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BMJ Quality Improvement Reports

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https://www.readbyqxmd.com/read/28352468/introduction-of-a-microsoft-excel-based-unified-electronic-weekend-handover-document-in-acute-and-general-medicine-in-a-dgh-aims-outcomes-and-challenges
#1
Pablo Kostelec, Pietro Emanuele Garbelli, Pietro Emanuele Garbelli
On-call weekends in medicine can be a busy and stressful time for junior doctors, as they are responsible for a larger pool of patients, most of whom they would have never met. Clinical handover to the weekend team is extremely important and any communication errors may have a profound impact on patient care, potentially even resulting in avoidable harm or death. Several senior clinical bodies have issued guidelines on best practice in written and verbal handover. These include: standardisation, use of pro forma documents prompting doctors to document vital information (such as ceiling of care/resuscitation status) and prioritisation according to clinical urgency...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28352467/electronic-printed-ward-round-proformas-freeing-up-doctors-time
#2
Darren Fernandes, Philip Eneje
The role of a junior doctor involves preparing for the morning ward round. At a time when there are gaps on rotas and doctors' time is more stretched, this can be a source of significant delay and thus a loss of working time. We therefore looked at ways in which we could make the ward round a more efficient place by introducing specific electronic, printed ward round proformas. We used the average time taken to write proformas per patient and the average time taken per patient on the ward round. This would then enable us to make fair comparisons with future changes that were made using the plan, do, study, and act principles of quality improvement...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28352466/systems-for-physical-health-care-for-mental-health-patients-in-the-community-different-approaches-to-improve-patient-care-and-safety-in-an-early-intervention-in-psychosis-service
#3
Josie Mouko, Rebecca Sullivan
Patients with mental illnesses have a high rate of physical comorbidity, and specifically, those with psychosis are at an increased risk of cardiometabolic disease and shortened lifespans, due to medication, lifestyle and illness factors. There are recognised challenges with physical health care in this group. At baseline, no patients on the Bath and North East Somerset Early Intervention in Psychosis caseload had a fully completed physical health assessment. Our aim was to offer a physical health check, blood tests, and ECG for all patients, trialling four phases of interventions...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28352465/a-multifaceted-approach-to-improving-the-quality-of-ent-emergency-clinic-referrals
#4
Chloe Swords, Laura Leach, Anand Kasbekar, Piyush Jani
It is imperative that primary care referrals are directed to the appropriate secondary care service. Patients presenting to a primary care physician with ENT conditions may require review in an Emergency Clinic. The latter clinics provide patients with rapid access to secondary care, for urgent, yet non-life-threatening conditions. In our department, we noticed that patients with conditions inappropriate to the capabilities of the Clinic were being booked in or reviewed too late; thus causing wasted journeys for the patient...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28321302/impact-of-health-portal-enrolment-with-email-reminders-at-an-academic-rheumatology-clinic
#5
Arielle Mendel, Shirley Chow
Missed appointments reduce the quality, safety and efficiency of healthcare delivery. 'No-Shows' (NS) have been identified as a problem within the rheumatology clinic at Sunnybrook Health Sciences Center in Toronto, Ontario. NS were studied through a prospective chart review and telephone interviews. Over 6 months, 110 NS took place (rate 2.5-6.8%). From interviews, 85% of NS were attributed to forgetting, being unaware of the appointment, having the wrong date, or another miscommunication. Fifty-seven percent of patients were interested in an appointment reminder, including electronic reminders (46%)...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28321301/early-aspirin-administration-post-coronary-artery-bypass-graft-surgery-changing-hospital-culture-through-a-two-cycled-audit
#6
Shefali Parikh, Justin Ratnasingham
"Early Aspirin" or a medium dose of aspirin 6 hours after Coronary Artery Bypass Graft (CABG) Surgery is strongly recommend by international guidelines (EACTS 2007/AHA 2011 guidelines, Level1a evidence) to protect venous graft patency. However, compliance with Early Aspirin prescription at our centre is poor due to long standing hospital cultural practices and lack of awareness. We completed a two-cycled retrospective audit of 53 (September 2015 Baseline), 65 (January 2016 First Cycle) and 58 (June 2016 Second Cycle) consecutive CABG patients...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28321300/identifying-highlighting-and-reducing-polypharmacy-in-a-uk-hospice-inpatient-unit-using-improvement-science-methods
#7
Alison Phippen, Jennie Pickard, Douglas Steinke, Matt Cope, Dai Roberts
Polypharmacy, the concurrent use of multiple medications by one individual is a growing global issue driven by an ageing population and increasing prevalence of multi-morbidity[1]. Polypharmacy can be problematic: interactions between medications, reduced adherence to medication, burden of medication to patients, administration time, increased risk of errors and increased cost. Quality improvement methods were applied to identify and highlight polypharmacy patients with the aim of reducing their average number of regular tablets/capsules per day by 25%...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28321299/successful-emergency-department-interventions-that-reduce-time-to-antibiotics-in-febrile-pediatric-cancer-patients
#8
Sandra Spencer, MIchele Nypaver, Katherine Hebert, Christopher Benner, Rachel Stanley, Daniel Cohen, Alexander Rogers, Jason Goldstick, Prashant Mahajan
Children with cancer and fever are at high risk for sepsis related death. Rapid antibiotic delivery (< 60 minutes) has been shown to reduce mortality. We compared patient outcomes and describe interventions from three separate quality improvement (QI) projects conducted in three United States (US) tertiary care pediatric emergency departments (EDs) with the shared aim to reduce time to antibiotic (TTA) to < 60 minutes in febrile pediatric oncology patients (Temperature > 38.0 C). A secondary objective was to identify interventions amenable to translation to other centers...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28321298/reducing-falls-in-a-care-home
#9
Rosie Cooper
Care home residents are 3 times more likely to fall than their community dwelling peers and 10 times more likely to sustain a significant injury as a result. 2 A project commenced at a care home in Aberdeen with the aim of reducing the number of falls by 20% by 30st April 2016 using the model for improvement. Qualitative data was gathered to establish staff belief about falls and their level of knowledge& understanding about falls risks and how to manage these. This informed the training which was delivered and iterative testing commenced with the introduction of the Lanarkshire Falls Risk/Intervention tool - where the multifactorial nature of a resident's falls risks are explored and specific actions to manage these are identified and implemented...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28321297/knowledge-is-power-a-quality-improvement-project-to-increase-patient-understanding-of-their-hospital-stay
#10
Eleanor Nicholson Thomas, Lloyd Edwards, Paul McArdle
Patients frequently leave hospital uninformed about the details of their hospital stay with studies showing that only 59.9% of patients are able to accurately state their diagnosis and ongoing management after discharge. 1 2 This places patients at a higher risk of complications. Educating patients by providing them with accurate and understandable information enables them to take greater control, potentially reducing readmission rates, and unplanned visits to secondary services whilst providing safer care and improving patient satisfaction...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28321296/improving-surgical-and-anaesthesia-practice-review-of-the-use-of-the-who-safe-surgery-checklist-in-felege-hiwot-referral-hospital-ethiopia
#11
Ryan Ellis, Ahmad Izzuddin Mohamad Nor, Iona Pimentil, Zebenaye Bitew, Jolene Moore
Development of surgical and anaesthetic care globally has been consistently reported as being inadequate. The Lancet Commission on Global Surgery highlights the need for action to address this deficit. One such action to improve global surgical safety is the introduction of the WHO Surgical Checklist to Operating Rooms (OR) around the world. The checklist has a growing body of evidence supporting its ability to assist in the delivery of safe anaesthesia and surgical care. Here we report the introduction of the Checklist to a major Ethiopian referral hospital and low-resource setting and highlight the success and challenges of its implementation over a one year period...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28316786/correction
#12
(no author information available yet)
[This corrects the article DOI: 10.1136/bmjquality.u220211.w7861.].
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28255441/correction
#13
(no author information available yet)
[This corrects the article DOI: 10.1136/bmjquality.u212617.w5031.].
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28243444/improving-consent-form-documentation-and-introduction-of-procedure-specific-labels-in-a-district-general-hospital
#14
Stefan Bajada, Samuel Dwamena, Zabihullah Abdul, Rhodri Williams, Owain Ennis
Informed consent is an important aspect in patient care. Failings in this area may result in patient dissatisfaction or litigation. The aim of this project was to assess our practice in consenting and institute changes to maintain best practice. A consecutive series of 140 patients undergoing elective and trauma procedures were randomly identified over a nine-month period. The consent forms were reviewed and the following information collected: patient/ consenter details, procedure, legibility, if copy was offered/ given to patient and adequacy of procedure-specific complications listed (scored 0-3)...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28243443/health-education-and-activity-lessening-the-inequalities-in-mental-health-hea-lti-mental-health
#15
Georgia Richmond, Conor Kenny, Jabed Ahmed, Lucy Stephenson, Jamie Lindsay, Patrick Earls, Donncha Mullin, Howard Ryland
Patients suffering from mental health illness have considerably more physical health disease burden than the rest of the population and are more likely to die 10 to 20 years younger compared with their peers. Diabetes, cardiovascular and respiratory disease have been recognised as contributing factors to premature death. Furthermore patients with severe mental illness undertake lower levels of physical activity. The aim of the project was therefore to address the inequalities in physical health that affect patients with mental health illness through designing and implementing a sustainable, transferable, patient-centred education and activity intervention...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28243442/speeding-up-laboratory-test-reporting-in-medical-emergency-and-cardiac-arrest-calls-a-quality-improvement-project
#16
Mohammed Al-Talib, Isla Leslie
Many hospitals deploy Medical Emergency (MET) and Cardiac Arrest teams to improve the management and treatment of patients who become critically ill. In many cases, blood results are key in allowing the clinicians involved in these teams to make definitive management decisions for these patients. Following anecdotal reports that these results were often delayed, we assessed the process of blood tests being reported in emergency calls, identified the key factors causing delays and sought to make improvements...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28243441/improving-theatre-turnaround-time
#17
Daniel Fletcher, David Edwards, Stephen Tolchard, Richard Baker, James Berstock
The NHS Institute for Innovation and Improvement has determined that a £7 million saving can be achieved per trust by improving theatre efficiency. The aim of this quality improvement project was to improve orthopaedic theatre turnaround without compromising the patient safety. We process mapped all the stages from application of dressing to knife to skin on the next patient in order to identify potential areas for improvement. Several suggestions arose which were tested in multiple PDSA cycles in a single theatre...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28243440/adopting-and-sustaining-a-virtual-fracture-clinic-model-in-the-district-hospital-setting-a-quality-improvement-approach
#18
Kartik Logishetty
Virtual Fracture Clinics (VFCs) are an alternative to the conventional fracture clinics, to manage certain musculoskeletal injuries. This has recently been reported as a safe, cost-effective and efficient care model. As demonstrated at vanguard sites in the United Kingdom, VFCs can enhance patient care by standardising treatment and reducing outpatient appointments. This project demonstrates how a Quality Improvement approach was applied to introduce VFCs in the District General Hospital setting. We demonstrate how undertaking Process Mapping, Driver Diagrams, and Stakeholder Analysis can assist implementation...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28243439/optimizing-the-electronic-health-record-to-standardize-administration-and-documentation-of-nutritional-supplements
#19
Sandra W Citty, Amir Kamel, Cynthia Garvan, Lee Marlowe, Lynn Westhoff
Malnutrition in hospitalized patients is a major cause for hospital re-admission, pressure ulcers and increased hospital costs. Methods to improve the administration and documentation of nutritional supplements for hospitalized patients are needed to improve patient care, outcomes and resource utilization. Staff at a medium-sized academic health science center hospital in the southeastern United States noted that nutritional supplements ordered for patients at high risk for malnutrition were not offered or administered to patients in a standardized manner and/or not documented clearly in the electronic health record as per prescription...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28174659/making-an-impakt-improving-care-of-chronic-kidney-disease-patients-in-the-community-through-collaborative-working-and-utilizing-information-technology
#20
Gang Xu, Rupert Major, David Shepherd, Nigel Brunskill
Chronic kidney disease (CKD) is a serious long-term condition, which if left untreated causes significant cardiovascular sequele. It is well recognized management of modifiable risk factors, such as blood pressure (BP), can lead to improved long-term outcomes. A novel information technology (IT) solution presents a possible solution to help clinicians in the community identify and manage at risk patients more efficiently. The IMproving Patient care and Awareness of Kidney disease progression Together (IMPAKT) IT tool was used to identify patients with CKD and uncontrolled hypertension in the community...
2017: BMJ Quality Improvement Reports
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