Selecting a Quality Improvement Project: 5 Questions for Trainees and Mentors
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ABSTRACT:
SUBMITTER: Horstman M
PROVIDER: S-EPMC10539144 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
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Project description:Venesection is a widely practised procedure, involving the removal of a unit of blood in order to treat haemochromatosis and polycythaemia. It is still well regarded due to a lack of better alternatives and a small side effect profile. At Barnet General Hospital, venesection has recently been a physician led service, unlike its neighbouring hospital at Chase Farm Hospital, which has a well run nurse led service. The current service being run at Barnet Hospital was beset with problems, including delays in service provision and discharge, using junior doctors who may not be comfortable with or have knowledge of pre and post procedure checks. Furthermore, the medical day treatment unit is comprised of highly skilled nurses. 100% of nursing staff felt comfortable gaining venous access, but none had any formal training. Following a practical tutorial, followed by formal teaching, the nurses now run the venesection service. This has been done at no cost to the hospital, has sped up discharges and this has subsequently led to the capacity of the unit to venesect patients to increase by 100%.
| S-EPMC4693056 | biostudies-literature
Project description:IntroductionThis quality improvement project has tracked postoperative measures for more than 5 years as we implement an opioid-free laparoscopic appendectomy protocol.MethodsWe used statistical process control charts to analyze real-world data captured from the medical record. Outcome measures included postanesthesia care unit (PACU) length of stay (LOS), 24-hour maximum pain scores, PACU intravenous opioid medication administration, hospital LOS, and postoperative day 1 morphine milliequivalent requirement. We monitored this family of measures in all appendectomy patients as our team adopted the opioid-free protocol; in addition, we rationally subgrouped patients into the opioid-receiving group versus the opioid-free group.ResultsA total of 2,483 pediatric laparoscopic appendectomies were performed between January 1, 2017, and June 30, 2023. Starting in 2017, we encouraged anesthesia providers to follow an opioid-free protocol for laparoscopic appendectomy. By October 2019, a ~50% adoption rate of intraoperative opioid-free anesthetic management had occurred. In total, 1,486 patients received opioids and 997 patients did not (opioid-free). No special cause variation was observed for the measured outcomes, including maximum 24-hour pain scores or PACU rescue opioid administration. We did notice reduced hospital LOS in addition to a reduced postoperative day 1 morphine milliequivalent requirement in the opioid-free group.ConclusionsThis quality improvement project implemented an opioid-free laparoscopic appendectomy protocol for pediatric patients without adversely affecting pain scores, rate of PACU rescue opioids, or hospital LOS.
| S-EPMC11838154 | biostudies-literature
Project description:Quality Improvement (QI) projects are seen increasingly as more valuable and effective in developing services than traditional audit. However, the development of this methodology has been slower in the mental health field and QI projects are new to most psychiatrists. This project describes a way of engaging trainees across Avon and Wiltshire Mental Health Partnership (AWP) Trust and the Severn School of Psychiatry in QI projects, using QI methodology itself. Through the implementation and development of training sessions and simple, low cost and sustainable interventions over a 10 month period, two thirds of core trainees and over a half of the advanced psychiatry trainees in the School are now participating in 28 individual QI projects and QI project methodology is to become embedded in the core psychiatry training course. As an additional positive outcome, specialty doctors, consultants, foundation doctors, GP trainees, medical students, as well as the wider multidisciplinary team, have all become engaged in QI projects alongside trainees, working with service users and their families to identify problems to tackle and ideas to test.
| S-EPMC4693062 | biostudies-literature
Project description:Mentoring has been a subject of study for 50 years. Most studies of mentoring programs evaluate the effect of the program on the participants but do not evaluate if different mentors have different effects on mentees. Open-source software (OSS) is software with a license that allows it to be freely used by other people. Such software has become foundational to the world economy. However, many OSS projects get abandoned by their creators. Various nonprofit organizations have arisen to help OSS projects become sustainable. One of the key services offered by many of these nonprofit organizations is a mentorship program where experienced OSS developers advise nascent projects on how to achieve sustainability. We use data from the Apache Software Foundation Incubator program where 303 mentors have mentored 286 projects, with most mentoring more than one project, to address this question: Is who a project has as a mentor associated with variation in project success? Who a project has as a mentor accounts for 45% of the variation in project outcomes, with some mentors being associated with positive and some with negative outcomes. These mentors could offer insights into how to improve the mentoring program. This result also demonstrates, more broadly, that the nature of specific mentoring relationships may be important to understanding how mentors impact outcomes in other mentoring programs.
| S-EPMC9384984 | biostudies-literature
Project description:Blood tests are a seemingly basic investigation, but are often a vital part of directing patient management. Despite the importance of this everyday process, we indentified the potential for improvement of the current phlebotomy service in our hospital, as both junior doctors and phlebotomists reported a lack of communication and standardised practice across the wards. Resulting delays in obtaining blood test results can impact detrimentally on patient safety and management. We designed a survey which highlighted inefficient handovers and discrepancies between wards as driving factors behind this. We therefore aimed to improve communication between phlebotomists and doctors, as well as the overall organisation of the service. This took the form of the "Phlebotomy Box," a box file system offering a set location for blood stickers to be situated. The box concept was optimised on a series of medical and surgical wards, incorporating multidisciplinary feedback from relevant teams. We measured how many untaken bloods were handed over to medical staff continuously, both pre- and post implementation of the phlebotomy box. Our baseline ward demonstrated poor handover rates of untaken bloods, ranging from 0% to 40%. This increased to a consistent 100% following introduction of the Phlebotomy Box and ongoing staff education. Once optimised, the box was trialled on a further two medical wards and one surgical ward, achieving 100% handover from an initial 0% to 67%. Quantitative improvement was also reflected qualitatively in widespread staff surveys, with overwhelmingly positive support and acceptance. In summary, the Phlebotomy Box innovation has led to 100% of untaken bloods being effectively handed over. We have demonstrated a significant improvement in communication and efficiency within the phlebotomy service, with tangible benefits to patient care, as minimising time lags can prevent delays in clinical decisions. The phlebotomy box represents a simplistic, sustainable intervention that could be easily replicated in other Trusts.
| S-EPMC5015820 | biostudies-other
Project description:To design a hospital-standardised phlebotomy handover method to improve the communication between phlebotomists and doctors. To reduce delays in patient management and discharges which occur due to poor handover. Qualitative data was collected to gauge junior doctors' experiences of the current handover process. Quantitative data was collected over a two-week period across two medical wards to measure the proportion of requested bloods that could not be taken by phlebotomists that were successfully handed over to doctors. Brainstorming sessions were held with junior doctors, phlebotomists and ward staff in order to design a, cheap, effective, sustainable, hospital-wide method of handover. The chosen intervention was a red ward-based phlebotomy handover folder for phlebotomists to place stickers of unbled patients in. The folder was trialled on two medical wards. Feedback obtained helped improve the intervention before implementing it hospital-wide. Seventeen of 23 junior doctors (74%) felt that a formalised handover process would be very useful. Baseline measurement over two weeks revealed that 24/129 blood tests ordered for phlebotomists to take were not taken. Only three (13%) of these were handed over to doctors. Post-intervention, 18/106 blood tests requested were not taken. All 18 (100%) were successfully handed over to doctors. Implementation of a hospital-standardised phlebotomy handover folder dramatically improved the communication and handover between phlebotomists and doctors allowing for medical teams to take prompt action on unbled patients. This intervention will help improve patient safety, reduce delays in management/discharge and reduce the number of jobs handed over to evening on-call teams.
| S-EPMC4645808 | biostudies-literature
Project description:Approximately one in four adults in the UK will experience a mental health difficulty at some point in their life. This figure is approximately 400 million people worldwide.[1] Depression alone is currently estimated to cost the UK 1.7% of GDP and is one of the largest causes of ill health in the world.[2] For conditions like psychosis, evidence tells us that people have poorer quality of life outcomes, are more likely to die early, become obese, smoke, be unemployed, and have long term physical conditions than average.[3] People's social situation is also likely to be more complex, with housing needs, social isolation, stigma, and poverty.[4] All of these factors can make it hard for a person with a long-term mental health condition, or those supporting them, to hold onto a sense of hope that positive change is possible or that "recovery" towards a life that holds optimum meaning to them is achievable. An innovative "pop up" Recovery College model was co-produced, delivered, and evaluated by a team of people with lived experience of mental health difficulties, known as peer trainers. The Recovery College offered courses containing the best evidence-based knowledge about recovery in mental health, self-care and self-management. Each learning session included theory, personal testament from peer trainers, and volunteers and demonstrations of practical self-care skills and techniques. The courses were open to people experiencing mental health difficulties, their families, friends, and professionals. After the college course finished each student was offered up to three individual coaching sessions to help support putting the lessons learnt from the college into practice. The project aimed to test whether this innovative educational and coaching model could offer hope, knowledge and practical skills in self-management to support resilience and recovery. The project was underpinned by quality improvement methodologies to develop, deliver, and refine the model.
| S-EPMC4693036 | biostudies-literature
Project description: Not available
| S-EPMC2249678 | biostudies-literature
Project description:BackgroundPost-stroke delirium (POD) in patients on stroke units (SU) is associated with an increased risk for complications and poorer clinical outcome. The objective was to reduce the severity of POD by implementing an interprofessional delirium-management.MethodsMulticentric quality-improvement project on five SU implementing a delirium-management with pre/post-comparison. Primary outcome was severity of POD, assessed with the Nursing Delirium Screening Scale (Nu-DESC). Secondary outcome parameters were POD incidence, duration, modified Rankin Scale (mRS), length of stay in SU and hospital, mortality, and others.ResultsOut of a total of 799 patients, 59.4% (n = 475) could be included with 9.5% (n = 45) being delirious. Implementation of a delirium-management led to reduced POD severity; Nu-DESC median: pre: 3.5 (interquartile range 2.6-4.7) vs. post 3.0 (2.2-4.0), albeit not significant (p = 0.154). Other outcome parameters were not meaningful different. In the post-period, delirium-management could be delivered to 75% (n = 18) of delirious patients, and only 24 (53.3%) of delirious patients required pharmacological treatments. Patients with a more severe stroke and POD remained on their disability levels, compared to similar affected, non-delirious patients who improved.ConclusionsImplementation of delirium-management on SU is feasible and can be delivered to most patients, but with limited effects. Nursing interventions as first choice could be delivered to the majority of patients, and only the half required pharmacological treatments. Delirium-management may lead to reduced severity of POD but had only partial effects on duration of POD or length of stay. POD hampers rehabilitation, especially in patients with more severe stroke.RegistryDRKS, DRKS00021436. Registered 04/17/2020, www.drks.de/DRKS00021436 .
| S-EPMC9217833 | biostudies-literature
Project description:Never events in the operating room are a surgeon's nightmare, with an incidence rate of 54%. These events are highly stressful for theatre staff and significantly compromise patient safety. The aim of this project is to avoid never events in trauma and orthopaedic theatres by ensuring that theatre staff adhere to the surgical pause and imaging pause protocols through regular audits.This prospective study was conducted in both trauma and elective orthopaedic theatres. It involved theatre staff members who were not part of the surgical team. The study was designed to take place on random days across different theatres, with the operating team unaware of the audit to ensure genuine behaviour and compliance.The audits focused on observing whether the surgical and imaging pause protocols were followed correctly. These protocols are critical for verifying patient identity, the surgical site, and the specific procedure and confirming the correct imaging is available and reviewed before proceeding. Data collected and corrective actions were implemented when non-compliance was observed, and data on compliance rates were systematically collected and analysed.Preliminary results indicate a substantial increase in compliance with both the surgical and imaging pause protocols, corresponding with a reduction in the occurrence of never events. Theatre staff reported improved understanding and confidence in performing these safety checks The use of external auditors who were not part of the surgical team provided an unbiased assessment of compliance, enhancing the reliability of the findings.In conclusion, the project demonstrates that regular audits, and data collected by non-surgical team staff, significantly improve adherence to surgical and imaging pause protocols, thereby reducing the incidence of never events in trauma and orthopaedic theatres. This approach highlights the importance of continuous monitoring and education in fostering a culture of safety and precision in surgical practice.
| S-EPMC11772924 | biostudies-literature