Quality Of Documentation Research Articles

Adherence to national trauma triage criteria in Norway: a cross-sectional study

BackgroundNorwegian hospitals employed individual trauma triage criteria until 2015 when nationwide criteria were implemented. There is a lack of empirical evidence regarding adherence to Norwegian national criteria for activation of the trauma team (NTrC) and the decision-making processes regarding trauma team activation (TTA) within Norwegian trauma hospitals. The objectives of this study were to investigate institutional adherence to the NTrC and to investigate similarities and differences in the decision-making process leading to TTA in Norwegian trauma hospitals.MethodsA digital semi-structured questionnaire regarding adherence to criteria, TTA decision-making and criteria documentation was distributed to all Norwegian trauma hospitals (n = 38) in the spring of 2022. Contact details of trauma coordinators and registrars were provided by the Norwegian Trauma Registry secretariat. Follow-up telephone interviews were conducted at the investigator’s discretion in cases of non-respondents or need to clarify answers.ResultsThirty-eight trauma hospitals were invited to answer the survey, where 35 hospitals responded (92%), making 35 the denominator of the results. Thirty-four (97.1%) hospitals stated that they followed NTrC. Thirty-three (94.3%) of the responding hospitals provided documentation of their criteria in use, of which twenty-eight (80%) of responding hospitals adhered to the NTrC. Three (8.6%) hospitals employed a tiered TTA approach with different sized teams. In addition four hospitals (11.4%) used specialized teams to meet the needs of defined patient groups (e.g. geriatric patients, traumatic brain injury). Twenty-one (60%) of the responding hospitals had written guidelines on who could perform TTA and in 18 hospitals (51.4%) TTA could be performed by pre-hospital personnel. Twenty-three (65.7%) of the hospitals documented which criteria that were used for TTA.ConclusionThere is good adherence to the national criteria for activation of the trauma team among Norwegian trauma hospitals after implementation of national guidelines. Individual hospitals argue the use of certain local criteria and trauma team activation decision-making processes to increase their precision in specific patient populations and demographics. Further steps should be done to reduce the variation in TTA decision-making processes among hospitals and improve documentation quality.

An Evaluation of London's Intermediate Minor Oral Surgery Service

ABSTRACTBackgroundOral surgery as a speciality has traditionally experienced significant demands, representing one of the largest volume and cost of referrals from primary to secondary care. The IMOS service was created with the objective to increase the efficiency and accessibility of oral surgery services to the public, as well as reduce pressures within hospital settings.AimsTo assess: The quality of the service provided. The waiting times. If the service met needs. Patient‐reported outcome and experience measures. MethodA random sample of patients referred to London Tier 2 IMOS providers were selected, 10 from each provider, totalling 180. They were evaluated to ascertain waiting times, treatment delivered, quality of documentation and level of complexity, level 1, 2, and 3. Patient‐Reported Experience Measures (PREMs) and Patient Reported Outcome Measures (PROMs) were also carried out to assess satisfaction.Results38.3% of referrals were classed as Level 1 and the remaining Level 2 and Level 3 were 60% and 1.67%, respectively. 37.2% of patients were seen within 0–49 days, and 72.3% of patients were seen and treated within 18 weeks. 90.8% of these cases were non‐surgical, 17.9% involved mandibular 3rd molar extractions, of which 46.6% were surgical.313 PREMs and 321 PROMs were collected, the experience survey revealed over 98.7% of patients felt anxiety and pain were managed well, with any concerns addressed. PROMs showed that 94.3% of patients did not require further calls or assistance post‐treatment. 72.4% of patients felt recovery was completed within 3 days of the treatment. 1.87% of patients required further assistance such as for dry socket and infection.ConclusionThe London IMOS service is an economical, safe and effective environment to provide minor oral surgery to the vast majority of patients, who would have otherwise been seen in secondary care. Development of pan London triage and communication pathways will further enhance the service and ensure smooth and efficient patient journeys.

Ambient artificial intelligence scribes: physician burnout and perspectives on usability and documentation burden.

This study evaluates the pilot implementation of ambient AI scribe technology to assess physician perspectives on usability and the impact on physician burden and burnout. This prospective quality improvement study was conducted at Stanford Health Care with 48 physicians over a 3-month period. Outcome measures included burden, burnout, usability, and perceived time savings. Paired survey analysis (n = 38) revealed large statistically significant reductions in task load (-24.42, p <.001) and burnout (-1.94, p <.001), and moderate statistically significant improvements in usability scores (+10.9, p <.001). Post-survey responses (n = 46) indicated favorable utility with improved perceptions of efficiency, documentation quality, and ease of use. In one of the first pilot implementations of ambient AI scribe technology, improvements in physician task load, burnout, and usability were demonstrated. Ambient AI scribes like DAX Copilot may enhance clinical workflows. Further research is needed to optimize widespread implementation and evaluate long-term impacts.

Transition of care: toward tailored transition of adolescents with osteoporosis and metabolic bone diseases to adult care through an integrated, people-centered, disease-specific health services framework

BackgroundThe Egyptian Academy of Bone and Muscle Health in collaboration with the Egyptian College of Pediatric Rheumatology have identified two indicators to ensure optimum health outcomes among children: one is developmentally and nutritionally appropriate healthcare, and the second is the availability of an effective transition of care model from pediatric care to adult health services. Currently, there is no national guidelines on transition of care for children and adolescents with osteoporosis and metabolic bone disease. To close this gap, this work was carried out to develop the Egyptian guidelines for transition model of care.ResultsThe final recommendation included 12 specific domains. These included the following: targeted population, transition age, transition readiness, patient-targeted care, and disease-specific knowledge, patient education, and optimum model for the transition of care, transition referral, management approach, high quality of care, documentation, and recent service approaches as well as standards and quality indicators. All the overarching principles and most voters agreed with the 12 amended recommendations.ConclusionTransitional care is the term used to describe services that seek to bridge this care gap. Based on the best available data and professional judgment, these consensus-based recommendations guide ways to achieve optimal outcomes in transitional care for adolescents with osteoporosis and metabolic bone disorders. Though focussed on transition of care of bone and muscle health, this article can be the bases for transition services for children with other chronic conditions. This could be used as a blueprint for additional national or internationally healthcare transition policies.

Enhancing Clinical Communication through AI-Powered Recording and Analysis: A Multi-Center Study of Scribr AI Implementation

This article examines the implementation and effectiveness of Scribr AI, an artificial intelligence-powered system designed to enhance doctor-patient communication through automated recording, transcription, and multilingual support in clinical settings. The article evaluates the platform's impact on clinical documentation, patient comprehension, and longitudinal care management across multiple healthcare facilities. Through a comprehensive article analysis of system usage, patient engagement, and healthcare provider feedback, the article demonstrates significant improvements in communication accuracy, patient understanding, and clinical workflow efficiency. The findings indicate that AI-enabled recording and translation systems can effectively bridge language barriers, enhance patient recall of medical instructions, and support precision medicine through detailed documentation of health histories. Additionally, the study reveals notable benefits for chronic care patients through improved tracking and accessibility of historical health data. These results suggest that AI-powered communication tools can play a crucial role in modernizing healthcare delivery while addressing persistent challenges in doctor-patient communication and medical documentation. The findings have important implications for healthcare institutions seeking to improve patient engagement, reduce communication barriers, and enhance the quality of clinical documentation.

Measuring the impact of a pastoral care intervention to increase referrals and improve the quality of chaplain documentation in patient records

The complexity of patient care demands that health care teams collaborate effectively. This means that when pastoral care staff engage with patients, they need to communicate their findings to other members of the multidisciplinary team to maximize patient benefits. In 2016, an Australian hospital found that pastoral care staff were able to visit only 30% of admitted patients, and that documentation of pastoral care visits was minimal. This paper describes and measures the impact of a quality improvement education program for pastoral care workers by auditing patient medical records pre- and post-intervention. The intervention did not significantly increase the number of pastoral care visits or referrals. Documentation of pastoral care visits was significantly improved in terms of the detail provided. More work is required to standardize indications for pastoral care referral and templates for pastoral documentation in patient medical records.

HPB SO63 - A Closed-Loop Audit on Surgical Ward Round Documentation in a Tertiary Hospital

Abstract Background Surgical ward rounds play a pivotal role in overall patient outcome during surgical and perioperative care. Clear and comprehensive documentations are crucial in providing an accurate account of ward round activities. We aimed to assess the quality of hepatopancreatobiliary (HPB) ward round documentation and the impact of a HPB surgical ward round proforma on the quality of documentation. Method 50 medical notes were reviewed in a tertiary centre to determine if key components of ward round documentation such as the date, time, diagnosis, procedure, consultant, person documenting, information communicated to patient, observations, investigations and management plan were documented. A proforma for ward round documentation was introduced. A re-audit was performed to review the impact of a proforma on ward-round documentation. Results The time of ward round, relevant history, NEWS and management plan were recorded in more than 50% of medical notes. However, the diagnosis, consultant, person documenting, information communicated to patient, wound review, medication review, fluid balance, investigations, follow up and discharge plans were documented in less than 50% of medical notes. After the introduction of a proforma, the date and time of the surgical ward round were documented in 94% of medical notes. 84% had initials of the consultants leading ward-rounds and the person documenting. More than 80% notes included relevant examination, information communicated to patient, wound and medications review. Conclusion Surgical ward round proformas have a role in improving ward round documentation. Good record keeping is essential for continuity of care, optimising quality of care and ensuring patient safety.

Symptom Screening for Hospitalized Pediatric Patients With Cancer

Pediatric patients with cancer experience severely bothersome symptoms during treatment. It was hypothesized that symptom screening and provision of symptom reports to the health care team would reduce symptom burden in pediatric patients with cancer. To determine if daily symptom screening and provision of symptom reports to the health care team was associated with lower total symptom burden as measured by the Symptom Screening in Pediatrics Tool (SSPedi) compared to usual care among pediatric patients with cancer admitted to a hospital or seen in a clinic daily for at least 5 days. This randomized clinical trial enrolled participants from July 2018 to September 2023 from 8 Canadian tertiary care centers that diagnose and treat pediatric patients with cancer. Patients aged 8 to 18 years with cancer expected to be in a hospital or clinic daily for at least 5 consecutive days were eligible for inclusion. Participants were randomized to intervention (n = 176) vs control (n = 169) groups. Data were analyzed from November 2023 to December 2023. Intervention participants completed the SSPedi once daily for 5 days. Printed symptom reports were provided daily to the health care team, and email alerts were distributed for severely bothersome symptoms. Control participants received usual care. The primary outcome was self-reported total SSPedi score on day 5. Secondary outcomes were individual SSPedi symptoms, pain, quality of life, symptom documentation, and intervention provision. The primary analysis compared the day 5 total SSPedi scores between randomized groups using a multiple linear regression model. For the secondary analysis comparing individual SSPedi symptom scores, the odds ratio for the intervention was estimated using a proportional odds model. Pain and quality of life were analyzed using the same approach as the primary outcome. Fisher exact test was used to compare symptom documentation, any intervention, and symptom-specific intervention between groups. A total of 345 participants were enrolled; median (range) participant age was 13.8 (8.0-18.8) years, and 150 participants (43.5%) were female. Day 5 SSPedi score was significantly better with symptom screening compared to usual care (adjusted mean difference, -2.5; 95% CI, -3.8 to -1.2). Symptom screening reduced the odds of higher individual symptom scores; 8 of 15 symptom reductions were statistically significant. There were no significant differences in pain or quality of life scores between groups. Five symptoms were documented or treated significantly more often with symptom screening than usual care. In this randomized clinical trial, among pediatric patients with cancer admitted to a hospital or seen in a clinic daily for at least 5 days, symptom screening with SSPedi improved total symptom scores compared to usual care. ClinicalTrials.gov Identifier: NCT03593525.

COVID-19 public health restrictions and opioid overdoes: a summative content analysis of emergency medical services records in three Texas counties

BackgroundWith the broad recognition of increased U.S. opioid overdose (OOD) rates between 2020 and 2021, media, public health, and healthcare organizations have raised significant concerns over the emergence of a simultaneous COVID-19-opioid “twindemic.” Research in this area has explored the possible relationships between negative externalities associated with the pandemic and/or COVID-19 public health interventions and increased risks for opioid use and overdose alongside diminished outcomes following OOD events.MethodsThe study offers a summative content analysis of Emergency Medical Service (EMS) responses to opioid overdose (OOD) events before and after the institution of COVID-19 restrictions. Specifically, the study investigates three Texas counties to evaluate changing OOD rates, patient demographics, and OOD event features. The analysis uses a previously validated machine learning tool to identify OOD events and conducted a summative content analysis of identified events.ResultsA total of 1170 OOD responses events were identified in the three-county dataset. This includes 874 in Travis County, 242 in El Paso County, and 54 in Williamson County. Each county experienced modest changes in EMS calls for OOD events between the pre-restriction and public health restriction time periods. Travis County’s OOD event rate declined from 454 to 420. El Paso’s increased from 103 to 139, and Williamson County’s increased from 23 to 31. These changes were not significant as percentage of possible OOD events or based on by-month comparison. The notable differences between pre-restriction and public health restriction periods were significant decreases in documentation of patient race/ethnicity in Travis and Williamson Counties, significant decreases in housing insecurity and use alone in Travis County, and an increase in transport refusal after treatment in the field in Travis County.ConclusionsUltimately the results presented here problematize prevailing analyses about the so-called opioid-COVID-19 “twindemic.” The data further support emerging trends about substantial geographic variation and show some ways that COVID-19 mitigation measures may have improved conditions for some populations, particularly in terms of housing security. Additionally, the results presented here indicate that further attention should be paid to the effects of first responder stress on documentation quality.

Increasing resuscitation status-related goals of care discussions for older adults with severe mental illness in a Canadian mental health setting: a retrospective study

BackgroundOlder adults with severe mental illness, including advanced dementia (AD), within geriatric admission units (GAU) often prioritise comfort care, avoiding life-prolonging procedures including cardiopulmonary resuscitation (CPR). Pre-2019, hospital policy lacked...

Designing and evaluating a web-based training program for medical record documentation: Insights from a developing country experience

BackgroundThe quality of medical documentation is crucial for enhancing patient care, as accurate records reduce medical errors and improve patient safety. Given the pivotal role of medical records in delivering high-quality healthcare services, effective training in documentation skills is essential. Whence, this study aimed to design and evaluate a web-based training program focused on medical record documentation, specifically for medical students in Iran (West Azerbaijan province, Urmia), but can be easily adapted to other pertinent cases. MethodThis semi-experimental study was conducted in 2023 and comprised three main phases: pre-intervention, intervention, and post-intervention. In the first phase, an online questionnaire assessing knowledge, attitudes, and performance was developed and integrated into the web-based education program. During the second phase, multimedia electronic content was created and made accessible to students for two months. In the final phase, the same online questionnaire was administered to the students again. The study involved 114 medical students from Urmia University of Medical Sciences. Among the 114 medical students (61 externs and 53 interns), 53.4 % were male, and 46.6 % were female. The data were analyzed using SPSS 16 software. ResultsFollowing the intervention, students’ knowledge scores are seen increase from 76.50 to 86.30, attitudes improved from 79.33 to 85, and performance enhanced from 74.92 to 81.40. Further statistical analysis reveals that the web-based training significantly impacted the knowledge, attitudes, and performance of the medical students regarding documentation, with a p-value less than 0.05. ConclusionThe findings of this specific study indicate that web-based education, supplemented with multimedia content, has led to significant improvements in the knowledge, attitudes, and performance of medical students in medical record documentation. While these positive outcomes suggest that the course characteristics played an important role, further investigation is no doubt needed to establish a direct causal relationship. Ongoing studies are surely recommendable. Nonetheless, implementing such educational approaches appears to be an essential ingredient for enhancing the documentation skills of future healthcare professionals. The study may open educational perspectives and inspire further ad hoc research in nearby domains making use of complex documentation.

Bibliometric Mapping of Factors Influencing Compliance in Nursing Care Documentation

ABSTRACT Accurate and complete nursing documentation plays an important role in ensuring the quality of nursing care and patient safety. However, adherence to documentation standards among nurses often remains a challenge that affects the overall quality of medical records and clinical interventions. This study was conducted to map research trends and factors affecting compliance in nursing documentation through a bibliometric analysis approach. The main objective of this study was to identify the main topics, key factors, as well as emerging publication trends related to nursing documentation compliance over the past few years. This study used the Publish or Perish application to collect 50 scientific articles published between 2016 and 2024, with keywords such as "compliance", "completeness", and "nursing care documentation". The data obtained was then analyzed using VOSviewer to visualize the bibliometric network based on the keywords that appeared in the literature. Through Network Visualization, Overlay Visualization, and Density Visualization, this study identified the main keywords such as "completeness", "motivation", "knowledge", and "compliance" that were most frequently discussed in related studies. The results of the analysis showed that documentation completeness and its influencing factors, such as nurse motivation and knowledge, are the main focus in the documentation compliance literature. In addition, the publication trend shows a significant increase in 2020 and 2021, most likely related to the COVID-19 pandemic situation that drives increased attention to the quality of documentation in healthcare. The conclusion of this study shows that adherence in nursing documentation, specifically related to the completeness, motivation, and knowledge of nurses, is an important topic that continues to grow in research. Although technologies such as electronic medical records are also relevant, the focus of research seems to be more on behavioral factors that influence documentation quality. This study provides guidance for researchers to identify gaps in the literature that could be further explored, especially in the development of more effective and integrated documentation systems. Keywords: Compliance, Completeness, Nursing Care Documentation, Motivation, Knowledge

Discharge against medical advice in pediatrics: a 10-year retrospective analysis in a tertiary care center.

There is still limited data on Discharge Against Medical Advice (DAMA) in the pediatric population. Most research comes from low-and middle-income countries, where the financial burden associated with medical care is often an important reason to leave a healthcare facility prematurely. Discharge against medical advice in the children's population is considered a significant issue that may lead to an increased risk of morbidity and mortality. Describe the characteristics and predictors of DAMA in children over ten years in in Riyadh, Saudi Arabia. Retrospective. Tertiary care center. This study included all patients aged <14 years who had DAMA during all admissions between 1 January 2012, and 31 December 2022. Data was retrieved from medical records and included 1) sociodemographic data, 2) medical history and clinical characteristics, 3) utilization of services during the admission leading to DAMA, and 4) interventions provided to prevent departure. 355 DAMA episodes. Males accounted for 45.4%, and the average age was 4.4 years. The overall DAMA prevalence of was 0.4%. At baseline, 277 children (78%) had at least a chronic illness or severe baseline condition; 59% had a potential life-limiting or life-threatening condition. Reasons for DAMA included disagreement about the treatment plan (14.9%), social reasons (12.6%), and perception that the child's condition improved (5.6%). An increased risk of DAMA recurrence was associated with pre-existing severe or chronic medical conditions (OR: 8.2, P=.004) and a discharge during the treatment phase (OR: 1.9, P=.040). Despite inconsistent documentation, preventive measures included the involvement of healthcare providers, social services, and patient relations. The study highlights the need for standardized protocols and improved documentation practices to effectively address discharge against medical advice. Needs to moderate documentation quality of DAMA episodes. The study was limited to a single center, which may affect the generalizability. Children might also have presented to receive care in another facility post-DAMA.

An Audit of General Surgery Clinical Records (2021) in Ribat University Hospital, Sudan.

Documentation is critical for effective patient management in hospitals, serving essential roles in improving patient care continuity, supporting clinical decisions, and fulfilling legal requirements. Comprehensive documentation not only aids in communication among healthcare providers but also serves as a vital record of patient history, facilitating accurate diagnosis and treatment. Clinical audits are systematic evaluations that compare current patient care practices against established criteria, helping identify deficiencies and promote adherence to quality standards. By increasing awareness of documentation practices, such audits can elevate the overall standard of clinical records, leading to improved patient care and safety. This is particularly important for healthcare professionals, as accurate records are essential for licensing and certification, as well as for demonstrating the delivery of quality care. This study aimed to conduct a medical audit of inpatient medical records in the General Surgery Department atRibat University Hospital to assess the documentation quality and improve patient outcomes. A cross-sectional study was performed on 518 long-stay medical records from Ribat University Hospital in 2021. A quantitative approach was used, employing a structured checklist of 26 points as the audit tool. Documentation was largely incomplete, with significant deficiencies identified: patient full name (17.6%), admission policy (21%), admission time (2%), treatment plan approval (2%), and discharge summary (4.4%). Better documentation was found for admission dates (86.3%), medical histories (81.5%), and diagnoses (87%). Accurate and comprehensive medical record documentation is essential for quality care. This audit revealed major areas needing improvement in the General Surgery Department, emphasizing the need for initiatives to enhance documentation practices.

A Systematic Review of the Use of Surgical Checklists in Transurethral Resection of Bladder Tumour.

Surgical checklists have previously been shown to improve surgical quality and patient outcomes. However, their use in transurethral resection of bladder tumour (TURBT), one of the most commonly performed urological procedures, has yet to be explored in depth. To evaluate the effect of surgical checklist implementation in TURBT on documentation quality, specimen quality, and oncological outcomes according to the existing literature. We then hope to develop an optimised TURBT checklist by identifying the most pertinent parameters for inclusion. A literature search using PubMed was performed to identify literature pertaining to the use of surgical checklists in the context of TURBT. A systematic review was then performed on the 41 identified studies, of which six were included in the final analysis. We explored three primary outcomes that arose from the literature, namely: (1) comprehensiveness of documentation; (2) resection quality; and (3) recurrence rates and recurrence-free survival (RFS). We found agreement in the literature that surgical checklist implementation does lead to an overall improvement in documentation. The effect of surgical checklists on resection quality and recurrence rates, however, was mixed in the literature, with some studies showing statistically significant improvements and others showing no significant change. There are multiple benefits to surgical checklist implementation in TURBT procedures. We propose an optimised 14-item surgical checklist that should be implemented in every TURBT report to ensure sufficient information documentation for risk stratification and post-operative management.

Enhancing Surgical Operative Note Standards at Doka Hospital, Sudan: A Clinical Audit.

Background Operating notes are crucial in surgical practice for post-operative care, future medical reference, and legal needs. They provide vital details about the procedure, guaranteeing patient safety and improving communication among medical staff. These notes include patient health status, surgical method, operation results, problems, and post-surgery plans. Established protocols for recording surgical operative notes are essential for medical education, research, and quality improvement efforts. The audit aimed to evaluate and enhance Doka Hospital's surgical operation notes, focusing on their quality, completeness, and potential areas for development. The audit aimed to apply necessary adjustments to raise standards and ensure high standards in medical treatment. Material and methods This retrospective-prospective study analyzed surgical postoperative notes from Doka Hospital's archives, following the implementation of a new format based on guidelines set by the Royal College of Surgeons of England. Staff training sessions were conducted to facilitate adoption. The audit population included surgical operative notes from the departments of general surgery and obstetrics and gynecology. The study collected 200 surgical operative notes, with 100 notes in the first cycle and 100 notes in the second cycle. Data was collected from the General Surgery and Obstetrics and Gynaecology departments using a predefined checklist, followed by analysis using the Microsoft Excel Sheets program (Microsoft Corporation, Redmond, USA). Ethical clearance was obtained from the ethical committee of Doka Hospital. The audit population consisted of 71 beds in a busy rural hospital with a majority of cases involving obstetrics and one-day surgical operations. Results Doka Hospital's surgical operative note review showed a significant improvement in documentation quality following a revised structure based on the Royal College of Surgeons of England's recommendations. Compliance with the criteria improved from 50.5% in the first cycle to 82.5% in the second cycle. Notable progress was made in date and time documentation, with a 96% increase in the second cycle. The proportion of anaesthetists' names also rose from 60% to 90%. The accuracy of recording surgical operation details increased from 87% to 94%. Documenting operational results, issues, and tissue removal also improved. Factors like the identity of the prosthesis or materials used remained unchanged in both cycles. Conclusion The introduction of a uniform style for recording surgical operational notes, together with focused training sessions, greatly improved the quality of surgical documentation at Doka Hospital.

A construction contract administration (CCA) framework for graduate architects’ professional development

PurposeConstruction contract administration should be carried out by a person (normally engineer or architect depending on the type of contract) with expert technical knowledge of the construction process, strong leadership quality, highly developed interpersonal skills and an understanding of contractual, legislative and statutory underpinnings. However, due to a shortage of architects, graduate architects have been assigned to perform a partial role. Architectural firms are disappointed with the quality of the graduates and still note that they have to mentor them to be competent for their jobs. This paper aims to develop a construction contract administration (CCA) framework for graduate architects that aids the smooth running of a construction contract.Design/methodology/approachSeven housing projects in Malaysia have been selected as case studies. Documentation review and semi-structured interviews relevant to selected case studies were conducted to collect data to develop the CCA framework. The draft framework will then be validated through a focus group study.FindingsA total of 5 themes and 11 sub-themes with core tasks were developed in the CCA framework. The themes involved are claims and legal matters management, communication and relationship management, project management, design management and quality assessment and management. Sub-themes are authority matters, building certification, meetings, coordination checklist, letter writing, contract documentation, building material, design brief, building sustainability and workmanship quality standards, contractors’ submission and building details.Originality/valueThe contribution of this study can be utilized for developing further models in the future that would improve the work performance of graduate architects. The framework assists the university by moving forward to the professional practice stage. In addition, it indirectly enhances the potential of graduate architects to perform efficiently and intensifies the bonding between project stakeholders.

Coffee and Cases (C&C) - Enhancing Knowledge Creation and Sharing for Organizational Learning From Clinical Debriefs in a Helicopter Emergency Medical Service: A Quality Improvement Study

Objectives The objective of this quality improvement (QI) study was to improve organizational learning from clinical debriefs known as “Coffee and Cases” (C&C) in a helicopter emergency medical service (HEMS) by increasing weekly learning summaries (LS) and documented learning points (DLP) as well as the dissemination thereof by at least 50% from baseline. Methods The problem analysis for sub-optimal organizational learning from C&C identified several factors, including lack of responsibility, poor documentation quality, and limited sharing of learning points. Using the Model for Improvement (MFI), interventions enhanced the learning environment, and improved documentation and dissemination. Changes included dedicated computers, introducing standardized processes, a newsletter, and a searchable DLP database. Statistical process control (SPC) charts were used to assess the effectiveness of interventions. Results Prior to interventions (August 2022 to January 2023), baseline mean counts of weekly DLPs, LSs, DLPs internally disseminated, and DLPs openly disseminated were 3.18, 2.67, 3.18, and 2.96, respectively. Plan-Do-Study-Act (PDSA) cycles included declaring C&C as a non-clinical portfolio, redesigning documentation processes, initiating monthly newsletters, developing a DLP repository, and designing a C&C visual brand. Signals of special cause variation showed improvements, with mean counts increasing. Weekly DLPs increased to 14.92, LSs to 5.2, internally disseminated C&C Snippets to 11.88, and openly disseminated C&C Snippets to 8.64. Conclusions Recognizing barriers to effective knowledge creation and sharing, our QI study aimed to increase weekly DLPs and LSs by 50% from baseline. It aligned with the relationship between knowledge management and organizational learning, emphasizing the importance of utilizing knowledge for improved performance. Our interventions enhanced the learning environment, ensured robust capturing of learning points and effective communication thereof, ultimately contributing toward improving organizational dissemination of learning from clinical debriefs. Our QI study demonstrates how enhanced knowledge creation and sharing can widen the benefits of learning from clinical team debriefs.

An Ethics Consult Documentation Simplification Project: Summation of Participatory Processes, User Perceptions, and Subsequent Use Patterns.

Healthcare ethics consultants in the Veterans Health Administration (VHA) document consults in an enterprise-wide web-based database entitled IEWeb, serving as a system of record for healthcare ethics documentation at 1300 VA facilities. The need arose to evolve the database from an ethics process training resource into a more streamlined documentation repository that captures essential consult elements. A VHA National Center for Ethics in Health Care (NCEHC) Improvement Team convened for three tasks: (1) Specify and prioritize IEWeb changes (occurred via six focus groups composed of "new user" and "super user" cohorts with analysis of existing documentation patterns); (2) Pilot the changes regionally (via regional communication, training, and reviews of pre-post use patterns); and (3) Measure the impact of national change implementation on user perspectives (via pre-and post-change implementation polls). Focus groups identified six implementable priority areas for ethics consult documentation improvement, including the development of a usable consult summary note for ready conversion from IEWeb fields into the electronic health record. Post-IEWeb updates showed an increased number of consults documented, a reduction in "time to consult documentation closure" by a mean of 4.5days, and a clinically-meaningful improvement in the quality of documentation (78% of ethics questions scored "above-bar" on the validation tool pre- vs. 89% scored "above-bar" post-IEWeb changes, n = 140). According to national survey findings, the number of consultants documenting "all" consults in IEWeb increased, satisfaction increased, and perception of documentation difficulty decreased. IEWeb simplification enabled ethics consultants to re-focus their documentation completion efforts by decreasing perception of documentation burden while improving documentation frequency and quality in a clinically-meaningful way.

Evaluation and Improvement of the Quality of Surgical Operative Notes in the Department of General Surgery at Dongola Teaching Hospital, Sudan.

Background Surgical operative notes are essential for patient care and legal documentation. However, inconsistencies in the quality of these notes at Dongola Teaching Hospital, Sudan, highlighted the need for improvement. In line with guidelines from the Royal College of Surgeons of England (RCSEng), this study aimed to enhance the documentation practices in the hospital by implementing a standardized format. Methods A retrospective audit was conducted over three months at the General Surgery Department of Dongola Training Hospital. In the first audit cycle, 81 surgical notes were assessed, revealing significant deficiencies in adherence to RCSEng standards. An intervention was introduced, including a standardized template, training for surgeons, and widespread dissemination of the new format. A second audit cycle followed to assess improvements. Results In the first audit cycle, adherence to documentation standards was 50.3%, with missing or incomplete information in key areas. After the intervention, adherence improved to 71.9%. Notable improvements included documentation of extra procedures (18% to 100%), prosthesis details (0% to 100%), and antibiotic prophylaxis (71% to 97%). However, a slight decline was observed in postoperative care instructions, dropping from 100% to 90%. Conclusion The introduction of a standardized template and training significantly improved the quality of surgical documentation. Continuous efforts are necessary to maintain these improvements, particularly in areas where adherence remains suboptimal, such as postoperative care instructions.