BMJ quality improvement reports最新文献_第10页

A quality improvement initiative on the management of osteoporosis in older people with Parkinsonism 老年帕金森患者骨质疏松症管理的质量改进倡议

BMJ quality improvement reports Pub Date : 2016-10-01 DOI: 10.1136/bmjquality.u210921.w5756

I. Singh, R. Fletcher, Linda Scanlon, Mandy Tyler, S. Aithal

{"title":"A quality improvement initiative on the management of osteoporosis in older people with Parkinsonism","authors":"I. Singh, R. Fletcher, Linda Scanlon, Mandy Tyler, S. Aithal","doi":"10.1136/bmjquality.u210921.w5756","DOIUrl":"https://doi.org/10.1136/bmjquality.u210921.w5756","url":null,"abstract":"The risk of falls is higher in patients with people with Parkinsonism (PwP) compared to those without Parkinsonism, and leads to adverse outcomes including fragility fractures. Osteoporosis is under-recognised, and the prevalence of fragility fractures in not well studied. The primary aim of this project is for 100% of new patient referrals to, and 80% of follow up patients within the movement disorder (MD) service with osteoporosis to be treated in accordance with evidence based osteoporosis guidance. Routinely captured information regarding demographics and fragility fractures was retrospectively extracted from the clinical workstation, clinic letters, and clinical coding between July and November 2015. The prevalence of fragility fracture was 22.6% (68/300), and only 40% (27/68) were on appropriate treatment for osteoporosis. A quality improvement (QI) methodology based on the model of improvement, Plan-Do-Study-Act (PDSA) cycles were used, and a monthly multidisciplinary team (MDT) meeting was introduced. This QI initiative has shown that MDT input can reduce referrals to physiotherapists; and also 100% of new patients, and 91% of follow up patients received evidence based osteoporosis treatment.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u210921.w5756","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63910530","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}

引用次数: 8

Developing Quality Improvement capacity and capability across the Children in Fife partnership. 在整个 "儿童在法夫 "伙伴关系中发展质量改进的能力。

BMJ quality improvement reports Pub Date : 2016-09-30 eCollection Date: 2016-01-01 DOI: 10.1136/bmjquality.u212664.w5045

Craig Morris, Ingrid Alexander

{"title":"Developing Quality Improvement capacity and capability across the Children in Fife partnership.","authors":"Craig Morris, Ingrid Alexander","doi":"10.1136/bmjquality.u212664.w5045","DOIUrl":"10.1136/bmjquality.u212664.w5045","url":null,"abstract":"A Project Manager from the Fife Early Years Collaborative facilitated a large-scale Quality Improvement (herein QI) project to build organisational capacity and capability across the Children in Fife partnership through three separate, eight month training cohorts. This 18 month QI project enabled 32 practitioners to increase their skills, knowledge, and experiences in a variety of QI tools including the Model for Improvement which then supported the delivery of high quality improvement projects and improved outcomes for children and families. Essentially growing the confidence and capability of practitioners to deliver sustainable QI. 27 respective improvement projects were delivered, some leading to service redesign, reduced waiting times, increased uptake of health entitlements, and improved accessibility to front-line health services. 13 improvement projects spread or scaled beyond the initial site and informal QI mentoring took place with peers in respective agencies. Multiple PDSA cycles were conducted testing the most efficient and effective support mechanisms during and post training, maintaining regular contact, and utilising social media to share progress and achievements.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63911344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Improving the Diagnosis of Neonatal Hypoglycemia in a Well-Baby Nursery. 在婴儿健康护理室改进新生儿低血糖症的诊断。

BMJ quality improvement reports Pub Date : 2016-09-19 eCollection Date: 2016-01-01 DOI: 10.1136/bmjquality.u214381.w5806

Eric Ly, Jennifer Alexander, Temi Akinmboni, Hyung Woo, Colleen Driscoll

{"title":"Improving the Diagnosis of Neonatal Hypoglycemia in a Well-Baby Nursery.","authors":"Eric Ly, Jennifer Alexander, Temi Akinmboni, Hyung Woo, Colleen Driscoll","doi":"10.1136/bmjquality.u214381.w5806","DOIUrl":"10.1136/bmjquality.u214381.w5806","url":null,"abstract":"Point of care glucose (POCG) measurements, used for detecting neonatal hypoglycemia, can have variable accuracy. The appropriate diagnosis of neonatal hypoglycemia in babies with low POCG measurements involves confirmatory serum glucose (CSG) testing. At our institution, no babies with low POCG measurements had CSG testing in their evaluation of neonatal hypoglycemia over a three year period. Our aim was to increase the percentage of CSG testing in babies with a low POCG. A secondary aim was to decrease the percentage of low-risk, asymptomatic babies who received POCG testing. Interventions included the design and implementation of an evidence-based protocol for the diagnosis and management of neonatal hypoglycemia (cycle 1), along with supportive education for multi-disciplinary providers on best practices related to neonatal hypoglycemia (cycle 2). Data were analyzed using statistical process control. During Cycle 1, the percentage of CSG testing in babies with POCG ≤40 mg/dL significantly increased from 0 to 33%, and increased further to 63% during Cycle 2. The initial gain was sustained over 2 years. The percentage of POCG testing among low-risk asymptomatic babies was 40% at baseline and did not change during the project period. 18 babies with low POCG results were spared from a diagnosis of neonatal hypoglycemia based on CSG testing. Implementation of a neonatal hypoglycemia protocol, along with supportive education, significantly improved rates of CSG testing, but not POCG overutilization, in our newborn population. Factors related to POCG overutilization should be further explored.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63912240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Erratum: Improving safety of sedation for transoesophageal echocardiography 勘误:提高经食管超声心动图镇静的安全性

BMJ quality improvement reports Pub Date : 2016-09-06 DOI: 10.1136/bmjquality.u202226.w1113corr1

引用次数: 0

Erratum: Promoting the role of patients in improving hand hygiene compliance amongst health care workers 勘误:促进患者在改善卫生保健工作者的手部卫生依从性中的作用

BMJ quality improvement reports Pub Date : 2016-09-06 DOI: 10.1136/bmjquality.u210787.w4336corr1

A. Awaji

引用次数: 0

Erratum: Improving analgesia in fractured neck of femur with a standardised fascia iliaca block protocol 更正:采用标准化髂筋膜阻滞方案改善股骨颈骨折的镇痛效果

BMJ quality improvement reports Pub Date : 2016-09-01 DOI: 10.1136/bmjquality.u202788.w1370corr1

引用次数: 1

Reducing the occurrence of errors in a laboratory's specimen receiving and processing department 减少实验室标本接收和处理部门错误的发生

BMJ quality improvement reports Pub Date : 2016-09-01 DOI: 10.1136/bmjquality.u211474.w4624

Nouf Al Saleem, K. Al-Surimi

{"title":"Reducing the occurrence of errors in a laboratory's specimen receiving and processing department","authors":"Nouf Al Saleem, K. Al-Surimi","doi":"10.1136/bmjquality.u211474.w4624","DOIUrl":"https://doi.org/10.1136/bmjquality.u211474.w4624","url":null,"abstract":"Frequent, preventable medical errors can have an adverse effect on patient safety and quality as well as leading to wasted resources. In the laboratory, errors can occur at any stage of sample processing; pre-analytical, analytical, and post analytical stages. However evidence shows most of the laboratory errors occur during the pre-analytical stage. The receipt and processing of specimens is one of the main steps in the pre-analytical stage. Errors in this stage could be due to mislabeling, incorrect test entry and entering the wrong location, among other reasons. Most of these errors are preventable. At the Riyadh Regional Laboratory of the Ministry of Health, we found that there was an average of 2.31 errors per 1000 processed samples; these errors had occurred during the pre-analytical stage. These samples were returned back from other laboratory departments, such as Chemistry, Hematology and Microbiology, to the receiving and processing department. We decided to carry out an improvement project where we applied a systematic approach to identify and analyse the root causes of the problem using quality tools such as a process flowchart and a fish-bone diagram. The Model for Improvement was used and several PDSA (Plan, Do, Study, Act) cycles were run to test interventions which aimed to prevent laboratory processing errors and mistakes. The project results showed a 25% reduction in errors during the pre-analytical stage.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u211474.w4624","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63911225","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}

引用次数: 5

A collaborative improvement project by an NHS Emergency Department and Scottish Ambulance Paramedics to improve the identification and delivery of sepsis 6. NHS急诊科和苏格兰救护车护理人员合作改进项目，以改进败血症的识别和交付。

BMJ quality improvement reports Pub Date : 2016-09-01 DOI: 10.1136/bmjquality.u212670.w5049

M. Carberry, John P. Harden

{"title":"A collaborative improvement project by an NHS Emergency Department and Scottish Ambulance Paramedics to improve the identification and delivery of sepsis 6.","authors":"M. Carberry, John P. Harden","doi":"10.1136/bmjquality.u212670.w5049","DOIUrl":"https://doi.org/10.1136/bmjquality.u212670.w5049","url":null,"abstract":"Early identification of patients with sepsis is key to the delivery of the sepsis 6 bundle including antibiotic therapy within an hour.[1-3] Demand versus capacity challenges in the Emergency Department (ED) led to delays in antibiotic and sepsis 6 delivery. An alerting tool was developed that provided criteria for Scottish Ambulance Service (SAS) Paramedics to alert the ED of potential sepsis patients. Data from patients presenting to the ED prior to the alerting process commencing (n=50) and during alerting (n=50) were analysed, a questionnaire was used to ascertain feedback from all staff groups; nurses doctors, and paramedics (n=38). Mean Time to triage improved by 82% from 17 minutes to 3 minutes (p=0.01), time to first antibiotic improved by 39% from 49 minutes to 30 minutes. Overall 78% of patients received antibiotics within an hour of leaving their home; no significant increase in workload was reported by staff. In conclusion alerting by paramedics of potential sepsis patients reduced the time taken to deliver the Sepsis 6 Bundle. Process reliability has been sustained over several months. This process has been spread to seven regional ambulance stations in Lanarkshire Scotland.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u212670.w5049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63911445","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}

引用次数: 5

Improving Emergency Department flow through optimized bed utilization 通过优化床位利用率，改善急诊科流程

BMJ quality improvement reports Pub Date : 2016-09-01 DOI: 10.1136/bmjquality.u206156.w2532

L. Chartier, Licinia Simoes, M. Kuipers, B. McGovern

{"title":"Improving Emergency Department flow through optimized bed utilization","authors":"L. Chartier, Licinia Simoes, M. Kuipers, B. McGovern","doi":"10.1136/bmjquality.u206156.w2532","DOIUrl":"https://doi.org/10.1136/bmjquality.u206156.w2532","url":null,"abstract":"Over the last decade, patient volumes in the emergency department (ED) have grown disproportionately compared to the increase in staffing and resources at the Toronto Western Hospital, an academic tertiary care centre in Toronto, Canada. The resultant congestion has spilled over to the ED waiting room, where medically undifferentiated and potentially unstable patients must wait until a bed becomes available. The aim of this quality improvement project was to decrease the 90th percentile of wait time between triage and bed assignment (time-to-bed) by half, from 120 to 60 minutes, for our highest acuity patients. We engaged key stakeholders to identify barriers and potential strategies to achieve optimal flow of patients into the ED. We first identified multiple flow-interrupting challenges, including operational bottlenecks and cultural issues. We then generated change ideas to address two main underlying causes of ED congestion: unnecessary patient utilization of ED beds and communication breakdown causing bed turnaround delays. We subsequently performed seven tests of change through sequential plan-do-study-act (PDSA) cycles. The most significant gains were made by improving communication strategies: small gains were achieved through the optimization of in-house digital information management systems, while significant improvements were achieved through the implementation of a low-tech direct contact mechanism (a two-way radio or walkie-talkie). In the post-intervention phase, time-to-bed for the 90th percentile of high-acuity patients decreased from 120 minutes to 66 minutes, with special cause variation showing a significant shift in the weekly measurements.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u206156.w2532","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63903942","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}

引用次数: 21

Understanding and overcoming barriers to timely discharge from the pediatric units 了解和克服障碍，及时出院的儿科单位

BMJ quality improvement reports Pub Date : 2016-09-01 DOI: 10.1136/bmjquality.u209098.w3772

Amira Mustafa, S. Mahgoub

{"title":"Understanding and overcoming barriers to timely discharge from the pediatric units","authors":"Amira Mustafa, S. Mahgoub","doi":"10.1136/bmjquality.u209098.w3772","DOIUrl":"https://doi.org/10.1136/bmjquality.u209098.w3772","url":null,"abstract":"Delays in the discharge of hospital patients cause a backlog for new admissions from the Emergency Departments (ED), outpatient clinics, and transfers from the Intensive Care Units (ICU). A variety of initiatives have been reported on previously which aim to tackle this problem with variable success. In this quality improvement project, we aimed to increase the proportion of discharged patients who leave the paediatric unit by 12:00 Noon from 7% to 30% by May 2015. A baseline discharge process map was studied to understand the possible causes of the delays. A survey was conducted to look for the most likely cause for the delay. A data collection tool was designed to record the various steps in the discharge process for the pre-and post-intervention phases. Using a series of PDSA cycles, interventions were introduced. The average time for the discharge process was two hours and the baseline average percent of patients discharged by 12:00 Noon was 7% of all discharges. The leading cause for the delayed discharges was late orders by the physicians. Post-intervention, there was increase in the percentage of patients discharged by 12:00 Noon from 7% to 34%. 42% of discharged patients had appropriate reasons for afternoon discharge. By excluding these patients, the percentage of adjusted timely morning discharge has increased from 36% to 70%. Continuous monitoring and engagement of teams with regular feedback were the most important factors in achieving and sustaining improvement in the timely morning discharge of patients from our paediatric units.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u209098.w3772","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63907975","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}

引用次数: 18