Department Quality Research Articles

Is Google Gemini better than ChatGPT at evaluating research quality?

ABSTRACT Google Gemini 1.5 Flash scores were compared with ChatGPT 4o-mini on evaluations of (a) 51 of the author’s journal articles and (b) up to 200 articles in each of 34 field-based Units of Assessment (UoAs) from the UK Research Excellence Framework (REF) 2021. From (a), the results suggest that Gemini 1.5 Flash, unlike ChatGPT 4o-mini, may work better when fed with a PDF or article full text, rather than just the title and abstract. From (b), Gemini 1.5 Flash seems to be marginally less able to predict an article’s research quality (using a departmental quality proxy indicator) than ChatGPT 4o-mini, although the differences are small, and both have similar disciplinary variations in this ability. Averaging multiple runs of Gemini 1.5 Flash improves the scores.

Improving distress screening in radiation oncology consultation.

332 Background: Receiving a cancer diagnosis and awaiting initial management recommendations is a stressful time. Distress should be recognized, documented, and treated promptly as part of quality oncologic care. The NCCN Distress Thermometer (DT) is a useful tool for patients to quantify their level of distress. This pilot study assesses the rate of distress screening at a high-volume academic healthcare network, before and after institutional quality improvement (QI) intervention. Methods: All patients seen for Radiation Medicine between 1/1/22 - 12/31/23 were reviewed. Rates of DT documentation at the time of consultation were assessed as the QI metric. Patients seen in 2022 served as a baseline of departmental compliance. The importance of distress assessment was formally introduced to physicians and advanced care practitioners (ACPs) in Q4 2022 during monthly departmental quality reports, with notice that a formal QI metric would be monitored beginning 1/1/23. Chi-square test was used to compare rates of DT documentation. Monthly departmental DT documentation rates were back presented to the physicians and ACPs during quality meetings. Results: 9391 patients were seen for radiation oncology consultation (2022 = 4311; 2023 = 5080). Baseline DT documentation was 51.0%. Initial compliance with the metric was below baseline, at 41.4% for Jan 2023. With continued feedback, education, and goal-setting, rates of DT use continually improved over Q1/Q2 2023 and remained relatively steady through the remainder of Q3/Q4 2023, reaching a monthly high of 89.8%. Overall DT documentation significantly improved for 2023 was 81.4% (χ 2 = 977.9, p < 0.0001). The rates of DT documentation were relatively consistent based on diagnoses codes, though lower amongst consults seen for metastatic disease (84.0% vs 73.4%, χ 2 = 24.28, p < 0.0001). Conclusions: Screening rates at consultation are modifiable and maintainable, but distress management remains a continuous quality improvement project as we explore services to address identified stressors and reassess distress levels at future visits.

Treatment Terminations During Radiation Therapy: A 10-Year Experience

Patients undergoing radiation therapy may terminate treatment for any number of reasons. The incidence of treatment termination (TT) during radiation therapy has not been studied. Herein, we present a cohort of TT at a large multicenter radiation oncology department over 10 years. TTs between January 2013 and January 2023 were prospectively analyzed as part of an ongoing departmental quality and safety program. TT was defined as any premature discontinuation of therapy after initiating radiation planning. The rate of TT was calculated as a percentage of all patients starting radiation planning. All cases were presented at monthly morbidity and mortality conferences with a root cause reviewed. A total of 1448 TTs were identified out of 31,199 planned courses of care (4.6%). Six hundred eighty-six (47.4%) involved patients treated with curative intent, whereas 753 (52.0%) were treated with palliative intent, and 9 (0.6%) were treated for benign disease. The rate of TT decreased from 8.49% in 2013 to 3.02% in 2022, with rates decreasing yearly. The most common disease sites for TT were central nervous system (21.7%), head and neck (19.3%), thorax (17.5%), and bone (14.2%). The most common causes of TT were hospice and/or patient expiration (35.9%), patient choice unrelated to toxicity (35.2%), and clinician choice unrelated to toxicity (11.5%). This 10-year prospective review of TTs identified a year-over-year decrease in TTs as a percentage of planned patients. This decrease may be associated with the addition of root cause reviews for TTs and discussions monthly at morbidity and mortality rounds, coupled with departmental upstream quality initiatives implemented over time. Understanding the reasons behind TTs may help decrease preventable TTs. Although some TTs may be unavoidable, open discourse and quality improvement changes effectively reduce TT incidents over time.

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.

Measuring research quality in a more inclusive way: Evidence from the UK Research Excellence Framework

Abstract Evidence suggests that common metrics of research quality—e.g. journal publications and citations—are systematically biased against certain groups. But does relying solely on them to evaluate quality lead to lower diversity in academia? In this paper, we start to answer this question by analysing data from the UK’s nationwide research assessment exercise, the Research Excellence Framework. We find that narrowly focussed output-based measures of departmental research quality do indeed negatively correlate with the diversity of departmental staff, while measures of research impact and of the quality of the research environment correlate positively. An aggregate measure that incorporates all three components is therefore likely to better promote staff diversity compared to more narrowly defined output-focused measures. More generally, our results suggest that comprehensive definitions of research quality may be more effective at promoting diversity in academia compared to narrower measures. We further argue that funding decisions informed by broader measures result in more efficient resource allocations across the higher education sector.

Patient and Operational Factors Do Not Substantively Affect the Annual Departmental Quality of Anesthesiologists' Clinical Supervision and Nurse Anesthetists' Work Habits.

Although safety climate, teamwork, and other non-technical skills in operating rooms probably influence clinical outcomes, direct associations have not been shown, at least partially due to sample size considerations. We report data from a retrospective cohort of anesthesia evaluations that can simplify the design of prospective observational studies in this area.Associations between non-technical skills in anesthesia, specifically anesthesiologists' quality of clinical supervision and nurse anesthetists' work habits, and patient and operational factors were examined. Eight fiscal years of evaluations and surgical cases from one hospital were included. Clinical supervision by anesthesiologists was evaluated daily using a nine-item scale. Work habits of nurse anesthetists were evaluated daily using a six-item scale. The dependent variables for both groups of staff were binary, whether all items were given the maximum score or not. Associations were tested with patient and operational variables for the entire day. There were 40,718 evaluations of faculty anesthesiologists by trainees, 53,772 evaluations of nurse anesthetists by anesthesiologists, and 296,449 cases that raters and ratees started together. Cohen's d values were small (≤0.10) for all independent variables, suggesting a lack of any clinically meaningful association between patient and operational factors and evaluations given the maximum scores. For supervision quality, the day's count of orthopedic cases was a significant predictor of scores (P = 0.0011). However, the resulting absolute marginal change in the percentage of supervision scores equal to the maximum was only 0.8% (99% confidence interval: 0.2% to 1.4%), i.e., too small to be of clinical or managerial importance. Neurosurgical cases may have been a significant predictor of work habits (P = 0.0054). However, the resulting marginal change in the percentage of work habits scores equal to the maximum, an increase of 0.8% (99% confidence interval: 0.1% to 1.6%), which was again too small to be important. When evaluating the effect of assigning anesthesiologists and nurse anesthetists with different clinical performance quality on clinical outcomes, supervision qualityand work habits scores may be included as independent variables without concern that their effects are confounded by association with the patient or case characteristics. Clinical supervision and work habits are measures of non-technical skills. Hence, these findings suggest that non-technical performance can be judged by observing the typical small sample size of cases. Then, associations can be tested with administrative data for a far greater number of patients because there is unlikely to be a confounding association between patient and case characteristics and the clinicians' non-technical performance.

Analysis of service quality in engineering design department through SERVQUAL framework

This paper aimed to explore the application of SERVQUAL in assessing the performance of in-house detailed engineering design in an engineering management firm. The goal is to evaluate service quality and identify gaps between customer expectations and perceptions across the five service quality dimensions. Results show that customers are dissatisfied with the department's service quality, and negative gaps exist across all 22 questions. Improvements in reliability, assurance, and responsiveness are recommended to enhance customer satisfaction. The study demonstrates a strong correlation between service quality dimensions and contract retention, highlighting the importance of improving service quality for long-term business success.

"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.

The Implementation of Green Practices to improve the service quality of front office at K Club Ubud

The K Club Ubud in Gianyar, Bali, has used green practises to enhance the front office department's service quality. The goal of this study is to examine these activities and identify the green practises indicators that must be maintained and improved. Questionnaires, interviews, observations, and documentation were used to collect data for this study. The sample strategy used in this investigation was simple random sampling. In order to collect data, online surveys are distributed to respondents. As part of the processing, the questionnaire was subjected to validity and reliability tests. The servqual test (quality of service) and importance-performance analysis (IPA) are then employed as data analysis techniques in this study. According to the findings of this study, the application of green practices has been done in an optimal manner, as evidenced by the outcomes of the application of 3R activities. The results of the servqual test, which show that the front office department at K Club Ubud has seven gaps (+) and one gap (-) in the form of eight question indicators, can be used to describe how successfully green practices have been implemented. According to the importance performance analysis (IPA) results, the front office department must maintain the quality of the services for one indication while making improvements for the other.

Can a self-inspection programme improve compliance with professional standards in a hospital pharmacy?

Abstract Introduction Pharmacies must comply with professional standards to provide high-quality services. However, gaining assurance of compliance can be challenging and self-inspection was investigated as a means of consistently achieving this. Aim This project aimed to develop and implement a self-inspection programme to assess compliance with professional standards in a hospital pharmacy. Through the self-inspections, we aimed to identify required improvements and maintain achieved compliance through effective reporting, evaluation, and communication of results. Methods Standards from Royal Pharmaceutical Society professional guidance1, standards2 and General Pharmaceutical Council standards3 were used to create 41 self-inspection questions. These assessed different aspects of medicines management, including the receipt, storage, dispensing, delivery, disposal, and security of medicines. They also assessed compliance with health and safety measures and service quality indicators taken from the monthly quality report, health and safety report, cleaning logs, expiry date checks and stock checks in the department. Self-inspections were conducted monthly over a 12-month period by members of the Pharmacy Senior Leadership Team. Self-inspections were recorded using the Tendable accreditation application. Training in using the application and a standard operating procedure was in place to support this. Questions in the self-inspection were only answered as “Yes” or “No”. Additional information, images or actions taken were required for any question that was negatively scored. Following self-inspections, results were calculated by the application and a summary generated. A full report was also produced by the application. These were analysed by the Pharmacy Quality Assurance Team and included in the monthly departmental quality report for review by the Pharmacy Senior Leadership Team. Any identified actions were communicated by e-mail to the relevant team leader and an inspection summary later displayed in the department. This study did not require ethics approval. Results Compliance with standards increased steadily from 75% on the first self-inspection to 95%, with an average of 89% over the 12 months. During the self-inspections, non-compliance with 14 different standards was identified. 3 concerned non-compliance of staff with processes, which was addressed and not repeated. 11 concerned non-compliance that was repeated, including delays in updating essential documents, delays in completing essential tasks, medicines storage not complying with requirements, a correct responsible pharmacist notice not displayed and building work disrupting services. All of these have now been resolved, except deficiencies in the storage of bulk fluids, where risks have been mitigated and a long-term plan is in place. Discussion/Conclusion Compliance with professional standards in the pharmacy has been improved through the implementation of a self-inspection programme. Questions in the self-inspection defined the required standards and guidance on conducting self-inspections ensured consistent assessment, enabling both compliance and non-compliance to be identified. Processes for reporting, evaluating and communicating results from the self-inspections directed how non-compliance was resolved. This promoted awareness of required standards and helped maintain achieved compliance. Limitations of the study included failing to assess compliance with standards not covered in the self-inspection questions. A regular review of self-inspection questions, standards and results is therefore required to maintain reliability and continued improvement.

Optimizing Acute Sickle Cell Care at Community Health Partners Medical Center

CONCLUSION Sickle cell disease (SCD) is an inherited disease affecting more than 100,000 Black and Hispanic patients in the US. An adult with SCD has an average life expectancy of 54 years compared to 76 years in a typical US adult. This poor survival rate can be attributed to disease and race-related biases, a lack of standardized procedures and dedicated care providers, and delayed or insufficient pain management in the acute care setting. Delays and disparities in care, particularly pain management in acute care setting, have been identified as one of the key deficiencies leading to a decreased quality of care and patient reported outcomes. This SCD quality improvement project seeks to improve the quality and timeliness of acute sickle cell vaso-occlusive care by utilizing an ED pain pathway, SCD-specific inpatient order sets, and educating providers on care-related biases for patients seeking acute care at Community Health Partners Medical Center (CHP). The primary objective is to improve efficacy, timeliness and patient-centered care in order to optimize health outcomes for patients with SCD seeking acute care at CHP. This is a collaborative effort between ED, Hospitalist and Pain Management teams. By identifying areas of strength and areas for improvement, we can work towards delivering more efficient, effective, and patient-centered care, ultimately leading to better health outcomes for patients with SCD disease in need of emergency services. Using the Epic EMR, a metric dashboard was created for SCD patients to measure time from arrival to ED order placement, time from arrival to medication administration, number of inpatient admissions, and length of stay. We focused on crucial time metrics and patient outcomes to gauge the department's efficiency and quality of care for SCD Vaso-occlusive pain crisis. Our intervention included delivering an educational presentation to the ED providers regarding appropriate recognition and treatment of SCD pain episodes, and by creating ED and inpatient SCD-specific order sets. The baseline data was evaluated from 3/1/2021-2/28/2022, and metrics were followed for one year after implementation of the intervention from 3/1/22-2/28/23. After implementation, the average time from arrival to ED order placement improved from 94.9 minutes to 69.4 minutes, a difference of 25.5 minutes or 27%. The average time from arrival to medication administration improved from 158.5 minutes to 135.3 minutes, a difference of 23.2 minutes or 14.6%. The average length of stay increased from 5.7 days to 8.4 days, an increase of 2.7 days or 32.2%. By providing education and SCD-specific order sets, we were able to significantly decrease the total amount of time to medication administration for SCD patients experiencing acute pain crises. While our methods were aimed at ED providers to simplify the input of orders, it did not address the time for nursing to obtain and administer the medication; future improvements could be made towards educating nursing staff to help administer medications sooner. One complicating factor is that these metrics were evaluated during the COVID pandemic, which was responsible for an overall increase in patient admissions and length of stay during this time period. These additional burdens have strained the ability of providers and nurses to provide timely care to SCD patients, though this will hopefully continue to improve as the pandemic recedes. Additionally, the proportion of ED patients who were admitted for further management decreased marginally from 25/39(61%) to 36/63(57%) though the overall number of patients seeking care in our acute care setting has increased. This increase in the number of patients utilizing our acute care may be partly due to an expanding Sickle Cell program at our facility. This analysis shows that by providing appropriate education and using a standardized order set and pathway, we observed a significant decrease in time to order placement to facilitate a faster administration of medications. While the results indicate positive changes in the acute setting, there are opportunities for continued improvement, particularly in reducing the time from order placement to medication administration to ensure more efficient, effective, and patient-centered care.

Implementation of Deviation Index to Optimization Procedures on Radiography Examination Using Digital Radiography

In the development of radiographic imaging technology at digital radiography (DR) is not accompanied by an increase in radiographers' awareness and knowledge of optimization procedures. The aim of this research will focus on the implementation of the deviation index to optimize procedures using digital radiography. The research method is descriptive and analytical by giving questionnaires to radiographers regarding awareness and knowledge of optimization procedures in radiographic examinations using deviation index (DI) on digital radiography (DR), This research was conducted on radiographer respondents with the research time being conducted between August - October 2023. Statistical analysis using SPSS 27 with prior data coding. After that, the measurement of the percentage of awareness and knowledge about optimization procedures using DI on DR will be categorized as <60%: bad, 60-75%: moderate, and>75: good. Then for the value determination p-value using test chi-squere to determine the correlation between knowledge of region, age, gender, education, and experience in optimization procedures using DI in DR. The study's findings regarding the use of optimization procedure demonstrate that radiographers' awareness and knowledge in applying DI on DR optimization methods is still lacking, with a percentage value of less than 60%. The results of the test chi-square demonstrate that there is no correlation between respondent data characteristics and knowledge p-value > 0.05. Therefore, attending radiation protection training and course is a crucial step toward raising radiographers awareness and knowledge of radiation protection on patient. because the radiology department's quality assurance and service quality measures are linked to initiatives to optimize procedures.

Value of care by reducing treatment terminations during radiation therapy.

6 Background: Disruptions in cancer care adversely affect patient clinical outcomes, particularly when a patient does not complete the prescribed course of treatment. Adverse outcomes include decreased overall survival and earlier/increased disease relapse or progression requiring additional salvage, palliative, and/or supportive therapies. We have reported on the incidence of treatment terminations (TT) in a large multi-center academic radiation medicine department. This study addresses the healthcare expenditure toward sub-optimal treatment associated with TT. Methods: TT of patients undergoing radiation treatment between 1/2013 and 1/2023 were prospectively tracked as part of departmental quality and safety monitoring. A TT was defined as the discontinuation of therapy at any point following informed consent and treatment simulation. The rate of TT was calculated as a percentage of all new patients who start radiation treatments. Cost of care was estimated using mean values from the 2023 Medicare Part B Fee schedule for New York, accounting for consultation, simulation and planning, treatment delivery, and weekly physician and physics treatment checks prior to TT. Cuts to the Medicare Physician Fee Schedule, Medicare reimbursement, and stagnant Medicare Conversion Factor relative to inflation over the 10 years were not accounted for. Results: There were a total of 1,467 TTs out of 28,707 planned treatment courses (5.1%). The average expenditure prior to TT was $8,584 per patient. Aggregated over the past decade, $12.59 million represents an underestimate of healthcare spend toward these situations at one institution. The rate of TT decreased from 9.3% in 2013 to 3.3% in 2022. As discussed separately, this TT rate was reduced via prospective analysis as part of our ongoing department quality and safety program, with incremental changes to pre-treatment evaluation, on-treatment management, and scheduling processes. Assuming stagnant clinical volume, this translates into decreased spend of $1.48 million annually toward incomplete (sub-optimal) treatments. Conclusions: Radiation TTs reflect major deviations from the original care plan. By understanding reasons for TT, we have more effectively selected optimal treatment paradigms and supported patients proactively through their treatment course. Avoiding divergence from intended cancer care decreases adverse outcomes, thereby improving value of the treatment course.

Understanding radiation treatment terminations as an element of quality.

408 Background: Disruptions in cancer care adversely affect clinical outcomes. The effect is magnified when treatments are not just protracted, but discontinued prematurely. The incidence of such treatment termination (TT) during radiation therapy has not been well studied. We herein present a single-institution cohort of TT at a large multi-center radiation oncology department over 10 years. Methods: As part of our ongoing departmental quality and safety monitoring program, TTs were prospectively tracked and assessed. A TT was defined as the premature discontinuation of therapy at any point following the initiation of radiation planning. The rate of TT was calculated as a percentage of all new patients who start radiation planning. Each TT between 1/2013 and 1/2023 was analyzed for a root cause, reviewed among multi-disciplinary Quality committee members, and presented monthly to the radiation department. Selected cases sparked discussion and efforts to identify interventions that may decrease the likelihood of similar TTs. Incremental departmental policy and procedure changes to critical pre-treatment evaluation, prospective contouring rounds, on-treatment management, and scheduling processes were implemented, collectively referred to as the “No-Fly” policy. Results: A total of 1,467 TTs were identified and analyzed. 688 (46.9%) involved patients treated with curative intent, 770 (52.5%) with palliative intent, and 9 (0.6%) for benign disease. The most common cause of TT was hospice and/or death (36.5%), 69.1% of which were in patients receiving palliative treatments. Other common causes identified are shown in Table 1. The overall 10-year rate of TT was 5.1% (1,467 of 28,707 planned treatment courses). The rate of TT decreased from 9.3% to 3.3% (2013 and 2022, respectively), with rates decreasing at each iteration of No-Fly from 8.8% (No-Fly 1, 2013-2014) to 5.2% (No-Fly 2, 2015-2018) to 4.0% (No-Fly 3, 2019-2022) (ANOVA p<0.001). Conclusions: Premature termination of radiation therapy can be deleterious for cancer patients. Determining the causes of TTs so that they may be mitigated is integral to effectively managing care and improving safety culture in radiation medicine departments. While some TTs may be unavoidable, open discourse and quality improvement changes are effective in reducing incidents over time. Understanding TTs is complimentary to other nationwide projects exploring how reducing missed radiation therapy appointment rates support access to high quality oncology care.[Table: see text]

Анализ внедрения системы менеджмента качества за 2019-2021 гг. в ГБУЗ РТ «Республиканская детская больница»

Abstract. Relevance. One of the most important tasks of each medical organization is to provide the population with high-quality medical care and accessible to every patient, which is ensured by the implementation of state, departmental and internal quality and safety control of medical activities. Internal quality control and safety of medical activities is a tool for self-control, can be ensured by implementing a quality management system that promotes the continuous development and improvement of a medical organization and is focused on continuous improvement of activities, taking into account the needs of all stakeholders. Aim. The article examines the analysis of the implementation of a quality management system for the quality of medical care provided to the population. Results. Based on the conducted research, it was revealed that the organization of internal quality control through the introduction of a quality management system in the State Medical Institution of the Republic of Tyva «Republican Children’s Hospital» has the following advantages.

Laparoscopic salvage procedures for adnexal torsion in pediatric and adolescent patients during the COVID-19 pandemic: a retrospective cohort study

BackgroundEarly management for adnexal torsion increases likelihood of ovarian/tubal salvage. The Coronavirus disease of 2019 (COVID-19) pandemic poses delays from symptom-onset to intervention. The primary objective was to evaluate rates of ovarian salvage and tubal salvage following ovarian torsion and adnexal torsion during the COVID-19 pandemic in a pediatric and adolescent gynecology population.MethodsThis was a retrospective quality improvement cohort study of pediatric and adolescent gynecology patients at a single children’s hospital who underwent laparoscopy for suspected ovarian torsion/adnexal torsion between March 2020 to March 2021. Descriptive statistics and t-tests were utilized.ResultsThere were 50 suspected adnexal cases in 47 patients. All underwent laparoscopy, revealing 39 adnexal torsion occurrences in 36 patients and 1 patient with recurrent adnexal torsion three times. All underwent pre-operative COVID-19 testing. Mean age was 13.9 ± 2.6 years for adnexal torsion cohort. Menarche was achieved in 88% (n = 44) and 12% (n = 6) were pre-menarchal. The primary outcome was ovarian salvage and tubal salvage rates, which were 97.4% (n = 38) and 89.7% (n = 35), respectively. Secondary outcomes assessed factors contributing to the primary outcome or operative delays. The mean age of menarche was 11.2 years (salvaged) and 12.5 years (non-salvaged) (p = 0.04). There were no differences in mean pain duration or mean COVID-19 testing time between groups. Left, right and bilateral adnexal torsion occurred in 42% (n = 21), 32% (n = 16), and 4% (n = 2) respectively. The most common pathologies were paratubal cyst (n = 17, 34%) and benign ovarian cyst (n = 16, 32%).ConclusionsOvarian salvage and tubal salvage rates were 97.4% and 89.7%, respectively during the time frame studied. These salvage rates during the study period are comparable to previous rates in a pre-COVID cohort at our institution. Institutional and departmental quality and safety initiatives likely contributed to this outcome.

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.

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.

Implementing Internal Quality Assurance Systems in the In-Service Teacher Education Programmes in Zimbabwean Universities: The Quality Discourse

The emerging discourses in the Zimbabwean teacher education system have been on the capacity of in–service teachers to be transformative through their preparation at university. The call, then, has been on universities to improve their quality assurance and its effective implementation for quality programmes and learning outcomes. There have been growing indications and expectations that university in–service teacher graduates should lead in transforming the educational and economic systems of nations presenting a strong explanation for effective quality assurance structures in universities. In this article, the researchers contended that without robust quality assurance systems at Zimbabwean universities’ teacher education programmes, the nation may not achieve the desired educational vision. The paper reports, analyses practices and lessons learnt on the implementation of internal quality assurance systems on in-service teacher education programmes at one state university in Zimbabwe. Underpinned by the sociocultural theory, the qualitative case study used semi–structured interviews and open–ended questionnaires. One quality assurance directorate, four departmental quality assurance lecturers drawn from each of the four School of Education departments and twelve final years in-service students were purposefully sampled. The results indicated that the university had weak internal quality assurance management structures failing to continuously monitor and evaluate in-service programmes and their implementation. The study recommended that the institution reconstitutes the quality assurance body by bringing together all stakeholders including in-service students to a dialogue table to discuss how quality assurance standards and practices can be designed, implemented and evaluated. Keywords: Implementation, internal quality assurance, university, teacher education, in-service