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A D Rogers, M Saggaf, N Ziolkowski
BACKGROUND: Patients with extensive burn injuries are susceptible to a host of accompanying adverse effects should they develop perioperative hypothermia, which occurs in up to ¼ of all major burn cases. This quality improvement project aimed to reduce the incidence of perioperative hypothermia to below 10% of cases in patients with major burn (Total Body Surface Area [TBSA] >15%), within a one year period. METHODS: A baseline diagnostic phase was undertaken to provide a greater understanding of the incidence, natural history and risk factors of perioperative hypothermia...
March 7, 2018: Burns: Journal of the International Society for Burn Injuries
Parika Pahwa, Sarah Lunsford, Nigel Livesley
BACKGROUND: Quality improvement (QI) involves the following 4 steps: (1) forming a team to work on a specific aim, (2) analyzing the reasons for current underperformance, (3) developing changes that could improve care and testing these changes using plan-do-study-act cycles (PDSA), and (4) implementing successful interventions to sustain improvements. Teamwork and group discussion are key for effective QI, but convening in-person meetings with all staff can be challenging due to workload and shift changes...
March 1, 2018: JMIR Medical Informatics
Asaph Rolnitsky, Maksim Kirtsman, Hanna R Goldberg, Michael Dunn, Chaim M Bell
Purpose: A mapping review to quantify representation of vulnerable populations, who suffer from disparity and often inequitable healthcare, in quality improvement (QI) research. Data sources: Studies published in 2004-2014 inclusive from Medline, Embase and Cochrane databases for English language research with the terms 'quality improvement' or 'quality control' or 'QI' and 'plan-do-study-act' or 'PDSA' in the years 2004-2014 inclusively. Study selection: Published clinical research that was a QI-themed, as identified by its declared search terms, MESH terms, abstract or title...
February 13, 2018: International Journal for Quality in Health Care
Jing Li, Preetham Talari, Andrew Kelly, Barbara Latham, Sherri Dotson, Kim Manning, Lisa Thornsberry, Colleen Swartz, Mark V Williams
BACKGROUND: Despite recommendations and the need to accelerate redesign of delivery models to be team-based and patient-centred, professional silos and cultural and structural barriers that inhibit working together and communicating effectively still predominate in the hospital setting. Aiming to improve team-based rounding, we developed, implemented and evaluated the Interprofessional Teamwork Innovation Model (ITIM). METHODS: This quality improvement (QI) study was conducted at an academic medical centre...
February 14, 2018: BMJ Quality & Safety
Christine Andrews, Colleen Whatley, Meaghan Smith, Emily Caron Brayton, Suzanne Simone, Alison Volpe Holmes
BACKGROUND AND OBJECTIVE: Neonatal hypothermia is common in low birth weight (LBW) (<2500 g) and late-preterm infants (LPIs) (34 0/7-36 6/7 weeks' gestation). It can be a contributory factor for newborn admission to a NICU, resulting in maternal-infant separation and increased resource use. Our objective was to study the efficacy of a quality-improvement bundle of hypothermia preventive measures for LPIs and/or LBW infants in a mother-infant unit. METHODS: We conducted plan-do-study-act (PDSA) cycles aimed at decreasing environmental hypothermia for LPIs and/or LBW infants in a mother-infant unit with no other indications for NICU-level care...
February 14, 2018: Pediatrics
Rod Sheaff, Ian Sherriff, Catherine Hagan Hennessy
BACKGROUND: Access times for, the costs and overload of hospital services are an increasingly salient issue for healthcare managers in many countries. Rising demand for hospital care has been attributed partly to unplanned admissions for older people, and among these partly to the increasing prevalence of dementia. The paper makes a preliminary evaluation of the logic model of a Dementia Learning Community (DLC) intended to reduce unplanned hospital admissions from care homes of people with dementia...
February 5, 2018: BMC Health Services Research
Charles W Mathias, Nathalie Hill-Kapturczak, Tara E Karns-Wright, Jillian Mullen, John D Roache, James C Fell, Donald M Dougherty
Recent developments in alcohol monitoring devices have made it more feasible to use contingency management (CM) procedures to reduce alcohol use. A growing body of literature is demonstrating the effectiveness of CM to reduce alcohol use among community recruited adults wearing transdermal alcohol concentration (TAC) monitoring devices. This article describes the quality improvement process aimed at adapting TAC-informed CM aimed at minimizing alcohol use and maximizing treatment completion. This extends literature to a high-risk population; adults arrested and awaiting trial (pretrial) for criminal charge of driving while intoxicated (DWI)...
January 31, 2018: Addictive Behaviors
Claire Gregory
The colorectal services at The Royal Bournemouth Hospital needed to adapt to meet the extra demand on fast-track patient referrals to the outpatient department, as a consequence of the changes in the National Institute for Health and Care Excellence (NICE) guidance on cancer referrals in June 2015. Learning from other units, a telephone assessment clinic (TAC) triaging patients straight to colonoscopy was trialled. A Plan-Do-Study-Act (PDSA) methodology was used. A baseline study showed that fast-track colorectal patients referred from their general practitioner (GP) were taking on average 30 days until they received their colonoscopy...
2018: BMJ Open Quality
Yuzeng Shen, Lin Hui Lee
Prolonged wait times at the emergency department (ED) are associated with increased morbidity and mortality, and decreased patient satisfaction. Reducing wait times at the ED is challenging. The objective of this study is to determine if the implementation of a series of interventions would help decrease the wait time to consultation (WTC) for patients at the ED within 6 months. Interventions include creation of a common board detailing work output, matching manpower to patient arrivals and adopting a team-based model of care...
2018: BMJ Open Quality
Kevin Verhoeff, Rachelle Saybel, Pamela Mathura, Bonnie Tsang, Vanessa Fawcett, Sandy Widder
Ensuring adequate vascular access in major trauma patients prior to decompensative physiological processes is crucial to patient outcomes. Most protocols suggest achieving two 18-gauge or larger intravenous lines immediately in patients with major trauma. We discuss a quality improvement approach to ensure that >90% of patients with major trauma (as defined by an injury severity score ≥12) at a level one trauma centre receive timely and adequate fluid access. Applying Donabedian principles for process improvement, we used the Alberta Trauma Registry to perform a 4-month chart audit on patients with major trauma at the University of Alberta Hospital...
2018: BMJ open quality
Alaina P Vidmar, Jonathan F Weber, Christina M Koppin, Roshanak Monzavi, Mimi S Kim
BACKGROUND: Classical congenital adrenal hyperplasia (CAH) is a potentially life-threatening condition, and adrenal crisis is a major cause of morbidity and mortality in affected children. Medical-alert identification (ID) could prevent complications of adrenal crisis by identifying the need for time-sensitive, critical treatment. Our objectives were to evaluate usage of medical-alert IDs by CAH youth, ownership and awareness of IDs amongst their parents, and the effect of an in-clinic educational intervention on ID utilization...
January 9, 2018: Journal of Pediatric Endocrinology & Metabolism: JPEM
M Lindsey Jacobs, Katherine Luci, Lauren Hagemann
OBJECTIVES: The purpose of this project was to develop, implement, and evaluate a 12-session Acceptance and Commitment Therapy (ACT) for Older Veterans group protocol. METHODS: The Plan-Do-Study-Act (PDSA) quality improvement model was the foundational process for this project. Veterans age 55 years and older participated in an ACT for Older Veterans group in an outpatient geropsychology clinic at a Veterans Affairs Medical Center. Study methods included analysis of participant feedback gathered in a focus group, process measures (i...
October 27, 2017: Clinical Gerontologist
Soo-Hoon Lee, Christopher Terndrup, Phillip H Phan, Sandra E Zaeh, Kwame Atsina, Nicole Minkove, Alexander Billioux, Souvik Chatterjee, Idoreyin Montague, Bennett Clark, Andrew Hughes, Sanjay V Desai
BACKGROUND: Although previous studies have investigated the efficacy of specific sign-out protocols (such as the illness severity, patient summary, action list, situation awareness and contingency planning, and synthesis by reviewer [I-PASS] bundle), the implementation of a bundle can be time consuming and costly. We compared 4 sign-out training pedagogies on sign-out quality. OBJECTIVE: To evaluate training interventions that best enhance multidimensional sign-out quality measured by information exchange, task accountability, and personal responsibility...
December 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
(no author information available yet)
No abstract text is available yet for this article.
November 25, 2017: Veterinary Record
Caroline Ward, Katie Knight, Mary-Rose Ballard, Georgina Keogh, Miriam Samuel, Sara Buttle, Claire Robb, Francesca Cleugh
AIMS: PATCH is a pilot acute community children's nurse led service delivering assessment and treatment for children at home who are moderately unwell and might otherwise be admitted to hospital or attend Paediatric Emergency Department (PED). Children are referred by PED or GP and followed up via telephone support and home visits depending on clinical need for duration of acute illness. METHODS: Pilot year funded by Imperial Charity. Using evaluation to build business case for sustained commissioned service...
December 2017: Emergency Medicine Journal: EMJ
Justin A Steggerda, Irene K Kim, Mark Haas, Xiaohai Zhang, Alexis Kang, Helen Pizzo, Elaine Kamil, Stanley Jordan, Dechu Puliyanda
Preformed and de novo donor specific antibodies (pDSA and dnDSA) are risk factors for ABMR. This study compares the effects of pDSA vs dnDSA in pediatric kidney transplant recipients. Sixteen pediatric patients with biopsy-proven ABMR were evaluated. Strong DSA (MFI >10 000) was recorded at transplant, rejection, and follow-up. DSAs with the highest MFI were termed iDSAs. Allograft biopsies were scored according to Banff 2013 criteria. Seven of 16 (44%) patients had pDSA at transplant; 9 (56%) developed dnDSA...
December 2017: Pediatric Transplantation
Kerry Campbell, Jessica Jaiven, Kimberly Banfield, Corinne Begg, Janice Butler, Leanne Thain
British Columbia Emergency Health Services (BCEHS) uses an internationally recognized Medical Priority Dispatch System to assign appropriate responses to 9-1-1 calls based on patients' clinical acuity. In 2015, 71% of Omega calls (classified as calls involving low acuity injuries) were assigned an ambulance. To better meet patients' needs, BCEHS collaborated with HealthLink BC's Nursing Services (HLBC NS) to audit over 2,000 calls. Based on the results, three Plan, Do, Study, Act (PDSA) cycles were implemented, yielding a 35% decrease in ambulances assigned and a 173% increase in referrals to HLBC NS to provide more suitable support...
2017: Healthcare Quarterly
Kristine H Münter, Thea P Møller, Doris Østergaard, Lone Fuhrmann
OBJECTIVE: Research has identified numerous safety risks in perioperative patient handover. In handover from ward to operating room (OR), patients are often transferred by a third person. This adds to the risk of loss of important information and of caregivers in the OR not identifying possible risk factors. The aim of this study was to describe the implementation process and completion rate of a new preoperative, ward-to-OR checklist. Our goal was a 90% fulfillment. METHOD: This study is a prospective, observational study in a Danish University Hospital including all patients undergoing surgery in 2013...
November 4, 2017: Journal of Patient Safety
Cara Bailey, Alistair Hewison, Shelly Orr, Marianne Baernholdt
BACKGROUND: Teaching nursing students how to provide patient-centered end-of-life care is important and challenging. As traditional face-to-face classroom teaching is increasingly supplanted by digital technology, this provides opportunities for developing new forms of end-of-life care education. The aim of this article is to examine how a global classroom was developed using online technology to enhance nursing students' learning of end-of-life care in England and the United States. METHOD: The PDSA (Plan-Do-Study-Act) quality improvement approach was used to guide the design and delivery of this curriculum innovation...
November 1, 2017: Journal of Nursing Education
Randi Sokol, Jessica Early, Amanda Barner, Sarah Gottfried, Richard Gumpert, Lorky Libaridian, Virginia Morrison, Alexandra Santamaria, Linda Shipton
Hepatitis C virus (HCV) is the most common blood-borne virus in the U.S., and its incidence continues to rise. With approval of direct-acting antiviral medications, treatment for Chronic Hepatitis C (CHC) has become highly efficacious with a minimal side effect profile. Primary care physicians are well-positioned to address this increased demand, yet most do not feel comfortable treating CHC. In this case report, we describe implementation of a multidisciplinary team-based approach for treating CHC at multiple primary care sites across a large safety net health system...
October 18, 2017: Healthcare
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