Quality Assessment Improvement Research Articles

Measuring the quality of patient-provider relationships in serious illness: A scoping review.

People affected by serious illness face several threats to their well-being: physical symptoms, psychological distress, disrupted social relations, and spiritual/existential crises. Relationships with clinicians provide a form of structured support that promotes shared decision-making and adaptive stress coping. Measuring relationship quality may improve quality assessment and patient care outcomes. However, researchers and those promoting quality improvement lack clear guidance on measuring this. To identify and assess items from valid measures of patient-provider relationship quality in serious illness settings for guiding quality assessment. Scoping review. We identified peer-reviewed, English-language articles published from 1990 to 2023 in CINAHL, Embase, and PubMed. Eligible articles described the validation of measures assessing healthcare experiences of patient populations characterized by serious illness. We used Clarke et al.'s theory of relationship quality to assess relationship-focused items. From 3868 screened articles, we identified 101 publications describing 47 valid measures used in serious illness settings. Measures assessed patients and other caregivers. We determined that 597 of 2238 items (26.7%) related to relationships. Most measures (n = 46) included items related to engaging the patient as a whole person. Measures evaluated how providers promote information exchange (n = 35), foster therapeutic alliance (n = 35), recognize and respond to emotion (n = 27), and include patients in care-related decisions (n = 23). Few instruments (n = 9) assessed patient self-management and navigation. Measures include items that assess patient-provider relationship quality in serious illness settings. Researchers may consider these for evaluating and improving relationship quality, a patient-centered care and research outcome.

Transitional analysis for multi-objective operative improvement of reformate quality and hydrogen production from a naphtha catalytic reforming process.

The hydrogen produced (H 2 ) in the Catalytic Naphtha Reforming (CNR) is important in quantity and quality, for the feedback of the process and for supplying the hydrotreatment processes in current refineries. In this work it is presented a study by process simulation using Aspen HYSYS® for finding operative transitional modes that simultaneously improve quality of the reformate and hydrogen production of the CNR. The operative conditions that were studied correspond to the recirculation ratio of hydrogen/hydrocarbon (H 2 /HC), with values between 2 and 6, and the temperature (T), between 450 and 525°C, in order to determining the best operative transitional route from the initial operative state to a local improved state, applying the method of superposition of response surfaces and criteria assessment of improvement in quality and quantity of hydrogen produced. A numerical multi-objective operative improvement analysis was performed resulting the objective variables as: Research Octane Number (RON)=90.72, mass fraction of H 2 produced (%m of H 2 )=2.9, quality of recycled H 2 (yH 2 ) R =0.87, and quality of produced hydrogen (yH 2 ) S =0.9653. Experimental pilot plant data and full-scale industrial data were compared with simulations observing significant similitudes.

Improving Diversity in a Novel Psoriasis Study

Diverse racial and ethnic representation in clinical trials has been limited, not representative of the US population, and the subject of pending US Food and Drug Administration guidance. Psoriasis presentation and disease burden can vary by skin pigmentation, race and ethnicity, and socioeconomic differences. Overall, there are limited primary data on clinical response, genetics, and quality of life in populations with psoriasis and skin of color (SoC). The Varying Skin Tones in Body and Scalp Psoriasis: Guselkumab Efficacy and Safety trial (VISIBLE) is underway and uses strategies aimed at addressing this persistent gap. To assess the innovative strategies used in the VISIBLE trial to recruit and retain diverse participants in a randomized clinical trial of psoriasis in participants with SoC. This was an ad hoc quality improvement assessment of participant recruitment and retention approaches used by the VISIBLE trial. VISIBLE enrolled and randomized 211 participants (mean [SD] age, 43 [13] years; 75 females [36%] and 136 males [64%]) with SoC and moderate to severe plaque psoriasis from August 2022 to March 2023 to evaluate guselkumab treatment. The self-identified race and ethnicity of the participants was: 1 American Indian/Alaska Native (0.5%), 63 Asian (29.9%), 24 Black (11.4%), 94 Hispanic/Latino (44.5%), 13 Middle Eastern (6.2%), 1 Pacific Islander/Native Hawaiian (0.5%), 12 multiracial (5.7%), and 3 of other race and/or ethnicity (1.4%). Using a combination of objective (colorimetry to determine Fitzpatrick skin type) and self-reported (race and ethnicity consistent with SoC) parameters, VISIBLE sought to broaden inclusion of participants from various backgrounds. Observed improvements were that participant enrollment occurred approximately 7 times faster than anticipated (vs historical recruitment data for psoriasis studies); 211 participants (100%) self-identified themselves as a race or ethnicity other than White; and more than 50% had skin tone in the darker half of the Fitzpatrick skin type spectrum (type IV-VI). Innovations implemented by VISIBLE were (1) assessment of the natural history of postinflammatory pigment alteration and improvements over time using combined objective colorimetry and clinician- and patient-reported outcomes; (2) evaluation of genetic and comorbidity biomarkers relevant to participants with SoC; (3) a diverse demographic-driven approach to site selection (emphasizing investigator and staff diversity and experience with populations with SoC); (4) provision of cultural competency training to enhance participant enrollment and retention; (5) collection of patient-reported outcomes data in participants' primary language; and (6) periodic, blinded central review and feedback on investigator efficacy scoring to promote consistency and accuracy in evaluating psoriasis in participants with SoC. VISIBLE is a unique study focused on addressing important knowledge and data gaps in populations of patients with psoriasis and SoC, with the goal of generating data to help improve clinical care and inform future best practices in diversity within dermatology research. The rapid study enrollment demonstrates that intentional and strategic approaches to clinical trial design and conduct can speed recruitment and bolster participation and retention of diverse populations in a dermatologic setting. ClinicalTrials.gov Identifier: NCT05272150.

Leveraging local health system resources to address quality healthcare gaps in sub-Saharan African: lessons from the SafeCare quality improvement programme in Ghana

IntroductionIn low- and-middle-income-countries (LMICs) like Ghana, universal access to quality healthcare remains a mirage and this undermines achievement of sustainable development goal (SDG) 3. The SafeCare Quality Improvement (QI) programme is an initiative of PharmAccess Foundation, a Netherlands-based non-governmental organisation (NGO). In 2009 SafeCare QI programme was launched in Ghana to help address gaps in healthcare quality standards, leveraging existing local resources. Over 600 private and public healthcare facilities are currently enrolled in the programme and is being adopted for nation-wide rollout by government of Ghana and implementing partners.ObjectiveThis paper explored views and experiences of frontline health staff and policy makers on the SafeCare quality improvement programme in Ghana and how local resources were leveraged in its implementation.MethodologyDesign/setting: The evaluation was conducted in 53 private and public healthcare facilities from seven administrative regions of Ghana across the coastal, middle, and northern geopolitical belts. The regions are Ashanti (n = 12), Bono East (n = 8), Bono (n = 3), Greater Accra (n = 12), Oti (n = 4), Savannah (n = 8) and Western (n = 9).Sampling: Quota and purposive sampling techniques were used to sample the healthcare facilities in accordance with the study eligibility criteria. Total of 45 focus group discussions (FGDs) and 47 individual in-depth interviews (IDIs) were conducted among frontline staff and policy makers from government and private local partner institutions.Analysis: Group and individual interviews were audio recorded, transcribed verbatim and thematic content analysis done using Nvivo (version 12.0) software.FindingsOverall, participants perceived the relevance and benefits of the SafeCare programme to be "very satisfactory" while the programme impact, rollout process and success were perceived to be "satisfactory". Quality healthcare standards were perceived to have improved in beneficiary health facilities due to participation in the SafeCare programme. Patient satisfaction, service utilisation and revenue generation in healthcare facilities were also attributed to the SafeCare programme. Proposals were made for harmonisation of existing QI assessment tools to mitigate duplications. Agreed data sharing protocols and interoperability with existing national database were also recommended to promote sustainability. Finally, low staff motivation, high workload, lack of financial and material resources were cited as potential impediments to full compliance with the SafeCare QI standards by healthcare facilities enrolled in the programme.ConclusionsSafeCare QI programme has contributed to QI and adherence to patient safety standards in Ghana. Sustainability is however dependent on continuous government commitment as the programme gets adopted as a national QI programme. Overlaps in content of QI assessment tools ought to be addressed to promote efficiency without compromising quality standards. The SafeCare programme demonstrates that health systems in LMICs have the potential to attain acceptable quality healthcare standards when they take advantage of existing local resources, including private-public partnership (PPP) and peer-learning opportunities.

A validated NICU database: recounting 50 years of clinical growth, quality improvement and research.

The importance of a Neonatal Intensive Care Unit (NICU) database lies in its critical role in improving the quality of care for very preterm neonates and other high-risk newborns. These databases contain extensive information regarding maternal exposures, pregnancy complications, and neonatal care. They support quality improvement (QI) initiatives, facilitate clinical research, and track health outcomes in order to identify best practices and improve clinical guidelines. The Parkland Memorial Hospital NICU database was originally part of the Maternal and Neonatal Data Acquisition, Transmission and Evaluation project funded by the Robert Wood Johnson Foundation to assess perinatal-neonatal care in Dallas County Texas, 1977-1982. Clinical data points were defined, transcribed and validated in 1977; revalidation has occurred multiple times. Data are prospectively extracted from health records of high-risk neonates among >11,000 births annually. The database contains clinical information on >50,000 neonates, including all initially admitted to the NICU regardless of gestational age or birthweight and since 10/03/2011, all neonates admitted for observation and transferred to the term newborn nursery. The database has provided the basis for QI studies and research designed to assess and improve neonatal care. We discuss the history, evolution, administration, impact on neonatal outcomes, and future directions of our database. IMPACT: A single neonatal intensive care unit (NICU) database was designed for prospective data collection, validated and maintained for 46yrs. This database has supported quality improvement assessment, original clinical research, education and administrative requirements and impacted clinical neonatal care.

Quality Improvement Assessment of Massive Transfusion Protocol (MTP) Utilization and Blood Component Return to Blood Bank in a Level 1 Trauma Center

Abstract Introduction/Objective The goal of MTP in management of patients with hemorrhage is to restore coagulation factors, oxygen carrying capacity, and platelets by transfusing equal amount of plasma, RBC, and platelets. Upon activation of MTP, blood components are released in rounds until deactivation. This quality improvement study was initiated to assess blood products transfused versus returned during MTP activation at our Level1 Trauma Medical Center. Methods/Case Report Upon MTP activation, the Blood Bank (BB) prepares first round of cooler with components at 5:5:1 ratio of plasma, RBC, apheresis platelets. We reviewed retrospective MTP data of eleven-month, from 10/2022- 08/2023. We analyzed patterns of blood component usage by service line, number of MTP rounds issued, and number of units transfused versus returned. Results (if a Case Study enter NA) MTP data was reviewed for 195 patients. MTP activation by service line included emergency department 58.5%, medical ICU (MICU) 14.4%, and surgical ICU (SICU) 11.8%. In many MTP activations, only one round of components was released. Overall, an average of 1.5 rounds were issued. Data of units transfused and returned by component type showed more RBC (43.1%) units were transfused than plasma (39.4%) suggesting MTP transfusion did not follow 1:1:1 ratio. Out of all issued blood units 58% were returned. The high fraction of returned blood components suggests MTP activation may not always truly indicate massive hemorrhage. This finding, and the notable frequency of MTP activation for MICU and SICU patients suggests that individual component order on an emergency-release basis may have been the appropriate option. Conclusion In general, the data suggests implementation of a quality improvement initiative focused on increasing awareness of criteria for MTP activation, and training of staff surrounding MTP is essential. We recently implemented an electronic emergency transfusion order set that allows providers to order individual components for non-massively bleeding patients.

Radiomics in distinguishing between lung adenocarcinoma and lung squamous cell carcinoma: a systematic review and meta-analysis.

The aim of this study was to systematically review the studies on radiomics models in distinguishing between lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC) and evaluate the classification performance of radiomics models using images from various imaging techniques. PubMed, Embase and Web of Science Core Collection were utilized to search for radiomics studies that differentiate between LUAD and LUSC. The assessment of the quality of studies included utilized the improved Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Radiomics Quality Score (RQS). Meta-analysis was conducted to assess the classification performance of radiomics models using various imaging techniques. The qualitative analysis included 40 studies, while the quantitative synthesis included 21 studies. Median RQS for 40 studies was 12 (range -5~19). Sixteen studies were deemed to have a low risk of bias and low concerns regarding applicability. The radiomics model based on CT images had a pooled sensitivity of 0.78 (95%CI: 0.71~0.83), specificity of 0.85 (95%CI:0.73~0.92), and the area under summary receiver operating characteristic curve (SROC-AUC) of 0.86 (95%CI:0.82~0.89). As for PET images, the pooled sensitivity was 0.80 (95%CI: 0.61~0.91), specificity was 0.77 (95%CI: 0.60~0.88), and the SROC-AUC was 0.85 (95%CI: 0.82~0.88). PET/CT images had a pooled sensitivity of 0.87 (95%CI: 0.72~0.94), specificity of 0.88 (95%CI: 0.80~0.93), and an SROC-AUC of 0.93 (95%CI: 0.91~0.95). MRI images had a pooled sensitivity of 0.73 (95%CI: 0.61~0.82), specificity of 0.80 (95%CI: 0.65~0.90), and an SROC-AUC of 0.79 (95%CI: 0.75~0.82). Radiomics models demonstrate potential in distinguishing between LUAD and LUSC. Nevertheless, it is crucial to conduct a well-designed and powered prospective radiomics studies to establish their credibility in clinical application. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=412851, identifier CRD42023412851.

The Data Linkage Hub: a Community of Practice

Objective and ApproachThis paper discusses the Data Linkage Hub (DLH) which is a centre for data linkage excellence and aims to produce and support the delivery of high quality, linked data assets for researchers in the UK. Here, we will give an overview of the DLH’s activity as a Community of Practice for Data Linkage. ResultsWe will discuss the different project types conducted in the DLH; the methods used ranging from bespoke linkage development to the adoption of generalised methodologies; and the customers of the DLH. We will also discuss the tools the DLH have developed, and make available to others, to standardise, streamline and improve quality assessment of linkage. This will include clerical matching tools known as CROW and the CMS, BAT, a bias analysis tool, and a package of PySpark code specifically developed for data linkage. In addition, we will explore the data linkage training materials we offer for different audiences and our involvement in a Data Linkage Champions Network, both increasing the awareness of data linkage and promoting best practise. Conclusion and ImplicationsThe impact of the DLH’s work is far reaching, underpinning statistical outputs, research and public policy. This success is down to the creation of a community of practice bringing together experts to regularly update and discuss linkage.

Use of Nursing Staff Competency Assessment for Quality Improvement in Urgent Care Clinic in PHC, Riyadh

Use of Nursing Staff Competency Assessment for Quality Improvement in Urgent Care Clinic in PHC, Riyadh

Specific therapeutic methods in lumbar facet syndrome tratment: prliminary study

Introduction: Specific therapeutic methods (STM) are manual techniques used to treat tissue blockade.Aim of this research is to determine efficacy of STM in treatment of lumbar facet syndrome (LFS).Patients and methods. The study included 60 patients suffering from LFS (65% women) aged ~47. The patients were treated ~24 days with the following 2-8 procedures: osteopathy, “myofascial release”, acupuncture, acupressure, “cupping”, neurodynamic, proprioceptive neuromuscular facilitation, kinesiotherapy, “kinesio-type taping”, homeopathy and electrotherapy. All patients were evaluated at admission and discharge through: a. pain scale with visual analogue scale (VAS) marked with numbers 1 to 10 (1 being state of no pain, 10 being state of maximum pain); b. disability with so-called Oswestry index (ODI) expressed in percentages (0-20% being minimum, 80-100% being complete disability); c. quality of sleep, rated through modified Pittsburgh index of sleep quality (PSQI) expressed between 0 (very poor) and 4 (very good). The assessment of improvement in pain intensity and level of disability was conducted via subtraction of values noted before treatment from values at the end of treatment, while the assessment of sleep quality improvement was conducted via subtraction of values noted at the end of treatment from the values noted before treatment. Non-parametric statistical analyses were used. Results: significantly lower values of VAS (p<0.0001) and ODI (p?0.0001), significant increase in PSQI (p?0.0001) at the end in relation to the beginning of treatment, as well as significant correlation between decrease in pain and disability (r=0.3292, p=0.0105). No significant difference in pain (p=0.9856) and disability (p=0.9171 decrease was noticed between sexes.Conclusion: STM is efficient in the treatment of pain attacks in patients of both sexes suffering from LBS.

Reducing Stimulant Prescribing Error: A Quality Improvement Initiative in Pediatric Outpatient Setting.

To evaluate the impact of the Songklanagarind ADHD Multidisciplinary Assessment and Care Team for Quality Improvement (SAMATI) initiative on reducing stimulant prescribing errors in a pediatric outpatient setting. A retrospective study examined attention deficit hyperactivity disorder (ADHD) registry data from January 2017 to June 2023 to assess the impact of the SAMATI initiative, implemented in early 2020. This initiative, integrating multiple components such as audit and feedback, clinical pharmacist involvement, and Electronic Medical Record utilization, aimed to enhance ADHD medication management. Using interrupted time series and control chart analyses, the study evaluated the initiative's effect on reducing stimulant prescribing errors. Additionally, parental satisfaction was measured to gauge the initiative's overall success. Out of 282 patients enrolled, 267 were included in the final analysis after exclusions. Post-intervention analysis showed significant reductions in various prescribing errors per thousand prescriptions: prescribing without concern drug-condition interaction (443 to 145, p < 0.001), prescribing without adequate monitoring (115 to 14, p < 0.001), lack of regular office visits (98 to 21, p = 0.007), and inappropriate dosage (66 to 14, p = 0.05). Medication errors severity classification also showed significant changes, with notable decreases in classes C and D errors. Parental satisfaction improved from 84% to 95%. The SAMATI initiative significantly reduced stimulant prescribing errors and enhanced parental satisfaction in ADHD care management. This study demonstrates the potential of comprehensive quality improvement strategies in improving medication management in pediatric healthcare. Further research in diverse settings is warranted to confirm these findings.

Assessment of Quality Improvement and Patient Safety Resources, including Event Reporting Systems, in Graduate Medical Education Training Programs - An Institutional National Survey

Background Quality improvement (QI) and patient safety (PS) education were requirements implemented in 2017 by the Accreditation Council for Graduate Medical Education (ACGME) for residents and fellows. Trainees must receive training and experience in QI processes, including an understanding of healthcare disparities, but how training and experience occur remains largely unknown. Our study aimed to determine how institutions have integrated these requirements into medical education. Methods A Google Forms survey was emailed to the Designated Institutional Officials (DIOs) of 650 United States’ institutions with ACGME accredited programs in September 2021. The survey consisted of 34 multiple choice questions related to QI and PS parameters and the event reporting system (ERS); a Likert scale was used. Results More than half (n=392) of the emails were undeliverable, leaving only 258 possible responders; 51 responses were received, and all but one met the inclusion criteria of having at least one training program, which translated to a response rate of 19% (=50/257). The survey found that while 90% of institutions had an institutional QI/PS Committee, only 30% of these institutions also had a Graduate Medical Education-specific QI/PS Committee as well. Most institutions provided QI (88%) or PS training (94%), but only 71% and 83%, respectively, had mandatory training. Most institutions utilized an ERS (96%). While one of the less common methods was education on the ERS, approximately two-thirds of responding DIOs believed that by providing education on the ERS, resident/fellow participation in event reporting would improve, as well as contribute to their total education. Conclusions Further ERS education is warranted to encourage resident/fellow participation to develop various protocols related to QI and PS parameters.

Chemometric assessment of electronic cigarettes based on the ICP-MS determination of multiple heavy metal concentrations

To elucidate the concentrations of heavy metal elements in commercially available electronic cigarettes and improve quality assessment. Inductively coupled plasma-mass spectrometry (ICP-MS) coupled to chemometrics was used to determine the concentrations of Cr, Ni, As, Cd, Sn, Sb, Hg, and Pb in the e-liquids and aerosols derived from 32 electronic cigarettes sold commercially under six brand names. The e-liquids contained: 4.858 to 274.658 (Cr), 17.292 to 3068.375 (Ni), 3.217 to 29.867 (As), 0.225 to 24.717 (Cd), 0.783 to 17.042 (Sn), 0.658 to 36.033 (Sb), 0.658 to 187.592 (Hg), and 2.458 to 17.417 (Pb) ng g−1. The aerosol samples contained: 276.075 to 3333.175 (Cr), 72.908 to 1150.183 (Ni), 4.567 to 86.958 (As), 0.400 to 12.842 (Cd), 1.092 to 32.142 (Sn), 0.976 to 10.633 (Sb), 3.483 to 234.708 (Hg), 27.833 to 849.100 (Pb) ng 100 puffs−1. The recovery of heavy metals ranged from 99.1% to 112.4% in the e-liquids and from 87.3% to 116.6% in the aerosols, with RSD values below 10%. Hierarchical cluster analysis grouped the e-liquids into eight clusters, and the aerosols into five, indicating differences between products within brands and between different brands. Orthogonal partial least squares discriminant analysis coupled with variable importance in projection (VIP > 1) identified As and Sb as the primary heavy metals causing differences between the e-liquids, while differences between the aerosols were caused by Hg, As, Pb, Cd, and Cr. The use of chemometric methods yields a greater depth of information that will support improvements to the quality control of e-cigarette products and the assessment of their potential risk to human health.

Regional impact assessment of air quality improvement: The air quality lifecourse assessment tool (AQ-LAT) for the West Midlands combined authority (WMCA) area

Poor air quality is the largest environmental health risk in England. In the West Midlands, UK, ∼2.9 million people are affected by air pollution with an average loss in life expectancy of up to 6 months. The 2021 Environment Act established a legal framework for local authorities in England to develop regional air quality plans, generating a policy need for predictive environmental impact assessment tools. In this context, we developed a novel Air Quality Lifecourse Assessment Tool (AQ-LAT) to estimate electoral ward-level impacts of PM2.5 and NO2 exposure on outcomes of interest to local authorities, namely morbidity (asthma, coronary heart disease (CHD), stroke, lung cancer), mortality, and associated healthcare costs. We apply the Tool to assess the health economic burden of air pollutant exposure and estimate benefits that would be generated by meeting WHO 2021 Global Air Quality Guidelines (AQGs) (annual average concentrations) for NO2 (10 μg/m3) and PM2.5 (5 μg/m3) in the West Midlands Combined Authority Area.All West Midlands residents live in areas which exceed WHO AQGs, with 2070 deaths, 2070 asthma diagnoses, 770 CHD diagnoses, 170 lung cancers and 650 strokes attributable to air pollution exposure annually. Reducing PM2.5 and NO2 concentrations to WHO AQGs would save 10,700 lives reducing regional mortality by 1.8%, gaining 92,000 quality-adjusted life years (QALYs), and preventing 20,500 asthma, 7400 CHD, 1400 lung cancer, and 5700 stroke diagnoses, with economic benefits of £3.2 billion over 20 years. Significantly, we estimate 30% of QALY gains relate to reduced disease burden. The AQ-LAT has major potential to be replicated across local authorities in England and applied to inform regional investment decisions.

Prototyping and evaluation of a novel machine vision system for real-time, automated quality grading of sweetpotatoes

Rapid advances in machine vision and artificial intelligence (AI) technologies have generated high interest in developing automated grading and sorting solutions for fresh produce of specialty crops. Sweetpotatoes are an economically important crop in the United States and beyond, but grading and sorting the commodity, especially for surface defects, remains a labor-intensive operation at commercial packing facilities. In addition to incurring high labor costs, manual grading is subjective and prone to human assessment error. This study was therefore aimed to develop automated grading technology based on machine vision and state-of-the-art AI to reduce labor dependence and improve quality assessment for sweetpotato packing lines. The developed grading system prototype consisted of a custom-designed roller conveyor to transport and rotate sweetpotatoes and an overhead color camera to perform full-surface quality assessment for size and surface defects. A YOLOv8-based computer vision pipeline was developed to segment and track each sweetpotato traveling on the conveyor and analyze sample quality conditions in real-time. The YOLOv8l model coupled with the BoT-SORT tracker achieved the overall Higher Order Tracking Accuracy (HOTA) score of 0.952. Based on the instance segmentation by YOLOv8l, the length and width of sweetpotatoes were estimated with percentage accuracies of 96.7 % and 90.3 %, respectively, while the instance segmentation for three classes of sweetpotatoes according to surface defect conditions yielded an overall accuracy of 82.6 %, regardless of samples. The final sample grading, which was realized by taking into account the quality information recorded from a sequence of multi-view images for each sample, achieved an overall accuracy of 91.7 % in grading four classes of sweetpotatoes. The developed prototype holds promise for next-stage integration with sorting mechanisms into a full-fledged sorting system and will be eventually beneficial for sweetpotatoes packers.

Patient Experience of Quality of Care: Special Reference to Inward Patients in National Eye Hospital in Sri Lanka

: Evaluation of healthcare provision is essential in the ongoing assessment and consequent quality improvement of medical services. However, healthcare systems have sought to achieve a balance in services that are not only clinically effective but are also judged by patients as acceptable and beneficial. National Eye Hospital services all patients with eye diseases and eye injuries.

Implementation of a hospital-wide massive transfusion protocol at a tertiary cancer center.

440 Background: Massive Transfusion Protocol (MTP) is a term used to describe a process to deliver blood products rapidly to treat life-threatening hemorrhage. MTPs follow a prescribed algorithm to efficiently replace blood products in set ratios. Three components of MTP include immediate availability of blood products, set types and ratios of blood products, and standardized roles for health care providers. MTP is associated with decreased morbidity and mortality compared to provider-driven decisions on blood transfusion. Methods: The Quality Improvement Assessment Board approved this initiative to standardize and create an MTP process outside of the Operating Room (OR). We assembled a multidisciplinary team to review and adopt evidence-based practices for MTP. A core group of content experts developed the relevant policy and protocol for activation and use of MTP in the Intensive Care Unit (ICU), Pediatric Intensive Care Unit (PICU), Emergency Room (ER), Interventional Radiology (IR) and inpatient floor. Simulations were held in these areas and Plan Do Study Act (PDSA) cycles used to improve the processes. Improvements included adjustment to the quantity and type of emergency release products immediately available, the timing of when platelets were delivered to providers and development of a ‘pull’ process for the Blood Bank to prepare additional blood products minimizing wastage. Following these changes, the MTP process became consistent and could be activated from all of the targeted locations. Each MTP episode was reviewed for outcomes and efficiency metrics. We held multidisciplinary care debriefings to review hemorrhagic events for areas of improvement. The OR had an existing process that was separate from this initiative, but will be aligned June 2023 and included in future analysis. Results: Baseline, from January 2022 to September 2022, 32 massive transfusion events occurred (3.5 per month). After implementation of the MTP protocol, from October 2022 to May 2023, the MTP protocol was activated 36 times (4.5 per month). There were 7 (22%) deaths at baseline and 5 (14%) after implementation. The average length of time from activation to receipt of first blood product was 26 minutes at baseline and 25 minutes with MTP. The average number of units administered at baseline included 7.7 units of red blood cells (RBC), 7.6 units fresh frozen plasma (FFP), 1 unit single donor platelets, and 2 units cryoprecipitate compared to after implementation of 6.9 units RBC, 6 units FFP, 1.6 units single donor platelets, and 3 units cryoprecipitate. The ICU was the most common MTP activation location (44%), followed by ER (19%), PICU (17%), the floor (14%) and IR (6%). Conclusions: It is feasible and safe to deploy an MTP throughout an institution. Preliminary data show a decrease in the percentage of patient deaths with use of MTP. Additional analysis are planned to evaluate the incremental improvements made with each PDSA cycle.

An evidence-based quality assessment tool for ovarian cancer care delivery.

384 Background: Ovarian cancer is the fifth leading cause of cancer death among women in the United States (US). Optimizing care for patients with ovarian cancer using a systematic, guideline-concordant approach improves outcomes. However, notable gaps persist for most patients with ovarian cancer in the US. Beginning in 2018, the Association of Community Cancer Centers (ACCC) implemented a quality improvement (QI) initiative in community and academic cancer centers to address care gaps. From this work, our expert steering committee published a quality document to inform evidence based ovarian cancer care delivery. Methods: In Phase II of this project we used the quality document to inform a qualitative baseline self-assessment and development of four six-month QI initiatives at cancer centers in the US. Based on this work, we developed a quality assessment tool to aid cancer centers in performing QI needs-assessments using the ovarian cancer quality document. The assessment tool applies evidence-based care recommendations in key areas identified by our multidisciplinary steering committee comprised of experts in ovarian cancer care. Results: The assessment tool includes a series of program-level questions and addresses seven key domains: 1. Care coordination and patient education, 2. Prevention and screening, 3. Diagnosis and initial management, 4. Treatment planning, 5. Disease surveillance, 6. Equity in care, and 7. Quality of life. Each domain has between two and seven key recommendations identified. Sites rate themselves on a four-point scale (1-unsatisfactory, 2-needs improvement, 3-acceptable, 4-good) for each key recommendation. Each key recommendation is given equal weight, and a combined score from 0-100 is calculated for each of the seven domains. The tool includes a macro-enabled spreadsheet that makes necessary calculations and provides an overall score, domain-specific sub-scores, and a list of key recommendations that received low ratings. The tool is to be used by clinical sites to self-assess the quality of ovarian cancer care currently provided at their cancer program and serves as a needs assessment. It is recommended that the site team performs the self-assessment in the context of a facilitated half-day multidisciplinary team meeting. After the self-assessment, sites are encouraged to develop QI initiatives to address the gaps identified using the format and structure we have previously described. Conclusions: The QI Assessment tool provides an important resource for cancer centers to conduct needs assessments in key areas of ovarian cancer care. The needs assessment can be used to inform the implementation of program-specific QI initiatives to elevate quality care delivery.

Assessment of quality improvement of simulation-based learning using an evidence-based framework in dental education.

Simulation-based education is of paramount importance in a dental pre-clinical setting. Hence, continuous quality improvement is crucial to optimize students' knowledge and clinical skills. This study aimed to evaluate the impact of evidence-based simulation learning (EBSL) compared with traditional-based simulation learning (TBSL) using Plan-Do-Study-Act (PDSA) model. This quality improvement project was undertaken at a private university. Guided by the PDSA model, rubber dam application tasks were conducted in the simulation lab in 2 phases. Phase 1 included TBSL and phase 2 included EBSL comprising of 2 PDSA cycles. 'Plan' stage involved obtaining feedback from students and the concerned staff. 'Do' stage included implementation of EBSL in eight steps adopted from Higgins's framework. 'Study' stage evaluated the outcomes and in 'Act' stage amendments were made to the first EBSL cycle. In the second PDSA cycle re-implementation and evaluation of the rubber dam application exercises were carried out. Descriptive data were presented as percentages and mean scores were compared using paired t-test. Thirty-seven year 2 students participated in this study. A significant improvement in the mean scores was observed between TBSL and EBSL (3.02 + 0.16 and 3.91 + 0.27, respectively, p < .001) using PDSA model with the highest mean score for rubber dam application in the second PDSA cycle for EBSL (4.00 + 0.01). Ninety-five per cent of the students provided positive feedback pertaining to EBSL. EBSL was effective in achieving high student satisfaction, desired knowledge, and skills required during simulation-based exercises. The PDSA cycle can be considered to optimize pre-clinical skills learning.

Picture Perfect: The Status of Image Quality in Prostate MRI.

Magnetic resonance imaging is the gold standard imaging modality for the diagnosis of prostate cancer (PCa). Image quality is a fundamental prerequisite for the ability to detect clinically significant disease. In this critical review, we separate the issue of image quality into quality improvement and quality assessment. Beginning with the evolution of technical recommendations for scan acquisition, we investigate the role of patient preparation, scanner factors, and more advanced sequences, including those featuring Artificial Intelligence (AI), in determining image quality. As means of quality appraisal, the published literature on scoring systems (including the Prostate Imaging Quality score), is evaluated. Finally, the application of AI and teaching courses as ways to facilitate quality assessment are discussed, encouraging the implementation of future image quality initiatives along the PCa diagnostic and monitoring pathway. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 3.