Implementation Of Quality Improvement Project Research Articles

ThP1.6 - Chaperone in Breast Examination: A Comprehensive Systematic Review of Patient and Clinician Perspectives, and Documentation

Abstract Aims The use of chaperones during breast examination is a logical step, particularly in an increasingly litigious society. This review aims to summarise the current information regarding patients’ and clinicians’ perspective in chaperone use in both specialities. Methods A PRISMA compliant search was conducted in electronic databases from inception until April 2023 for qualitative literature regarding patients and clinician perspective in chaperone use in breast and plastic surgery. An inductive thematic analysis in three domains (physician-associated, patient-associated factors and chaperone documentation) was done. Results 10 studies were included after screening 939 articles. Regarding breast surgery, the presence of male and older surgeons, nurse availability, rural setting, and patients’ psychiatric comorbidities were found to increase the propensity of having a chaperone present during consultations. With medico-legal concerns being a prominent factor for male breast surgeons, female breast surgeons highlighted the need for technical support as their main motivation for having a chaperone while logistical issue was a common hindrance. Gender of physicians remained to be an important factor for patients, but conflicting evidence was found regarding patient preferences for chaperone and purpose for having a chaperone present during consultations. Poor documentation was generally observed despite implementing quality improvement projects. Conclusion This study emphasizes the vital role of chaperones in clinical practice, urging a precise definition and targeted resolution for implementation challenges. Patient preferences highlight the need for a personalized approach, and increased awareness among healthcare professionals is essential.

Increasing venous thromboembolism risk assessment through a whole hospital-based intervention: a pre-post service evaluation to demonstrate quality improvement.

Venous thromboembolism (VTE) is a primary cause of morbidity and mortality in hospitalized patients. VTE risk assessment is a crucial part of the VTE prevention guideline. However, VTE risk assessment was not consistently undertaken for admitted patients. The aim of this study was to identify whether a quality improvement project implemented to change documentation of VTE risk assessment for hospitalized patients impacted patient safety by decreasing the rate of VTE incidences. The study was set in a 600+ bed acute hospital that provides medical and surgical services for adult patients during the period October 2018-September 2020. The hospital adopted the American College of Chest Physicians (ACCP) 9th edition VTE prevention guidelines and followed the Modified Caprini risk assessment tool. Following the FOCUS-Plan-Do-Check-Act (FOCUS PDCA) improvement methodology, the improvement team implemented multicomponent interventions over a 3-month period, including conducting educational sessions, sharing VTE documentation compliance results, giving reminders during rounds, assigning a VTE liaison physician within each clinical specialty, and updating and communicating the hospital adopted VTE guidelines. A total of 17 612 patients were included, respectively, 8971 in pre-intervention and 8641 post-intervention period. Documentation of VTE risk assessment upon admission increased significantly in the post quality improvement intervention period (60% vs. 42%, relative increase of 30%, χ2 = 1.43, P < 0.001). The run chart trend analysis demonstrated significant improvement shift and improvement trend after quality improvement project implementation, and it was sustained for 15 months. There was no impact on patient safety with a slight not statistically significant decrease in the VTE incidences rate post intervention period (0.4% vs. 0.5%, relative decrease of 1%, χ2 = 0.82, P < 0.397). The quality improvement project intervention significantly increased the percentage of patients assessed for VTE risk in a hospital setting.

Improving the emergency services using quality improvement project and Donabedian model in a quaternary teaching hospital in South India

IntroductionThe primary goal of quality improvement is to enhance patient outcomes, particularly in the emergency department (ED). Timely and effective care is crucial in these situations. By comprehending the challenges,...

Critical Success Factors For Quality Improvement Projects In Pasuruan, East Java, Indonesia

Purpose: This study aims to determine the factors influencing the successful implementation of quality improvement projects. Theoretical framework: This research will focus on finding critical success factors for quality improvement projects and prioritizing improvements to improve the performance and success of quality improvement project implementation. Design, Methodology and Approach: The research used Smart PLS-SEM and Importance Performance Analysis (IPA). Smart PLS-SEM was first used to determine critical success factors for Quality Improvement Projects (QIPs). Furthermore, IPA was used to determine the position of each factor based on its importance and achievements. Findings: The result showed all dimensions and indicators significantly affect the success of quality improvement projects. The dimension with the highest outer loading value is the quality performance measurement dimension. The next step is measured using the IPA method to determine the critical factors for project success. The results of the IPA analysis show that quality control and leadership are crucial factors in the success of quality improvement projects in the second quadrant. At the same time, the factor that prioritizes improvement is quality assurance (first quadrant). Research, Practical &amp; Social implications: Research, Practical, and Social Implications: The research implies that quality control and leadership are critical success factors for quality improvement projects. Leadership plays an essential role in implementing quality improvement projects, and leadership commitment is an important key to the success of these projects. In addition, there is a requirement for support from leadership regarding resource allocation. This resource allocation includes labor, costs, information systems, machines, and tools. Another factor that is critical to the success of these projects is quality control. Implementation of quality control has a vital role during the quality improvement project process and after the project. With quality control, the product suits the specifications and standards and meets the targets and standards set. Products that track the results of the implementation of quality control can ensure that the product's quality is guaranteed and follows the target set. Originality/Value: This research combines two methods to determine the critical success factors in implementing quality improvement projects. Previous research, using SEM-PLS and IPA method measurements, was carried out separately, measuring the importance and performance levels. In this study, the outer loading results in the original sample measurement with SEM-PLS for importance value in the IPA method.

The Quest for Improving Sickle Cell Care: Creating High-Level Quality Improvement Goals with a Care Process Team

Background: A Care Process Team (CPT) is an interdisciplinary team focused on improvement effort across systems or a population cohort with high degree of variation in care, high volume, high cost, or institutional priority. The Texas Children's Hospital Quality &amp; Safety Department has implemented CPTs for several disease populations including, asthma, diabetes, and pain management. In 2021, the sickle cell CPT (SCCPT) was launched in partnership with the Texas Children's Cancer and Hematology Center. An early step in developing a CPT is delineating goals via a balanced scorecard, a comprehensive framework that translates the team's strategic objectives into a coherent set of performance measures. After establishing priority quality metrics, the SCCPT sought to establish an operational structure and to define and implement specific quality improvement (QI) initiatives to improve outcomes. Methods: The SCCPT assembled a multi-disciplinary expert panel which included providers, nurses, division leadership, data architects, analysts, and quality specialists. After a systematic review of the literature identified metrics with best practice evidence, a modified-Delphi process was used to rank quality metrics according to standards set forth by the National Quality Forum. High-priority metrics were organized into a balanced scorecard. Goals were developed based on Institute of Healthcare QI methodology. A QlikView® dashboard was created to abstract patient data from the electronic medical record. Results: The expert panel met 7 times between January to October 2021. The systematic review found 26 quality measures for SCD and subsequently panel review expanded the list to 34 measures. Expert consensus was reached and 5 metrics were selected for the final SCCPT balanced scorecard. The SCCPT initiated routine meetings in January 2022. Three goals and SMART aims were prioritized from balanced scorecard metrics relating to stroke screenings, disease-modifying drug education and prescriptions, and assignment of a primary Hematology team. Baseline data revealed that 60% of eligible children with SCD had obtained a transcranial Doppler ultrasound within the last 15 months. Hydroxyurea was prescribed to 70% of patients with Hb SS or S/beta-0-thalassemia disease. Primary Hematologist and nurse coordinator teams were assigned to 50% and 23%, respectively. To design and implement QI projects, two teams were created: one focused on prevention-related metrics and the other on treatment-related metrics. Discussion: The successful launch of the SCCPT involved the convening a team of multi-disciplinary members, creation of a balanced scorecard, prioritizing goals, and analyzing baseline data to set SMART aims related to improving SCD care. Two operational teams were created and have proceeded to design and implement QI projects related to SMART aims.

Improving Complex Brachytherapy Efficiency in the Current Financial Climate.

To optimize multidisciplinary collaboration in the setting of limited resources to increase the efficiency of complex brachytherapy workflow for patients with locally advanced cervical cancer. High Dose Rate (HDR) brachytherapy is a critical component in the treatment of women with locally advanced cervical cancer. The completion of HDR brachytherapy to provide a complete treatment of concurrent chemoradiation and brachytherapy of <56 days has been well established. A quality improvement (QI) initiative was born out of the need to accommodate an increasing volume of patients with locally advanced cervical cancer. The challenges addressed were: different location of the operating room (OR), HDR brachytherapy suite, MR scanner; Inconsistent OR days; Post-Anesthesia Care Unit (PACU)/transportation delays; Anesthesiology staffing constraints. The QI initiative required multidisciplinary collaboration. A new protocol was finalized which provided protected OR time, and changed analgesia from general anesthesia requiring prolonged monitoring in PACU, to a pre-procedural epidural with moderate sedation. Additionally, a dedicated anesthesiologist was assigned to discuss process improvement, and the medical history for these complex patients as it relates to anesthesia safety. The streamlined process allows the patients' physical time in PACU to be bypassed; a dedicated brachytherapy nurse competent in moderate sedation recovery accompanies the patient to CT simulation. An MR protocol was established with tentative slots secured. The primary metric was the change in the number of interstitial cases performed. Additional metrics included: total case time, anesthesiology delay, MR delay, and number of OR days where 2 complex cases are performed. Prior to initiation of QI initiative, from 01/2022-09/2022 there were 27 cases, average 3.0/month. After implementation of QI project, from 10/2022-02/2023 there were 32 cases, average 6.4/month, a 113.3% increase. Total case time decreased from baseline 9.3 hours to average 6 hours (Range: 3.8-10.6). Anesthesiology related delays were on average 18.5 minutes (Range: -15-35). MR related delays were on average 87.6 minutes (Range: 35-275). These changes now permit the flexibility of performing 2 complex interstitial cases per day, instead of one. The average days per month where two interstitial cases are performed increased from 0.4 to 1.4. As hospital systems continue to face economic constraints, it is critical that we leverage our existing resources in order to provide timely care to our patients. This QI initiative shows that despite the limitation in brachytherapy operations, systems can be changed through multidisciplinary collaboration to improve efficiencies and increase capacities while working within financial workforce constraints to provide optimal patient care.

Increasing staff time for patient facing care on an inpatient geriatric unit through modification of multidisciplinary board rounds: a quality improvement project

BackgroundNHS staff recruitment and retention have failed to keep pace with service demands and workforce burn-out is of significant concern. This quality improvement project (QIP) aimed to increase staff time...

Pediatric tracheostomy audiometric outcomes - A quality improvement initiative.

Pediatric tracheostomy patients disproportionately experience hearing loss and are at risk for delayed identification due to their medical complexity. Nonetheless, protocols to monitor hearing in these children are lacking. This quality improvement (QI) initiative aimed to increase the rates of audiometric testing within 12 months of pediatric tracheostomy placement. A retrospective cohort study included children who underwent tracheostomy under 18 months of age between 2012 and 2020. Rates of audiometric assessments before and after QI project implementation (2015) were reported along with hearing loss characteristics. A total of 253 children met inclusion. Before project initiation (2012-2014), 32% of children (28/87) obtained audiometric testing within 12 months after tracheostomy. During the first three years of implementation (2015-2017), 39% (38/97) were tested, while 55% (38/69) were tested during the subsequent three years (2018-2020) (P=.01). A passing newborn hearing screen was obtained for 70% of the 210 children with a recorded result, and 198 survived at least 12 months to receive audiometric testing at a median of 11.3 months (IQR: 6.2-22.8) after tracheostomy. Hearing loss was identified for 44% of children (N=88), of which 42 children initially passed newborn hearing screen. A second assessment was obtained for 62% of children (123/198) at a median of 11.3 months (IQR: 4.5-17.5) after the initial test. In this group, 23% with a previously normal audiometric exam were found to have hearing loss (15/66). QI initiatives designed to monitor hearing loss in children with a tracheostomy can result in improved rates of audiometric assessments. This population has disproportionately high rates of hearing loss, including delayed onset hearing loss making audiometric protocols valuable to address speech and language development delays.

Publishing Quality Improvement Projects: Know the Guidelines Before Starting Your Project

Health care clinicians, educators, and students who plan and implement quality improvement (QI) projects must know reporting guidelines for successful project planning and publication. We aimed to identify QI guidelines, which authors can locate, and highlight how best to use them for manuscript preparation. We also address guidelines for educational QI projects. Because of the increasing number of Doctor of Nursing Practice projects generated, these students and their mentors must be familiar with commonly used guidelines for reporting QI projects to facilitate peer review, demonstrate quality and rigor of work, reduce revisions, and potentially accelerate a paper's acceptance for publication.

Using multi-criteria decision analysis to describe stakeholder preferences for new quality improvement initiatives that could optimise prescribing in England.

Hospital decision-makers have limited resources to implement quality improvement projects. To decide which interventions to take forward, trade-offs must be considered that inevitably turn on stakeholder preferences. The multi-criteria decision analysis (MCDA) approach could make this decision process more transparent. An MCDA was conducted to rank-order four types of interventions that could optimise medication use in England's National Healthcare System (NHS) hospitals, including Computerised Interface, Built Environment, Written Communication, and Face-to-Face Interactions. Initially, a core group of quality improvers (N = 10) was convened to determine criteria that could influence which interventions are taken forward according to the Consolidated Framework for Implementation Research. Next, to determine preference weightings, a preference survey was conducted with a diverse group of quality improvers (N = 356) according to the Potentially All Pairwise Ranking of All Possible Alternatives method. Then, rank orders of four intervention types were calculated according to models with criteria unweighted and weighted according to participant preferences using an additive function. Uncertainty was estimated by probabilistic sensitivity analysis using 1,000 Monte Carlo Simulation iterations. The most important criteria influencing what interventions were preferred was whether they addressed "patient needs" (17.6%)' and their financial "cost (11.5%)". The interventions' total scores (unweighted score out of 30 | weighted out of 100%) were: Computerised Interface (25 | 83.8%), Built Environment (24 | 79.6%), Written Communication (22 | 71.6%), and Face-to-Face (22 | 67.8%). The probabilistic sensitivity analysis revealed that the Computerised Interface would be the most preferred intervention over various degrees of uncertainty. An MCDA was conducted to rank order intervention types that stand to increase medication optimisation across hospitals in England. The top-ranked intervention type was the Computerised Interface. This finding does not imply Computerised Interface interventions are the most effective interventions but suggests that successfully implementing lower-ranked interventions may require more conversations that acknowledge stakeholder concerns.

Vulnerable yet Unprotected: The Hidden Curriculum of the Care of the Incarcerated Patient.

Vulnerable yet Unprotected: The Hidden Curriculum of the Care of the Incarcerated Patient.

IMPROVEMENT IN BIRTHING EXPERIENCE FOLLOWING CHANGE IN EPISIOTOMY PRACTICES AT TEACHING HOSPITAL IN INDIA

Background:- Episiotomy or perineotomy is a minor surgical procedure performed in labour room to facilitate delivery of the baby and to prevent injury to perineum. The analysis of the labour room statistics revealed that the rate of episiotomy was extremely high (87%).The episiotomy wound related complications resulted in extended hospital stay and unsatisfactory birthing experience among the delivered women. Methodology:- Different methods of root cause analysis like Fish bone analysis and Five Why method were used at Pravara Rural hospital,Loni a tertiary care hospital. Necessary educational programmes were implemented and policy decisions regarding indications of episiotomy were made. Regular monitoring and analysis was done to sustain the results. Results:-The historical data of three months before project implementation revealed that the rate of episiotomy was 87.00% among 1691 deliveries conducted. The reduction in rate of episiotomy was predominantly observed in multipara. At the end of eight weeks of QI project, the rate of episiotomy in primipara and multipara was 70.20 % and 20.00% respectively. The overall incidence of surgical site infection (SSI) in the obstetric unit decreased from 3.2 percent to 2.5 percent. Conclusion:- Implementation of quality improvement project helped in significant reduction in the rate of episiotomy. It indirectly helped in reduction of episiotomy related complications and hospital stay.

What Should Be the Topics of a Prospective Study on Ovarian Masses in Children?-Results of a Multicenter Retrospective Study and a Scoping Literature Review.

Purpose: to determine management problems of ovarian masses in girls in order to form a baseline for prospective randomized studies of the established topics and quality improvement of our management. Materials and Methods: We performed a national analysis of clinical aspects of ovarian masses in girls operated on in Poland, analyzed retrospectively medical files of all consecutive patients aged 0–18 who underwent surgeries for ovarian lesions between 2012 and 2017 at 17 pediatric surgical departments and complemented the analysis with a scoping review of a recent primary research related to ovarian masses in children. Results: The study group comprised 595 patients. Forty-four (7.39%) girls were diagnosed with malignant tumors. The overall preservation rate was 64.54%. The analysis revealed that positive tumor markers (OR = 10.3), lesions larger than 6 cm (OR = 4.17) and solid mass on ultrasound examination (OR = 5.34) are interdependent variables differentiating malignant tumors from non-malignant lesions ( = 79.1; p = 0.00000). Our scoping review revealed 10 major branches of research within the topic of ovarian masses in pediatric population. Conclusions: We have developed an overview of the field with the emphasis on the local environment. Our next step is a multi-institutional prospective study of a quality improvement project implementation based on the obtained knowledge.

Reflective writing: a tool to support continuous learning and improved effectiveness in implementation facilitators

BackgroundImplementation facilitators support the adoption of evidence-based practices and other improvement efforts in complex healthcare settings. Facilitators are trained to develop essential facilitation skills and facilitator effectiveness is typically evaluated post-implementation, but little is known about how facilitators apply and adapt didactic knowledge after training, or how learning and refining experiential knowledge occurs during the facilitation process. We propose the use of reflective writing as a tool to document and support facilitator learning and facilitator effectiveness.MethodsUsing an instrumental case study of the Coordination Toolkit and Coaching (CTAC) project, we explore the use of reflective writing by facilitators to support their learning and effectiveness. Six primary care clinics participated in weekly hour-long facilitation calls over a 12-month period to implement quality improvement projects related to care coordination. Two facilitators completed templated reflections after each facilitation call for their assigned sites, totaling 269 reflections. We used the declarative-procedural-reflective model, which defines the process of skill development in clinical practice, to qualitatively analyze the reflections. Two independent coders used content analysis principles to code text that captured facilitators’ observations, evaluations, interpretations, and communication. Descriptive statistics were used to analyze reflections by facilitator and by code within and across reflections.ResultsCTAC facilitators primarily used the reflections to summarize the calls (observation), assess the facilitation process and the tasks and activities they used (evaluation), document their thoughts about how to improve their own effectiveness (interpretation), and describe their communication with implementing teams. Ninety-one percent of reflections included observations, 42% interpretation, 41% evaluation, and 44% facilitator communication. In total, we coded 677 segments of text within reflections: 39% represented observation, 20% interpretation, 18% evaluation, and 23% facilitator communication.ConclusionsThe process of reflective writing allowed the CTAC facilitators the time and structure to evaluate their facilitation and to think critically about how to adjust their facilitation in response to their observations and interpretations. Reflective writing is a feasible and acceptable tool to support and document facilitator learning and effectiveness.Trial registrationThe project was registered with ClinicalTrials.gov (NCT03063294) on February 24, 2017.

How to sustainably build capacity in quality improvement within a healthcare organisation: a deep-dive, focused qualitative analysis

BackgroundA key characteristic of healthcare systems that deliver high quality and cost performance in a sustainable way is a systematic approach to capacity and capability building for quality improvement. The aim of this research was to explore the factors that lead to successful implementation of a program of quality improvement projects and a capacity and capability building program that facilitates or support these.MethodsBetween July 2018 and February 2020, the Southern Adelaide Local Health Network (SALHN), a network of health services in Adelaide, South Australia, conducted three capability-oriented capacity building programs that incorporated 82 longstanding individual quality improvement projects. Qualitative analysis of data collected from interviews of 19 project participants and four SALHN Improvement Faculty members and ethnographic observations of seven project team meetings were conducted.ResultsWe found four interacting components that lead to successful implementation of quality improvement projects and the overall program that facilitates or support these: an agreed and robust quality improvement methodology, a skilled faculty to assist improvement teams, active involvement of leadership and management, and a deep understanding that teams matter. A strong safety culture is not necessarily a pre-requisite for quality improvement gains to be made; indeed, undertaking quality improvement activities can contribute to an improved safety culture. For most project participants in the program, the time commitment for projects was significant and, at times, maintaining momentum was a challenge.ConclusionsHealthcare systems that wish to deliver high quality and cost performance in a sustainable way should consider embedding the four identified components into their quality improvement capacity and capability building strategy.

Abstract P827: W.I.N.G.S. to Acute Stroke Treatment

Background: Nearly 2 million neurons die each minute during an acute ischemic stroke (AIS). Research demonstrates patients receiving timely treatment for AIS can have more favorable outcomes. In 4 th quarter (Q) 2018, a Stroke Center’s average door-to-needle (DTN) time was 54 minutes, acceptable for American Stroke Association’s (AHA/ASA) Get with the Guidelines (GWTG) quality requirement of DTN in 60 minutes or less. Nevertheless, time is brain and decreased DTN times can potentially improve patient outcomes. With this in mind, the emergency department (ED) implemented a quality improvement project (QIP) focused on DTN time reduction. Purpose: Improve the ED workflow by developing standardized roles and task prioritization to reduce DTN times by 20% from 54 minutes to 42 minutes by 4 th Q 2019. Methods: Guidelines and goals were established using AHA/ASA GWTG-Stroke criteria. Included were AIS patients with symptoms occurring prior to ED arrival, met eligibility criteria, and received intravenous tissue plasminogen activator (IV t-PA). Patients with symptoms occurring after ED arrival or during the hospital stay were excluded. An interdisciplinary workgroup collaborated to formulate an evidence-based solution for workflow opportunities identified by simulations, observations, and subjective feedback. Standardized roles, similar to cardiac life support, were created. An innovative acronym, W.I.N.G.S. (weight, IV access, NIHSS, glucose, scan), was developed to strategize adoption and implementation. Education, chart reviews, and timely feedback were given to stakeholders for every stroke intervention to promote engagement. Results: In 4 th Q 2019, average DTN time decreased to 35 minutes (n=16, 35.2% reduction). The average DTN time for 1 st Q 2020 is 31 minutes (n=14, 42.6% reduction). Since QIP implementation, the current DTN record is 12 minutes. Conclusions: W.I.N.G.S. is now a commonly term used in the ED. The multidisciplinary approach was instrumental in implementing a feasible QIP based on evidence and did not compromise patient safety. Sustainability is dependent on continued commitment and engagement of the team to celebrate achievements and reflect, reevaluate, and revise any insufficiencies.

Crossing Boundaries: Mentorship in Global Health.

* Abbreviation: GH — : global health On my first day in the NICU in Malawi, I helped care for an infant who suffered from severe lack of oxygen and trauma due to a difficult birthing process. Before this experience, I had felt ready to work at a Malawian hospital as a pediatric resident. I had taken a tropical medicine course, and my home institution mentor had run simulations and led discussions addressing the practicalities and ethics of practicing medicine within resource-limited settings. But that afternoon, when the infant became apneic, personally experiencing what had only been simulated felt much harder. The 1 available nurse and I performed compressions and manual breaths, but he never recovered spontaneous respirations. My host institution mentor arrived soon after we discontinued resuscitative efforts. With his guidance, I spoke to our patient’s family and witnessed the Malawian expression of grief in the form of wailing songs and prayers. Afterward, he and I discussed questions with which I was struggling, namely, at what point would I be causing more harm than good by continuing to resuscitate this child, knowing the limited long-term care resources available in Malawi? Both home and host institution mentors helped me navigate this clinical situation and process my patient’s death, ultimately enriching my global health (GH) experience and … Address correspondence to Maya I. Brasher, MD, Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School, UT Health Science Center at Houston, 6431 Fannin St, Suite MSB 3.244, Houston, TX 77030. E-mail: maya.i.brasher{at}uth.tmc.edu

Reducing the Contamination Rate and the Unnecessary Requesting of Blood Culture Test through Quality Improvement Project

Background: Blood stream infections are major leading causes of morbidity and mortality in hospitalized patients. Increasing the awareness of the clinicians and nurses about the proper protocol of blood culture test is very important in reducing the contamination rate and the unnecessary requesting of blood culture. Objectives: to reduce the contamination rate and the unnecessary requesting of blood culture from different departments through implementation of hospital wide Quality Improvement Project (QIP). Methodology: Blood cultures were tested in the Microbiology Laboratory of Najran Armed Forces hospital, Saudi Arabia, in the period from June 2019 to July 2020 and their results were compared before and after the implementation of the QIP. Results: The comparison between the blood cultures results before and after QIP implementation showed statistically significant (19.6%) reduction in the contamination rate, (14%) reduction in the total number of blood culture requests and (11.6%) reduction in the negative results rate. Conclusion: The reduction in the total number, negative results and contamination rate of blood culture test after QIP implementation were considered as performance indicators that the recommendations of QIP were effective and implemented strictly.

Planning and implementing quality improvement projects in clinical practice: Third-year nursing students' learning experiences.

To evaluate the impact of an educational design to develop nursing students' competence to work systematically with quality improvement in clinical practice. Competence in how to improve the quality and safety of healthcare services based on new knowledge is crucial for healthcare quality. Nursing education should give students opportunities to engage in quality improvement projects to gain this competence. This project qualitatively evaluated the impact of the course on students' ability to plan and implement a quality improvement project in their clinical placement. Data from retrospective focus group interviews and written project reports were analysed by means of qualitative content analysis. Fifty-five students participated in the study. COREQ reporting guidelines were used. Three themes were derived from the analysis: (a) the importance of anchoring the quality improvement project in the clinic; (b) experiencing the steps of a quality improvement project; and (c) challenging student role. Course design that facilitates student-run small-scale quality improvement projects under supervision can enhance nurse students' competence in quality improvement work, as well as raise the students' awareness of the responsibility they will undertake as future nurses. Nursing students work on quality improvement project in clinical placement may enhance their awareness and competence in developing quality and safety of healthcare services as future nurses.

An Optimal Care Coordination Model (OCCM) for Medicaid patients with lung cancer: Finalization of the model and implications for clinical practice in the United States.

104 Background: In 2016, the Association of Community Cancer Centers (ACCC) launched a 3-year initiative to design, test, and refine an OCCM for Medicaid patients with lung cancer. The aim was to help cancer programs identify and reduce the barriers experienced by Medicaid patients by strengthening lung cancer care delivery systems. Methods: Phase I included Model development. Phases II and III included selection of 7 community-based cancer programs as testing sites to implement quality improvement projects, utilizing qualitative and quantitative assessments. Beta testing demonstrated the Model’s ability to offer practical guidance on improving care coordination to achievable target levels in high-impact areas such as patient access to care, prospective multidisciplinary case planning, and tobacco cessation. Opportunities were identified to improve care coordination beyond lung cancer to other tumor sites. Refinements for clarity of intent, ease of use, specificity, and uniformity across assessment areas were implemented, based on feedback from testing sites. Members of the Technical Expert Panel and the Advisory Committee, ACCC staff, and consultants revised the Model using consensus decision-making. Results: The final OCCM is composed of 12 inter-related assessment areas: patient entry into lung cancer program; multidisciplinary treatment planning; clinical trials; supportive care; survivorship care; financial, transportation, and housing needs; tobacco education; navigation; treatment team integration; physician engagement; electronic health records and patient access to information; and quality measurement and improvement. Each assessment area has 5 levels and corresponding metrics—level 1 represents the most basic provision of care, and level 5 represents optimal care coordination, which may be attainable for some cancer programs and aspirational for others. Progress implies cumulative and sustained fulfillment of lower level criteria. The OCCM can be deployed by cancer programs, regardless of size, setting, resource level, or cancer type. Dissemination to promote wider use is planned through an online benchmarking tool, blogs, a brochure, podcasts, and other resources. Conclusions: The OCCM can be utilized by cancer programs for objective self assessments of care delivery capabilities across 12 high-impact areas. Dissemination can advance multidisciplinary coordinated care delivery and improve clinical outcomes for patients nationwide, regardless of cancer type.