Quality and Safety in Health Care最新文献

{"title":"254 Improving care for congestive heart failure by transfering competency to specialised nurses","authors":"J. Patrick, Funck François, Henegariu Viviana, Boireau Amélie, Dagorn Joël, Adalla Dora, B. Michel","doi":"10.1136/QSHC.2010.041624.90","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.90","url":null,"abstract":"Background Chronic Heart failure management is based on ESC recommendations. In most countries, medical therapy is based on a medical examination and despite the improvement of medical therapies; most of CHF patients are not optimally managed. Nurses are more and more implicated in CHF management. Methods We have compared double blind medical prescription of a Heart failure trained Nurse (specific training on CHF, ESC recommendations, BNP use and pathophysiology, patient education) and a heart failure specialised cardiologist in 120 consecutive patients. We focusing on clinical examination, BNP interpretation, treatment evaluation and therapeutic modifications proposed. Results We have included 120 consecutive patients. Mean age was 70.2±5. Mean LVEF was 32±5%. Mean BNP was 230±120 pg/ml NYHA classification was similar in 85% of cases. Treatment evaluation was similar in 89% of the patients and 96% of patients considered as under optimal therapy by the heart failure specialist were identified by the HF nurse. Therapeutic modifications proposed by HF nurse were confirmed by the HF specialist in 85% of the patients. ESC recommendations were followed in 100% of the cases. Differences in prescription between HF nurse and HF specialist are mainly related to spironolactone/Angiotensin II receptor antagonist introduction in addition to ACEI therapy. Conclusion A trained HF nurse could act as first line prescriber in CHF with a low risk profile. Données actuelles La gestion de l'insuffisance cardiaque chronique est basée sur les recommandations de l'ESC. Dans la plupart des pays, le traitement médical repose sur un examen médical et en dépit de l'amélioration des thérapies, la plupart des patients atteints d'ICC ne sont pas géré de façon optimale. Les infirmières sont de plus en plus impliquées dans la gestion de CHF mais ont encore un rôle limité à la prise de cosntantes et de prélèvements. Méthodes Nous avons comparé en double aveugle la prescription médicale d'une infirmière formée spécifiquement à insuffisance cardiaque (formation spécifique sur la maldie, les traitemetns, les bilans et la façon de les interpréter, les recommandations de la société européenne de cardiologie, l'utilisation du BNP et de la physiopathologie, l'éducation des patients) et un cardiologue spécialisé chez 120 patients insuffisants cardiaques consécutifsen nous concentrant sur l'examen clinique, l'interprétation de la BNP, l'évaluation des traitements thérapeutiques et des modifications proposées. Résultats Nous avons inclus 120 patients consécutifs. L'Âge moyen était de 70.2±5. La FEVG moyenne était de 32±5%. Le BNP moyen était de 230±120 pg/ml, la classe NYHA a été similaire dans 85% des cas. Traitement de l'évaluation a été similaire dans 89% des patients et 96% des patients sous traitement considéré comme optimal par le spécialiste en insuffisance cardiaque ont été identifiés comme tels par l'infirmière spécialisée","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"48 1","pages":"A136 - A137"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83505028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"249 Stroke network, stroke, intravenous thrombolysis, intra-hospital delay, imaging","authors":"M. Girot, E. Wiel, A. Hardy, G. Smith, J. Pruvo, X. Leclerc, P. Goldstein","doi":"10.1136/qshc.2010.041632.37","DOIUrl":"https://doi.org/10.1136/qshc.2010.041632.37","url":null,"abstract":"Aim and Background The stroke network is organised around the Stroke Unit (SU) which is known to be effective to reduce mortality and handicap in all types of strokes. However, most of patients do not receive imaging in a timely manner, only 40% of patients admitted in a hospital with SU are hospitalised in this unit and less than 1% of patients are thrombolysed. The aim of our study was to evaluate the efficacy of the stroke network before the stroke unit for improving. Programme We conducted a prospective study during 2 months to evaluate the intra-hospital management of patients admitted for suspected stroke in emergency department (ED) before the SUof our University Hospital in terms of delay, imaging and orientation. We compared the length of stay in ED for patients admitted for suspected stroke and for patients hospitalised for other neurological reasons. Results 258 patients were admitted for suspected stroke. This diagnosis was confirmed in 225 patients, including 44 transient ischaemic attack, 155 ischaemic stroke, 26 hemorrhagic stroke; 13 patients received intravenous thrombolysis. 27% were admitted within 3 h after symptom onset, 8% between 3 and 4 h 30 and 20% awaked with stroke. The delay of admission was significantly shorter in patients with hemorrhagic stroke and in patients for whom the emergency telephone system have been used. Median delay for imaging was1 h 59 min in the all population and was 53 min for patients admitted within 3 h. Only 12% of patients received CT scan within 25 min of hospital admission. Two third of the patients were admitted in stroke unit. The mean length of stay at the ED was 25 min for thrombolysis patients, 5 h 20 for the others admitted in stroke unit and 5 h 57 for all the population hospitalised for stroke, which did not differ from the length of stay for the other neurological hospitalisations. Discussion The impact of the stroke network is proved by the high percentage of patients admitted in stroke unit and the shorter delay of management for patients who are thrombolysed. However, the benefit is not observed for all patients with stroke. Conclusion These data suggest areas for improvement in hospital-level stroke system of care which could increase patient access to stroke unit and therefore potentially reduce stroke related morbidity and mortality. It should be recommended for all patients admitted for stroke and not only for patients who can be thrombolysed. Objectif(s), Contexte Les autorités sanitaires françaises ont favorisé la mise en place d'une filière d'organisation des soins, structurée autour de l'unité neurovasculaire (UNV) dont le bénéfice est attendu quel que soit l'âge du patient, le type et la sévérité de l'AVC. Malgré cette organisation, l'accès rapide à l'imagerie est réservé à une minorité de patients, 40% des patients admis dans un établissement avec UNV y sont admis et moins de 1% des patients victimes d'AVC sont actuellement thrombolysés. L'objectif d","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"23 1","pages":"A182 - A183"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78681200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"185 Assessment of imaging orders for acute renal colic and pyelonephritis in the emergency department","authors":"B. Clémence","doi":"10.1136/QSHC.2010.041632.28","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041632.28","url":null,"abstract":"Background and objectives One of the quality improvement programmes implemented by the emergency department of Rennes university hospital concerns the clinical impact and appropriateness of orders for imaging tests in urologic emergencies. Our objective was to evaluate compliance with a recommended low-dose protocol in cases of acute renal colic and complicated pyelonephritis and the clinical impact of this protocol on the quality of care. Programme Acute renal colic and pyelonephritis are common reasons for arrivals in the emergency department. A multidisciplinary team within the emergency department developed a radiology protocol for management of these cases. For all cases of suspected acute renal colic but for complicated cases of pyelonephritis only, a low-dose CT scan was recommended. No radiology exam was recommended by the emergency department for simple acute pyelonephritis. Emergency physicians and radiologists were to apply the low-dose protocol to all cases tagged ‘CT-scan for pyelonephritis’ and ‘CT-scan for renal colic’. Results This was a before-after comparison based on the review of 315 files. The clinical impact of the protocol was threefold: (i) Positive impact on existing practices: There was a significant increase in orders for CT-scans in complicated forms of acute renal colic and pyelonephritis, in line with earlier recommendations; (ii) Changes in practice: There was a decrease in orders for plain abdominal X-rays which are very often used for diagnosis in cases of acute flank pain; CT-scanning was used in preference to abdominal x-ray plus abdominal ultrasound for both acute renal colic and pyelonephritis; the radiation dose was reduced but nevertheless remained higher than the low-dose recommended in the literature; (iii) Implementation of the protocol did not affect the time taken to perform the exams nor to manage patients in the emergency department. Discussion and conclusion Certain questions remain unanswered such as the issue of radiation exposure in young patients in whom these afflictions may recur. Moreover, not all physicians agree on all points, such as the management of simple acute pyelonephritis. In addition, the latest consensus conference guidelines recommend first-line abdominal X-ray and ultrasound for the management of acute renal colic. The next step is therefore to use our findings as a basis for a review of the protocol by the whole team in order to make any necessary adjustments. Contexte, objectif (s) Dans le cadre des démarches d'amélioration de la qualité, le CHU de Rennes a développé des programmes d'évaluation des pratiques professionnelles dont un axe retenu était celui de l'impact et de la pertinence de la prescription et du délai des examens d'imagerie. Cette étude a été appliquée à l'imagerie des urgences urologiques médicales. Programme La colique néphrétique et la pyélonéphrite sont deux motifs fréquents de consultation dans un service d'urgence. Dans le service des ur","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"97 1","pages":"A173 - A174"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90662511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"157 Control of methicillin-resistant staphylococcus aureus infections in two neonatal care units","authors":"B Colomb, M.-F. Bouthet, S. Aho, K. Astruc, G Guerre, Catherine Neuwirth, N Henri, S Amiot, A Lévy, Jean-Bernard Gouyon","doi":"10.1136/qshc.2010.041624.3","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.3","url":null,"abstract":"Context Grouped cases of nosocomial bacterial infections (NBI) due to methicillin-resistant staphylococcus aureus (MRSA) were observed over a 1-year period (May 2007 to May 2008) in the neonatal intensive care unit and the unit of neonatology of a university hospital. Main purpose To assess the implementation of preventive measures and the concomittant changes of the incidence of severe MRSA infections. Method A head committee has been brought up on May 2008 (CLIN's president, head division of paediatrics, paediatricians and nurses of the neonatal units, chief nurses, hygienists, and bacteriologists). Two operational groups consisting of 15 persons each have been set up (one for each neonatal unit). Their aim was to provide information and formation to the care givers, and also to set up an internal audit of the care practices. The teams of the neonatal units were directly involved in the identification of at risk situations using a voluntary and anonymous declaration system. Over the May 2008–December 2008 period, the two operational groups performed the analysis of the results and suggested 90 actions that were validated by the head committee. Since May 2008, a direct observation of the practices of care has been started and the data have been stored in a computer software. This observation was performed by specifically trained nurses (two full-time employments). Meetings of the operational groups have been held monthly in order to evaluate changes in clinical practices (hand hygiene, central venous catheter insertion, etc…), analyse cases of NBI (definitions according to the CDC classification) and changes in nasal MRSA carriage rate (screening started in May 2008). In each neonatal unit, panels presented the conclusions of these meetings. An independent external audit of this method has been conducted in November 2008 by the Institut National de Veille Sanitaire (INVS) and the CCLIN Est. Results Among 90 identified points of improvement, 82 (90%) actions have been implemented between May and December 2008. Hydro-alcoholic solution's consumption doubled from June 2008. Conformity rate for hand hygiene grew from 85% (July 2008) to 94% (December 2008) in the NICU, and from 38% to 95% in the unit of neonatology. The conformity rate for central venous catheter insertion grew from 42% (September 2008) to 81% (November 2008). Between May 2007 and May 2008, 19 MRSA infections were identified (10 bacteremia, six pneumonia with positive broncho-alveolar lavage, one meningitis, two positive culture of catheters without bacteremia) versus three MRSA infections between June 2008 and May 2009 (two bacteremia, one pneumonia). The decrease in MRSA infection rate was statistically significant. The incidence of nasal MRSA carriage significantly decreased from June 2008. Discussion The main characteristics of this continuous internal audit were: A direct involvement of all care givers (nurses, doctors, technicians…), A voluntary anonymous report system that per","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"23 1","pages":"A49 - A50"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78170415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"237 Improved and ambulatory care for patients in cardiac readaptation by a score","authors":"M. C. IIliou, T. Badoual, P. Tuppin","doi":"10.1136/QSHC.2010.041632.36","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041632.36","url":null,"abstract":"Background Cardiac rehabilitation prescriptions are one of the quality criteria for international and french guidelines after an cardiovascular event. However, in France, cardiac rehabilitation rates were lower than 25%. One of the explanations may be a low centre ability, and underused of out patient facilities. Our aim was to evaluate which are the parameters linked with the optimisation of the patient management and improve the centres efficiency. Methods We performed a pilot study during a representative month (June 2009) in the two APHP centres with assessment of different characteristics of patients referred to cardiac rehabilitation. We studied the follows items: length of refer after cardiac event, waiting time to an outpatient appointment, clinical criteria (age, disease, exercise capacity, transfer limitations), residence (transportation mode and travelling time) and social parameters (precariousness, work, disability, loneliness). A multivariate logistic model was used to evaluate independent significant factors predicting the outpatient management. Then, a score was elaborated according to the significant identified variables. Results We included 157 patients, mean age 61.8±14.0 years (from 19 to 88 years old). Pejorative access to outpatient management was linked to remote residence in 27 cases, patient willingness in 25 cases, medical condition in 24 cases, social disability in 13 cases and older age in eight cases. Univariate analysis showed significant differences between patients who can be managed as in or outpatient: ambulatory patients are younger (59.1 vs 63.5 years), male, have a better exercise capacity (83 vs 67 watts), more transport facilities, a short travelling time, without loneliness and lack of psychological or language barriers. In multivariate analysis, the independent parameters were: medical vs surgical origin (OR 1.6), transportation time (OR 1.6, <30 min), loneliness (OR 2.9), exercise capacity(>70 watts, OR 1.97) and patient willingness (OR 5.4). A score >6 is predictive to a major barrier to an outpatient management. Discussion As medical and practical factors can interfere with the ambulatory management of cardiac patients, the patient willingness still the major barrier which require special practitioner accuracy. In order to asses the score validity, we propose,after spread this, a future evaluation of optimal way through the cardiologic channels. Conclusion Outpatient management should in order to optimise access to cardiac rehabilitation care. Objectifs, contexte La prescription de réadaptation cardiaque est un des critères de qualité reconnue par les recommandations internationales et de l'HAS dans le post infarctus du myocarde. Or, les différents registres français montrent que cette prescription est peu fréquente (inférieure à 25 %). Une des hypothèses pouvant expliquer cette situation est le faible nombre de places disponibles dans les centres de réadaptation. De plus, la prise en charge a","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"57 1","pages":"A181 - A182"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85536611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"138 Improving hand hygiene to decrease healthcare associated infections: impact of a ten year strategy in southwestern France","authors":"P. Parneix, D. Zaro-Gon, B. Jarrige, E. Galy, C. Léger, M. Fanon, C. Gautier, S. Marie, A. Mahamat","doi":"10.1136/QSHC.2010.041608.7","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041608.7","url":null,"abstract":"Background In 1998, under the pressure of consumer associations, the so-called health safety law erected transparency and prevention of nosocomial infections as a major priority public health declined in national guidelines beginning in 1999. The Southwestern France healthcare associated infection control centre (CCLIN So) was created in 1992 with the mission of implementing the national policy in the 473 healthcare facilities located in 7 administrative regions including 3 overseas one. Program Reduce cross contamination by improving hand hygiene's observance was the main objective of the program. Hand disinfection promotion with handrub products (HP), erected as a national strategy in 2001, was achieved throughout infection control professionals networks animated by the CCLIN in each region. Implementation of hand hygiene day with a common tools kit, including video clips promoting HP use, started in 2005. Three multi-centres hand hygiene compliance audits were performed between 1999 and 2008. An annual prevalence study and follow-up of the resistance of the Staphylococcus aureus (S. aureus) via a microbiology laboratories’ network, implemented in 1993, have accompanied the program. Public reporting in the field of healthcare associated infection (HAI) including an indicator of the HP consumption has been a strong support of the strategy enhanced in our region by a software creation to monitor monthly consumption at a ward level. The observance of the hand hygiene, the frequency of methicillin-resistant S. aureus (MRSA) and the prevalence of MRSA HAI were followed as indicators. Results In 1999 the audit showed that 39.7% of care situations were associated with no hand hygiene and proportion of disinfection among hand hygiene was 10.4%. By 2005 these two percentages reached 23.6% and 38.7% respectively to achieve in 2008 10.0% and 71.0%. HP consumption rose from 91 036 litres in 2005 to 187 011 in 2007 associated with an increase percentage of achieved national objective from 22.7% to 44.7%. In parallel 64% of health facilities have organised the 2005 day with 28 632 participating healthcare professionals (HCPs) and 61% in 2007 with 24 299 HCPs trained and 6 099 consumers now associated at this yearly event. The SARM proportion among S. aureus strains was 41.4% in 1999 and it decreased steadily through 37.8% in 2005 to 31.5% in 2008. The prevalence of HAI with SARM decreased from 0.63% of hospitalised patients in 1999 to 0.30% in 2008 with a drop of the HAI prevalence from 5.5% to 3.8% in the same period. Discussion Implementing a policy of active promotion of hand hygiene with prioritising disinfection, faster and more efficient; allowed a significant increase of its observance in southwestern France healthcare facilities. This was made possible by an organisation and a national programme implemented by the CCLIN. The clinical impact of this action can be evaluated throughout the decrease of HAI and MRSA frequencies. The new French hospital hy","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"21 1","pages":"A8 - A9"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85607290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"279 Name of program: evaluation of the strategy of treatment for myocardial infarction by the RESCUe network","authors":"E. Carlos, E. Nicolas, Peiretti Alexandra, Douheret Florian, Roussel Eric, Mann Yvan, Echahed Khalid, Capel Olivier, J. Xavier, Serre Patrice, Bonnefoy Eric","doi":"10.1136/qshc.2010.041624.60","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.60","url":null,"abstract":"Background The purpose of this study was to determine whether implementation of regional guidelines improves the management of acute myocardial infarction with ST-elevation (STEMI), in terms of reperfusion decision and orientation. Program The editing of local guidelines in a hospital or a network of care is recognised as a useful approach, but rarely evaluated. The RESCUe network has defined and implemented a guideline shared by 30 hospitals to improve MI care pathway and transfer of STEMI. To evaluate the guideline's impact, the emergency doctors involved in the network included in a prospective register all suspected MI entering the prehospital care pathway, to analyse their route since the call to the centre 15. Recent data were compared to those collected before the guideline dissemination. The acute phase indicators spotting good practices as defined by French National Authority for Health were evaluated: rate and time to reperfusion, rate of direct referral to transfer to interventional cardiology center (ICC), rate of patients receiving anti-platelet therapy, analgesia and Heparin, in hospital mortality. Results Between February 2008 and May 2009, 568 patients with less than 24 h STEMI at the acute phase were managed by the 18 mobile intensive care units (MICU) and the 8 ICC of the zone covered by RESCUe network. Their data were compared to those of 544 patients managed between January 2004 and December 2005, using the same inclusion criteria and analysis. The exhaustivity not evaluated in 2005, was 95% in 2009. The comparison of the results between 2005 and 2009 shows: a significant improvement (p<0.05): of the reperfusion rate (all techniques) from 86 to 90%, for those receiving primary percutaneous coronary intervention (PPCI) from 23 to 63%, antalgic therapy from 33 to 50% and heparin (unfractionned heparin and low molecular weight heparin) from 69 to 90%. The rate of clopidogrel therapy, recently implemented reached 87% in 2009. a significant reduction (p<0.05) of the: median ‘door to balloon’ time from 240 to 105 min, thrombolytic therapy rate from 66 to 27% and rate of patients not receiving reperfusion therapy from 14 to 10%. an in hospital mortality rate of 6%. Discussion The establishment of regional guideline allowed improving STEMI care pathway since the call to the 15 Center to the reperfusion for patients managed by mobile intensive care units. The access to reperfusion therapy and recommended treatments for the patients managed within this care pathway has significantly improved between 2005 and 2009, according to guidelines, with a privileged referral to the interventional cardiology center. Conclusion The establishment of a regional guideline with measurement of its implementation brings together health professionals and significantly improve the acute care pathway for MI management, for patients benefit. Guideline and clinical practice indicators are efficient tools (i) to implement good practices according to guidelines","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"141 1","pages":"A107 - A108"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88290768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"037 Urinary incontinence and expanded bladders: evolution of treatment through the PERINICE network","authors":"B. Mauroy, J. Bonnal, R. Matis, I. Brassart, A. Gagnat","doi":"10.1136/QSHC.2010.041616.19","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041616.19","url":null,"abstract":"Background The PERINICE network is dedicated to multi-field care of pelvic static disorders and adult urinary and/or anal incontinence in the Nord/Pas-de-Calais region. It is the typical network borne from the need to offer homogenous treatment and care through a network with all the characteristics of a high-quality health network: multi-expertise with over 500 health professionals specialised in one of the eight specialities of perineology geographical proximity with a group of centres allowing a direct access across the region within a range of less than 50 km professional training through the development of best practice recommendations, the training of students within ‘mobility courses/internships’ across the relevant expertises and on-the-job training assessment of professional practices (‘EPP’), quality of care, improvement of the patient quality of life shared standardised IT medical file (‘DMP’) unique to all the network and IT database which enables evaluation, information sharing, virtual meetings and helps creating an epidemiologic register (‘Register’). It is essential to improve medical as well as economical practices Programme: Overview, Development and Follow-up Expanded bladder is a common cause of urinary incontinence due to over-hydration, as well publicised by the media. The treatment received through the network and its specialists allowed to highlight this situation. Its discovery and associated best practice recommendations have been rapidly communicated to all the 500 professionals of the network. This information is disseminated in the network through the various means of communication: amendment to the DMP with the addition of the item expanded bladder’ IT learning tool accessible through the PERINICE Web site ongoing ‘on-the-job’ training sessions discussions and exchanges during the multi-field meetings training and teaching of future professionals and physiotherapists through ‘mobility internships’ The general population also benefits from these developments given the information shared by informed professionals and the public access of the Web site: http://www.perinice.fr This allows to prevent vesical expansion through hydration and insufficient number of mictions. Clinical Results The data from the PERINICE Register suggest that based on 811 patients, 288 (ie, 30.7%) had an expanded bladder. These results confirm the clinical feel and reinforce the new recommendations of clinical best practice. Since then, the initial treatment we offer is to correct bad habits through self-reeducation including reduction of liquid intake and space between mictions. Self-reeducation itself has cured 35% of these patients while avoiding surgery. Discussion (Potential for Development, Restrictions) and Conclusion (Lessons Learnt and Messages for Others) As a result of data centralisation, the network allows to develop specific protocols that would not be identified by one isolated professional. The example of expanded bladder illustr","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"11 1","pages":"A42 - A43"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88620324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"079 The stroke marche regional audit program","authors":"A. Deales, M. Fratini, F. Racco, R. Zorzan, Francesco Cicchitelli, M. Belligoni","doi":"10.1136/qshc.2010.041624.47","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.47","url":null,"abstract":"Objective To improve, in the regional healthcare system, standards of care of patients suffering of Stroke through implementation of integrated clinical pathways (ICPs) and development of a ‘Regional Audit Program’. Programme Establishment of multidisciplinary and multiprofessional regional expert panels with the mission of selecting and sharing the best evidence-based interventions for Stroke, setting indicators and standards to assess performances and outcomes. Creation of multidisciplinary and multiprofessional local workteams (one for each Local Health Authority and hospital) with the aim of implementing recommendations in daily practice using integrated care pathways (ICPs) as an effective tool to reach integration at different levels of care and professional competences. Development of a ‘Regional Audit Program’ incorporating the selected indicators to measure the performances of the whole regional healthcare system and the patients outcomes. Elaboration of reports on the state of healthcare quality delivered for Stroke. Auditing and benchmarking activities at central and local levels to analyse the results of the reports and review activities with low performance values. Results From data collected in the monitoring system we generated two reports. Results refer to years 2006 and 2007. Data collection was conducted in eight out of 15 hospitals of Marche Region, for two consecutive months, random selected, both in 2006 and 2007 (182 patients in 2006, 178 patients in 2007). We have summarised results of a sample of the most representative indicators in the following table. Indicators Media (%) Régional standard (%) 2006 2007 CT within 6 h from arrival at hospital 97 97 80 Screening for Dysphagia within 24 h 91 91 95 DVT Prophylaxis 78 85 95 Physiatric assessment within 48 h 50 66 95 Antithrombotics within 48 h 87 87 95 Rehabilitation* 63 73 Not set Stroke team meetings 49 67 Not set Patients/caregiver education 43 34 95 Discharged on Anticoagulants† 42 100 85 Discharged on Antithrombotics 89 100 90 Pneumonia* 4 5 Not set Urinary tract infections* 11 1 Not set Falls* 0 0 Not set * During hospitalisation. † Atrial fibrillation. Discussion, conclusion The program has demonstrated to work, enabling the system to assess quality of care delivered to patients suffering of Stroke. Although the results are still limited, they show a good performance on assessment, prevention of complications (apart from pressure ulcers), medications and secondary prevention but still an healthcare quality far from standards in the field of multiprofessional integration, patients/caregiver education and provision of rehabilitation. On the basis of such results, activities of organisational and clinical audit and benchmarking were undertaken and several actions were planned to remodel interventions and organisational systems to achieve standards of care for all patients with stroke within Marche Region. In December 2009 we'll collect data from about 500 patients from ","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"5 1","pages":"A93 - A94"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75977404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"117 Assessment of mortality-morbidity conferences in terms of postoperative results in a colorectal surgical department","authors":"F. Marianne, Panis Yves, Bretagnol Frédéric","doi":"10.1136/QSHC.2010.041616.6","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041616.6","url":null,"abstract":"Aim The aim of mortality-morbidity conferences is to increase medical care. In a recent french multicentric trial on colorectal surgery,1 both mortality and morbidity rates were 3.4% and 35%, respectively. The aim of this study was to assess the impact of mortality-morbidity conferences on medical care, especially in terms of operative results, in a colorectal surgical department. Methods All consecutive patients undergoing elective or urgent colorectal and intestinal resections were collected in a prospective database, including patients'characteristics, diagnosis, type of surgery, and postoperative course. All patients were followed 3 months after surgery. A mortality-morbidity conference was systematically performed every 6 months. Seven periods of 6 months were analysed. Results From May 2006 to October 2009, 958 intestinal and/or colorectal resections (urgent procedures in 10% of cases) were performed, including: small bowel resection (n=71), ileocaecal resection (n=140), right (n=93) and left (n=241) colectomy, subtotal colectomy (n=100), rectal resection (n=231) and others (n=82). Comparing the first and the last period, the number of operated patients and laparoscopic procedures increased that is, 115 versus 157 and 59% versus 68%, respectively (p<0.05). The conversion rate into open procedures decreased, 15% versus 3% (p<0.05). The overall mortality rate remained within 5%. The overall morbidity rate and the infectious morbidity decreased, 50% versus 37% (p<0.05) and 25% versus 19% (p<0.05), respectively. The hospital stay was decreased, 14+/−9 days versus 12+/−9 days, (p<0.05). But, the anastomotic leakage and the readmission rates were similar, 10% versus 7.5% and 8% versus 7.6%, respectively. Conclusion The mortality-morbidity conferences lead to improve the medical care in terms of operative results, especially concerning the overall morbidity rate and the hospital stay. Contexte/objectif L'objectif de l’évaluation des pratiques professionnelles est l'amélioration continue de sa propre pratique médicale. En chirurgie colo rectale, la mortalité et la morbidité post-opératoires sont évaluées respectivement à 3,4% et 35% dans l’étude récente de l'Association Française de Chirurgie.1 Le but de notre étude était l'auto-évaluation prospective des résultats opératoires d'un service universitaire de chirurgie colorectale pour mieux connaître et éventuellement améliorer ces valeurs de mortalité et morbidité à l’échelle d'un jeune service. Programme Tous les patients opérés électivement ou en urgence pour une chirurgie de résection intestinale ou colo rectale ont été colligés de manière prospective dans une base de données recueillant les caractéristiques du patient, le diagnostic, le type de chirurgie et la morbi-mortalité post opératoire (126 items) avec un suivi à 3 mois. Tous les 6 mois, une revue de morbi-mortalité (RMM) était faite, lors de la journée de séminaire du service, impliquant tous les p","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"1961 1","pages":"A29 - A30"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91245799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}