Implementation Of Improvement Measures Research Articles

From intermittent antibiotic point prevalence surveys to quality improvement: experience in Scottish hospitals.

BackgroundIn 2008, the Scottish Antimicrobial Prescribing Group (SAPG) was established to coordinate a national antimicrobial stewardship programme. In 2009 SAPG led participation in a European point prevalence survey (PPS) of hospital antibiotic use. We describe how SAPG used this baseline PPS as the foundation for implementation of measures for improvement in antibiotic prescribing.MethodsIn 2009 data for the baseline PPS were collected in accordance with the European Surveillance of Antimicrobial Consumption [ESAC] protocol. This informed the development of two quality prescribing indicators: compliance with antibiotic policy in acute admission units and duration of surgical prophylaxis. From December 2009 clinicians collected these data on a monthly basis. The prescribing indicators were reviewed and further modified in March 2011. Data for the follow up PPS in September 2011 were collected as part of a national PPS of healthcare associated infection and antimicrobial use developed using ECDC protocols.ResultsIn the baseline PPS data were collected in 22 (56%) acute hospitals. The frequency of recording the reason for treatment in medical notes was similar in Scotland (75.9%) and Europe (75.7%). Compliance with policy (81.0%) was also similar to Europe (82.5%) but duration of surgical prophylaxis <24hr (68.6%), was higher than in Europe (48.1%, OR: 0.41, p<0.001). Following the development and implementation of the prescribing indicators monthly measurement and data feedback in admission units illustrated improvement in indication documented of ≥90% and compliance with antibiotic prescribing policy increasing from 76% to 90%. The initial prescribing indicator in surgical prophylaxis was less successful in providing consistent national data as there was local discretion on which procedures to include. Following a review and a focus on colorectal surgery the mean proportion receiving single dose prophylaxis exceeded the target of 95% and the mean proportion compliant with policy was 83%. In the follow up PPS of 2011 indication documented (86.8%) and policy compliant (82.8%) were higher than in baseline PPS.ConclusionsThe baseline PPS identified priorities for quality improvement. SAPG has demonstrated that implementation of regularly reviewed national prescribing indicators, acceptable to clinicians, implemented through regular systematic measurement can drive improvement in quality of antibiotic use in key clinical areas. However, our data also show that the ESAC PPS method may underestimate the proportion of surgical prophylaxis with duration <24hr.

Analysis of Factors Influencing the Generation of Unqualified Clinical Samples and Measures to Prevent this Generation

BackgroundWe investigated the influence of pre-analytical factors on the results of clinical tests and thereby analyzed approaches to improve quality management in clinical laboratories.MethodsUnqualified clinical samples were selected from all the samples received at our clinical laboratory. The data were collected for 2009 and 2010, i.e., the years before and after the establishment of the laboratory quality management system. The rate and causes of generation of unqualified samples were analyzed, and measures to improve the laboratory practices were studied and implemented.ResultsA total of 1,051 unqualified samples were identified from among the 553,158 samples (the overall incidence rate of unqualified samples was 0.19%). The number of unqualified samples substantially varied according to the nature of the sample, and clinical samples collected for routine blood tests or coagulation tests were the predominant unqualified samples. The main causes of generation of unqualified samples were insufficient sample volumes and improper methods of mixing the samples. The rate of generation of unqualified samples decreased significantly after the implementation of improvement measures (0.26% in 2009 vs. 0.13% in 2010, P<0.001).ConclusionsThe number of unqualified samples decreased significantly after the establishment of the laboratory quality management system, which promoted active communication among and training of the clinical staff to reduce the occurrence of pre-analytical errors. Comprehensive control of pre-analytical factors is an important approach in improving the clinical laboratory practices.

SU‐E‐J‐68: Plan Rejections during Treatment Planning: A Part of Normal Process Or An Opportunity for Improvement

Purpose: To describe a process for learning from radiation treatment plan(RTP) rejections by physicians and physicists for improvement of quality, safety, and efficiency of treatment planning. In our clinic IMRT treatment plans are pre‐checked by physicists for technical and quality validation before review by the physician. Any problems identified during physics or physician reviews of RTPs offer an opportunity to identify systematic and random deviations and to develop tools, processes, and training to eliminate or reduce such problems in the future. We describe a process wherein the collection of plan rejections and related reasons is considered a part of normal process and not as additional work. Methods: In our clinic we use the DMAIC formalism for management of our operations, whereby processes are understood as comprising of define, measure, analyze, improve and control activities. Systematically quantifying plan rejections and the corresponding reasons offers an opportunity for improvement of treatment planning process and monitoring the effectiveness of corrective measures. This was accomplished through a set of features in our electronic whiteboards that seamlessly and effectively collect rejection information that were further analyzed for identification of improvement opportunities. Efficacy of any implemented improvement measures can then also be evaluated by quantifying future rejections. In this study we concentrate on plan rejections by physicists. Results: There were 110 plan rejections by physicists from September 2010 to Mar 2011. The rejections were due to plan‐quality, plan technical integrity and in some cases data‐entry errors. These rejections were used to identify systematic opportunities for training and better education and for design of in‐house developed auto‐planning and quality‐control scripts. Conclusions: Systematic and sustainable collection of treatment plan rejections for purposes of process improvement is possible. We have demonstrated that this data collection can be seamlessly integrated in normal treatment planning process through the use of electronic white boards.

Quality Improvement in Palliative Care Services and Networks: Preliminary Results of a Benchmarking Process in Catalonia, Spain

A wide range of palliative care services has been implemented in Catalonia over the past 20 years. Quantitative and qualitative differences in the organization of palliative care services between districts and settings can result in wide variability in the quality of these services, and their accessibility. We implemented a benchmark methodology to compare dimensions of care and organization, to identify aspects requiring improvement, and to establish indicators to measure progress. The overall aim was to generate a consensus document for submission to the Department of Health (DoH) of the Government of Catalonia. A Steering Committee convoked a meeting in Barcelona (Catalonia, Spain) and representatives (n = 114) of all the 37 districts within our health care remit (rural, urban, intermediate, and metropolitan) and settings of the health care system (hospitals, social health centers, community, and nursing homes) attended and took part in plenary sessions and workshops to define areas that, in their experience, were considered weak. Twenty-one consensus recommendations achieving high levels of consensus were generated for submission to the DoH. These included the formal definition of the model of care and organization of palliative care services at all levels in the region, the implementation of measures for improvement in different settings and scenarios, systems for continuous care, and facilities for the continuing training of health care personnel. These proposals have since been implemented in a trial region and, depending on the outcomes, will be applied throughout our health service. We conclude that benchmark methodology is valuable in acquiring data for use in improving palliative care organization for patients' benefit.

The Copenhagen Psychosocial Questionnaire in Germany: From the validation of the instrument to the formation of a job-specific database of psychosocial factors at work

The German version of the Copenhagen Psychosocial Questionnaire (COPSOQ) was established and tested in a sample of 2561 employees in order to: (a) assess the questionnaires' psychometric properties; and (b) develop an appropriate instrument to use in the assessment of psychosocial risk factors. A shortened version of the instrument was developed, reducing the number of items from 141 to 87. With this, a database has been established since 2005. In a cooperation model between science (Freiburg Research Centre of Occupational and Social Medicine) and companies or organizations, new COPSOQ data are added to the dynamically growing database with profession-specific profiles of psychosocial factors at work. In return, companies can compare their results with job-related data in the database, facilitating the interpretation of their results and the implementation of improvement measures. The COPSOQ database has reached > 25,000 respondents. Ongoing projects will expand the German COPSOQ database and include representative samples. Furthermore, a job exposure matrix for psychosocial factors at work will be constructed in 2009. Finally, in several projects, a first assessment has been followed by efforts to improve the problematic areas of psychosocial working conditions.

The Application of Process Quality Control Tools in the Production Process

Based on the quality survey of the working procedure of interior hole grinding of the ceramic shaft bush parts, this paper analyzes and studies it by the quality control tools such as Pareto diagram and Cause and effect diagram, and finds out the main deficiency indicator. The main influencing factor is that the verticality of the interior hole is Ultra-poor in the Process quality deficiencies. A series of the testing data of this deficiency indicator has been analyzed in order to obtain the factors influencing the deficiency indicator. Finally, comparison is made between the quality status before and after implementing improvement measures and measures of adjusting processes are taken to greatly improve the effect and the product qualified rate, which can provide reference for enterprises to improve the quality in the production process.

Assessment of the Impact of Improvement Measures on Air Quality: Case Study of Delhi

It is well known that the ambient air pollution attributable to road traffic depends on a number of factors such as the quality of fuel used, engine technology, driving conditions, emission control devices, and meteorological conditions. In spite of the efforts to control emissions from road traffic by way of stringent emission norms (such as Euro-III and IV) for automobile engines and improved fuel quality, the road traffic emissions form a significant proportion of urban air pollutants. This is primarily due to constant increase in number of motor vehicles and their use in the urban areas. Recognizing this aspect and with a view to provide clean air, the Supreme Court of India has issued an order in a public interest litigation matter, directing that public transport vehicles, namely intracity buses, should be run on compressed natural gas (CNG) in Delhi. The directive of the Supreme Court was implemented but along with it many other actions/measures were also implemented by the concerned authorities. These measures included operation of taxis and auto rickshaws on CNG, scrapping of all commercial vehicles including taxis aged 15 years and above, introduction of Euro-I emission norms for private passenger cars, use of unleaded petrol, and premixing of 2T oil with petrol for two wheeler motor vehicles. The result of the combined efforts is a perceivable change in the ambient air quality for the better. But questions and debates were frequent as to whether the improved quality of air is mainly due to CNG and if so how much is to be attributed to CNG. To answer these questions a detailed study was carried out to quantify the emissions and their reductions due to different measures. This paper presents an account of the study. In this study the quantity of criteria pollutants such as carbon monoxide, nitrogen oxides and particulate matter and hydrocarbons are estimated on the basis of vehicle kilometers traveled by different vehicles in the city during the course of time when the improvement measures were being effected on an incremental basis. The results of the study are discussed and the contribution of each of the measures is estimated. The implemented improvement measures were extremely successful. The improvement was, as made out to be, not simply because of CNG conversion of buses but due to the combined effect of many other steps like improved vehicle technologies and fuel quality, phasing out the old diesel vehicles, conversion of auto rickshaws to CNG, etc. The results are of interest to both the analysts and policy makers in appreciating the impact of each of the measures.

Problems of Improving Industrial Wholesale Prices

Implementation of measures for improvement of planning and strengthening the economic stimulation of industrial production is closely connected with improving price formation. The existing system of wholesale prices for industrial products has serious deficiencies that impede the large-scale transition of enterprises to the new conditions of work.

Lens extraction in diabetic patients.

<h3>Aims</h3> Anorexia Nervosa (AN) is a mental health disorder in which one restricts their calorific intake to reduce their weight, leading to serious health implications. It has become increasingly prevalent particularly during the COVID-19 pandemic. The eating disorders (ED) service has seen an increase in the number of young people being referred (figure 1). This has resulted in protracted waiting times from receipt of referral to formal assessment by the team and an associated strain on resources available to manage this group. I set out to explore what this has meant for patient care and whether there are ways these patients could be managed more efficiently whilst ensuring the best outcome. <h3>Methods</h3> Measures existed within the ED service to support patients prior to assessment to reduce mental and physical deterioration. The effects and success of these haven’t been evaluated, nor are the interventions particularly centred around young people developing ED during the pandemic. In the first instance I retrospectively reviewed the notes of 60 patients aged 10-18 diagnosed with AN between December 2019 and December 2021. I examined whether Key Performance Indicators (KPI) were breached by looking at waiting time from referral to assessment. In addition, weight for height (W4H) at referral was compared to W4H at assessment, admissions to hospital during this period were considered, physical or mental health deterioration prior to assessment and reasons for developing AN were also reviewed. I suggested and implemented improvement measures to mitigate deterioration whilst awaiting an assessment. These measures included: • A triage pack containing a meal plan and signposting in case of deterioration (e.g., AN charity, crisis team contact) • Introduction of a GP letter featuring advice for monitoring and safety net advice • Paediatric clinic appointment for those thought to need physical review prior to assessment. This clinic is run by a liaison Paediatrician working as part of the ED team. I then carried out the same analysis on patients after the measures were put in place. Comparisons have been made to ascertain whether patients referred between January and March 2022 show less physical and mental deterioration compared to those referred prior to implementing the measures. Additionally, I interviewed staff and patients to obtain their views on the changes introduced. <h3>Results</h3> The characteristics of the young people from both the pre and post intervention group were comparable. Of note, prior to intervention, KPI was met in 36.7% of young people with the remaining 63.3% breaching KPI. The interventions have so far resulted in an overall improvement with more young people meeting KPI and less deterioration seen prior to assessment with interventions being viewed as positive in general by both staff and young people. <h3>Conclusion</h3> It is important that young people receive the best standard of care catered to their specific needs. These results are promising and provide a further framework for managing this group of patients as although the adverse effects of the covid-19 pandemic have lessened, the long-term effects on mental health are not fully appreciated.