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BMJ Open Quality

Daniel Stocki, Conor McDonnell, Gail Wong, Gloria Kotzer, Kelly Shackell, Fiona Campbell
Background: Due to inadequate pain assessment documentation in our paediatric post-anaesthetic care unit (PACU), we were unable to monitor pain intensity, and target factors contributing to moderate and severe postoperative pain in children. The purpose of this study was to improve pain assessment documentation in PACU through a process improvement intervention and knowledge translation (KT) strategy. The study was set in a PACU within a large university affiliated paediatric hospital...
2018: BMJ Open Quality
Matthew Charles Mason, Rebecca Katie Griggs, Rachel Withecombe, Eunice Yun Xing, Charlotte Sandberg, Matthew Keith Molyneux
National Health Service England published the National Safety Standards for Invasive Procedures (NatSSIP) in 2015. They mandated that individual trusts produce Local Safety Standards for Invasive Procedures (LocSSIPs), a set of safety standards drawn from the NatSSIP that apply to a particular clinical situation in a given department, for all invasive procedures. The project goal was to design and implement the LocSSIP within the endoscopy department. A draft LocSSIP was produced, and a pilot study conducted to gain initial feedback on its use...
2018: BMJ Open Quality
Wade Anthony Weigel, Michael Gluck, Andrew S Ross, Otto S Lin, Barbara L Williams, Craig C Blackmore
Pancreatic extracorporeal shock wave lithotripsy followed by endoscopic retrograde cholangiopancreatography is accepted worldwide as a treatment for a large, symptomatic, obstructing pancreatic stones. However, timely completion of the combined process requires coordination of equipment and personnel from two different complex procedures. We used Lean management tools in a week-long event to redesign the process around the patient. Using idea-generated Plan Do Study Act cycles to refine the process, from scheduling to postprocedure recovery, equipment and personnel were aligned to allow these two procedures to occur in immediate succession...
2018: BMJ Open Quality
Yehudit Bauernfreund, Matthew Butler, Sumathi Ragavan, Elizabeth L Sampson
Delirium affects 18%-35% patients in the acute hospital setting, yet is often neither detected nor managed appropriately. It is associated with increased risk of falls, longer hospital stay and increased morbidity and mortality rates. It is a frightening and unpleasant experience for both patients and their families. We used quality improvement tools and a multicomponent intervention to promote detection and improve management of delirium on the acute medical unit (AMU). We reviewed whether a delirium screening tool (4AT) had been completed for all patients aged over 65 years admitted to the AMU over 1 week...
2018: BMJ Open Quality
Kirit Singh, Fatima Ghazi, Rebecca White, Benedicta Sarfo-Adu, Peter Carter
Early Intervention in Psychosis (EIP) services aim to rapidly initiate specialist packages of care for those people newly experiencing symptoms. The intention of such rapid engagement is to mitigate the negative effects of a prolonged duration of untreated psychosis. Aiming to achieve a 'parity of esteem' between mental and physical health, a new target was introduced by the National Health Service (NHS) England, where 50% of new referrals were expected to receive a concordant package of care within 2 weeks from the National Institute for Health and Care Excellence...
2018: BMJ Open Quality
Muge Capan, Stephen Hoover, Kristen E Miller, Carmen Pal, Justin M Glasgow, Eric V Jackson, Ryan C Arnold
Background: Increasing adoption of electronic health records (EHRs) with integrated alerting systems is a key initiative for improving patient safety. Considering the variety of dynamically changing clinical information, it remains a challenge to design EHR-driven alerting systems that notify the right providers for the right patient at the right time while managing alert burden. The objective of this study is to proactively develop and evaluate a systematic alert-generating approach as part of the implementation of an Early Warning Score (EWS) at the study hospitals...
2018: BMJ Open Quality
Smita Bakhai, Aishwarya Bhardwaj, Parteet Sandhu, Jessica L Reynolds
The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines focus on atherosclerotic cardiovascular disease (ASCVD) risk reduction, using a Pooled Cohort Equation to calculate a patient's 10-year risk score, which is used to guide initiation of statin therapy. We identified a gap of evidence-based treatment for hyperlipidaemia in the Internal Medicine Clinic. Therefore, the aim of this study was to increase calculation of ASCVD risk scores in patients between the ages of 40 and 75 years from a baseline rate of less than 1% to 10%, within 12 months, for primary prevention of ASCVD...
2018: BMJ Open Quality
Amar Shah, Auzewell Chitewe, Emma Binley, Forid Alom, James Innes
Early intervention following initial referral into healthcare services can have a significant impact on the prognosis and outcomes of patients. Long waiting times and non-attendance can have an immediate and enduring negative impact on patients and healthcare service providers. The traditional management options in reducing waiting times have largely revolved around setting performance targets, providing financial incentives or additional resourcing. This large-scale quality improvement project aimed to reduce waiting times from referral to first appointment and non-attendance for a wide range of services providing primary and secondary care mental health and community health services at East London NHS Foundation Trust (ELFT)...
2018: BMJ Open Quality
Rebecca E Sadun, Melissa A Wells, Stephen J Balevic, Victoria Lackey, Erica J Aldridge, Nicholas Holdgagte, Samya Mohammad, Lisa G Criscione-Schreiber, Megan E B Clowse, Mamata Yanamadala
Teratogenic medications are often prescribed to women of childbearing age with autoimmune diseases. Literature suggests that appropriate use of contraception among these women is low, potentially resulting in high-risk unintended pregnancies. Preliminary review in our clinic showed suboptimal documentation of women's contraceptive use. We therefore designed a quality improvement initiative to target three process measures: documentation of contraception usage and type, contraception counselling and provider action after counselling...
2018: BMJ Open Quality
Mallika L Mendu, Constantinos I Michaelidis, Michele C Chu, Jasdeep Sahota, Lauren Hauser, Emily Fay, Aimee Smith, Mary Ann Huether, John Dobija, Mark Yurkofsky, Charles T Pu, Kathryn Britton
30-day readmissions for patients at skilled nursing facilities (SNF) are common and preventable. We implemented a readmission review process for patients readmitted from two SNFs, involving an electronic review tool and monthly conferences. The electronic review tool captures information related to preventability and factors contributing to readmission. The study included 128 patients, readmitted within 30 days from 1 October 2015 through 1 May 2017, at a tertiary care academic medical centre in Boston, MA, and two partnering SNFs...
2018: BMJ Open Quality
Rosalie Amanda Heller, Lisi Hu
Handover is widely identified by the National Confidential Enquiry into Patient Outcome and Death, the Royal College of Physicians (RCP) and Health Foundation as an area that can lead to shortcomings in patient care. We recognised that the current weekend handover process in the Trauma and Orthopaedics department at Frimley Park Hospital was dated, time-consuming and did not promote handover of sufficient patient details. The Royal College of Surgeons, British Medical Association and RCP have guidelines on handover...
2018: BMJ Open Quality
Shannon L MacDonald, Pamela L Joseph, Ida J Cavaliere, Mark Theodore Bayley, Alexander Lo
Ontario physicians are legally obligated to report patients who may be medically unfit to drive to the Ministry of Transportation of Ontario (MTO). Currently at Toronto Rehabilitation Institute (TRI), there are no standardised processes for MTO reporting, resulting in inconsistent communication regarding driving with patients and between healthcare providers, redundant assessments and ultimately reduced patient satisfaction. TRI received 10 patient complaints regarding the driving reporting process in the 5 years prior to this project and a large number of patients were not being reported appropriately...
2018: BMJ Open Quality
Tita Alissa Bach, Lars-Martin Berglund, Eva Turk
Objective: To provide an overview of documented studies and initiatives that demonstrate efforts to manage and improve alarm systems for quality in healthcare by human, organisational and technical factors. Methods: A literature review, a grey literature review, interviews and a review of alarm-related standards (IEC 60601-1-8, IEC 62366-1:2015 and ANSI/Advancement of Medical Instrumentation HE 75:2009/2013) were conducted. Qualitative analysis was conducted to identify common themes of improvement elements in the literature and grey literature reviews, interviews and the review of alarm-related standards...
2018: BMJ Open Quality
Mona Chopra, Neerja Arora, Shailja Sinha, Silvia Holschneider, Nigel Livesley
Despite recent progress, the maternal mortality ratio (MMR) in India remains high at 174 per 100‚ÄČ000 live births. Bhagwan Mahavir Hospital (BMH) is a secondary level hospital in New Delhi. In 2013, five women died in BMH's postpartum ward. In January 2014, a United States Agency for International Development-funded team met with BMH staff to help improve their system for providing postpartum care to prevent maternal deaths. The hospital staff formed a quality improvement (QI) team and, between January and December 2014, collected data, conducted root cause analyses to understand why postpartum women were dying and tested and adapted small-scale changes using plan-do-study-act cycles to delivery safer postpartum care...
2018: BMJ open quality
Brigid M Gillespie, Emma L Harbeck, Joanne Lavin, Kyra Hamilton, Therese Gardiner, Teresa K Withers, Andrea P Marshall
Background: Surgical Safety Checklists (SSC) have been implemented widely across 132 countries since 2008. Yet, despite associated reductions in postoperative complications and death rates, implementation of checklists in surgery remains a challenge. The aim of this study was to assess the impact of a patient safety programme over time on SSC use and incidence of clinical errors. Design: A prospective longitudinal design over three time points and a retrospective secondary analysis of clinical incident data was undertaken...
2018: BMJ Open Quality
Jimmy Ng, Ahmed Abdelhadi, Peter Waterland, Jonathan Swallow, Deborah Nicol, Steve Pandey, Miguel Zilvetti, Ahmed Karim
Introduction: Increasing pressure and limitations on the NHS necessitate simple and effective ways for maintaining standards of patient care. This quality improvement project aims to design and implement user-friendly and clear ward round stickers as an adjunct to surgical ward rounds to evidence standardised care. Project design and strategy: Baseline performance was measured against the recommended standards by the Royal College of Physicians, General Medical Council and a study performed at the Imperial College London...
2018: BMJ Open Quality
Thomas Collyer, Martyn Robertson, Thomas Lawton, Alice Rothwell
In anaesthesia, the use of comparative performance reports, their impact on patient care and their acceptability is yet to be fully clarified. Since April 2010, postoperative data on theatre cases in our trust have been analysed and individual comparative performance reports distributed to anaesthetists. Our primary aim was to investigate whether this process was associated with improvement in overall patient care. A short survey was used to assess our secondary aim, the usefulness and acceptability of the process...
2018: BMJ Open Quality
Catherine Matte, Johnston Hoang, Dev Jayaraman, Laurence Green, Suzanne N Morin
Introduction: The most recent Global Initiative for Chronic Obstructive Lung Disease consensus recommends a 5-day course of corticosteroid (CS) therapy for acute chronic obstructive pulmonary disease exacerbations (ACOPDE). As inappropriate use of CS therapy is associated with adverse events, we implemented a peer-to-peer education intervention to improve adherence to guidelines for patients with ACOPDE admitted to a medical clinical teaching unit at a tertiary care university centre...
2018: BMJ open quality
Chiara Lombardo, Tine Van Bortel, Adam P Wagner, Emma Kaminskiy, Ceri Wilson, Theeba Krishnamoorthy, Sarah Rae, Lorna Rouse, Peter Brian Jones, Manaan Kar Ray
Reducing physical intervention in mental health inpatient care is a global priority. It is extremely distressing both to patients and staff. PROactive Management of Integrated Services and Environments (PROMISE) was developed within Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) to bring about culture change to decrease coercion in care. This study evaluates the changes in physical intervention numbers and patient experience metrics and proposes an easy-to-adopt and adapt governance framework for complex interventions...
2018: BMJ Open Quality
James Andrew Jones, James Catton, Glen Howard, Paul Leeder, Lesley Brewer, James Hatton, Dominick E Shaw
Background: Cancer survival in the UK has doubled in the last 40 years; however, 1-year and 5-year survival rates are still lower than other countries. One cause may be a delay between referral into secondary care and subsequent investigation. We set out to evaluate the impact of a straight to test pathway (STTP) on time to diagnosis for upper gastrointestinal (UGI) cancer. Methods: Six hospital Trusts across the East Midlands Clinical Network introduced a STTP enabling general practitioners to refer patients with suspected UGI cancer (oesophageal/gastric) for immediate investigation, without the need to see a hospital specialist first...
2018: BMJ Open Quality
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