence the type or number of parameters chosen as KPI during routine visits. The parameters rated with the highest importance (rate 10) that could be considered for an easy, fast, and universal use in routine visits to assess the reproductive status were: First service CR (%), Overall pregnancy rate (%) for cows, and age at first calving (d) for heifers.

Centralizing a controlled substance compliance and drug diversion prevention program within a multihospital health system

DISCLAIMER

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

Challenges with monitoring and detecting drug diversion in healthcare facilities continue to be a trending topic amid the opioid epidemic. This article aims to provide insight into the expansion of an academic medical center's drug diversion and controlled substances compliance program. The justification and structure of a multihospital, centralized program are discussed.

SUMMARY

Establishing dedicated controlled substances compliance and drug diversion resources has become increasingly common as awareness of the widespread healthcare impact has grown. One academic medical center recognized the value in expanding from 2 dedicated full-time equivalents (FTEs) with a scope of one facility to multiple FTEs with a scope of 5 facilities. The expansion included considering current practices at each facility, establishing the centralized team's scope, gaining organizational support, recruiting a diverse team, and forming an effective committee structure.

CONCLUSION

There are multiple organizational benefits from establishing a centralized controlled substances compliance and drug diversion program, including standardization of processes, associated efficiencies, and effective risk mitigation by identifying inconsistent practices across the multifacility organization.

Impact of Implementing Key Performance Indicators on Catheter-Associated Urinary Tract Infection (CAUTI) Rates Among Adult ICU Patients in Saudi Arabia

Background

The prevalence of catheter-associated urinary tract infections (CAUTIs) in hospitals characterizes one of the most significant problems in healthcare. This study aims to assess whether the implementation of impact of key performance indicators (KPIs) checklist reduces the number of CAUTI in adults present in intensive care unit (ICU) with indwelling catheters.

Methods

This is a retrospective analytical study conducted in a tertiary hospital in Riyadh, Saudi Arabia, from June 2020 to June 2021. One hundred and thirty-four patients with CAUTIs met the criteria and were included in the study. Socio-demographic data was collected to enable informed analysis based on personal information (age, gender, marital status, monthly income, level of education, and department) and medical history (duration of catheterization, types of organisms, history of chronic illness, and duration of hospitalization). The research also used a prevention of CAUTI checklist containing 26 items. The outcome measures were 1) the rate of CAUTIs measured pre- and post-implementing performance measurement indicators (KPI) of CAUTIs prevention practice and 2) the prevention of catheter-associated urinary tract infection in three areas: general information recording, insertion practices, and maintenance practices.

Results

The study found that there was compliance with the prevention of CAUTIs in terms of recording the general patient's information (72%), insertion practices (52%), and maintenance practices (50%). However, most safety practices, including poor hygiene and safety standards, patient handling, and audited protocol programs, were not strictly followed, resulting in increased risk factors for CAUTIs.

Conclusion

Compliance with the prevention of CAUTIs in terms of recording the general patient's information, insertion practices, and maintenance practices lies within the range of 50-75%, and the recommended practices are usually followed. A targeted education on CAUTI-prevention practices curtailing the most aggravating risk factors and adopting a safety culture driven by a patient handling and audited protocol program should be explored to reduce hospital CAUTIs.

Door to Disposition Key Performance Indicator in Three Saudi Arabian Hospitals' Emergency Departments during COVID-19 Pandemic

Objective: The COVID-19 pandemic impacted health systems and Emergency Departments (ED) services worldwide. This study attempts to assess the impact of COVID-19 on the performance of the emergency department during COVID-19 in three hospitals in Riyadh city, Saudi Arabia. Methods: Ada’a data was used for this retrospective cohort study. The hospitals included in this study were: a 300-bed maternity and children’s hospital; a 643-bed general hospital; and a 1230-bed tertiary hospital. All patients who visited the ED in the time period from September 2019 to December 2021 were included. The outcome variable was the Door to Disposition (DTD) which estimates the percentage of patients seen within 4 h from Door to Disposition. A two-way ANOVA test was used to examine the differences in the outcome variable by hospital and by the phase of COVID-19. Results: Both hospital and the phase of COVID-19 were significantly different in terms of the percentage of patients seen within four hours in the ED (DTD) (p-value < 0.05). On average, the DTD percentages dipped slightly in the early phase of COVID-19 (64.0% vs. 69.8%) and jumped sharply in the later phase (73.6%). Additionally, the average DTD score for the maternity and pediatric hospital (87.6%) was sharply higher than both general and tertiary hospitals (63.2%, and 56.5%, respectively). Conclusion: COVID-19 led to a significant drop in emergency department services performance in the early stage of the pandemic as patients spent more time at the ED. However, for the designated COVID-19 hospital, the ED performance improved as more patients spent less than 4 h at the ED in the early stages of COVID-19. This is a clear indication that careful planning and management of resources for ED services during a pandemic is effective.

Improved Time Resolved KPI and Strain Characterization of Multiple Hosts in Shake Flasks Using Advanced Online Analytics and Data Science

Shake flasks remain one of the most widely used cultivation systems in biotechnology, especially for process development (cell line and parameter screening). This can be justified by their ease of use as well as their low investment and running costs. A disadvantage, however, is that cultivations in shake flasks are black box processes with reduced possibilities for recording online data, resulting in a lack of control and time-consuming, manual data analysis. Although different measurement methods have been developed for shake flasks, they lack comparability, especially when changing production organisms. In this study, the use of online backscattered light, dissolved oxygen, and pH data for characterization of animal, plant, and microbial cell culture processes in shake flasks are evaluated and compared. The application of these different online measurement techniques allows key performance indicators (KPIs) to be determined based on online data. This paper evaluates a novel data science workflow to automatically determine KPIs using online data from early development stages without human bias. This enables standardized and cost-effective process-oriented cell line characterization of shake flask cultivations to be performed in accordance with the process analytical technology (PAT) initiative. The comparison showed very good agreement between KPIs determined using offline data, manual techniques, and automatic calculations based on multiple signals of varying strengths with respect to the selected measurement signal.

Analysis of Successful Behaviors Leading to Groundwork Scoring Skills in Elite Judo Athletes

The present study aimed (1) to propose an approach of observational analysis of the preceding standing judo (tachi-waza (TW)) context to a groundwork (ne-waza (NW)) grappling score (NWGS), and (2) to analyze the outcomes of applying such a model in high-level judoists. We conducted an observational analysis of 176 NW scoring actions of 794 combats observed in Baku’s World Judo Championships of 2018. Women scored more NWGS, performing more corporal controls but less segmental controls compared with the men. Moreover, NWGS were scored predominately during the second and third minutes of combat, independently of the sex or the weight category. Most NWGS occurred after an asymmetrical lateral structure, without showing associations with a particular type of NWGS. The movement structure of the attacking action during TW leading to an NWGS was predominantly techniques without turn, followed closely by techniques with turn, and barely performed after supine position techniques. Data showed that NWGS occurred more frequently after a failed TW attack (68.6%) than after a scored TW attack (31.4%). The TW attacker achieved NWGS with a higher frequency (62%) than the TW defender (38%), who mainly took advantage of a failed TW attack (98.5% vs. 1.5%, after failed vs. scored TW, respectively). The grip configurations most frequently employed during TW were dorsal-sleeve and flap-sleeve; overall, frontal grips were predominant over dorsal grips. However, no specific TW grip was related to success or grip progression before an NWGS. Our results will help judo coaches understand the influence of these factors on judo performance and optimize the planning and execution of technical–tactical content.

Use of a new set of key performance indicators for evaluating the performance of an in vitro fertilization laboratory in which blastocyst culture and the freeze-all strategy are the primary treatment in patients with in vitro fertilization

Objective

To evaluate the performance of an in vitro fertilization (IVF) laboratory using a new set of key performance indicators (KPIs) when the main treatment of IVF patients had been changed.

Methods

Patients who underwent fresh embryo transfer and the freeze-all strategy in August, September, and October 2017 were retrospectively studied to evaluate the performance of an IVF laboratory in September when implantation rate of fresh embryo transfer decreased. KPIs associated with blastocyst culture and the first frozen embryo transfer (FET) cycle in patients with the freeze-all strategy were compared over 3 months.

Results

Day 5 usable blastocyst and good quality blastocyst rates, and day 3 usable/good quality embryo rates were not different among the three periods. The implantation rate and KPIs associated with morphological changes in warmed blastocysts in the first FET cycle in patients with the freeze-all strategy were also not different among the periods.

Conclusions

KPIs associated with embryo quality, blastocyst culture, and the pregnancy outcome of the first FET cycle in patients with the freeze-all strategy suggested that performance was unaffected in our IVF laboratory in September. These KPIs might be useful for internal quality control analysis of IVF laboratories.

Contemporary evaluation of adverse outcome risks associated with 'did not wait' emergency department presentations

OBJECTIVE

Did not wait (DNW) is a frequently cited ED key performance indicator. We conducted a network-based observational study of consecutive DNW presentations.

METHODS

Prospective cohort study of Western Sydney Local Health District with a primary outcome measure of reported 30-day all-cause mortality and secondary outcomes of demographic characteristics and representation risk. For re-presenting patients who were subsequently admitted, a manual review of electronic records and incident report systems based on a priori plan assessed each case for the length of stay and adverse outcomes.

RESULTS

During the study window, there were 1114 DNW presentations with 172 (15.4%) re-presentation within 72 h. The analysis of re-presented patients did not reveal adverse outcomes or prolonged length of stay. A review of available outcomes data revealed one DNW patient died within 30 days but had a previous palliative plan for terminal illness.

CONCLUSION

While a proportion of DNW patients re-presented within 72 h, an excess prevalence of poor outcomes were not observed.

Development and Implementation of an Obstetric Milestone Pathway

To improve key discharge metrics and achieve more consistency in clinical care, a team at our large health care system developed and implemented the use of an obstetric milestone pathway (OMP). The OMP was integrated into daily multidisciplinary discharge rounds, during which nurses discussed the plan of care and progress toward discharge for each woman and her newborn. The OMP provided nursing staff with a tool for implementing a plan of care and for preparing a woman and her newborn for discharge. Use of the OMP was associated with a decrease in clinical errors, improved patient satisfaction scores, and decreased costs related to length of stay. By using Six Sigma techniques and gaining participation of front-line staff, our team developed a clinical pathway intended to improve the quality, safety, and efficiency of maternal/newborn care.

Design and validation of a model for quality control monitoring of dichotomous in vitro fertilization outcomes

OBJECTIVE

To develop and validate a practical model for quality control monitoring of dichotomous in vitro fertilization (IVF) outcomes such as pregnancy resulting from the transfer of euploid blastocysts.

DESIGN

We designed and validated a model for quality control monitoring of dichotomous IVF outcomes. We demonstrate use of this model for assessment of euploid blastocyst transfer quality control based on fetal heartbeat rate per embryo. The model uses 3 weighted moving averages with window sizes of 21, 51, and 101 embryo transfers to detect short and long-term shifts in success rates. The quality warning limit was set to have a 2-sided type I error rate of 0.30 per 100 embryo transfers and the control limit was set to have a type I error rate of 0.05 per 100 embryo transfers. Simulation studies were performed to validate the model through assessment of type I and type II errors using custom computer programs.

SETTING

Not applicable.

PATIENT(S)

Patients undergoing IVF.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Type I and type II error rates and statistical power analysis.

RESULT(S)

Validated quality warning and control limits are presented for a range of expected outcome rates. The power to detect a 20% decrease from an expected fetal heartbeat rate of 50%, when the decrease persisted for 50 embryo transfers, was 86% for the warning limit and 57% for the control limit.

CONCLUSION(S)

This model can be used for continuous quality control assessment of dichotomous IVF outcomes such as pregnancy rates.

Fault Prediction and Early-Detection in Large PV Power Plants Based on Self-Organizing Maps

In this paper, a novel and flexible solution for fault prediction based on data collected from Supervisory Control and Data Acquisition (SCADA) system is presented. Generic fault/status prediction is offered by means of a data driven approach based on a self-organizing map (SOM) and the definition of an original Key Performance Indicator (KPI). The model has been assessed on a park of three photovoltaic (PV) plants with installed capacity up to 10 MW, and on more than sixty inverter modules of three different technology brands. The results indicate that the proposed method is effective in predicting incipient generic faults in average up to 7 days in advance with true positives rate up to 95%. The model is easily deployable for on-line monitoring of anomalies on new PV plants and technologies, requiring only the availability of historical SCADA data, fault taxonomy and inverter electrical datasheet.

Long-term influence of technical, physical performance indicators and situational variables on match outcome in male professional Chinese soccer

This study aimed to determine whether the role of technical, physical performance indicators and situational variables in determining match outcome has varied from a long-term analysis (seasons 2012 to 2017) of the Chinese Soccer Super League (CSL). The sample included 1,429 matches where 17 technical performance-related indicators, 11 physical performance-related indicators and two situational variables (match location and quality of opposition) were analysed. Three binary logistic regression models (inclusion of different variables) were used to measure the level of association between factors and match outcome over the six seasons studied. Results of models 1 and 2 revealed that shots on target, possession, total distance in ball possession, total distance out of ball possession, and match location exerted a decreased influence on winning the matches from 2012 to 2014 seasons. However, these indicators play a more important role in winning matches from 2014 to 2017 seasons. Additionally, the quality of opposition has a continuously increased negative effect on the match outcome. In model 3, more variables, such as high-speed distance, high-speed out of ball possession, had a meaningful influence on winning the match. These results provide valuable information about performance indicators and situational variables on winning the matches from a long-term approach.

Effect of a Seeding System on Competitive Performance of Elite Players During Major Tennis Tournaments

The performance of professional tennis players in the four major Grand Slam tournaments has always been an important research topic, which advances the understanding of the current development of tennis. However, there is little known about the difference between higher-ranked and lower-ranked players considering match performance statistics. The study was aimed to explore the technical, tactical, and physical performance indicators that best discriminate seeded and non-seeded male players in Grand Slams. A total of 549 matches played by 189 individual players during 2015–2017 Grand Slam men’s singles were sampled, with corresponding match statistics gathered for each player observation, concerning players’ serving, returning, net point, break point, efficiency, and physical performance. The results showed that the seeded players outperformed the non-seeded players in serve and return, break point, net point, and efficiency-related indicators, while the following indicators contributed most to the separation of two player categories: serve and return of serve points won (%), ace (%), peak serve speed, net points won (%), break point per return game, break point saved, winner and unforced error ratio, and dominance ratio. The research findings evidenced the decreased competitive balance in men’s competition during Grand Slams due to a rank-based seeding system, whereas coaches could use the information to fine-tune the training benchmarks and match planning.

Which key performance indicators are optimal to assess clinical management of assisted reproduction cycles?

Like all industries, fertility clinics should identify and follow reference markers of its activity-key performance indicators (KPI)-to allow assisted reproductive technology outcomes to be monitored and compared. Clinical KPIs revolve around following set parameters of the patient population, procedures, and outcome data. Moreover, KPIs should also include identified protocols and standard operating procedures followed in daily practice and should keep track of multiple pregnancy rates, a ruthless confounder of assisted reproductive technology outcomes.

Which key performance indicators are most effective in evaluating and managing an in vitro fertilization laboratory?

The laboratory is the heart of an in vitro fertilization (IVF) clinic, and a quality management system is critical for its administration. We review the main structural, process, and outcome key performance indicators (KPIs) to provide laboratory managers with concrete tools aimed at enhancing the quality of their work. Three concepts must be stressed when dealing with KPIs in IVF: [1] always consider the three types of indicators (structural, process, and outcome related), [2] carefully adapt the control chart to either promptly identify issues and adopt corrective measures, or redefine the control limits in a process called "progress building," [3] consider that achieving a healthy live birth is a multidisciplinary effort that is subject to several confounders, which must be recognized and accounted for in the analyses. In this regard, future KPIs shared among clinicians and embryologists are desirable to enhance the quality of infertility care for IVF patients.

Identification of Key Performance Indicators for Hospital Management Using an Extended Hesitant Linguistic DEMATEL Approach

Performance analysis is of great significance to increase the operational efficiency of healthcare organizations. Healthcare performance is influenced by numerous indicators, but it is unrealistic for administrators to improve all of them due to the restriction of resources. To solve this problem, we integrated double hierarchy hesitant fuzzy linguistic term sets (DHHFLTSs) with the decision-making trial and evaluation laboratory (DEMATEL) and proposed a DHHFL– DEMATEL method to identify key performance indicators (KPIs) in healthcare management. For the developed approach, the judgments of experts on the inter-relationships among indicators were represented by DHHFLTSs, and a novel combination weighting approach was proposed to obtain experts’ weights in line with hesitant degree and consensus degree. Then, the normal DEMATEL method was extended and used for examining the cause and effect relationships between indicators; the technique for the order of preference by similarity to the ideal solution (TOPSIS) method was utilized to generate the ranking of performance indicators. Finally, the feasibility and effectiveness of the proposed DHHFL–DEMATEL approach were illustrated by a practical example in a rehabilitation hospital.

Identification and Preference of Game Styles in LaLiga Associated with Match Outcomes

The objective was to model the teams' styles of play (SoPs) in elite football and relate them to the match result. For this, the twenty Spanish first division teams in the 2016-2017 season were analysed, using nine interaction performance indicators (IRi). A principal component (PC) analysis was applied. From two PCs four SoPs were established: deep or high-pressure defending, and elaborate or direct attack. The SoPs were distributed according to average performance obtained throughout the championship. The connection between the preferred SoP and the final result was estimated. Teams with elaborate offensive styles and teams defensively minded got better results. In addition, most of the teams showed variability in their SoP. The applications of the study are (1) the IRi have served to identify SoP and can be used as a reference to optimize team performance; (2) teams should have a varied SoP repertoire, as well as being prepared to deal with different SoPs; (3) particular player profiles should be connected with the desired SoP when creating the squad and (4) clubs should develop a varied range of SoPs at their academies.

Gaming National Emergency Access Target performance using Emergency Treatment Performance definitions and emergency department short stay units

OBJECTIVE

To evaluate potential gaming of the 4 h ED length of stay metric known as the National Emergency Access Target (NEAT) in Australia and Emergency Treatment Performance (ETP) in New South Wales (NSW).

METHODS

Descriptive statistical analysis was used to recalculate and compare the scores for NEAT and the NSW ETP using variations in the definitions of their measurement on 32 184 presentations during 2016. A computer simulation using a discrete event model illustrated the effect of the use of ED short stay beds on the ETP scores.

RESULTS

Using the timestamp of the intent to discharge a patient, called, 'ready for departure' instead of the time of a patient physically leaving the department, resulted in an apparent 6% performance improvement. A local interpretation of the NSW state definition of the 'transferred' patient resulted in the ETP for 'admitted' patients improving by 16%. The discrete event model demonstrated that without changing patient length of stay, ETP scores can be improved by optimising the time of the admit decision or increasing the number of ED short stay beds.

CONCLUSIONS

The opportunity of NEAT may be squandered unless gaming of the definitions and use of ED short stay beds is addressed. We argue that the longstanding issue of 'departure time' should be defined as 'physically leaving' the department, in accordance with the Australasian College for Emergency Medicine (ACEM) definition. Patient occupancy is a real measure of ED resource use and NSW and national recommendations should be adjusted. ACEM accreditation of EDs should include review of their application of NEAT definitions to ensure they truly reflect patient flow processes.

Constructing an active health and safety performance questionnaire in the food manufacturing industry

To design a comprehensive health and safety management performance system, extant literature on the health and safety performance indicators of and management systems for the application of occupational health and safety management systems was reviewed; additionally, the provisions of occupational health and safety laws were examined with a total of three main categories, including 28 active safety and health management performance categories. In the present study, health and safety management performance was evaluated by food manufacturing industry employees. An active performance evaluation questionnaire was developed by adopting the Delphi method to seek professional and expert opinion. With food manufacturing workers as participants, an in-depth discussion was conducted regarding the status of active health and safety performance indicators. Six active health and safety performance indicators were determined: emergency response; change management; procurement management; communication; prevention management; security behavior. These performance indicators have not been sufficiently implemented and require improvement.

[Evaluation and assessment of the health care process in patients with carbon monoxide poisoning in Germany]

BACKGROUND

Carbon monoxide poisoning (COP) is the most common cause for poisoning by inhalation in Germany. In the past 8 years, a marked increase in the number of COP-related deaths has been registered nationwide. A national German guideline is missing.

METHODS

The national and international literature was screened systematically. Existing international guidelines and expert recommendations for the diagnosis and treatment of COP were compared and evaluated. Furthermore, quality of health care was analyzed by a prospective preclinical dataset of emergency rescue services and retrospective analysis of routine data from 2014 to 2016 in Germany.

RESULTS

There is not a single evidence-based guideline worldwide. We determined 8 key performance indicators based on the five recommendations available for treatment of COP. These indices were subdivided into prehospital terms, hospital facilities, and diagnostic and therapeutic measures performed; they act as indicators for quality of care. In particular, the key figure "start oxygen" revealed that up to 41 % of the patients had not been treated with inhaled oxygen. In summary, data capture showed considerable incompleteness that is mainly due to missing time stamps.

CONCLUSION

In order to achieve a consistent treatment of patients with COP which meets the standard of recommended care, there is an urgent need for a consented national guideline. Another objective is to establish a nationwide prospective registry evaluating the treatment of carbon monoxide poisoning.

Doing it hard in the bush: Aligning what gets measured with what matters

What gets measured gets managed. Funding of health services is substantially determined by operational activity and specific outcome indicators. In day-to-day clinical decision-making, surrogate markers, such as glycosylated haemoglobin and blood pressure, are commonly used to modify risks of 'hard' outcomes that include kidney failure, ischaemic cardiac events, stroke and all-cause mortality. In many settings, surrogates are all we have to go on. As a consequence, current health funding models heavily rely on surrogate-based key performance indicators [KPIs]. While surrogates are convenient and provide immediate information, there is an obligation to ensure that they are appropriate, reliable and validated in context. In contrast, hard outcomes, the real consequences of illness, are usually realised over an extended timeframe. Additionally, and for a host of reasons, hard endpoints have the greatest social, emotional and economic impact for people at the far end of the health system; those in rural and remote settings - 'in the bush' - especially Indigenous Australians. We propose a health service assessment approach that aligns short-term decision-making with patient-centred and longer term hard outcomes, one that takes into account community, cultural and environmental factors, especially remoteness. Communities should have a major say in determining what health indicators are measured and managed.

Reducing Energy Consumption in Serial Production Lines with Bernoulli Reliability Machines

In this paper, an integrated model to minimize energy consumption while maintaining desired productivity in Bernoulli serial lines is introduced. Exact analysis of optimal allocation of production capacity is carried out for small systems, such as three- and four-machine lines with small buffers. For medium size systems (e.g., three- and four-machine lines with larger buffers, or five-machine lines with small buffers), an aggregation procedure is introduced to evaluate line production rate, and then use it to search optimal allocation of machine efficiency to minimize energy usage. Insights and allocation principles are obtained through the analyses. Finally, for larger systems, a heuristic algorithm is proposed and validated through extensive numerical experiments.

National turnaround time survey: professional consensus standards for optimal performance and thresholds considered to compromise efficient and effective clinical management

Background Turnaround time can be defined as the time from receipt of a sample by the laboratory to the validation of the result. The Royal College of Pathologists recommends that a number of performance indicators for turnaround time should be agreed with stakeholders. The difficulty is in arriving at a goal which has some evidence base to support it other than what may simply be currently achievable technically. This survey sought to establish a professional consensus on the goals and meaning of targets for laboratory turnaround time. Methods A questionnaire was circulated by the National Audit Committee to 173 lead consultants for biochemistry in the UK. The survey asked each participant to state their current target turnaround time for core investigations in a broad group of clinical settings. Each participant was also asked to provide a professional opinion on what turnaround time would pose an unacceptable risk to patient safety for each departmental category. A super majority (2/3) was selected as the threshold for consensus. Results The overall response rate was 58% ( n = 100) with a range of 49-72% across the individual Association for Clinical Biochemistry and Laboratory Medicine regions. The consensus optimal turnaround time for the emergency department was <1 h with >2 h considered unacceptable. The times for general practice and outpatient department were <24 h and >48 h and for Wards <4 h and >12 h, respectively. Conclusions We consider that the figures provide a useful benchmark of current opinion, but clearly more empirical standards will have to develop alongside other aspects of healthcare delivery.

Paediatric International Nursing Study: using person-centred key performance indicators to benchmark children's services

AIMS AND OBJECTIVES

The aim of the Paediatric International Nursing Study was to explore the utility of key performance indicators in developing person-centred practice across a range of services provided to sick children. The objective addressed in this paper was evaluating the use of these indicators to benchmark services internationally.

BACKGROUND

This study builds on primary research, which produced indicators that were considered novel both in terms of their positive orientation and use in generating data that privileges the patient voice. This study extends this research through wider testing on an international platform within paediatrics.

DESIGN

The overall methodological approach was a realistic evaluation used to evaluate the implementation of the key performance indicators, which combined an integrated development and evaluation methodology.

METHODS

The study involved children's wards/hospitals in Australia (six sites across three states) and Europe (seven sites across four countries). Qualitative and quantitative methods were used during the implementation process, however, this paper reports the quantitative data only, which used survey, observations and documentary review.

RESULTS

The findings demonstrate the quality of care being delivered to children and their families across different international sites. The benchmarking does, however, highlight some differences between paediatric and general hospitals, and between the different key performance indicators across all the sites.

CONCLUSIONS

The findings support the use of the key performance indicators as a novel method to benchmark services internationally. Whilst the data collected across 20 paediatric sites suggest services are more similar than different, benchmarking illuminates variations that encourage a critical dialogue about what works and why.

RELEVANCE TO CLINICAL PRACTICE

The transferability of the key performance indicators and measurement framework across different settings has significant implications for practice. The findings offer an approach to benchmarking and celebrating the successes within practice, while learning from partners across the globe in further developing person-centred cultures.

Comparison of appendicectomy outcomes: acute surgical versus traditional pathway

INTRODUCTION

The acute surgical unit (ASU) is an evolving novel concept introduced to address the challenge of maintaining key performance indicators (KPIs) in the face of an increasing acute workload.

METHODS

The aim of this retrospective study was to compare the performance of the ASU (from June 2008 to December 2010) at Auckland City Hospital with the traditional model (from January 2006 to May 2008) and benchmark the results against other similar published studies. The analysis was on the basis of KPIs for 1857 appendicectomies, which form a large volume of acute surgical presentations.

RESULTS

Our results show significant improvement in length of stay (2.8 days, 2.6 days, P = 0.0001) and proportion of daytime operations (59.4%, 65.8%, P = 0.004), in keeping with other studies on benchmarking.

CONCLUSION

The introduction of ASU has led to significant improvements in some KPIs for appendicectomy outcomes in the face of an increasing workload.