Quality and Safety in Health Care最新文献

{"title":"196 Care network promoting the education of type 2 diabetic patients: short term efficacy and comparison with a hospital service specialised in diabetic care","authors":"B. Philip, Durain-Sieffert Danielle, Contal Irène, Cheryl Benjamin, D. Kevin, F. Renaud, Ziegler Olivier","doi":"10.1136/QSHC.2010.041632.29","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041632.29","url":null,"abstract":"Background, objectives The diabetes care network ‘Maison du diabète et de la nutrition de Nancy et 54’ (MDN54) is a territorial structure which organises formalised and structured therapeutic patient education (TPE) by a multidisciplinary team for type 2 diabetic patients (T2DM) or obese people, usually not treated by an endocrinologist. The goal of this study was to (1) compare baseline characteristics of the T2DM patients from MDN54 with patients followed in a diabetes university hospital department (CHU), (2) to describe the follow up of those patients during 1 year and (3) to compare the changes of some relevant parameters between the territorial and the hospital structure. Programme: description, implementation, monitoring elements T2DM patients are registered at MDN54 by their general practitioner. The patients take part to TPE programs according to a formalised programme as recommended by the HAS: educational diagnosis, group sessions and/or individual face-to-face meeting with an educator, assessment of self-management, and more educational sessions if needed. The sessions are conducted by a multidisciplinary team including private nurses, dieticians, physiotherapists, psychologists and chiropodist. All the sessions take place outside the hospital, at the head office of the MDN54 or in other quarters or cities (rooms offered by local authorities). The family physician is responsible for the annual diabetes check up according to the french national guidelines. TPE programmes have been adapted to primary care during training courses for general practitioners organised by the CHU team. This annual monitoring includes relevant clinical characteristics (body mass index, blood pressure, diabetes complications: retinopathy, neuropathy, wound risk level for diabetic feet, …) and biological results (HbA1c, LDL-cholesterol, HDL-cholesterol, triglycerides, creatinine's clearance by MDRD, microproteinuria, etc). The MDN54’s cohort included 486 T2DM patients registered between 2005 and 2008; 243 patients had had a complete initial annual assessment and 100 patients 2 successive annual assessments. CHU's cohort included 1997 patients and among them 848 T2DP with 2 successive annual assessments on the same period. Seventy-five patients of both populations were matched (CHUap and MDN54ap) using the propensity score on the initial values of several parameters (age, sex, duration of diabetes, BMI, total cholesterol, creatinine's clearance, retinopathy, renal failure, neuropathy, wound risk, hypertension, peripheral vascular disease, treatment with insulin). Results in terms of clinical impact Initial age (62.8 vs 63.0 years), BMI (31.7 vs 31.3 kg/m2) and HbA1c (7.53 vs 7.49%) of the two cohorts (MDN54 vs CHU) were similar (p=NS). Diabetes' duration (14.3 vs 9.0 years), rate of retinopathy (28.3 vs 10.4%) and nephropathy (44.9 vs 22.2%) were higher in the CHUs cohort (p<0.001). There was an improvement in HbA1c level for MDN54 patients at 1 year (7.53 vs 7","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77857728","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":null,"pages":null},"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":"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":null,"pages":null},"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":"054 Decrease in physical restraints for aged fall prone patients in a long term care setting","authors":"Michel Micheline, M. Olivier, Beaumanoir-Lambotte Aude","doi":"10.1136/qshc.2010.041624.68","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.68","url":null,"abstract":"The use of physical restraint has not been proven to be effective to prevent the risk of fall and is associated with harmful consequences on health, autonomy and dignity respect. Although prevalence in hospitals remains high. The aim of the Quality Improvement Program was to decrease the prevalence of physical restraint in a long term geriatric ward at the University Hospital of Rennes for elderly people at high risk of fall. The program consisted in assessing the risk of fall for each patient at several times and in educational meetings. Risk assessment was driven by the care-givers themselves in five geriatric units concerning 165 patients over a 6 month period, from November 2007 to May 2008, with 1 year follow-up. Educational meetings aimed to improve appropriation of recommended alternatives to physical restraint by the nursing team and, in case of no alternative, to improve recommended practice of physical restraint. These guidelines were reminded during several educational sessions by doctors and one specialist nurse in each team over the 6 month period of risk assessment. From May 2008 to May 2009 evaluation of the clinical impact of the program was conducted, by assessing following indicators: number of falls, prevalence of all kinds of physical restraints, rate of formal prescription. Following prognostic and confounding factors were also collected for all the patients included: main pathology, age, gender, history of previous falls, disability level, MMSE status, use of psychotropic drugs. Results At the first round of the practice appraisal, prevalence of restraint was bed rails: 67% and belts: 36%. Main determining factors of physical restraint were significantly a low score of MMSE (score 6/30 in restrained patients vs 12/30), a worst disability rate in restrained, especially concerning orientation, judgement and mobility. Severe balance trouble was found in 80% of restrained people versus 38%. The main pathologies were Alzheimer's dementia (85%) and stroke (13%). Six months later the prevalence declined respectively to 30% and 5%, and one year later, it was respectively 32% and 5%. In the same time, the precise prescription, as recommended, of bed rails and belts by a doctor rose from 41% to 76%. Alternatives were the acceptance of fall risk, the prescription of hips protectors, use of mattresses on the floor. Fall rate increased but falls were better collected than before. Only 3% patients felt after withdrawing restraint. Impact on quality of life but was effective even if not measure by a validated scale was not possible for the patients included. Satisfaction of both care-givers and families was good. Discussion: the role of the specialist nurse was important regarding the management of this program. Conclusion The improvement of a non restraining care-strategy has been effective and had a good impact on quality of life of dementia patients. This improvement should persist in the future despite the increasing prevalence of seve","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79335436","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":null,"pages":null},"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":"216 Use of good practice indicators by the College of General Practitioners of East Paris","authors":"Atlan Pierre, Dupagne Dominique, W. Philippe, G. Jean-Louis, Pigneur Jacques","doi":"10.1136/QSHC.2010.041624.84","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.84","url":null,"abstract":"Background and objectives The CGEP (French acronym for the College of General Practitioners of East Paris) is an independent association with no funding from industry which has been certified by HAS (French National Authority for Health) and CNFMC (National Councils for Continuous Medical Education). Its members are private and salaried general practitioners. The objective of CGEP is to improve health by improving care through the use of good practice indicators (GPI). The focus is on practice improvement (the aim) rather than on practice assessment per se (the tool). Programme This was a 3-year programme initiated in 2007, run by the association's committee, and with 29 participating GPs. The programme involves an analysis of practice and sharing of experience by GPs on chosen GPIs for common diseases (in particular iatrogenic disease, sleep disturbances, orders for tests, diabetes, and hypertension). The GPI criteria were reliability of the recommendations (ie, no conflict of interest with the health care industry), their relevance to professional practice, and feasibility within the scope of general practice. These criteria are potential guarantors of health improvements through guideline implementation. Practice analysis and sharing of experience occurred twice at a 6 to 12 months interval. Participants received guides on each indicator for practice analysis. They were able to make qualitative and quantitative comparisons of their own practice over time and also compare their practice with that of their peers at different times. The indicators were also used to measure trends in practice for the whole group. Results No participant dropped out suggesting that the initiative was relevant and feasible. There was a positive trend towards compliance with guideline recommendations by almost all participants and especially by the group as a whole (eg, for orders for tests, diabetes, child obesity). For example, group compliance showed increases: from 37% to 86% of patient files for the GPI ‘no a non steroidal anti-inflammatory drug during pregnancy’ (iatrogenic disease during pregnancy); from 33% to 79% for the GPI ‘advice on the correct use of condoms’ (sexually transmitted infections); from 37% to 56% for the GPI ‘prescription of alternatives to benzodiazepines’ (sleep disturbances). Although compliance is a surrogate endpoint for determining clinical impact, it is nevertheless essential. Discussion and conclusion Relevant and reliable GPIs are essential. Without them, there is no practice improvement plan and consequently no managed clinical improvement. However, GPIs are few and far between despite work done by HAS and the first-rate journal Prescrire. CGEP plans to turn the present initiative into a permanent project but its scope of action is seriously hampered by administrative ‘beating about the bush’ and by mandatory participation of GPs in various schemes (CME/PPA/CDP). The participation of specialists and allied health professionals, besi","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76666690","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":"213 How to improve the quality of medication management from prescription to administration: Experience in a medical ICU","authors":"P. Michel, Veinstein Anne, Chatellier Delphine, Frat Jean Pierre, Bescond Véronique, Grassin Joelle, Voultoury Julien, R. René","doi":"10.1136/QSHC.2010.041624.27","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.27","url":null,"abstract":"Background The lack of quality observed on the prescriptions and the errors of administration of treatments are often explained in ICU by their multiplicity and the frequency of their modifications. The frequency of theses errors in ICU justifies the implementation of programs of improvement of the quality in this domain1 2 Methods After an audit of the practices, we targeted the most frequent errors and workbench of the strict rules of prescription, retranscription and administration of medicines. Follow-up The complexity of the analysis of a file and the wish to set up a long-lasting procedure made choose the method of sampling. Every month, 10 files were randomly selected and analysed by a student in pharmacy during two consecutive days. A grid of analysis was pre-established by the pharmacist and one ICU MD. Each files was double-checked for validation by the pharmacist and the ICU doctor. A first step analysis was conducted during 9 months identifying several types of error an then allowing the establishment of the rules of practice and their communication to all the medical medical team (Period 1). The results of the period 1 were compared to those of the next 45 months (period 2). Résults Among 2374 patients admitted during period 2 (20586 days), 420 files (18%) were analysed corresponding to 4% of days of ICU hospitalisation. Types of errors Period 1192 D/patients Period 2 Absence of written prescription 32.3% 7% Incomplète prescription 49.5% 12.5% Errors of posology or medication type 9.4% 0% Association or galenic not corresponding 1.5% 1.2% Incidence of the errors of prescriptions (per day per patient) 0.92/D. Patient 0.13/D. Patient Errors of retranscription 20.8% 3.3% Errors of administration 33.3% 9.2% Incidence of the “nurse” errors (per day per patient) 0.54/D. Patient 0.08/D. Patient Conclusion The establishment of strict rules, the choice of documents of care adapted to the prescriptions and to the plans of care as well as a regular follow-up of the obtained results Their communication within the team allows a very sensitive improvement of the quality of treatments administered to the patients. Contexte Les défauts de qualité observés sur les prescriptions médicales et les erreurs d'administration des traitements sont souvent expliqués en Réanimation par leur multiplicité et la fréquence de leurs modifications. La fréquence de telles erreurs en Réanimation justifie la mise en place de programmes d'amélioration de la qualité dans ce domaine.1 2 Programme mis en œuvre Après un audit des pratiques, nous avons ciblé les erreurs les plus fréquentes et établi des règles strictes de prescription, de retranscription et d'administration des médicaments . Eléments de suivi La complexité de l'analyse d'un dossier et le souhait de mettre en place une procédure pérenne a fait choisir la méthode d'échantillonnage. Chaque mois, 2 journées de 10 dossiers tirés au sort sont analysées par un étudiant en pharmacie à ","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74632146","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":"105 Effects of a specifically-designed intensive care information system length of stay and mortality","authors":"Brisson Hélène, Arbelot Charlotte, Lu Qin, B. Bélaid, Vezinet Corinne, Bodin Liliane, Movschin Marie, Rouby Jean-Jacques","doi":"10.1136/QSHC.2010.041624.25","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.25","url":null,"abstract":"Introduction An intensive care information system (ICIS) has numerous advantages. It enables all the patients' data to be collected in a “computer file”. The automatic acquisition of data reduces human error, and computerised physician order entry limit errors in administering medication. Thanks to computerised data, the creation of a “clinical decision support system” enables diagnosis optimisation and follow-up of treatments. The goal of this study was to evaluate the impact of a personalised ICIS on critically ill patients' mortality and length of stay in the intensive care unit (ICU). Materials and methods The system chosen for Multidisciplinary ICU (12 beds) of Pitie-Salpetriere hospital in Paris was the program Metavision (IMDsoft, Tel Aviv, Israel). It is an adjustable system, offering the possibility of being completely reformatted and adapted according to specific needs. A team consisting of doctors, nurses, auxiliary nurses, and monitors was trained for 2 weeks to use the program. Then, for 1 month, the ICIS was personalised for the unit before being implemented. After defining the various clinical, biological, and radiological parameters indispensable for diagnosis and follow-up of acute respiratory disease, haemodynamic, renal, and hepatic failures, screens were created, integrating pertinent parameters in the form of tables and graphics. These screens enable all the relevant elements to be grouped together, but also allow the visualisation of their evolution along time. We compared the Simplified Acute Physiology Score (SAPS II) and the Sequential Organ Failure Assessment (SOFA) at patient's admission, length of patients' stay in the ICU, and mortality over two 6-month periods: before the implementation of Metavision from June to November 2008, and after implementation, from March to August 2009. Data were compared between groups by a Mann–Whitney test (median and IQR 25–75%), and a χ2 test. The first 3 months following the implementation of Metavision were not taken into account, in order to exclude the difficulties inherent to the implementation of a new computerised system. Results One hundred twelve patients were hospitalised between June and November 2008, and 160 between March and November 2009. SAPS II and SOFA scores showed no difference between the two groups: (SAPS II: 39 (26–54) vs 44 (28–59), p=0.7, SOFA: 6 (3–10) vs 6 (4–10), p=0.49). The length of stay in intensive care was shortened by 2 days after implementation of Metavision: 9 (5–20) versus 7 (3.5–14), p=0.02. A trend was observer towards a decrease in mortality: 17% to 14.5%, p=0.6. Discussion The interest of the system we have chosen is its adjustability, its ability to combine on the same screen (“clinical decision support screen”), a high number of clinical, biological, or radiological data. These screens enable the assessment of therapies on patients' organ failures. ICIS enables optimisation of patient's care, which may explain the reduction in duration of pat","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74922139","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":"199 How to follow the assessment of renal transplantation patients?","authors":"G. Mourad, R. Geneviève, Deshormière Nadine","doi":"10.1136/qshc.2010.041624.100","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.100","url":null,"abstract":"Objective (s), context A problem of Length of Stay was identified in 2006, on renal transplanted patients. In deed the average Length of stay (23 days) of the CHRU was superior of 3 days to the national one (19 days). The objective of the assessment realised by all the medical and paramedical teams was to identify all the reasons of the increase of stay to try to eliminate them. Program: description, implementation elements of follow-up To reach the defined objective, the professionals, realised a first analysis of their practices by identifying all the step of the care of patients (HAS method: clinical pathway) and the dysfunctions. This study was completed par a file review of the renal transplanted patients on the total clinical pathway. All the professionals participated to the first evaluation over twelve months. Regular assessments on main criteria were realised for two years (Length of the stay, ischaemia time…), as well as punctual assessment (audit of protocol—files review…) Results All these studies allowed: The definition of the target clinical path of the renal transplanted from the immediate post operating to the exit of the establishment validated by all the professionals. The identification and quantification of critical points of each step of the care of patient The definition of principal reasons of deviance of the length of stay such as: the professional variability of practice on the care process of patients the delays of exit due to the not knowledge of the immuno-depressant treatment (often by ignorance, in particular because of the language) or in the detection of histories of not - compliance therapeutics. the main complications arising at 82% of the population. Different types of improvement were identified. The patient's education formalisation of therapeutic education on immuno-depressant treatment training of the nurses to these education doing a systematic traceability of the information connected to this education in the patient file evaluation of this education for each patient The medical and nurses protocols harmonisation and updating of care protocols The first elements allowed making decrease average of length of stay of 23 days in 2006 in 16 days in 2007. Since 2007, average of Length of Stay from immediate post operating to exit of the patient (clinical pathway target) is the tracer indicator. This indicator evolved positively thanks to actions plan. A new evaluation of the clinical pathway was realised in 2009. The therapeutic education and his traceability are in accordance with the protocols what allows us to eliminate one cause of deviance of length of stay. The turn over of paramedical teams requires a systematic training of newcomers and an evaluation of knowledge. The main protocols of care were audited on files and their application is largely respected. The main study of 2009 concerns essentially the complications, and in particularly the urinary infection. The analysis specifies their characteristics,","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90102804","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":null,"pages":null},"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}