The EcoHD score: a quality improvement tool for the auto-evaluation of the environmental sustainability process in hemodialysis centers

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Patient satisfaction with hospital catering services is a vital indicator of healthcare quality, particularly among hemodialysis patients whose nutritional requirements are highly specific and restrictive. Objective: This study aimed to assess and evaluate patient satisfaction with hospital catering services at the Hemodialysis Center in Zliten City, Libya. Methods: This study used a descriptive cross-sectional design with regard to the catering services provided to them. A total of 200 patients participated in the study, and data were collected using a structured questionnaire that included demographic information, Likert-scale items, and open-ended questions. The data were analyzed using descriptive statistics and Chi-square tests. The findings revealed that the majority of patients were male (59%) and within the age range of 40–65 years. The highest satisfaction levels were reported for food hygiene (4.0 ± 0.5) and food temperature (3.8 ± 0.8), while the lowest satisfaction scores were given to meal variety (2.8 ± 1.1) and dietary suitability (3.1 ± 1.0). Statistical analysis indicated a significant association between longer dialysis duration and dissatisfaction with meal variety (p = 0.013), while no significant differences were observed based on gender or age. Open-ended feedback further emphasized concerns about limited variety, bland taste, and the lack of meals tailored to cultural or dietary needs. Overall, the results highlight strengths in hygiene and food safety but reveal deficiencies in variety and dietary suitability. These findings suggest the need for improving hospital menus through greater diversification, cultural adaptation, and closer alignment with patients’ dietary requirements in order to enhance patient satisfaction and overall quality of Healthcare, Conclusion: The study highlights the need for improvements in hospital catering services, particularly in meal diversity and renal-specific dietary planning. Incorporating patient feedback into food service planning can enhance satisfaction, support nutritional care, and improve the overall treatment experience for hemodialysis patients. These findings can inform future quality improvement initiatives in Libyan hospital settings.

Background: The Centers for Disease Control and Prevention developed the Infection Control Assessment and Response (ICAR) tools to assist health departments in assessing infection prevention practices and to guide quality improvement activities. ICAR tools are available for the following healthcare settings: acute care (including hospitals and long-term acute-care hospitals), outpatient, long-term care, and hemodialysis. The Virginia Healthcare-Associated Infections and Antimicrobial Resistance (HAI/AR) Program developed a scoring report that provides a quantitative measure for each infection control domain and summarizes strengths and opportunities for improvement. The scoring report aims to provide feedback to facility administration in a simple, user-friendly way to increase their engagement, prioritize follow-up actions for areas in need of improvement, and to analyze statewide data systematically to identify and address major defects. Methods: Scoring reports were developed for acute care, long-term care, and hemodialysis facilities. Each report includes 2 tables: infection control domains for gap assessment and direct observation of facility practices. The first table has rows for infection control assessment domains, and the second table summarizes direct observations conducted during the ICAR visit such as hand hygiene, point-of-care testing, and wound dressing change. Each row is stratified by the score, which is determined by responses to the ICAR tool, for each domain or observation, interpretation of the score, strengths, and opportunities for improvement. Stoplight colors with assigned percentages are used for score interpretation. ICAR visit results from 5 long-term care facilities (LTCFs) and 3 hemodialysis centers were entered into a REDCap database and analyzed. Results: Data from these visits elucidated consistent gaps in Infection Prevention and Control programs and defined what practices are most lacking. The low-performance areas in LTCFs included hand hygiene, personal protective equipment (PPE), environmental cleaning and disinfection, and antimicrobial stewardship. In hemodialysis centers, respiratory hygiene and cough etiquette, injection safety, and surveillance and disease reporting had the lowest scores. Positive feedback on the scoring report was received from facilities and other state HAI programs. Conclusion: The Virginia HAI/AR Program developed a scoring report that engaged healthcare facility administration, including corporate leadership, by providing a composite score with interpretation. The report prioritized areas for improvement and guided public health follow-up visits. Common gaps in infection prevention practices were identified across facilities, and this information has been used to determine statewide training needs by facility type. The scoring report is an effective method to help allocate state resources and improve communication and engagement of healthcare facilities. Reports can be adapted for use in other jurisdictions.Funding: NoneDisclosures: None

Targeting specimen misprocessing safety events with failure modes and effects analysis.

Using the Model for Improvement and Plan-Do-Study-Act to effect SMART change and advance quality.

Introduction: Quality improvement and safety in intensive care are rapidly evolving topics. However, there is no gold standard for assessing quality improvement in intensive care medicine yet. In 2007 a pilot project in German intensive care units (ICUs) started using voluntary peer reviews as an innovative tool for quality assessment and improvement. We describe the method of voluntary peer review and assessed its feasibility by evaluating anonymized peer review reports and analysed the thematic clusters highlighted in these reports.Methods: Retrospective data analysis from 22 anonymous reports of peer reviews. All ICUs – representing over 300 patient beds – had undergone voluntary peer review. Data were retrieved from reports of peers of the review teams and representatives of visited ICUs. Data were analysed with regard to number of topics addressed and results of assessment questionnaires. Reports of strengths, weaknesses, opportunities and threats (SWOT reports) of these ICUs are presented. Results: External assessment of structure, process and outcome indicators revealed high percentages of adherence to predefined quality goals. In the SWOT reports 11 main thematic clusters were identified representative for common ICUs. 58.1% of mentioned topics covered personnel issues, team and communication issues as well as organisation and treatment standards. The most mentioned weaknesses were observed in the issues documentation/reporting, hygiene and ethics. We identified several unique patterns regarding quality in the ICU of which long-term personnel problems und lack of good reporting methods were most interestingConclusion: Voluntary peer review could be established as a feasible and valuable tool for quality improvement. Peer reports addressed common areas of interest in intensive care medicine in more detail compared to other methods like measurement of quality indicators.

O-15: ImproveCareNow (ICN) as a quality improvement (QI) tool in a paediatric inflammatory bowel disease (pIBD)

Background In healthcare, quality improvement (QI) tools are predominantly used to address human, system and process factors to improve clinical care. We believe that QI tools can also be used to address similar factors in medical education, to facilitate improvement in learning outcomes and competencies for new junior doctors in a postgraduate medical education program in our anaesthesia and critical care unit. Methods A stepwise competency checklist was devised to guide the learning and monitor the percentage who had completed the required learning activities and tests at the end of each month. This was tabulated as monthly competency scores, and served as a measure of effectiveness of the education program. QI tools, namely the Fishbone diagram and Pareto chart, were used to identify modifiable root causes and prioritise interventions. Results Monthly competency scores ranged 30–50% at baseline, and improved to 60–75% after 6 months, with the implementation of a series of QI interventions. Conclusion QI tools were utilised to guide education interventions, with consequent improvement in the monthly competency scores of our junior doctors. Focused improvement cycles that are aligned to learning outcomes are key to the success of using QI tools in medical education.

Developing an Infection Prevention Position for a Multi-Center Hospital-based Dialysis System

Bloodstream Infection Rates in Outpatient Hemodialysis Facilities Participating in a Collaborative Prevention Effort: A Quality Improvement Report

Intradialytic Oral Nutritional Supplements Improve Quality of Life

Psychomotor performance in lung transplant recipients: Simple reaction time

Background and Aims The number of patients in chronic hemodialysis with a high demand for socio-economic resources is growing worldwide. Home HemoDialysis (HHD), particularly when aided by Information Technology, may help in decreasing unnecessary travels, reducing costs and promoting the active role of patient and caregiver. Nevertheless, it remains significantly underused (Europe: <2% of dialysis patients). The inability or unwillingness of patients and their families to participate in their own treatment is one of the most important barriers to HHD. It is already known that HHD delivered by a paid caregiver and supported by public funds is well accepted by patients. As a step forward, we decided to combine assisted HHD with teledialysis (TD) to encourage patients to transition towards self-assisted HHD. Since 2018, our Department has been providing HHD with the assistance of Personal Support Workers (PSW). In 2023, a TD platform was built, to promote the empowerment and incorporate patients in HHD into the daily management at the central institution. Herein we present a preliminary economic analyses to determine the direct and indirect cost savings of HHD, implemented with TD, compared to in-person care. Method Currently, in the ASL Lecce, the Regional Health System of the province of Lecce, Puglia, Italy, 800 patients undergo haemodialytic treatment. A telehealth hub&spoke model of dialysis care across a distributed network was created to connect facilities within the hospital, satellite dialysis units, and patients receiving HHD. The HHD program started in June 1st, 2018; since then, 123 patients have been treated. During pandemic restrictions, HHD provided an effective renal care model for 39 patients with COVID-19. On 1st September 2023, the 29 patients receiving HHD were involved in the telemedicine-assisted dialysis model that was implemented on a tender basis (clinical-demographic data in Table 1). The TD platform is intended as a set of infrastructural, software and hardware components functional for continuous monitoring dialysis treatments, as depicted in Fig. 1, requiring the availability of real-time consultations with nephrologists. Results We report the costs related to self-assisted HHD, PSW-assisted HHD and TD programs as awarded in the call for tender. The overall costs of the TD platform are listed in Table 2. In Table 3 the effective costs, indicated as direct (in center hemodialysis or HHD) and indirect (mainly travels, only for in-center hemodialysis), are reported. As a consequence, the TD program will allow to save the annual costs related to transport as follows: A similar evaluation may be proposed for all in-center dialytic techniques compared to HHD plus TD service. Conclusion Given the growing need for economic and environmental sustainability, the expected savings related to a higher numbers of patients attracted to HHD, particularly self-assisted, are noteworthy. Since patients involved in TD program are mostly elderly and suffer from multiple comorbidities, the high cost of the TD-assisted modalities may be justified by the reduced complications and hospitalizations and the promotion of the patient empowerment. At the end of a 5-years period, a cost-minimization analysis of the project will be performed to investigate on the effective utility of TD in increasing the number of HHD eligible patients and ameliorating the overall quality of life.

End-stage renal disease patients' experience of care is an integral part of the assessment of the quality of the care provided at hemodialysis centers and is needed to promote patient choice, quality improvement, and accountability. The purpose of this study is to evaluate the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS®) survey and its equivalence in different age, gender, race, and education subgroups. The ICH-CAHPS survey was administered to 1454 patients from 32 dialysis facilities. For the characteristics compared, the sample had 756 participants younger than 65years old, 739 men, 516 Black, 567 White, and 970 with less than high school diploma. Three different patient experience constructs were studied including nephrologist's communication and caring, quality of care and operations, and providing information to patients. We used item response theory analysis to examine the possibility of differential item functioning (DIF) by patient age, gender, race, and education separately after controlling for the other DIF characteristics and additional confounding variables including survey mode, mental, and general health status as well as duration on dialysis. The three constructs studied were unidimensional and no major DIF was observed on the composites. Some non-equivalences were observed when confounders were not controlled for, suggesting that such covariates can be important factors in understanding the possibility of disparity in patients' experience. The ICH-CAHPS is a promising survey to elicit hemodialysis patients' experience that has good psychometric properties and provides a standardized tool for assessing age, gender, race, or education disparity.

Objective: To use quality improvement tools to optimize pediatric behavioral health (BH) integration, a promising approach to increasing access to behavioral health care services for children. Method: As part of the practice transformation efforts of a pediatric BH integration initiative implemented in three community health centers, we used Failure Modes and Effects Analysis (FMEA), a quality improvement tool, to examine barriers in implementing 2 core BH integration workflows: universal screening to identify developmental and behavioral concerns and implementation of real-time “warm” hand-offs. Results: Failure modes fell broadly into 2 categories across both workflows: (a) parental/caregiver characteristics and receptivity to the new workflow and (b) consistent implementation of the workflow by health center staff. Failures related to parental/caregiver characteristics included low literacy, language incongruence, and feeling burdened, intimidated, or offended by the screening process. Failures related to implementation of the workflow involved difficulties in administration of the correct age-appropriate screening form and incomplete hand-offs between primary care providers and behavioral health clinicians. Improvement strategies were identified to address both workflow failures, including making changes to electronic medical record functionality, modifying behavioral health clinician scheduling template, and retraining staff. Conclusions: Pediatric primary care practices planning for, or in the early stages of, BH integration may consider using the FMEA tool to support successful implementation. Implications for Impact Statement The present study demonstrates that Failure Modes and Effects Analysis (FMEA) is a useful quality improvement (QI) tool to identify barriers of implementing pediatric BH integration and systematically planning improvement efforts. Behavioral health clinicians, including pediatric psychologists, primary care providers, and other members of the primary care team can leverage these findings to inform behavioral health (BH) integration model implementation in the pediatric primary care setting.