BMJ quality improvement reports最新文献

{"title":"The Handy Approach - Quick Integrated Person Centred Support Preparation.","authors":"Liliana Risi, Juliette Brown, Paul Sugarhood, Babalal Depala, Abi Olowosoyo, Cynthia Tomu, Lorena Gonzalez, Maloles Munoz-Cobo, Oladimeji Adekunle, Okumu Ogwal, Eirlys Evans, Amar Shah","doi":"10.1136/bmjquality.u214461.w5681","DOIUrl":"10.1136/bmjquality.u214461.w5681","url":null,"abstract":"<p><p>Cost effective care requires comprehensive person-centred formulation of solutions. The East London NHS Foundation Trust Community Health Services in Newham have piloted models of Integrated Care called 'Virtual Wards' which aim to keep people living with multiple long-term conditions, well at home by minimising system complexity. These Virtual Wards comprise Interdisciplinary Teams (IDTs) with a General Practitioner (GP) seconded to provide leadership. Historically assessments have been dominated by biomedical approaches with disability emphasised over personal aspirations and ability. New professional skills are needed to organise information from diverse approaches into a common framework, which can enable agreed goals of care to be delivered collaboratively. From June 2014 to January 2016 we aimed to improve the documentation of person-centred goals of care in 100% of our assessments. Change ideas were tested and team development addressed to improve documentation of aspirations for care for people being referred and if achieved, then to test ideas to improve coproduction of care. Change ideas included Enhanced Clinical Supervision (ECS) by a GP with additional expert skills; Flash Teaching (FT) defined as five-minute weekly discussion on topics generated from the case-mix to develop a shared understanding of Integrated Care; Structured Formulation using a novel, quick, integrated assessment framework called the Handy Approach (HA) with the hand as a memory prompt to bring the personal together with the mental, social and physical domains and finally we tested focusing on 'Team Primacy' (mutual regard within the team) to embed behaviour change. 181 cases were tracked and documentation of personal aspirations for care by case showed: ECS 0/21 (0%); FT 5/50 (10%); ECS/FT plus the HA 35/83 (42%); Team Primacy plus ECS/FT/HA 27/27 (100%). By January 2016 prompted by using the Handy Approach in a highly functional team, all members of the IDT consistently documented personal aspirations.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u214461.w5681","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35139801","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}

{"title":"A Multifaceted Quality Improvement Programme to Improve Acute Kidney Injury Care and Outcomes in a Large Teaching Hospital.","authors":"Leonard Ebah,&nbsp;Prasanna Hanumapura,&nbsp;Deryn Waring,&nbsp;Rachael Challiner,&nbsp;Katharine Hayden,&nbsp;Jill Alexander,&nbsp;Robert Henney,&nbsp;Rachel Royston,&nbsp;Cassian Butterworth,&nbsp;Marc Vincent,&nbsp;Susan Heatley,&nbsp;Ged Terriere,&nbsp;Robert Pearson,&nbsp;Alastair Hutchison","doi":"10.1136/bmjquality.u219176.w7476","DOIUrl":"https://doi.org/10.1136/bmjquality.u219176.w7476","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is now widely recognised as a serious health care issue, occurring in up to 25% of hospital in-patients, often with worsening of outcomes. There have been several reports of substandard care in AKI. This quality improvement (QI) programme aimed to improve AKI care and outcomes in a large teaching hospital. Areas of documented poor AKI care were identified and specific improvement activities implemented through sequential Plan-Do-Study-Act (PDSA) cycles. An electronic alert system (e-alert) for AKI was developed, a Priority Care Checklist (PCC) was tested with the aid of specialist nurses whilst targeted education activities were carried out and data on care processes and outcomes monitored. The e-alert had a sensitivity of 99% for the detection of new cases of AKI. Key aspects of the PCC saw significant improvements in their attainment: Detection of AKI within 24 hours from 53% to 100%, fluid assessment from 42% to 90%, drug review 48% to 95% and adherence to nine key aspects of care from 40% to 90%. There was a significant reduction in variability of delivered AKI care. AKI incidence reduced from 9% of all hospitalisations at baseline to 6.5% (28% reduction), AKI related length of stay reduced from 22.1 days to 17 days (23% reduction) and time to recovery (AKI days) 15.5 to 9.8 days (36% reduction). AKI related deaths also showed a trend towards reduction, from an average of 38 deaths to 34 (10.5%). The number of cases of hospital acquired AKI were reduced by 28% from 120 to 86 per month. This study demonstrates significant improvements related to a QI programme combining e-alerts, a checklist implemented by a nurse and education in improving key processes of care. This resulted in sustained improvement in key patient outcomes.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u219176.w7476","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35083658","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}

{"title":"Increasing the uptake of electronic prescribing in primary care.","authors":"Nazia Imambaccus,&nbsp;Samuel Glace,&nbsp;Rory Heath","doi":"10.1136/bmjquality.u212185.w4870","DOIUrl":"https://doi.org/10.1136/bmjquality.u212185.w4870","url":null,"abstract":"<p><p>Electronic prescribing is a form of paperless prescribing that is reported to reduce prescription mistakes and increases the cost effectiveness of the process. In England, around 1.5 million prescriptions are generated in general practice daily. Thus by reducing costs and increasing efficiency of this system through electronic prescribing, costs can be driven down. In this Quality Improvement project, a GP practice in London with approximately 3000 patients on record was assessed for its electronic prescribing rates throughout 3 intervention cycles over a period of 2 months. A baseline value of how many patients were already assigned to electronic prescribing was obtained and a period of normal change over a fortnight without any intervention was also assessed (an increase in 15 patients). These values were then used to illustrate any benefits of the interventions completed during the intervention cycles. An introduction of a new electronic prescribing form saw fortnightly uptake rates increase by 20%. The addition of leaflets and posters in the practice produced a decrease of 26% in fortnightly uptake rate. The final intervention included a staff meeting, computer notes to remind staff of electronic prescribing and attaching the new forms to paper prescriptions. This saw an increase in rates of 80% over two weeks. Overall, this project has illustrated that information provision of electronic prescribing needs to be more than just forms or posters. Indeed, the most effective way of improving rates relies on having a driven and motivated staff who are themselves well informed on electronic prescribing alongside adequate information placement for patients to access.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u212185.w4870","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35083654","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}

{"title":"Hydration Stickers - Improving oral hydration in vulnerable patients.","authors":"Alysha Bhatti,&nbsp;Javier Ash,&nbsp;Shyam Gokani,&nbsp;Suveer Singh","doi":"10.1136/bmjquality.u211657.w6106","DOIUrl":"https://doi.org/10.1136/bmjquality.u211657.w6106","url":null,"abstract":"<p><p>Dehydration is a growing problem among elderly patients in hospital wards. Incidents such as those raised in the Francis Report highlight a problem that may not have been sufficiently addressed by current schemes. This improvement project aimed to identify the barriers faced by staff in improving oral hydration and to design and implement an effective solution. A 33 patient pilot study carried out at Chelsea & Westminster Hospital NHS Trust, United Kingdom, revealed that a significant proportion of patients were reported to be dehydrated on admission, with few having their hydration needs addressed. Staff cited time pressures and unclear task responsibility as the major barriers. The intervention was a Hydration Sticker education scheme. These stickers were placed on patient cups, notes and beside areas as a visual prompt for staff and family members to encourage the patient to drink. The intervention was implemented on the Acute Assessment Unit and Stroke ward through a poster campaign. The Hydration Stickers scheme resulted in a 6.5-fold increase in patients' hydration needs being assessed and addressed. Coupled with the low implementation cost and ease of use, Hydration Stickers may be a simple, effective, transferable and sustainable solution to the problem of dehydration among elderly inpatients.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u211657.w6106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35083655","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}

{"title":"Choosing Wisely: A Quality Improvement Initiative to Decrease Unnecessary Preoperative Testing.","authors":"John Matulis, Stephen Liu, John Mecchella, Frederick North, Alison Holmes","doi":"10.1136/bmjquality.u216281.w6691","DOIUrl":"10.1136/bmjquality.u216281.w6691","url":null,"abstract":"<p><p>Dartmouth-Hitchcock Medical Center is a rural, academic medical center in the northeastern United States; its General Internal Medicine (GIM) division performs about 900 low and intermediate surgical risk preoperative evaluations annually. Routine preoperative testing in these evaluations is widely considered a low-value service. Our baseline data sample showed unnecessary testing rates of approximately 36%. A multi-disciplinary team used a micro-systems approach to analyze the existing process and formulate a rapid cycle improvement strategy. Our improvement efforts focused on implementation of a Nurse Practitioner and Physician Assistant (Associate Provider) clinic to incorporate standardized protocols for preoperative assessment. Plan-Do-Study-Act (PDSA) cycles included creation of a dedicated Associate Provider run preoperative clinic, modifying and operationalizing a scheduling scheme, and creating and implementing Electronic Health Record (EHR) tools. We used Statistical Process Control (SPC) methods to analyze time ordered data for the usual care process and to compare performance with the novel preoperative clinic. The Associate Provider preoperative clinic showed unnecessary testing rates of 4% compared with 23% in the usual care cohort (p<.001) within 3 months of implementation. When testing rates across the entire division were analyzed, there was no significant change. In our GIM division this preoperative clinic was effectively staffed with Associate Providers. Dedicated leadership support, incorporating input from a diverse improvement team, and balancing innovation with other clinical needs are important elements for success. We hypothesize that protecting clinical time to focus on preoperative care, monitoring and modifying scheduling processes, and improving support for electronic health record tool implementation would have yielded further performance improvements. Our experience provides valuable learning for other primary care practices with similar challenges. Identifying appropriate patients for inclusion in these clinic visits while optimizing primary care provider collaboration are important future challenges.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b6/bc/bmjqir.u216281.w6691.PMC5457968.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35083652","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}

{"title":"Evaluating the quality improvement impact of the Global Tracheostomy Collaborative in four diverse NHS hospitals.","authors":"Brendan A McGrath, James Lynch, Barbarella Bonvento, Sarah Wallace, Val Poole, Ann Farrell, Cristina Diaz, Sadie Khwaja, David W Roberson","doi":"10.1136/bmjquality.u220636.w7996","DOIUrl":"10.1136/bmjquality.u220636.w7996","url":null,"abstract":"<p><p>Tracheostomies are predominantly used in Head & Neck Surgery and the critically ill. The needs of these complex patients frequently cross traditional speciality working boundaries and locations and any resulting airway problems can rapidly lead to significant harm. The Global Tracheostomy Collaborative (GTC) was formed in 2012 with the aim of bringing together international expertise in tracheostomy care in order to bring about rapid adoption of best practices and to improve the quality and safety of care to this vulnerable group. The primary aim of this project was to improve the safety and quality of care delivered to adult patients with new or existing tracheostomies. We implemented changes guided by the GTC using multiple PDSA cycles over a 12-month period. Interventions were across three themes: educational, patient-centred (earlier vocalisation and enteral intake) and organisational. We hypothesised that systematic healthcare improvements would reduce the severity of harm resulting from tracheostomy-related safety incidents and improve surrogate markers of the quality of patient-centred care. Furthermore, we hypothesised that raising the quality and safety of healthcare services would lead to more efficient care, measured by earlier tracheostomy decannulation times and reduced hospital lengths of stay. This Quality Improvement project implemented the GTC into four diverse NHS Trusts in Greater Manchester. Key drivers implemented included multidisciplinary tracheostomy steering groups, ward rounds and bedside teams, standardisation of tracheostomy protocols, staff education and meaningful involvement of patient and family. Surrogates for the quality and safety of care were captured for all patients using a bespoke database. Implementing the GTC into four NHS Trusts rapidly and positively impacted on patient safety metrics and surrogates for the quality of care delivered. It is likely that the comprehensive resources of the GTC will be of benefit to other NHS hospitals and indeed other healthcare systems around the world.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u220636.w7996","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35083216","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}

{"title":"Improving bowel preparation for colonoscopy in a cost effective manner.","authors":"Syed Anjum Gardezi,&nbsp;Clare Tibbatts","doi":"10.1136/bmjquality.u204560.w5376","DOIUrl":"https://doi.org/10.1136/bmjquality.u204560.w5376","url":null,"abstract":"<p><p>Colonoscopy is a key investigation used to exclude large bowel pathologies including surveillance for CRC (Colorectal cancer) Poor bowel preparation (bowel prep) is one of the most important factors affecting its diagnostic yield. Different formulations of bowel prep are currently in use depending upon patient tolerance, indication & co-morbidities. In University Hospital Llandough we retrospectively reviewed the outcome of colonoscopies performed over period of 3 months, in relation to the type and outcome of bowel preparations used. We implemented a change of patient instruction and pre-assessment of bowel preparation prescribed. We repeated the same measurements over 3 different cycles on 3 different occasions and compared the outcome. We noticed that quality of bowel preparation noticeably improved from 80% to almost 93% if patients were given appropriate advice in a written format, prior to procedure. In addition to improvement in the quality of assessment & reducing the number of repeat procedures, by changing the bowel preparation product and postage methods we estimated savings of almost £150,000 for the trust in a year.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u204560.w5376","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35083657","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}

{"title":"Improving inpatient care for older adults: Implementing Dementia Commissioning for Quality and Innovation (CQUIN).","authors":"Judith R Harrison","doi":"10.1136/bmjquality.u212202.w4875","DOIUrl":"10.1136/bmjquality.u212202.w4875","url":null,"abstract":"<p><p>Dementia is a common condition, and people with dementia occupy around 25% of hospital beds. Commissioning for Quality and Innovation (CQUIN) is an NHS payment framework that links part of English healthcare providers' income to quality improvement. The dementia CQUIN goals are designed to encourage the recognition of dementia in hospital. The Royal Surrey County Hospital, Guildford, introduced new procedures to meet the dementia CQUIN targets. Adherence to the changes was a problem. This project aimed to improve hospital's implementation strategy. At baseline, completion rates for dementia CQUIN assessments were just 27%. Interventions were informed by semi-structured interviews with junior doctors and dementia leads in neighbouring trusts. Progress was measured by regular audits and interventions were made over several months. Changes suggested by junior doctors and nurses proved very effective, and involving the multidisciplinary team produced the most significant improvement. Gradual progress was made until we achieved and maintained 90% completion for dementia assessments. In conclusion, we made changes to working practices to achieve the CQUIN targets and promoted quality care for older adults. Our experience highlighted the importance of involving multidisciplinary frontline staff in the design of service changes.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/21/1b/bmjqir.u212202.w4875.PMC5457972.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35083656","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}

{"title":"Design and Implementation of a Trauma Care Bundle at a Community Hospital.","authors":"Ryan Andres, Elan Hahn, Steffen de Kok, Rafi Setrak, Jeffrey Doyle, Allison Brown","doi":"10.1136/bmjquality.u218901.w5195","DOIUrl":"10.1136/bmjquality.u218901.w5195","url":null,"abstract":"<p><p>The Niagara Health System (NHS) in Ontario, Canada is comprised of three non-designated trauma center (NTC) hospitals which provide primary care to approximately 100 trauma patients annually. NTCs often lack standardized resources such as trauma surgeons, trauma-trained emergency room physicians, Advanced Trauma Life Support certified staff, trauma protocols, and other resources commonly found at designated trauma centers. Studies indicate that these differences contribute to poorer outcomes for trauma patients treated at community hospitals in Ontario, including the NTC hospitals of the NHS. In other settings healthcare checklists and bundles have proven effective in streamlining processes to ensure effective, efficient and timely patient care. Quality Improvement (QI) tools and methods were used to design, implement, and evaluate a trauma care bundle at one of the NHS's community hospitals. We assessed outcome and process measures through a chart audit of all trauma care patients in the NHS from July 2015 - November 2015. A Safety Attitudes Questionnaire (SAQ) was administered to health system staff who were involved in the pilot to assess balancing measures. Between July-November 2015, 39 patients were treated at the St. Catharines Hospital that were identified as either Canadian Triage and Acuity Scale (CTAS) I or CTAS II trauma patients. Of those 39 major trauma patients, 15 received care using the trauma care bundle, representing a 38% uptake. Patients who received care with the trauma bundle had an average Emergency Department (ED) length of stay (LOS) of 1.7 hours, compared with those patients in whom the bundle was not used, whose average ED LOS was 3.4 hours. The SAQ administered to ED physicians who used the bundle (n=10) highlighted the impact on ED patient safety. These early findings suggest that the bundle provides a substantial improvement to the current trauma care process within the Niagara Health System.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2b/3c/bmjqir.u218901.w5195.PMC5457967.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35083651","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}

{"title":"Proper Electronic Order Linkage of Electrocardiograms at a Large Children's Hospital Improves Reporting and Revenue.","authors":"David S Spar,&nbsp;Wayne A Mays,&nbsp;David S Cooper,&nbsp;Lucille Sullivan,&nbsp;Terra Hicks,&nbsp;Jeffrey B Anderson","doi":"10.1136/bmjquality.u217231.w6746","DOIUrl":"https://doi.org/10.1136/bmjquality.u217231.w6746","url":null,"abstract":"<p><p>Electrocardiograms (ECGs) are performed to determine an individual's cardiac rhythm. Approximately 25,000 ECGs are performed yearly throughout our hospital system. Historically only 68% of all ECGs were performed with the proper order linked to the electronic ECG reading system (MUSE). Failure to link the orders to the electronic reading system leads to problems in patient safety, reporting and hospital revenue. Our aim was to increase the percentage of linked ECG orders in MUSE compared to total ECGs performed from 68% to 95%. We created a detailed process map of ECG order linking to the MUSE electronic system. FMEA and Pareto chart creation were used to determine etiology of process failures. Multiple interventions (LOR1 to LOR3) were implemented utilizing the PDSA technique. Process control charts were used to evaluate change. FMEA and Pareto chart determined most common failures were related to: 1) ECG order not electronically acquired properly, 2) duplicate ECGs and 3) ECG order was not electronically placed. We performed multiple interventions including: 1) ECG performance education, 2) created reminders on the ECG machines, 3) specialized electronic linking system for physician readers and 4) bar-code scanners for all ECG machines. These changes improved ECG order linking to MUSE from 68% to 95% over 6-months. In direct comparison between fiscal year (FY) FY2014 to FY2015, the number of ECGs performed increased 2% while billing increased by 23%. Utilization of quality improvement methodology allowed us to identify failures for ECG order linking. We established multiple successful interventions amongst different hospital locations and improved our compliance, billing and reporting of ECGs.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u217231.w6746","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35083653","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}