Departmental Quality Improvement Research Articles

The Scope of Work, Roles, and Tasks of Dedicated Patient Safety Officer

Purpose: This study aimed to identify the scope of work, roles, and tasks of dedicated patient safety officers.Methods: The scope of work, roles, and tasks of dedicated patient safety officers were derived through literature review, analysis of job descriptions of patient safety and quality improvement departments, and consultation opinions from related organizations. A survey was conducted to determine the scope of work, roles, and task performance of dedicated patient safety officers.Results: This study identified 13 work scopes and 66 roles and tasks for dedicated patient safety officers. The thirteen work scopes exhibited a performance rate of over 70%, with more than 70% of the 66 roles and tasks performed, excluding 14. The items with the highest role and task performance rate were ‘5.3 Operate staff training related to patient safety and quality improvement activities according to plan’ (100.0%) for medical institutions with 500 beds or more, and ‘2.2 Establishing a patient safety and quality improvement action plan’ (96.8%) for medical institutions with less than 500 beds. The item with the lowest role and task performance rate was ‘12.3 Participate in National Patient Safety Day,’ with 54.2% for institutions with 500 beds or more and 42.9% for institutions with less than 500 beds.Conclusion: This study is significant in that it clarifies the scope of work, roles, and tasks for dedicated patient safety officers. To enable dedicated patient safety officers to perform the 13 identified work scopes and 66 roles and tasks, an organization must be operated in a manner that enhances patient safety and quality. Currently, the number of legal dedicated patient safety officers is insufficient to perform all roles and tasks. This study suggests that one patient safety assistant should be assigned to every 100 beds, and one dedicated patient safety officer assigned to every 150 beds.

Waiting Room Zero Until Noon: An Emergency Department Quality Improvement Initiative With Downstream Effects

Waiting Room Zero Until Noon: An Emergency Department Quality Improvement Initiative With Downstream Effects

104 Implementation of an Emergency Department Quality Improvement Program to Improve Care for Emergency Department Patients With Opioid Use Disorder at Four Southwest Michigan Hospitals

104 Implementation of an Emergency Department Quality Improvement Program to Improve Care for Emergency Department Patients With Opioid Use Disorder at Four Southwest Michigan Hospitals

Spectrum of Cognitive Biases in Diagnostic Radiology.

Cognitive biases are systematic thought processes involving the use of a filter of personal experiences and preferences arising from the tendency of the human brain to simplify information processing, especially when taking in vast amounts of data such as from imaging studies. These biases encompass a wide spectrum of thought processes and frequently overlap in their concepts, with multiple biases usually in operation when interpretive and perceptual errors occur in radiology. The authors review the gamut of cognitive biases that occur in radiology. These biases are organized according to their expected stage of occurrence while the radiologist reads and interprets an imaging study. In addition, the authors propose several additional cognitive biases that have not yet, to their knowledge, been defined in the radiologic literature but are applicable to diagnostic radiology. Case examples are used to illustrate potential biases and their impact, with emergency radiology serving as the clinical paradigm, given the associated high imaging volumes, wide diversity of imaging examinations, and rapid pace, which can further increase a radiologist's reliance on biases and heuristics. Potential strategies to recognize and overcome one's personal biases at each stage of image interpretation are also discussed. Awareness of such biases and their unintended effects on imaging interpretations and patient outcomes may help make radiologists cognizant of their own biases that can result in diagnostic errors. Identification of cognitive bias in departmental and systematic quality improvement practices may represent another tool to prevent diagnostic errors in radiology. ©RSNA, 2024 See the invited commentary by Larson in this issue.

An Emergency Department Quality Improvement Project to Decrease Lumbar Puncture Rates in Febrile Infants 22 to 28 Days Old.

Most providers have routinely performed universal lumbar puncture (LP) on well-appearing, febrile infants 22 to 28 days old. In 2021, the American Academy of Pediatrics recommended clinicians should perform an LP in this age group if inflammatory markers are abnormal. This quality improvement project aimed to decrease LP rates in febrile infants 22 to 28 days old in the emergency department (ED) within 1 year, regardless of race/ethnicity, from a baseline of 87%. We used our institution's quality improvement framework to perform multiple Plan-Do-Study-Act cycles. A multidisciplinary team reviewed the febrile infant literature, local epidemiology, and identified key drivers. We provided departmental education, updated our clinical pathway, and used clinical decision support. We analyzed baseline (January 2017-March 2022) and intervention data (April 2022-March 2024) and tracked data using statistical process control charts. Our primary outcome measure was rates of LP in the ED for this cohort. Process measures included rates of infants with procalcitonin results. ED length of stay, rates of first LP attempt after hospitalization, and missed bacterial meningitis were balancing measures. The baseline LP rate of 87% decreased to 44% during the intervention period, resulting in a downward centerline shift. There were no significant differences when LP rates were analyzed by race/ethnicity. There was an upward centerline shift in the process measure of infants with procalcitonin results. There was no observed special cause variation in our balancing measures. Quality improvement efforts, including education, clinical pathway updates, and clinical decision support, safely reduced rates of LPs in febrile infants 22 to 28 days old.

Surgical and Patient-Reported Outcomes After Mastectomy and Implant-Based Prepectoral Reconstruction Using TIGR® Synthetic Mesh.

Background Single-stage direct-to-implant (DTI) breast reconstruction after mastectomy has gained popularity over the last decade, thanks to the wide use of biological matrices and synthetic meshes. Despite their high cost, there is no evidence of superior outcome from the biological matrices compared to the synthetic meshes. In this study, we aimed to evaluate our experience with TIGR, a synthetic, long-term absorbable mesh, in mastectomy and immediate breast reconstruction (MIBR) with a focus on patient-reported outcomes (PROMs). Methods This was a single-trust prospective quality improvement study conducted between 2017 and 2019. The main objectives were complication rates including infection, implant loss, and other surgical complications in patients undergoing TIGR mesh-assisted MIBR in the prepectoral plane for either cancer or risk reduction. PROMs were measured using the validated European Organisation for Research and Treatment of Cancer (EORTC) breast questionnaire module. Clinical evaluations were conducted at one week, three weeks, and 12 months postoperatively. All patients provided written consent, and the audit was registered with the Quality Improvement Department of the organization. Results One hundred and twelve meshes were used in 93 patients with a mean age of 49 (24-75) years and a body mass index (BMI) of 23.4 (19.1-29.6). During the follow-up period, complications occurred in 26 patients (28%), including infection in four (4.3%), complete skin flap necrosis in one (1%), partial flap necrosis in three (3.2%), and implant loss in four (4.3%) patients. PROM data from 41 individuals indicated a moderate overall quality of life (82.7%), with high functional domain scores with relatively lower emotional functioning scores. Symptom domains generally scored poorly except for body image and sexual functioning. Conclusion Mastectomy and immediate prepectoral breast reconstruction using TIGR mesh is safe with low major complication rates. It is associated with high functional and quality of life scores but low scores in symptom domains which could be multifactorial. However, limitations due to study type and follow-up duration suggest caution in generalizing findings.

"The Perfect Week": A Novel Departmental Quality Improvement Initiative

Introduction: Patient-centered care in the Emergency Department (ED) is an often overseen but critical component of holistic healthcare. ‘The Perfect Week' was a novel initiative by the ED at Mediclinic City Hospital seeking to explore opportunities to improve patient-centered care at our facility with an emphasis on patient experience. Objective: To improve workflow performance, safety, and patient experience through implementation of multifaceted strategies, focused on improvements in workflow, placement, and resource allocation in the ED. Methods: The Emergency Department at Mediclinic City Hospital, Dubai initiated a Quality Improvement Project, entitled "The Perfect Week." Over a period of 7 days, multiple new strategies were implemented including 1) additional staff per shift, 2) placement of a physician in triage (PIT), 3) frequently used medication available in cupboard for STAT orders in triage, 4) setting up a treatment room to expedite orders placed by PIT doctor ("PIT STOP") prior to shifting to majors area, 5) inter-departmental prioritization of ED order requests, 6) emergency physician in charge (EPIC) to facilitate flow, expedite admissions/discharges and deal with time consuming tasks. During the week-long project, multiple variables were measured, with a specific focus on the following: 1) Time from registration to triage, 2) Time from being triaged to being seen by a doctor, 3) Time from ordering analgesia to execution of order, 4) Time from Trop I sample collected to reaching lab, 5) Time from Trop I reaching lab to preliminary result, 6) Ultrasound turnaround time (TAT), 7) CT scan TAT, 8) ED Length of Stay (LOS), 9) Admission waiting time. Efficiency assessed by measuring the time it took for each variable. Subjective feedback on patient experience measured by means of Google reviews. We compared this week with the previous weeks to assess whether efficiency has improved. Results: An overall improvement was noted in all variables measured. Reduced times were noted especially in triage to time seen by doctor (mean reduction time 13 min), Ultrasound TAT (by 8 min), CT scan TAT (by 17 min), ED LOS (by 18 min) and admission waiting time (by 9 min). A total of eighty-two positive Google reviews were received in 1 week, with feedback primarily focused on patients' reduced length of stay, waiting time, efficiency, and healthcare provider empathy. Conclusion: Performance, safety, and patient experience significantly improved during "The Perfect Week" as demonstrated above. Additional staffing, of note, including a PIT, PIT STOP nurse and EPIC, was found to have considerable beneficial impact on patient experience.

Improving Burns and Plastic Surgery Induction Programmes: A Departmental Quality Improvement Project.

Changes to the undergraduate medical curriculum now offer a greater focus on community-based teaching, communication skills and medical humanities. Unfortunately, this has been at the expense of surgical teaching. The senior house officer is usually the first port of call when a patient is being referred to a plastic surgery department. Therefore, a reasonable level of knowledge is required with regard to emergency presentations, examination skills, and clinical skills to appropriately manage the injury. The primary aims of this quality improvement project are to firstly improve the newly starting doctor's confidence in undertaking an on-calls in either trauma or burns following the induction programme and to also improve their level of satisfaction. The Quality Improvement Project (QIP) team consisted of a Foundation Year 2 doctor, a core surgical trainee, and a registrar. Three Plan, Do, Study, Act (PDSA) cycles were completed to improve the quality of the induction programme. In the first PDSA cycle, junior doctors were provided with a handbook that covered necessary topics regarding burns and plastic surgery. In the second cycle, a structured presentation which included case-based discussions, was incorporated into the trauma aspect of the induction. Finally, in the third cycle, a structured presentation which included case-based discussions, was incorporated into the burns aspect of the induction. Data was collected in the form of a questionnaire one month following the departmental induction for each cycle. The questionnaire assessed the doctor's confidence levels and degree of satisfaction with the induction programme. Students were also given the opportunity to complete written descriptive feedback at the end of the questionnaire. Furthermore, pre- and post-induction questionnaires on the day of induction for the December and April cohort of doctors were also obtained. Results: A total of 16 doctors completed the questionnaires. Overall satisfaction, confidence in undertaking trauma on-calls, and confidence in undertaking burns on-calls improved from 3.84/5, 1.83/5, and 2.67/5 in the first cycleto 4.6/5, 3.6/5, and 3.6/5 in the third cycle, respectively. Satisfaction with the clinical emergencies and case discussions aspect of the induction programme improved from 2.17/5 in the first cycle, to 4.6/5 in the third cycle. With regards to the pre- and post-induction questionnaire on the day of induction, the December cohort's correct answer percentage improved from 58.3% to 94.4%, and the April cohort improved from 47.2% to 93.3%. Whilst it is unlikely to completely prepare new junior doctors for the transition into clinical practice in a unique speciality such as burns and plastic surgery, our study highlights the value of a thorough, multi-stage induction in ensuring junior doctors feel confident to deliver high quality and safe patient care.

QI Connect: Matching researchers to projects.

464 Background: At any given health system, there are often quality improvement (QI) projects without enough manpower to complete the work, and students and trainees who are looking for projects to work on but can’t find any. The question becomes how we connect these two groups in a win-win situation. Many job search websites use a “matching” function in which profiles of applicants are matched with requirements from employers to make connections. Our goal is to apply a similar software/data-basing solution to QI projects in healthcare systems to improve project completion rates, increase QI experience among medical students, residents, and fellows, and improve continuity of projects. Methods: We created a dual facing database, with one branch aimed at collecting projects, and the other side aimed at recruiting trainees/students. Faculty or QI departments approach the project side and are asked to provide the following types of data about their QI project: field, clinical vs basic, onsite vs virtual, role of the trainee, timing (business hours or flexible), IRB approval, description, and main point of contact. Trainees who are interested in matching a project, fill out a set of profile questions that mirror the project parameters. Trainees and projects are matched in an algorithmic order based on prioritization we have selected in discussion with faculty and student interests. One key is that the project point of contact is NOT made available until after a successful “match” to avoid “carpet bomb” emailing of faculty members. In order to fill the database we have networked with physicians, department chairs, interest group listservs, and chief residents across our hospital and medical school. Results: In our first year’s pilot run we collected 17 projects, and had profound student interest with 70 profiles filled. We limited the number of matched projects to just 5 that best fit, and received positive feedback from students and mentors. Since then we have grown the database to 47 projects and 153 students/trainee profiles. These initial promising results have also prompted the creation of a new elected position in the medical school for two Research VP’s in each class. Conclusions: We have built a clear proof of concept that virtual match making for QI projects can close the gap between unfilled projects, and trainees seeking opportunities. Although the metrics suggest that trainees seeking research are far outpacing available projects, we believe that far more projects currently exists, and a major area of improvement will be to continue to bring visibility to the database. Nonetheless without acquiring any additional funding or manpower, we are able to increase the scholarly profiles of trainees, and overall QI productive output at our institution.

Fracture-related infection: Analysis of healthcare utilisation and associated costs

AimsA consensus definition of fracture related infection (FRI) has been created with the aim of standardising diagnosis and eliminating heterogeneity that prevents accurate comparison between existing studies. FRI remains one of the most challenging complications in musculoskeletal trauma surgery and carries with it a significant cost burden. A review of UK finances has not been completed utilising consensus diagnostic criteria. The goal of this study was to investigate the hospital-associated healthcare cost related to the treatment of FRI within an NHS major trauma centre. MethodThrough retrospective case-control analysis, 1240 patients with close fractures were identified. Of those, 21 patients with FRI were compared to 63 uninfected patients. Patients were matched based on fracture location, type of procedure and proximity in age. The costs assessed included hospitalisation, imaging, outpatient consultation, pharmaceuticals and procedure charges. Cost data was retrieved from healthcare resource group (HRG) guidelines, NHS Business Service Authority's (NBSA) prescription rates and internal costing. ResultsThe FRI group were found to incur a 2.51 increase in total medial healthcare cost compared to the control group (£22,058 vs £8798 [p < 0.001]), which was primarily due to increased procedural costs (£13,020 vs £6291 [p < 0.001]) and length of hospital stay (£7552 vs £2124 [p < 0.001]). ConclusionWhilst diagnosis of FRI has a more rigorous definition following the new consensus, prevalence and cost outcomes are similar to previous studies. Given the deficiency in funding and ongoing challenges of resource allocation to the NHS, it is prudent to incorporate studies such as this into stratifying departmental budgets and quality improvement. Level of evidenceIII.

8 Changes in Emergency Department Quality Improvement Practices Between 2019 and 2023: Analysis of the Emergency Quality (E-QUAL) Network Quality Readiness Assessments

8 Changes in Emergency Department Quality Improvement Practices Between 2019 and 2023: Analysis of the Emergency Quality (E-QUAL) Network Quality Readiness Assessments

P07 Quality improvement project of acute referrals to the on-call dermatology service

Abstract With dermatology services now integrating neural networks and artificial intelligence into departments, the importance of technology to streamline services has been timely in light of the increased influx of referrals needing remote reviews from both community and secondary care. We performed a department quality improvement project to compare referrals made to the on-call dermatology service, Dudley Group NHS trust, during September 2019 and September 2020 against the ‘COVID-19: Clinical guidelines for the management of dermatology patients remotely’. Data were collected from telephone, paper and email referrals made in September 2019 and 2020. Referral data including patient demographics, nature and urgency of referrals, diagnosis, availability of medical photography and follow-up arrangements was collated on a Microsoft Excel Proforma. Of 74 total referrals (35 in 2019; 39 in 2020), hospital referrals in September 2020 (92%, n = 36) largely outweighed GP referrals (8%, n = 3). Urgent referrals made by hospital departments rose from 17% (n = 5 of 29) in September 2019 to 53% (n = 19 of 36) in September 2020. Medical photography, often essential for triage and diagnosis, was available only at the time of referral in 8.6% (n = 3) of cases in 2019 and 48.7% (n = 19) in 2020. The rise may be explained by an increased dependence on remote services. With current pressures placing greater demand on resources, there is a need for online referral systems. Moving away from emails, letters and phone calls ensures a less user-dependent interface. Medical photography can be implemented as an integral feature of referral. Online systems facilitate triage and remote management in keeping with dermatological guidelines.

WTP2.5 Improving the Recording of Thoracic Surgeries on Dendrite Database – Departmental Quality Improvement Project

Abstract Objectives Well-maintained database of thoracic operations is critical for quality improvement, service provision and driving research forwards. We examined adequacy of operative recording on clinical database. Methods Thoracic operations were uploaded onto Dendrite database. Operative entries on Dendrite were compared with surgeries performed from October 2021 to June 2022. Missing operative records were identified. Incomplete entries were categorised into missing procedure names, procedure dates and operation notes. Personal reminders, published league table of best performers in weekly departmental meetings were introduced in February 2022 to encourage surgeons to record data accurately. Results 599 thoracic surgeries were performed in the nine-month period. 20% of operations were not recorded on Dendrite. 5% of records lacked, procedure names, 2% lacked operation notes and 0.2% lacked procedure date. Table below demonstrates monthly data before and after improvement measures. Missed and incomplete entries were significantly lower in the post-intervention period (42) compared to pre-intervention (104) (p=0.002). Conclusion Maintaining complete and accurate database is paramount in most services. However, the level of compliance can be variable. This study demonstrates that motivational approach to completing database can increase engagement and compliance. Furthermore, we plan to introduce virtual dendrite training programme and re-evaluate effect on data recording.

Observed Versus Expected Distribution of Patient Self-Reported Race and Ethnicity in Quality Improvement Review Processes at a Single Safety Net Academic Institution.

Background While there is a plethora of evidence describing racial and ethnic disparities in obstetric care and outcomes, little has been published evaluating potential inequities in departmental Patient Safety and Quality Improvement (PSQI) processes. Objective The study aims to describe the distribution of patient-reported race or ethnicity for safety events at a single safety net teaching hospital. We hypothesized that the observed versus expected case distribution for each racial or ethnic group would be similar, signifying proportional representation in the PSQI reporting and review process. Study design We performed a cross-sectional study including all Safety Intelligence (SI) events filed on obstetric and gynecologic patients and all cases reviewed at monthly PSQI multidisciplinary departmental meetings from May 2016 to December 2021. We compared the distribution of patients' self-reported race or ethnicity as documented in the medical record to our patient population's expected race or ethnicity distribution based on historical institutional data. Results Two thousand and fiveSI events were filed on obstetric and gynecologic patients. Of those, 411 cases were selected for review by the departmental multidisciplinary PSQI committee, which meets once monthly. Of the 411 cases reviewed by the PSQI committee, 132 met Severe Maternal Morbidity (SMM) criteria defined by the American College of Obstetricians and Gynecologists (ACOG). Fewer SI reports were filed on Asian patients and those who declined to provide race or ethnicity (observed 4.3% versus expected 5.5%, p=0.0088 and 2.9% versus expected 1%, p<0.0001, respectively). For cases reviewed by the departmental PSQI committee and for those which met SMM criteria, there was no significant difference in race/ethnicity distribution. Conclusions There was a disparity between fewer safety events filed for Asian patients and those not reporting race/ethnicity. It was reassuring that our process did not identify other racial/ethnic disparities. However, given the widespread systemic inequities in healthcare, further evaluation of our PSQI process, and PSQI processes beyond our institution, is needed.

PATHOLOGY TEACHING LEARNING METHODS – STUDENTS’ PERCEPTION AND FEEDBACK

Background: Pathology is a key subject at the pre-clinical stage of medical training which needs regular feedback. The clinical years of medical students start from 3rd year MBBS, where importance of pathogenesis of disease is taught that enable the students to appreciate medicine with better conception. Monitoring the teaching and learning methods of the facilitators is necessary for departmental quality improvement. Objectives: The objective of the present cross-sectional study was to evaluate the student’s feedback in form of questionnaire about pathology teaching followed in the college in Lahore Medical &amp; Dental College from 2021 to Dec 2021. Methodology: 345 students participated in the study and filled a structured pre-validated feedback questionnaire regarding the didactic lecture method of teaching being followed at pathology department Lahore Medical and Dental College. Questionnaire included set of questions on teaching and learning methods. Descriptive statistics were used in the form of frequency distribution and percentages were used to analyze the data. Results: 33.3% students found pathology subject interesting, 47.5% clinically helpful, and 27.5% considered General Pathology to be a difficult subject. Conclusion: Taking feedbacks from the students is one of the accepted and reliable methods of assessment. Majority of the students were satisfied with the present teaching learning method. Introduction of integrated teaching and case based and group-based discussion was favored by majority of the students. Regular feedback will improve our future teaching strategy.

Do two-week wait (2WW) referrals for breast pain alone correlate with cancer diagnosis? A departmental review and quality improvement project

Background/Introduction: Our department has an increasing caseload of two-week wait (2WW) referrals to the breast outpatient clinic. A proportion are referred with breast pain as their only symptom/clinical finding.

MSPP02 Presentation Time: 4:10 PM: A Six Minute Brachytherapy Waste Audit: A Feasible, Efficient Method for Identifying Opportunities to Enhance the Environmental Sustainability of a Radiation Oncology Department Practices

<h3>Purpose</h3> Operating rooms (OR) have been identified as a major source of greenhouse gas emissions in part due to their waste generation - producing an estimated 30% of hospital waste. Today, unused surgical supplies that end up in the waste system can account for 15% of total surgical supply costs. Nearly all forms of brachytherapy require use of an OR, or designated procedural suite, thus significant opportunities exist to engage staff in analyzing current practices and finding ways to reduce waste. We established a waste audit protocol to increase employee engagement and measure a single department's OR waste. <h3>Materials and Methods</h3> A three-month brachytherapy OR waste audit was conducted. The waste audit team consisted of a brachytherapy attending, two brachytherapy radiation therapists, radiation oncology residents, and a research coordinator. Standardized documents created for the audit included: a one-page waste-audit template, a one-page supply audit, and an email template sent to the brachytherapist whose cases were audited. Equipment used included a patient scale and phone camera used to document standard setup, supplies used, and waste generated. The audit was performed by an independent auditor (a resident and/or research coordinator) upon conclusion of the OR case. Procedural waste was weighed and photographed, and later analyzed collaboratively at waste audit team meetings. <h3>Results</h3> A total of 21 randomly selected HDR brachytherapy OR cases were audited between December 2021 - February 2022. The average length of time required to complete the waste audit was 6 minutes. Results were presented to all brachytherapy staff at an already established monthly meeting, and to the greater department during a five-minute time slot at the monthly departmental Quality Improvement conference. An educational poster was created depicting proper waste sorting of common OR and brachytherapy supplies into biohazard versus non-biohazard waste. All templates and education material were packaged into an public online waste audit "toolkit" which may be adapted by other departments. Further implementation of waste mitigation efforts remain underway. <h3>Conclusions</h3> The OR waste audit protocol described here serves as an efficient, feasible model that seamlessly integrates into brachytherapy practices. The standardized templates and "toolkit" may be used widely by other procedural suites, outpatient clinics, radiation oncology departments, and specialties beyond radiotherapy to evaluate current waste practices, improve care, and possibly reduce costs. Importantly, this waste audit tool serves as an easy entry point, and a call-to-action, for healthcare professionals and radiation oncologists to begin to transition to environmentally sustainable care.

An Evidence-Based Industry-Standard Departmental Quality Improvement Project to Improve Customer Service – the Net Promoter Score

<h3>Purpose/Objective(s)</h3> In 2003, an article in the Harvard Business Review by Reichheld, et al, identified a simple single investigative question – "How likely is it that you would recommend [company X] to a friend or colleague?" – that best represented customer loyalty and would predict company growth. With a renewed interest in patient satisfaction, this survey has been adapted in the healthcare community, but there are no known publications describing its use in a radiation oncology clinic. <h3>Materials/Methods</h3> From April of 2019 through February of 2022, hard-copy forms were given to patients after CT simulation and at completion of therapy in a private room onsite. The question read, "How likely are you to refer patients who are friends or family to [Institution] Radiation Oncology?" If he or she agreed to answer the survey, the respondent used a Likert scale from 0 to 10 (least to most likely) and added comments in a free-text section. Responses with a 0 to 10 score were logged with no identifying information and were classified as "promoters" (9 to 10) or "detractors" (0 to 6); a monthly Net Promoter Score was calculated by dividing the number of "promoters" by the sum of "promoters" and "detractors." Comments, if available, were additionally transcribed. The scores and comments were shared with the department once weekly in morning huddle. <h3>Results</h3> Patients filled out 1318 forms (62%). Monthly Net Promoter scores ranged from 94.44 to 100. The average response was 9.74 with marks of 9.76, 9.74, 9.75, and 10.00 for 2019, 2020, 2021, and 2022, respectively. In 2019 and 2020, replies were separated by timepoints of CT simulation (9.73 and 9.71) and after radiotherapy (9.75 and 9.78). During this timeframe, comments were further analyzed by qualitative analysis and were classified into "staff appreciation," "patient feelings/treatment," "wait times," "respect," and "communication." <h3>Conclusion</h3> The Net Promotor Score is an available tool to get immediate feedback from patients, allowing rapid service recovery, if needed. In our department, scores were consistently favorable with little difference through the COVID-19 pandemic, and patients noted that they were appreciated, felt respected, and experienced short wait times.

An Emergency Department Quality Improvement Project for Intravenous Levetiracetam Administration

Background: Levetiracetam is a readily available, safe anticonvulsive medication. It is frequently administered as IV piggyback with a pump, carrier fluid, and tubing. The Established Status Epilepticus Treatment Trial demonstrated levetiracetam being similarly effective to previously used treatments in doses up to 4500 mg administered over 10 minutes. Objective: We sought to compare usage, cost, and waste of IV piggyback with IV push administration of levetiractam following implementation of an IV push protocol in an academic emergency department. Methods: A three-month review of levetiracetam administration was done following protocol implementation using IV push for initial treatment of benzodiazepine-refractory status epilepticus. The review quantified the number of IV push vs IV piggyback doses for all indications and evaluated cost of supplies necessary for administration. Results: During the study period, 137 patients received 142 doses of IV levetiracetam. Fifty-one doses (36%) were given as IV push rather than IV piggyback. The majority of doses 116 (82%) were 1000-2000 mg and 11 doses (8%) 3500-4500 mg. Estimated three-month savings with complete transition of IV piggyback to IV push would exceed $6000 just in our ED. The amount of sterile solution carrier fluid was also reduced and IV pump time freed. Conclusion: Implementation of an emergency department IV push levetiracetam protocol resulted in cost savings. Opportunities remain to improve clinical implementation practices. Medication administration represents one crucial target area where healthcare systems can implement policies to reduce waste and commit to climate-smart health care.

289 Impact of an Emergency Department Quality Improvement Initiative to Promote Safe Discharge of Low-Risk Chest Pain Patients

Through participation in the Michigan Emergency Department Improvement Collaborative (MEDIC), an interdisciplinary team of physicians, advanced practice professionals, and nurses aimed to increase the safe discharge rate of adult low-risk chest pain patients. The purpose of this quality improvement project was to implement a standardized clinical pathway, including the use of the HEART score to promote the safe discharge of low-risk emergency department (ED) patients with chest pain.