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BMJ Quality Improvement Reports

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https://www.readbyqxmd.com/read/28607684/a-multifaceted-quality-improvement-programme-to-improve-acute-kidney-injury-care-and-outcomes-in-a-large-teaching-hospital
#1
Leonard Ebah, Prasanna Hanumapura, Deryn Waring, Rachael Challiner, Katharine Hayden, Jill Alexander, Robert Henney, Rachel Royston, Cassian Butterworth, Marc Vincent, Susan Heatley, Ged Terriere, Robert Pearson, Alastair Hutchison
Acute kidney injury (AKI) is now widely recognised as a serious health care issue, occurring in up to 25% of hospital in-patients, often with worsening of outcomes. There have been several reports of substandard care in AKI. This quality improvement (QI) programme aimed to improve AKI care and outcomes in a large teaching hospital. Areas of documented poor AKI care were identified and specific improvement activities implemented through sequential Plan-Do-Study-Act (PDSA) cycles. An electronic alert system (e-alert) for AKI was developed, a Priority Care Checklist (PCC) was tested with the aid of specialist nurses whilst targeted education activities were carried out and data on care processes and outcomes monitored...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28607683/improving-bowel-preparation-for-colonoscopy-in-a-cost-effective-manner
#2
Syed Anjum Gardezi, Clare Tibbatts
Colonoscopy is a key investigation used to exclude large bowel pathologies including surveillance for CRC (Colorectal cancer) Poor bowel preparation (bowel prep) is one of the most important factors affecting its diagnostic yield. Different formulations of bowel prep are currently in use depending upon patient tolerance, indication & co-morbidities. In University Hospital Llandough we retrospectively reviewed the outcome of colonoscopies performed over period of 3 months, in relation to the type and outcome of bowel preparations used...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28607682/improving-inpatient-care-for-older-adults-implementing-dementia-commissioning-for-quality-and-innovation-cquin
#3
Judith R Harrison
Dementia is a common condition, and people with dementia occupy around 25% of hospital beds. Commissioning for Quality and Innovation (CQUIN) is an NHS payment framework that links part of English healthcare providers' income to quality improvement. The dementia CQUIN goals are designed to encourage the recognition of dementia in hospital. The Royal Surrey County Hospital, Guildford, introduced new procedures to meet the dementia CQUIN targets. Adherence to the changes was a problem. This project aimed to improve hospital's implementation strategy...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28607681/hydration-stickers-improving-oral-hydration-in-vulnerable-patients
#4
Alysha Bhatti, Javier Ash, Shyam Gokani, Suveer Singh
Dehydration is a growing problem among elderly patients in hospital wards. Incidents such as those raised in the Francis Report highlight a problem that may not have been sufficiently addressed by current schemes. This improvement project aimed to identify the barriers faced by staff in improving oral hydration and to design and implement an effective solution. A 33 patient pilot study carried out at Chelsea & Westminster Hospital NHS Trust, United Kingdom, revealed that a significant proportion of patients were reported to be dehydrated on admission, with few having their hydration needs addressed...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28607680/increasing-the-uptake-of-electronic-prescribing-in-primary-care
#5
Nazia Imambaccus, Samuel Glace, Rory Heath
Electronic prescribing is a form of paperless prescribing that is reported to reduce prescription mistakes and increases the cost effectiveness of the process. In England, around 1.5 million prescriptions are generated in general practice daily. Thus by reducing costs and increasing efficiency of this system through electronic prescribing, costs can be driven down. In this Quality Improvement project, a GP practice in London with approximately 3000 patients on record was assessed for its electronic prescribing rates throughout 3 intervention cycles over a period of 2 months...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28607679/proper-electronic-order-linkage-of-electrocardiograms-at-a-large-children-s-hospital-improves-reporting-and-revenue
#6
David S Spar, Wayne A Mays, David S Cooper, Lucille Sullivan, Terra Hicks, Jeffrey B Anderson
Electrocardiograms (ECGs) are performed to determine an individual's cardiac rhythm. Approximately 25,000 ECGs are performed yearly throughout our hospital system. Historically only 68% of all ECGs were performed with the proper order linked to the electronic ECG reading system (MUSE). Failure to link the orders to the electronic reading system leads to problems in patient safety, reporting and hospital revenue. Our aim was to increase the percentage of linked ECG orders in MUSE compared to total ECGs performed from 68% to 95%...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28607678/choosing-wisely-a-quality-improvement-initiative-to-decrease-unnecessary-preoperative-testing
#7
John Matulis, Stephen Liu, John Mecchella, Frederick North, Alison Holmes
Dartmouth-Hitchcock Medical Center is a rural, academic medical center in the northeastern United States; its General Internal Medicine (GIM) division performs about 900 low and intermediate surgical risk preoperative evaluations annually. Routine preoperative testing in these evaluations is widely considered a low-value service. Our baseline data sample showed unnecessary testing rates of approximately 36%. A multi-disciplinary team used a micro-systems approach to analyze the existing process and formulate a rapid cycle improvement strategy...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28607677/design-and-implementation-of-a-trauma-care-bundle-at-a-community-hospital
#8
Ryan Andres, Elan Hahn, Steffen de Kok, Rafi Setrak, Jeffrey Doyle, Allison Brown
The Niagara Health System (NHS) in Ontario, Canada is comprised of three non-designated trauma center (NTC) hospitals which provide primary care to approximately 100 trauma patients annually. NTCs often lack standardized resources such as trauma surgeons, trauma-trained emergency room physicians, Advanced Trauma Life Support certified staff, trauma protocols, and other resources commonly found at designated trauma centers. Studies indicate that these differences contribute to poorer outcomes for trauma patients treated at community hospitals in Ontario, including the NTC hospitals of the NHS...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28607676/evaluating-the-quality-improvement-impact-of-the-global-tracheostomy-collaborative-in-four-diverse-nhs-hospitals
#9
Brendan A McGrath, James Lynch, Barbarella Bonvento, Sarah Wallace, Val Poole, Ann Farrell, Cristina Diaz, Sadie Khwaja, David W Roberson
Tracheostomies are predominantly used in Head & Neck Surgery and the critically ill. The needs of these complex patients frequently cross traditional speciality working boundaries and locations and any resulting airway problems can rapidly lead to significant harm. The Global Tracheostomy Collaborative (GTC) was formed in 2012 with the aim of bringing together international expertise in tracheostomy care in order to bring about rapid adoption of best practices and to improve the quality and safety of care to this vulnerable group...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28469912/increasing-patient-safety-event-reporting-in-an-emergency-medicine-residency
#10
Sven Steen, Cassie Jaeger, Lindsay Price, David Griffen
Patient safety event reporting is an important component for fostering a culture of safety. Our tertiary care hospital utilizes a computerized patient safety event reporting system that has been historically underutilized by residents and faculty, despite encouragement of its use. The objective of this quality project was to increase patient safety event reporting within our Emergency Medicine residency program. Knowledge of event reporting was evaluated with a survey. Eighteen residents and five faculty participated in a formal educational session on event reporting followed by feedback every two months on events reported and actions taken...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28469911/improving-antimicrobial-prescribing-practice-for-sore-throat-symptoms-in-a-general-practice-setting
#11
Mohammad Razai, Kamal Hussain
Acute sore throat is a common presentation in primary care settings. We aimed to improve our compliance with national antibiotic guidelines for sore throat symptoms to 90% in 3 months' time period. The national guidelines are based on Centor criteria. A retrospective audit of 102 patient records with sore throat symptoms presenting between 1 January to 30 December 2015 showed that over 50% were given antibiotics. Those who were prescribed antibiotics, 27% did not meet NICE criteria and 85% of patients were given immediate antibiotic prescription...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28469910/increasing-organ-donor-registration-in-a-primary-care-clinic
#12
Navneet Natt, Erin Klar, Ingrid Cheung, Pavan Matharu, Risa Bordman
Only 30% of Ontarians are registered organ donors in spite of the vast unmet need for organ donations in Ontario, Canada. The purpose of this quality improvement (QI) initiative was to increase the number of registered organ donors in a primary care practice by providing an educational fact sheet and registration form to patients in the clinic's waiting room. Three Plan-Do-Study-Act (PDSA) cycles were conducted. In the first PDSA cycle, we created an information sheet to explain the need for organ donors and the registration process...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28469909/gout-in-primary-care-can-we-improve-patient-outcomes
#13
Jacqueline Callear, Georgina Blakey, Alexandra Callear, Linda Sloan
In the United Kingdom, gout represents one of the most common inflammatory arthropathies predominantly managed in the primary care setting. Gout is a red flag indicator for cardiovascular disease and comorbidity. Despite this, there are no incentivised treatment protocols and suboptimal management in the primary care setting is common. A computer based retrospective search at a large inner city GP practice between January 2014-December 2014 inclusive, identified 115 patients with gout. Baseline measurements revealed multiple gout related consultations, poor medication compliance, high uric acid levels and deficiencies in uric acid monitoring...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28469908/measuring-and-improving-cervical-breast-and-colorectal-cancer-screening-rates-in-a-multi-site-urban-practice-in-toronto-canada
#14
Joshua Feldman, Sam Davie, Tara Kiran
Our Family Health Team is located in Toronto, Canada and provides care to over 35 000 patients. Like many practices in Canada, we took an opportunistic approach to cervical, breast, and colorectal cancer screening. We wanted to shift to a proactive, population-based approach but were unable to systematically identify patients overdue for screening or calculate baseline screening rates. Our initiative had two goals: (1) to develop a method for systematically identifying patients eligible for screening and whether they were overdue and (2) to increase screening rates for cervical, breast, and colorectal cancer...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28469907/reducing-unnecessary-coagulation-testing-in-the-emergency-department-reduced
#15
Michael Fralick, Lisa K Hicks, Hina Chaudhry, Nicola Goldberg, Alun Ackery, Rosane Nisenbaum, Michelle Sholzberg
The PT/INR (prothrombin time/international normalized ratio) and aPTT (activated partial thromboplastin time) were tests developed in the early 20th century for specific and unique indications. Despite this, they are often ordered together routinely. The objective of this study was to determine if a multimodal intervention could reduce PT/INR and aPTT testing in the emergency department (ED). This was a prospective multi-pronged quality improvement study at St. Michael's Hospital. The initiative involved stakeholder engagement, uncoupling of PT/INR and aPTT testing, teaching, and most importantly a revision to the ED order panels...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28469906/improving-access-for-urgent-patients-in-paediatric-neurology
#16
Khalid Mohamed, Basema Al Houri, Khalid Ibrahim, Abdulhafeez M Khair
Referral and flow management is an important part of outpatient care; some patients require to be seen earlier than the next available appointment because of the nature of their presentation. We did not have a clear pathway for urgent patients being referred to our pediatric neurology service. When we reviewed this process in our Quality Improvement meeting we identified wide variation in the length of time such patients wait to be seen in clinic ranging from 2 to 11 weeks. Only 25% of patients identified as requiring urgent clinic appointments were seen in clinic within 2 weeks of triage...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28469905/switch-al-wakra-hospital-journey-to-90-hand-hygiene-practice-compliance-2011-2015
#17
Feah Altura- Visan, Almunzer Zakaria, Jenalyn Castro, Omar Alhasanat, Khalil Al Ismail, Naser Al Ansari, Manal Hamed
Hand Hygiene is the cheapest and simplest way to prevent the spread of infection, however international compliance is below than 40% (WHO, 2009). In the experience of Al Wakra Hospital, the improvement in hand hygiene compliance highlighted not just interventions towards training and education but also behavioral motivation and physical allocations of hand hygiene appliances and equipment. Through motivating the behavioral, emotional, physical and intellectual dimensions of the different healthcare worker professions, hand hygiene compliance has increased from 60...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28469904/introducing-a-new-junior-doctor-electronic-weekend-handover-on-an-orthopaedic-ward
#18
Siddharth Maroo, Dipak Raj
Junior Doctors working on the Orthopaedic wards at a district general hospital identified the lack of a formal weekend handover. The Royal Colleges,GMC and Foundation Programme curriculum all emphasise the importance of a safe and effective handover. Doctors found that the current system of using a written, paper-based handover was unreliable, un-legible, and inefficient. Baseline measurements were sought in the form of a questionnaire which allowed us to obtain the limitations to the current handover. After this and a focus group, a new electronic, 'Microsoft Word' based handover was created and a repeat surgery issued in 2 weeks...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28469903/transitional-care-management-in-the-outpatient-setting
#19
Analiza Baldonado, Ofelia Hawk, Thomas Ormiston, Danielle Nelson
Patients who are high risk high cost (HRHC), those with severe or multiple medical issues, and the chronically ill elderly are major drivers of rising health care costs.1 The HRHC patients with complex health conditions and functional limitations may likely go to emergency rooms and hospitals, need more supportive services, and use long-term care facilities.2 As a result, these patient populations are vulnerable to fragmented care and "falling through the cracks".2 A large county health and hospital system in California, USA introduced evidence-based interventions in accordance with the Triple AIM3 focused on patient-centered health care, prevention, health maintenance, and safe transitions across the care continuum...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28469902/reducing-returns-to-theatre-for-neck-of-femur-fracture-patients
#20
Selina Graham, Mark Dahill, Derek Robinson
The Royal United Hospital, Bath, admits approximately 550 patients with neck of femur fractures per year. The risks from returning to theatre for this patient group are often life-threatening. Post-operative wound ooze was noted to cause a significant rate of return to theatre, with increased lengths of stay and patient morbidity. A wound closure protocol was agreed by the consultant body. This information was disseminated by email and teaching sessions to all members of the multidisciplinary team, including surgeons, theatre staff and ortho-geriatricians...
2017: BMJ Quality Improvement Reports
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