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BMJ Quality Improvement Reports

Kirsten Beck, Elaine Albert, Andrew Johnsen, Courtney Newhouse, John McGuire
Medical rounds in the Pediatric Intensive Care Unit (PICU) took about four hours each day to complete. The length of rounds was affecting the advancement of care of the patients, the engagement of sub-specialty providers who needed to be present on other rounds, and the engagement of the PICU faculty and staff due to overburdening waste created by the long duration of rounds. Specific interventions were identified aimed at reducing the duration of rounds each day, increasing engagement of the rounding team and satisfying the needs of the patients and families...
2016: BMJ Quality Improvement Reports
Robert Jackson, Philip Cheng, Sarah Moreman, Nicola Davey, Lisa Owen
Constipation is a common and often overlooked problem, but it can cause serious complications for patients including pain, nausea, urinary retention, and prolonged hospital admission. There are no recognised criteria for the diagnosis of constipation in the acute hospital setting, and it is often the role of the ward doctor to identify and manage this problem. Completion and monitoring of "stool charts" by nursing and medical staff is key to proper recognition and management of constipation. A baseline study found that while charts were completed well, they were only monitored by doctors 17...
2016: BMJ Quality Improvement Reports
Martin Carberry, John Harden
Early identification of patients with sepsis is key to the delivery of the sepsis 6 bundle including antibiotic therapy within an hour.[1-3] Demand versus capacity challenges in the Emergency Department (ED) led to delays in antibiotic and sepsis 6 delivery. An alerting tool was developed that provided criteria for Scottish Ambulance Service (SAS) Paramedics to alert the ED of potential sepsis patients. Data from patients presenting to the ED prior to the alerting process commencing (n=50) and during alerting (n=50) were analysed, a questionnaire was used to ascertain feedback from all staff groups; nurses doctors, and paramedics (n=38)...
2016: BMJ Quality Improvement Reports
Eric Ly, Jennifer Alexander, Temi Akinmboni, Hyung Woo, Colleen Driscoll
Point of care glucose (POCG) measurements, used for detecting neonatal hypoglycemia, can have variable accuracy. The appropriate diagnosis of neonatal hypoglycemia in babies with low POCG measurements involves confirmatory serum glucose (CSG) testing. At our institution, no babies with low POCG measurements had CSG testing in their evaluation of neonatal hypoglycemia over a three year period. Our aim was to increase the percentage of CSG testing in babies with a low POCG. A secondary aim was to decrease the percentage of low-risk, asymptomatic babies who received POCG testing...
2016: BMJ Quality Improvement Reports
Craig Morris, Ingrid Alexander
A Project Manager from the Fife Early Years Collaborative facilitated a large-scale Quality Improvement (herein QI) project to build organisational capacity and capability across the Children in Fife partnership through three separate, eight month training cohorts. This 18 month QI project enabled 32 practitioners to increase their skills, knowledge, and experiences in a variety of QI tools including the Model for Improvement which then supported the delivery of high quality improvement projects and improved outcomes for children and families...
2016: BMJ Quality Improvement Reports
Alice Willison, Vicki Tully, Peter Davey
The urine albumin creatinine ratio (UACR) detects abnormal levels of protein in the urine and should be performed annually to detect kidney disease in patients with diabetes mellitus. UK national audits show that 25% of patients do not have annual tests and our data suggested that some patients had more than one test per year. Data from 20 patients showed that 55% had more than one UACR test per year, with a total of 19 unnecessary tests at an estimated cost of £20,000 per year. However 20% had not had a UACR in the previous year, so unreliable testing was potentially causing harm as well as waste...
2016: BMJ Quality Improvement Reports
Sarah Pinnington, Brigid Atterton, Sarah Ingleby
Severe sepsis is a clinical emergency. Despite the nationwide recognition of the sepsis six treatment bundle as the first line emergency treatment for this presentation, compliance in sepsis six provision remains inadequately low. The project goals were to improve compliance with the implementation of the Sepsis Six in patients with severe sepsis and/or septic shock. In improving timely care delivery it was anticipated improvements would be made in relation to patient safety and experience, and reductions in length of stay (LoS) and mortality...
2016: BMJ Quality Improvement Reports
Amira Mustafa, Samar Mahgoub
Delays in the discharge of hospital patients cause a backlog for new admissions from the Emergency Departments (ED), outpatient clinics, and transfers from the Intensive Care Units (ICU). A variety of initiatives have been reported on previously which aim to tackle this problem with variable success. In this quality improvement project, we aimed to increase the proportion of discharged patients who leave the paediatric unit by 12:00 Noon from 7% to 30% by May 2015. A baseline discharge process map was studied to understand the possible causes of the delays...
2016: BMJ Quality Improvement Reports
Lucas Brien Chartier, Licinia Simoes, Meredith Kuipers, Barb McGovern
Over the last decade, patient volumes in the emergency department (ED) have grown disproportionately compared to the increase in staffing and resources at the Toronto Western Hospital, an academic tertiary care centre in Toronto, Canada. The resultant congestion has spilled over to the ED waiting room, where medically undifferentiated and potentially unstable patients must wait until a bed becomes available. The aim of this quality improvement project was to decrease the 90th percentile of wait time between triage and bed assignment (time-to-bed) by half, from 120 to 60 minutes, for our highest acuity patients...
2016: BMJ Quality Improvement Reports
Nouf Al Saleem, Khaled Al-Surimi
Frequent, preventable medical errors can have an adverse effect on patient safety and quality as well as leading to wasted resources. In the laboratory, errors can occur at any stage of sample processing; pre-analytical, analytical, and post analytical stages. However evidence shows most of the laboratory errors occur during the pre-analytical stage. The receipt and processing of specimens is one of the main steps in the pre-analytical stage. Errors in this stage could be due to mislabeling, incorrect test entry and entering the wrong location, among other reasons...
2016: BMJ Quality Improvement Reports
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2016: BMJ Quality Improvement Reports
(no author information available yet)
[This corrects the article DOI: 10.1136/bmjquality.u202226.w1113.].
2016: BMJ Quality Improvement Reports
Emma Saunsbury, Gabrielle Howarth
Blood tests are a seemingly basic investigation, but are often a vital part of directing patient management. Despite the importance of this everyday process, we indentified the potential for improvement of the current phlebotomy service in our hospital, as both junior doctors and phlebotomists reported a lack of communication and standardised practice across the wards. Resulting delays in obtaining blood test results can impact detrimentally on patient safety and management. We designed a survey which highlighted inefficient handovers and discrepancies between wards as driving factors behind this...
2016: BMJ Quality Improvement Reports
Khalid Mohamed, Amira Mustafa, Sona Tahtamouni, Eshraga Taha, Reham Hassan
This quality improvement project aimed to reduce the 'no show' rate in a paediatric neurology clinic in Qatar. No show, in outpatient clinics, is defined as patients who fail to attend their scheduled clinic appointments. It is one of the targets for improving quality of care. It leads to longer waiting times for patients to be seen in outpatient clinics, and the result is patients missing their important appointments. It also results in a waste of the clinic resources, and physician and other healthcare practitioners' time...
2016: BMJ Quality Improvement Reports
(no author information available yet)
[This corrects the article DOI: 10.1136/bmjquality.u210787.w4336.].
2016: BMJ Quality Improvement Reports
(no author information available yet)
[This corrects the article DOI: 10.1136/bmjquality.u209539.w3933.].
2016: BMJ Quality Improvement Reports
(no author information available yet)
[This corrects the article DOI: 10.1136/bmjquality.u210329.w4679.].
2016: BMJ Quality Improvement Reports
Inderpal Singh, Justin Okeke
Inpatient falls (IF) are the most commonly reported safety incidents. The high rate of inpatient falls was reported in a newly built hospital, within Aneurin Bevan University Health Board, Wales (UK). The aim of the project is to reduce the incidence of IF and associated adverse clinical outcomes in a hospital with 100% single rooms. The key mechanism for improvement was education and training of nursing staff around falls risk factors. A Plan-Do-Study-Act methodology was used and a geriatrician-led, systematic nurse training programme on the understanding and correct use of existing multifactorial falls risk assessment (FRA) tool was implemented in April 2013...
2016: BMJ Quality Improvement Reports
Darren Fernandes, Udayaraj Umasankar
Ischaemic stroke can result in approximately 2 million brain neurones being damaged for each minute that it is left untreated. Various trials and studies such as the National Institute of Neurologic Disorders (NINDS) trial, the European Cooperative Acute Stroke Study (ECASS), ECASS II, and the Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) study have clearly demonstrated the beneficial effects of intravenous tissue plasminogen activator (tPA) for treatment of acute stroke...
2016: BMJ Quality Improvement Reports
Nihad Abdallah, Rory Conn, Abdel Latif Marini
Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff...
2016: BMJ Quality Improvement Reports
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