Implementation Of Quality Improvement Initiatives Research Articles

Anesthesia-Specific Software Module for Voluntary Adverse Event Reporting

Objectives Hospital staff are expected to report adverse events to safety leaders and risk managers. At our institution, staff report adverse events via an incident reporting software system, known as “RL.” These “RL reports” are kept separate from patient medical records. Within the Anesthesiology Department, we noted low numbers of RL reports relative to known adverse events. Anesthesiology-related events were scattered within the RL software and therefore difficult to find. We hypothesized that compiling these events in one location would increase reporting rates and allow for deeper analysis of filed adverse events. Methods We created an Anesthesia-specific RL software module, which included all anesthesia-related adverse events in one location. Additionally, we tracked the impact on RL reporting of two other quality improvement initiatives, including an intradepartmental quality assurance form, implemented during the study period. Results The Anesthesia RL software module led to a 3.2-fold increase (P < 0.001) in the monthly average of filed RL reports. The increase was even greater (11.1-fold, P < 0.001) when excluding the most prevalent category of RL reports (Controlled Substance Discrepancies). The intradepartmental quality assurance form had minimal impact on filed RL reports. “Controlled Substance Discrepancies,” “Other,” and “Equipment issue” were the most common event types. Most events were classified as constituting no harm to the patient. Conclusions Creating a specialty-specific RL software module led to increased RL reports, even when accounting for other implemented quality improvement initiatives, and allowed for deeper analysis of the filed reports. Our findings may be replicated for other specialties.

Impact of Updating Surgical Instrumentation Preference Cards on Operating Room Operations

Hospital systems across the United States have implemented quality improvement initiatives designed to mitigate unnecessary waste and decrease healthcare costs that are frequently passed on to patients. One key source of waste is excess sterile instrumentation in surgical operating rooms. This quality improvement project identified waste by auditing and updating surgical instrumentation preference cards (SIPCs) for the three most common procedures at a multi-center academic health system. Unnecessary items were recorded and savings calculated using 2022 supplier price data. Forty-nine procedures were audited, resulting in changes to 111 unique SIPCs. Although this process produced significant savings for the health system, it was limited to fewer than 10% of the total cases performed. Total savings were observed at $337,007 with savings of $56,254 for open instrumentation. A manual audit of all SIPCs across the institution and regular updates has the potential to decrease instrumentation waste and annual expenditures by approximately $4 million.

Quality Improvement Project to Reduce Admission Hypothermia of Preterm Infants Born at Less than 32 Weeks or 1,500 g

Purpose: Hypothermia upon admission to the neonatal intensive care unit (NICU) contributes significantly to various neonatal complications, particularly in preterm infants. This study aimed to assess the impact of quality improvement (QI) interventions, including using plastic bags and head caps, and adjusting delivery room temperatures, on improving the admission body temperature and reducing hypothermia in infants born at less than 32 weeks or weighing 1,500 g.Methods: This study retrospectively analyzed the medical records of infants born at less than 32 weeks or weighing 1,500 g who admitted to the NICU at Samsung Medical Center from January 2022 to February 2024. The QI program that was initiated in April 2023 focused on managing admission temperatures using plastic bags and head caps, and maintaining delivery room temperatures at ≥25 °C. The admission temperature and short-term outcomes pre- and post-QI were compared.Results: In a study of 270 patients, implementing QI initiatives significantly raised the admission temperature from 36.2±0.5 to 36.4±0.4 °C (p<0.01), particularly impacting infants weighing ≥1,000 g, in whom mild hypothermia occurrences dropped from 76.3% to 43.9% (p<0.01). This improvement in temperature management significantly decreased both mild and severe hypothermia rates post-QI. Additionally, implementing all three initiatives was more effective than when two or fewer initiatives were implemented.Conclusion: Simple and cost-effective QI interventions can increase admission temperatures and decrease hypothermia in neonates. Further research is essential to explore the long-term outcomes and develop effective hypothermia management strategies in neonatal care.

Elective Repeated Cesarean Section (ERCS)

Objective: To investigate the timing of elective repeat cesarean deliveries at Al-Batool Teaching Hospital in Diyala, Iraq. Methods: A retrospective analysis was conducted of 100 women who underwent elective repeat cesarean delivery at 37-40 weeks gestation at Al-Batool Teaching Hospital. Emergency cesarean deliveries were excluded. Results: The majority of elective repeat cesarean deliveries (78%) were performed at 37 weeks gestation. Cesarean deliveries at 38, 39, and 40 weeks accounted for 4%, 2%, and 16% of the sample, respectively. Conclusions: In this cohort, most elective repeat cesarean deliveries were conducted at 37 weeks gestation, rather than the recommended 40 weeks. Delivering earlier than 39-40 weeks in the absence of medical indications reduces the chances of successful vaginal birth after cesarean. These findings suggest that evidence-based protocols were not consistently followed for timing of elective repeat cesarean sections at this institution. Further research is needed to identify barriers to adhering to delivery guidelines and implement quality improvement initiatives to optimize cesarean delivery timing when clinically appropriate.

Implementing Quality Improvement Initiatives to Improve the Use of Adolescent- and Youth-Friendly Health Services in Zou, Benin.

In Benin, the unmet need for family planning services is especially high for adolescent girls and youth aged 15-24 years. The Challenge Initiative (TCI) supported the health system to assess and improve the quality of adolescent and youth sexual reproductive health services and enhance contraceptive uptake in 65 service delivery points (SDPs) of the Zou department. Between June 2019 and March 2021, TCI supported the health districts in Zou to train an assessment team to complete 3 cycles of quality assessments (QAs) using a QA checklist adapted to the local context. Based on assessment scores, the SDPs were categorized into poor, moderate, or good to excellent quality. The SDP managers developed remedial action plans after each cycle and for each SDP and followed up with supportive supervision. The first QA cycle showed that 52% of assessed SDPs achieved a good to excellent classification; by the second QA cycle, this reached 74%. However, the quality of adolescent- and youth-friendly health services regressed during the third QA cycle (during COVID-19 pandemic disruptions), when only 40% of SDPs achieved the good to excellent category. Between the first and second QA cycles, contraceptive uptake for adolescents and youth improved in the SDPs that had good or excellent quality of services, compared to the ones that were of lower quality (established significance level of 5% with a P value of .031). Further assessments could deepen our understanding of the internal and external factors that can affect service quality. The findings reinforce the importance of investing in quality improvement strategies to maximize the use of sexual and reproductive health services among adolescents and youth. They also underscore the need for a contextual and nuanced approach to ensure enduring results.

Program evaluation and early outcomes of a severe preeclampsia and eclampsia maternal safety bundle in a single institution in the Philippines

BACKGROUND: To reduce maternal morbidity and mortality associated with hypertension, standards for maternal safety and efforts to implement a structured team approach have been undertaken. Following the formulation of a policy document, a maternal safety bundle was developed. The implementation of bundle components including eclampsia kits, clinical pathways, and educational module occurred in phases due to pandemic restrictions. An eclampsia kit and clinical pathways were implemented in 2020. An online lecture was launched in 2021 followed by in-person eclampsia simulation workshop beginning 2022. OBJECTIVES: This paper aims to report the early outcomes of a severe preeclampsia and eclampsia maternal safety bundle implementation in a private hospital between 2020 to 2023. MATERIALS AND METHODS: Demographic information, posttest knowledge assessment and pre- and post- eclampsia workshop confidence scores were recorded. Structure, process, and outcome measures were determined. Descriptive statistics were used for participant demographics and score percentages. Paired t-Test with a significance level of P<0.05 was used to compare the pre- and post-simulation confidence scores. Summary data for outcome and process metrics were manually calculated. Summary categorical data was used for structure metrics. RESULTS: Two hundred eighty-eight (288) participants completed the online didactic lecture. Average posttest knowledge assessment score was 88.1%, 88.88%, and 82.6% from 2020 to 2023. Ninety-nine participants completed the eclampsia simulation workshops. Mean post-simulation confidence scores were greater than mean pre-simulation confidence scores (42.3 vs. 39, p=0.0259 in 2022 and 41.975 vs 36.65, P=0.0035 in 2023). There is 100% compliance with timely management of severe hypertension and eclampsia prevention and a decreasing trend in hypertension related severe maternal morbidity rates. CONCLUSION: A severe preeclampsia and eclampsia maternal safety bundle is a feasible quality improvement initiative that promotes peer learning, strengthens clinical competencies, and improves access to emergency resuscitation supplies. The results of this program evaluation may serve as a framework for implementing quality improvement initiatives on maternal safety.

An assessment of adaptation and fidelity in the implementation of an audit and feedback-based intervention to improve transition to adult type 1 diabetes care in Ontario, Canada

BackgroundThe fit between an intervention and its local context may affect its implementation and effectiveness. Researchers have stated that both fidelity (the degree to which an intervention is delivered, enacted, and received as intended) and adaptation to the local context are necessary for high-quality implementation. This study describes the implementation of an audit and feedback (AF)-based intervention to improve transition to type 1 diabetes adult care, at five sites, in terms of adaptation and fidelity.MethodsAn audit and feedback (AF)-based intervention for healthcare teams to improve transition to adult care for patients with type 1 diabetes was studied at five pediatric sites. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to document the adaptations made during the study. Fidelity was determined on three different levels: delivery, enactment, and receipt.ResultsFidelity of delivery, receipt, and enactment were preserved during the implementation of the intervention. Of the five sites, three changed their chosen quality improvement initiative, however, within the parameters of the study protocol; therefore, fidelity was preserved while still enabling participants to adapt accordingly.ConclusionsWe describe implementing a multi-center AF-based intervention across five sites in Ontario to improve the transition from pediatric to adult diabetes care for youth with type 1 diabetes. This intervention adopted a balanced approach considering both adaptation and fidelity to foster a community of practice to facilitate implementing quality improvement initiatives for improving transition to adult diabetes care. This approach may be adapted for improving transition care for youth with other chronic conditions and to other complex AF-based interventions.Trial registrationClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.

How social networks influence the local implementation of initiatives developed in quality improvement collaboratives in health care: A qualitative process study.

Quality improvement collaboratives (QICs) have facilitated cross-organizational knowledge exchange in health care. However, the local implementation of many quality improvement (QI) initiatives continues to fail, signaling a need to better understand the contributing factors. Organizational context, particularly the role of social networks in facilitating or hindering implementation within organizations, remains a potentially critical yet underexplored area to addressing this gap. We took a dynamic process perspective to understand how QI project managers' social networks influence the local implementation of QI initiatives developed through QICs. We explored the case of a QIC by triangulating data from an online survey, semistructured interviews, and archival documents from 10 organizations. We divided implementation into four stages and employed qualitative text analysis to examine the relationship between three characteristics of network structure (degree centrality, network density, and betweenness centrality) and the progress of each QI initiative. The progress of QI initiatives varied considerably among organizations. The transition between stages was influenced by all three network characteristics to varying degrees, depending on the stage. Project managers whose QI initiatives progressed to advanced stages of implementation had formed ad hoc clusters of colleagues passionate about the initiatives. Implementing QI initiatives appears to be facilitated by the formation of clusters of supportive individuals within organizations; this formation requires high betweenness centrality and high network density. Flexibly modifying specific network characteristics depending on the stage of implementation may help project managers advance their QI initiatives, achieving more uniform results from QICs.

Prevalence of Cervical Cancer and Clinical Management of Women Screened positive using visual inspection with acetic acid and Cervicography in selected public sector health facilities of Manicaland and Midlands provinces of Zimbabwe, 2021.

Zimbabwe has high cervical cancer (CC) burden of 19% and mortality rate of 64%. Zimbabwe uses Visual Inspection with Acetic Acid and Cervicography (VIAC) for CC screening. Manicaland and Midlands provinces recorded low VIAC positivity of 3% (target 5-25%) and treatment coverage of 78% (target = 90%) between October 2020 and September 2021. We explored VIAC positivity rate and clinical management of clients screening positive in Manicaland and Midlands provinces. We conducted a retrospective cross-sectional study using routine VIAC and CC management data for period October 2020 to September 2021. Two samples were used, 1) a sample drawn from 48,000 women VIAC screened to measure positivity rate, and 2) a sample of 1,763 VIAC positive women to assess clinical management. Kobo-based tool was used to abstract data from facility registers, and data were analyzed using STATA 15. We analyzed data for 2,454 out of 48,000 women screened through VIAC. About 82% (2,007/2,454) were HIV positive, median ages were 40 and 38 years for HIV positives and negatives respectively. Most (64% and 77%) of HIV positive and negative clients respectively were married. VIAC positivity was 5.9% and 3.4% among HIV positive and negative women screened for the first time, and 3.2% and 5.6% for repeat visits respectively. Overall, 89.1% (1,571/1,763) of VIAC positive women received treatment. Most (41%) of those treated received thermocoagulation. Overall, 43.1% of clients received treatment on VIAC day, and 77.4% within 30 days. Six-month post-treatment coverage was 3.8%. VIAC positivity among HIV positive women screening for the first time was 5.9%, within the expected 5-25%. Treatment coverage was high, and turnaround time from diagnosis to treatment met national standards. Post-treatment coverage was suboptimal. We recommend continued implementation of quality improvement initiatives, capacity building of clinicians, and optimization of post-treatment review of clients.

The big bang vs. phased approach: ASCO standard implementation within a large academic medical center.

419 Background: The implementation of quality improvement initiatives within a large academic medical center can present as challenging and complex. Research findings indicate that the most successful of the large service corporations maintain a strong focus on the small, functional units who carry out the core activities that involve interaction with customers. (Quinn J, Baruch J, Zien K. Innovative Explosion: Using Intellect and Software to Revolutionize Growth Strategies. New York: Free Press; 1997.) This phased approach allows a larger medical center the opportunity to target implementation around one or two sites at a time with a focus on the staff education, workflow processes, and technology integration. Our institution found that the big bang approach can pose as a threat to the success of implementation at a large academic medical center. Methods: The initial approach taken by our large academic medical center was the roll out of all required ASCO PC4 standards throughout the entire enterprise: the big bang approach. This approach would entail the implementation of 7 standards, 17 sub-standards within 15 sites and over 84 departments within the span of one year. Instead, we took the phased approach: a less burdensome, more efficient, and cost-effective strategy. Between 11/2023 1/2023, we implemented a total of 6 standards within two sites and 3 departments. In the span of three month, a multidisciplinary approach was applied, engaging all levels of employees at each site, including MDs, NPs, MAs and Front Desk Staff. The two sites identified were strategically selected based on current resources and initiative alignment with those of ASCO requirements. On 1/30/23 the two sites went live with 6 ASCO standards. Results: Some challenges in implementation included training of staff in a timely manner, influencing the change of behavior, and education retention of staff. Despite the challenges faced, between 2/6/23 and 3/24/23 data showed adequate engagement and compliance. 567 patients were identified by for patient tracking through developed reporting, 328 patients had a chart review or a follow-up from the oncology care coordinator. Between 1/30/23 and 3/24/23, 61% of patients were screened for SDOH needs with 32 referrals to a community health worker, 8 referrals to social service and 12 interventions with patients indicating self-harm. 100% of patients received education around OMH, with a total of 1,923 MyChart messages sent to patients regarding support with ACP. 68.8% of clinician completed adequate goals of care documentation to meet standard requirements and new workflow. Conclusions: A phased approach of first piloting ASCO's PC4 quality program at 2 sites within our large cancer center was successful. The experiential knowledge gained will allow more efficient role out of necessary staff education, workflow processes, and technology integration to support wider adoption across our center.

Nurses' Adherence to the Portuguese Standard to Prevent Catheter-Associated Urinary Tract Infections (CAUTIs): An Observational Study.

Urinary tract infections are among the most prevalent types of healthcare-associated infections (HAIs) in hospitals and nursing homes, and they are primarily a result of unnecessary catheter usage and inadequate care. In Portugal, epidemiological data indicate that catheter-associated urinary tract infections (CAUTIs) remain widespread in clinical settings, resulting in increased morbidity and mortality rates among vulnerable populations. This study aimed to assess urinary catheter use in an oncology ward in Portugal and to evaluate nurses' adherence to the government-endorsed standards for preventing CAUTIs. An observational study was conducted over a four-month period with daily assessments of nurses' practices during urinary catheter insertion and maintenance using a government-endorsed auditing tool. Data were collected through on-site observations and nurses' feedback. The findings revealed a urinary catheter utilization rate of 17.99%. However, there was a lack of complete adherence to government-endorsed standards among oncology nurses (0%). These results indicate that current practices lack evidence-based standardization. Therefore, there is a need to develop and implement quality improvement initiatives to enhance patient safety and experiences.

Vital Signs: Maternity Care Experiences - United States, April 2023.

Maternal deaths increased in the United States during 2018-2021, with documented racial disparities. Respectful maternity care is a component of quality care that includes preventing harm and mistreatment, engaging in effective communication, and providing care equitably. Improving respectful maternity care can be part of multilevel strategies to reduce pregnancy-related deaths. CDC analyzed data from the PN View Moms survey administered during April 24-30, 2023, to examine the following components of respectful care: 1) experiences of mistreatment (e.g., violations of physical privacy, ignoring requests for help, or verbal abuse), 2) discrimination (e.g., because of race, ethnicity or skin color; age; or weight), and 3) reasons for holding back from communicating questions or concerns during maternity (pregnancy or delivery) care. Among U.S. mothers with children aged <18 years, 20% reported mistreatment while receiving maternity care for their youngest child. Approximately 30% of Black, Hispanic, and multiracial respondents and approximately 30% of respondents with public insurance or no insurance reported mistreatment. Discrimination during the delivery of maternity care was reported by 29% of respondents. Approximately 40% of Black, Hispanic, and multiracial respondents reported discrimination, and approximately 45% percent of all respondents reported holding back from asking questions or discussing concerns with their provider. Approximately one in five women reported mistreatment during maternity care. Implementing quality improvement initiatives and provider training to encourage a culture of respectful maternity care, encouraging patients to ask questions and share concerns, and working with communities are strategies to improve respectful maternity care.

Exploring Barriers and Facilitators to Reducing the Environmental Impact of the Operating Room

IntroductionThe operating room (OR) is a major contributor to greenhouse gas emissions both nationally and globally. Successful implementation of quality improvement initiatives requires understanding of key stakeholders' perspectives of the issues at hand. Our aim was to explore surgical, anesthesia, and OR staff member perspectives on barriers and facilitators to reducing OR waste. Materials and methodsIdentified stakeholders from a single academic medical center were interviewed to identify important barriers and facilitators to reducing surgical waste. Two team members with qualitative research experience used deductive logic guided by the Theoretical Domains Framework of behavior change to identify themes within transcripts. ResultsNineteen participants including surgeons (n = 3, 15.8%), surgical residents (n = 5, 26.3%), an anesthesiologist (n = 1, 5.3%), anesthesia residents (n = 2, 10.5%), nurse anesthetists (n = 2, 10.5%), nurses (n = 5, 26.3%), and a surgical technologist (n = 1, 5.3%) were interviewed. Twelve of the 14 themes within the Theoretical Domains Framework were discovered in transcripts. Barriers within these themes included lack of resources to pursue environmental sustainability in the OR and the necessity of maintaining sterility for patient safety. Facilitators included emphasizing surgeon leadership within the OR to reduce unused supplies and spreading awareness of the environmental and economic impact of surgical waste. ConclusionsInterviewed stakeholders were able to identify areas where improvements around surgical waste reduction and management could be made at the institution by describing barriers and facilitators to sustainability-driven interventions. Future surgical waste reduction initiatives at this institution will be guided by these important perspectives.

Implementing Lean Six Sigma in a multispecialty hospital through a change management approach

PurposeMany healthcare institutions, such as hospitals, have recently implemented quality improvement initiatives such as Lean Six Sigma (LSS). However, only a few have sustained the initiatives and remained successful. One of the main reasons for the failure of LSS implementation is that managers tend to view LSS as individual projects. Managers lack a Change Management (CM) focus during the implementation. The primary purpose of this study is to document the implementation of LSS through a CM approach to improve sustainability.Design/methodology/approachDefine-Measure-Analyse-Improve-Control (DMAIC) and the Awareness-Desire-Knowledge-Ability-Reinforcement (ADKAR), a popular CM approach, are combined to propose a new framework. The usefulness of the proposed framework is demonstrated using a case study in a multispeciality hospital located in southern India.FindingsThe study found that several factors are responsible for the high Length of Stay (LOS) for patients in the Emergency Department (ED). By implementing this proposed model to implement LSS and taking corrective actions, the average LOS was reduced from 267 to 158 min (a 40% reduction approximately).Practical implicationsThe complete step-by-step approach is explained, and the LOS was considerably reduced during the pilot project. The findings will provide valuable insights for healthcare practitioners to understand the steps involved in the combined DMAIC-ADKAR model. The findings would also give healthcare practitioners the confidence to identify suitable tools and implement LSS in organisations where the practitioners work.Originality/valueAccording to the authors' knowledge, this is the first study that synergises two models (DMAIC and ADKAR) into a single framework to implement in a hospital.

Unpacking the ‘process of sustaining’—identifying threats to sustainability and the strategies used to address them: a longitudinal multiple case study

BackgroundAlthough sustainability remains a recognised challenge for Quality Improvement (QI) initiatives, most available research continues to investigate sustainability at the end of implementation. As a result, the learning and continuous adjustments that shape sustainability outcomes are lost. With little understanding of the actions and processes that influence sustainability within QI initiatives, there is limited practical guidance and direction on how to enhance the sustainability of QI initiatives. This study aims to unpack the ‘process of sustaining’, by exploring threats to sustainability encountered throughout the implementation of QI Initiatives and identifying strategies used by QI teams to address these threats over time.MethodsA longitudinal multiple case study design was employed to follow 4 QI initiatives over a 3-year period. A standardised sustainability tool was used quarterly to collect perceptions of sustainability threats and actions throughout implementation. Interviews (n=38), observations (32.5 h), documentary analysis, and a focus group (n=10) were conducted to enable a greater understanding of how the process of sustaining is supported in practice. Data were analysed using the Consolidated Framework for Sustainability (CFS) to conduct thematic analysis.ResultsAnalysis identified five common threats to sustainability: workforce stability, improvement timelines, organisational priorities, capacity for improvement, and stakeholder support. Each of these threats impacted multiple sustainability constructs demonstrating the complexity of the issues encountered. In response to threats, 12 strategies to support the process of sustaining were identified under three themes: engagement (five strategies that promoted the development of relationships), integration (three strategies that supported initiatives to become embedded within local systems), and adaptation (four strategies that enhanced understanding of, and response to, emergent conditions and contextual needs).ConclusionsSustaining improvements from QI initiatives requires continuous investment in relationships, resilience to integrate improvements in local systems, and flexibility to understand emergent conditions. Findings provide practitioners, funders, and researchers with a better understanding of, and preparation for, the threats associated with sustaining improvements from QI initiatives and offer insight into specific actions that can be taken to mitigate these risks. This learning can be used to inform future initiative design and support, to optimise the sustainability of healthcare improvements.Trial registrationNot applicable

O172 Room for improvement: a multi-centre audit of our current compliance with surgical antibiotic prophylaxis guidelines in Ireland

Abstract Introduction In 2017, a national point prevalence study in Ireland showed low compliance with Surgical Antibiotic Prophylaxis (SAP) duration, with 70% of prescriptions exceeding recommended duration. We hypothesise that there has been little improvement since then and we aim to define our compliance issues more broadly than duration alone. Methods To assess compliance with SAP guidelines at a locally, a multi-site audit was conducted over a 14-day period in July 2022. Data was collected at one major, public hospital and one private hospital, both in the Dublin region. Procedures performed in an operating theatre from all surgical specialties were audited. Results A total of 303 procedures were audited across both sites with 165 public and 138 private included. Overall, compliance with local SAP guidance, according to indication, duration and agent was present in 72 patients (23.7%). Performance in both centres was similar (22% public versus 26% private). Of patients in whom SAP was indicated, all 182 (100%) received it. 91 patients (30%), had no indication for SAP. 19 patients (21.1%) still received SAP despite having no indication. Antibiotic duration surpassed 48 h in 58 (25%) procedures, with 40 (17.5%) receiving antibiotic prophylaxis for more than 6 days. Compliance with appropriate agent recommendation was 43.5%. Conclusion Compliance with SAP guidance is low. Despite contrasting work processes in public versus private settings, compliance with SAP guidelines are similar. Work is currently underway to identify barriers to compliance in order to implement quality improvement initiatives and to address this.

Postpartum Hemorrhage Prevention Quality Improvement Initiatives and Blood Transfusion Utilization [ID: 1378079

INTRODUCTION: The universal implementation of active management of the third stage of labor, quantitative assessment of blood loss, and hemorrhage risk assessment on admission is recommended to reduce the incidence and morbidity of postpartum hemorrhage. We evaluated the effect of these quality improvement (QI) initiatives, in addition to an active management protocol for iron deficiency anemia antepartum, on the use of blood transfusion during delivery hospitalization. METHODS: We obtained blood transfusion data for the obstetric service at a tertiary care university hospital from January 1, 2017 to July 13, 2022, as well as data for every delivery during that time period (N=11,101). Institutional review board approval was obtained for the study. Patients whose transfusions were administered for nonobstetric indications were excluded. We compared the frequency of blood transfusions and number of units transfused per patient before and after the implementation of QI initiatives. RESULTS: There was a significant downward trend in the frequency of blood transfusions (P=.003) and the number of units transfused per patient (P=.000006) during the study period. The transfusion rate was 3.3% in the year prior to any intervention and 1.78% after implementation of all QI initiatives. No differences were observed in the characteristics of the patient population relevant to hemorrhage risk during the study period. CONCLUSION: This study provides evidence that in addition to reducing postpartum hemorrhage and its morbidity, these QI initiatives also help reduce blood transfusion utilization.

Development of the Illinois Surgical Quality Improvement Collaborative (ISQIC): Implementing 21 Components to Catalyze Statewide Improvement in Surgical Care.

In 2014, 56 Illinois hospitals came together to form a unique learning collaborative, the Illinois Surgical Quality Improvement Collaborative (ISQIC). Our objectives are to provide an overview of the first three years of ISQIC focused on (1) how the collaborative was formed and funded, (2) the 21 strategies implemented to support quality improvement (QI), (3) collaborative sustainment, and (4) how the collaborative acts as a platform for innovative QI research. ISQIC includes 21 components to facilitate QI that target the hospital, the surgical QI team, and the peri-operative microsystem. The components were developed from available evidence, a detailed needs assessment of the hospitals, reviewing experiences from prior surgical and non-surgical QI Collaboratives, and interviews with QI experts. The components comprise 5 domains: guided implementation (e.g., mentors, coaches, statewide QI projects), education (e.g., process improvement (PI) curriculum), hospital- and surgeon-level comparative performance reports (e.g., process, outcomes, costs), networking (e.g., forums to share QI experiences and best practices), and funding (e.g., for the overall program, pilot grants, and bonus payments for improvement). Through implementation of the 21 novel ISQIC components, hospitals were equipped to use their data to successfully implement QI initiatives and improve care. Formal (QI/PI) training, mentoring, and coaching were undertaken by the hospitals as they worked to implement solutions. Hospitals received funding for the program and were able to work together on statewide quality initiatives. Lessons learned at one hospital were shared with all participating hospitals through conferences, webinars, and toolkits to facilitate learning from each other with a common goal of making care better and safer for the surgical patient in Illinois. Over the first three years, surgical outcomes improved in Illinois. The first three years of ISQIC improved care for surgical patients across Illinois and allowed hospitals to see the value of participating in a surgical QI learning collaborative without having to make the initial financial investment themselves. Given the strong support and buy-in from the hospitals, ISQIC has continued beyond the initial three years and continues to support QI across Illinois hospitals.

Recovery of Patient-reported Quality of Life After Esophagectomy

BackgroundEsophagectomy is an important, but potentially morbid, operation used to treat benign and malignant conditions that may significantly impact patient quality of life (QOL). Patient-reported outcomes (PROs) are measures of QOL that come directly from patient self-report. This study characterizes patterns of change and recovery in PROs in the first year after esophagectomy. MethodsLongitudinal QOL scores measuring physical function, pain, and dyspnea were obtained from esophagectomy patients during all clinic visits. PRO scores were obtained using the National Institutes of Health–sponsored Patient-Reported Outcomes Measurement Information System from April 2018 to February 2021. Mean PRO scores over 100 days after surgery were compared with baseline PRO scores using mixed-effects modeling with compound symmetry correlational structure. ResultsOne hundred three patients with PRO results were identified. Reasons for esophagectomy were malignancy (87.4%), achalasia (5.8%), stricture (5.8%), and dysplasia (1.0%). When comparing mean PRO scores at visits ≤ 50 days after surgery with preoperative PRO scores, physical function scores declined by 27.3% (P < .001), whereas dyspnea severity and pain interference scores had increased by 24.5% (P < .001) and 17.1% (P < .001), respectively. Although recovery occurred over the course of the 100 days after surgery, mean physical function scores and dyspnea scores were still 12.7% (P = .02) and 26.4% (P = .001) worse, respectively, than mean preoperative levels. ConclusionsDespite declines in QOL scores immediately after esophagectomy, recovery back toward baseline was observed during the first 100 days. These findings are of considerable importance when counseling patients regarding esophagectomy, tracking recovery, and implementing quality improvement initiatives. Further long-term follow-up is needed to determine recovery beyond 100 days.

Utility of the finance-electronic medical record digital dashboard in pediatric otolaryngology

BackgroundThe time and cost of data collection via chart review of the electronic medical record (EMR) is a research barrier. This study describes the development of a digital dashboard conjoining EMR and finance data and its application in a pediatric otolaryngology practice. MethodsThe dashboard creates a common language crosswalk between surgeries via the EMR, financial data, and national Vizient database. First, all Otolaryngology procedures billed via ICD-10 or CPT codes were categorized into Procedure Groups, which constitute the common language that links all data sources. The joined dataset was inputted into a Tableau workbook supporting dynamic filtering and custom real-time analysis. ResultsThe dashboard includes 84 Procedure Groups within Otolaryngology. Examples for pediatrics include Sistrunk procedure and supraglottoplasty. User-friendly dynamic filtering by Procedure Group, surgery date range, age, insurance, hospital, surgeon, and discharge status were developed. Outcomes include length of stay, telephone callbacks, postoperative hemorrhage, reoperations, return to Emergency Department, readmissions, and mortality. National comparisons can be analyzed via embedded Vizient data. The usability of the dashboard was tested by evaluating pediatric tonsillectomy outcomes, which revealed a significantly higher rate of postoperative hemorrhages and reoperations during the COVID-19 pandemic. ConclusionThe hybrid finance/EMR dashboard creates a crosswalk between data sources and shows utility for use in evaluating patient outcomes via real-time data analysis and dynamic filtering. This innovative dashboard expedites data extraction, promoting efficient implementation of quality improvement initiatives and surgical outcomes research.