Improvement Interventions Research Articles

Development of the Team Evaluation and Assessment Measure Quality Improvement (TEAM-QI) and Proof-Of-Concept Testing in Maternity Teams.

Poor teamwork is often implicated in serious healthcare delivery failings, leading to calls for effective team improvement interventions. Taking a complex, adaptive systems perspective, we adapted an oncology team quality improvement program to make it appropriate for other areas of clinical care. Study phases included: (1) meetings with National Health Service, policy and service user representatives (n = 19), a rapid review of existing maternity teamwork interventions, and mapping of the proposed program content to an evidence-based model of team effectiveness; (2) feasibility and acceptability testing of the team questionnaire component, and content analysis of free-text responses with four maternity teams within two NHS Trusts (n = 26). Meetings with representatives highlighted the importance of non-punitive, continuous team-led assessment, and the ability to compare performance to similar teams while enabling adaptability to different team types. Program content mapped well to known components of team effectiveness. Internal consistency of the questionnaire was acceptable (Cronbach alpha = 0.79-0.92). Most team members (76.9%) reported benefits in identifying priorities for improvement. Preliminary proof of concept was supported but larger-scale evaluation including testing in other clinical areas is warranted.

Rationale, design and pre-randomization data for a cluster randomized trial to assess the effect of a digitally enabled quality improvement intervention on LDL-C control in established atherosclerotic cardiovascular disease patients: The SAPPHIRE-LDL Trial.

Translating evidence into clinical practice in the management of established atherosclerotic cardiovascular disease patients is challenging. Few quality improvement interventions have successfully improved patient care. The main objectives are to evaluate the impact of a digitally enabled multifaceted quality improvement (QI) intervention on the control of LDL-cholesterol (LDL-C) in atherosclerotic cardiovascular disease (ASCVD). We designed a pragmatic two-arm cluster randomized trial involving 28 clusters (outpatient clinics from public or private hospitals or private practices). Clusters are randomized to receive a digitally enabled multifaceted QI intervention or to routine practice (control). The QI intervention includes reminders, electronic clinical decision support algorithms, audit and feedback reports, and distribution of educational materials to health care providers, as well as electronic educational materials and app-based tools for drug adherence control, lipid profile control, and communication to participants. The primary endpoint is the LDL-C at 06 months after the intervention period. All analyses are performed following the intention-to-treat principle and take the cluster design into consideration by using individual-level regression modeling (generalized estimating equations-GEE). If proven effective, this low-cost, digitally enabled multifaceted QI intervention would be highly useful in promoting optimal LDL-C control in ASCVD patients. ClinicalTrials.gov NCT05622929.

Diagnostic inequalities relating to physical healthcare among people with mental health conditions: a systematic review.

Inaccurate diagnosis of physical health problems in people with mental health conditions may contribute to poorer health outcomes. We review the evidence on whether individuals with mental health conditions are at risk of diagnostic inequalities related to their physical health. We searched MEDLINE, PsycINFO, Embase, and CINAHL, 1 September 2002-18 Septemebr 2024 (PROSPERO 2022: CRD42022375892). Seventy-nine studies were eligible for inclusion. Risk of Bias (RoB) was assessed using the Newcastle-Ottawa or RoB2 tools and results were presented as a narrative synthesis. Findings from the included studies suggests that people with mental health conditions face diagnostic inequalities for their physical health. A minority of studies adopted a design that specifically measured professional- and service-related factors associated with diagnostic inequalities. Most studies, however, measured diagnostic endpoints only, meaning that no inference could be made regarding the relative impact of patients' and clinicians' behaviour in producing inequalities. Further investigations should consider the stage of the diagnostic process at which inequalities occur, to improve knowledge of the mechanisms underpinning diagnostic inequalities, and support the development of targeted improvement interventions. This study is funded by The Health Foundation's grant to the University of Cambridge for The Healthcare Improvement Studies (THIS) Institute. Grant number not applicable.

Instruments Evaluating the Duration and Pace of Clinical Encounters: A Scoping Review

ObjectiveHurried encounters in clinical settings contribute to dissatisfaction among both patients and clinicians and may indicate and contribute to low-quality care. We sought to identify patient- or clinician-reported instruments concerning this experience of time in clinical encounters. MethodsWe searched multiple databases from inception through July 2023. Working in duplicate without restrictions by language or clinical context, we identified published instruments or single items measuring perceptions of time adequacy in clinical encounters. We characterized these by time domain (perceived duration or pace of the encounter), responder (patient or clinician), and reference (experience of care in general or of a particular encounter). ResultsOf the 96 instruments found, none focused exclusively on perception of time adequacy in clinical encounters. Nonetheless, these instruments contained 107 time-related items. Of these, 81 items (77%) measured the perception of the encounter duration, assessing whether there was adequate consultation time overall or for specific tasks (e.g., listening to the patient, exploring psychosocial issues, formulating the care plan). Another 19 (18%) assessed encounter pace, and 7 (7%) assessed both duration and pace. Pace items captured actions perceived as rushed or hurried or the perception that patients and clinicians felt pressed for time or rushed. Patients were the respondents for 76 (71%) and clinicians for 24 (22%) items. Most patient-reported items (48 of 76) referred to the patient’s general care experience. ConclusionThere are existing items to capture patient and clinician perceptions of the duration and/or pace of clinical encounters. Further work should ascertain their ability to identify hurried consultations and to detect the effect of interventions to foster unhurried encounters. Practice implicationsThe available items assessing patient and clinician perceptions of duration and pace can illuminate the experience of time adequacy in clinical encounters as a target for quality improvement interventions. These items may capture unintended consequences on perceived time for care of interventions to improve healthcare access and efficiency.

Abstract 59: Results of a Pilot Multimodal Quality Improvement Intervention to Accelerate Blood Pressure Reduction and Anticoagulant Reversal for Acute Spontaneous Intracerebral Hemorrhage

Abstract 59: Results of a Pilot Multimodal Quality Improvement Intervention to Accelerate Blood Pressure Reduction and Anticoagulant Reversal for Acute Spontaneous Intracerebral Hemorrhage

Abstract WMP51: Addressing Sleep Apnea Post-Stroke and Transient Ischemic Attack (ASAP) Stepped-Wedge Cluster-Randomized Trial: Effectiveness of a Quality Improvement Intervention to Increase Sleep Apnea Diagnostic Testing

Abstract WMP51: Addressing Sleep Apnea Post-Stroke and Transient Ischemic Attack (ASAP) Stepped-Wedge Cluster-Randomized Trial: Effectiveness of a Quality Improvement Intervention to Increase Sleep Apnea Diagnostic Testing

What about physician wellness? Impact of a quality improvement intervention

BackgroundEmergency department (ED) consultations with general internal medicine (GIM) are required when patients need admission, assistance with safe disposition or evaluation and management of complex or acute medical needs. GIM...

P-237. The CLABSI (Central Line Audit by Staff Investigators) Intervention: Reducing Central Line Use in a Medical ICU using Physician-Led Prospective Audit and Feedback of Catheter Necessity

Abstract Background Prompt removal of unnecessary central lines has been associated with reduction in central line associated bloodstream infections (CLABSI). Following the COVID-19 pandemic, sustained increases in central line utilization and CLABSI were seen at our medical ICU (MICU). Here we present a quality improvement intervention of a weekly physician-led audit and feedback to reduce central line utilization. Methods The intervention was conducted in the MICU at a single tertiary-care hospital from June 2023 to February 2024. Once weekly, 2 physicians did an electronic medical record audit of all central lines. Line necessity was defined as requiring one or more of the following: irritant medication use, renal replacement therapy, hemodynamic monitoring, total parenteral nutrition, or inability to obtain peripheral access. Lines for renal replacement therapy (HD lines) were excluded from evaluation as they were medically necessary by definition. Once an unnecessary line was identified, the primary ICU fellow and attending were sent a text message prior to morning rounds to recommend removal. Central line removal rates and patient demographic data were collected from June 2023 to February 2024. Data on central line utilization and CLABSI rates were collected from July 2023 to December 2023 and compared to data from January 2022 to June 2023. Results 365 patients and 447 central lines were reviewed. 49 (11%) central lines were deemed unnecessary and removal recommended, of which 26 (53%) were removed within 24 hours. The central line device utilization ratio (DUR) in line days per patient days decreased by 20%, from 0.48 to 0.38 [p = < 0.0001]. When HD lines were included, we observed a reduction in DUR by 8%, from 0.61 to 0.56 [p = < 0.0001]. The CLABSI National Healthcare Safety Network Standardized Infection Ratio (SIR) pre-implementation was 2.84 and post-implementation was 2.83 [p = 1.00]. Conclusion A physician-led, once weekly prospective audit and feedback of central line necessity led to a substantial decline in central line utilization rates in our medical ICU. There was no observed reduction in CLABSI SIR, however this may be due to the short intervention period and low incidence rate of CLABSI; over time it would be expected that a reduction in central line days would lead to a reduction in CLABSI. Disclosures All Authors: No reported disclosures

P-1769. Improving Surgical Prophylaxis for Patients with Penicillin Allergy Label

Abstract Background Patients with a penicillin allergy label (PAL) have an increased risk of surgical site infection when receiving a β-lactam alternative for surgical prophylaxis. The updated 2022 Drug Allergy Parameters support the use of cefazolin for patients with a penicillin allergy history including anaphylaxis. We evaluated antibiotic use for surgical prophylaxis in a large academic center. Methods We performed a quality improvement intervention to decrease inappropriate use of non-β-lactam antibiotic surgical prophylaxis in patients with PAL at a 1091-bed tertiary hospital. Beginning in 10/2018, we provided education at anesthesia grand rounds and surgical safety meetings regarding preferential use of cefazolin in patients without severe PAL. In 12/2023, we updated institutional guidelines to recommend cefazolin use in all patients except those with history of anaphylaxis to cephalosporins, isolated hives to cefazolin, and β-lactam-associated severe cutaneous drug reactions. This was communicated to anesthesia and surgery stakeholders. Peri-operative antibiotic prophylaxis alert cards were hung in the operating rooms (Figure 1) and clindamycin and gentamicin were removed from OR medication-dispensing machines (ORMD). Results There was a significant decrease in clindamycin use from 11.2% in the pre-education period to 6.2% after education, further reduced to 1.7% since updating institutional guidelines and removing clindamycin and gentamicin from ORMD. Concurrently, cefazolin use increased from 9.0% to 26.0% to 39.5% in the same periods (Figure 2). This was seen across surgical services (Figure 3). Decreases were also seen in gentamicin use. There was no significant change IV vancomycin use as an alternative for patient with PAL. There was no increase in episodes of perioperative anaphylaxis related to these interventions. Conclusion There remains significant opportunity to optimize surgical prophylaxis for patients with PAL. QI efforts such as acquiring stakeholder support and development and dissemination of teaching materials were effective in reducing suboptimal perioperative antibiotic prophylaxis. Informative posters at point of care and removal of clindamycin and gentamicin from OMRD further reduced inappropriate surgical prophylaxis in patients with PAL. Disclosures All Authors: No reported disclosures

P-1895. Outpatient Parenteral Antimicrobial Therapy Multidisciplinary Partnership Reduces Readmissions and Emergency Center Visits in a Comprehensive Cancer Center

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) programs have reduced readmissions without impacting emergency center (EC) visits. Our initial pilot OPAT program improved laboratory monitoring without decreasing readmissions or EC visits. We expanded the program and made additive quality improvement interventions. Outcomes Associated with Outpatient Parenteral Antimicrobial Therapy Interventions in Patients Receiving Care at a Comprehensive Cancer Center *Previously published initial pilot program. **Compared with baseline among patients with >/= 1 EC visit. OPAT, Outpatient parenteral antimicrobial therapy; APP, advanced practice provider; EMS, electronic medical system; EC, emergency center; ID, infectious diseases Methods We obtained demographic data and baseline frequencies of 30-day unplanned readmissions and EC visits from our electronic medical system (EMS) for 48 patients over 6 weeks prior to pilot implementation. Using the Model for Improvement, we made iterative additions, including pharmacist regimen review, monitoring within the EMS, online commercial laboratory result access, weekly nursing phone calls after discharge, and expansion to infectious disease outpatient starts. After interventions, we compared categorical variables to baseline by using Chi-square or Fisher’s exact test, as appropriate, and compared continuous variables by using nonparametric Wilcoxon rank sum test. We performed multivariable logistic regression to identify risk factors independently associated with readmission. Results During June 2018–November 2023, our OPAT program provided care for 1,274 patients. Readmissions decreased from 30% to 15% (p = 0.02) (Figure). Mean number of EC visits per patient decreased (1.3 vs. 1.0, p = 0.002). In multivariable analysis, EMS monitoring and online access to laboratory results were independently associated with decreased readmission risk (aOR 0.22 [95% CI: 0.09-0.56]). Nursing calls after discharge independently protected against readmission (aOR 0.18 [95% CI: 0.07-0.47]). Patients with Eastern Cooperative Oncology Group-Performance Status ≥2 were readmitted more often than those with < 2 (aOR 1.63 [95% CI: 1.05-2.52]). Conclusion Improving efficiency and access to laboratory data and weekly nursing phone follow up were associated with fewer readmissions among OPAT patients with cancer. This study is the first, to our knowledge, to show an impact of OPAT on EC visits in any population. OPAT patients with poor functional status have an increased risk for readmission and may benefit from closer monitoring. OPAT programs can improve safety for adult patients with cancer despite competing risks inherent to this population. Disclosures Natalie J Dailey Garnes, MD, MPH, MS, AlloVir: Grant/Research Support

P-993. Increased Reporting of RPR Seronegative Infants with Congenital Syphilis to the Chicago Department of Public Health, A Quality Improvement Project

Abstract Background We are in the midst of an epidemic of congenital syphilis (CS). Nationwide CS diagnosis and treatment recommendations provided by the Centers for Disease Control are dependent on the timing of maternal treatment, and laboratory and procedural results of the mother and infants. There are specific circumstances where infants with a non-reactive rapid plasma reagin (RPR-) should receive a 10-day course of treatment in the context of inadequate maternal treatment. Depending on the institutional reporting practices of CS to departments of public health, there may be scenarios where RPR-based reporting protocols will leave out this specific cohort. Methods Baseline data of Infants stratified by RPR status was collected through electronic medical record (EMR) review for those born at the University of Chicago Comer Children’s Hospital in Chicago, IL between January 2011 and December 2022, using billing codes & penicillin administration data. From September 1st, 2023, through March 31st, 2024, a quality improvement intervention was implemented that involved communicating with the hospital’s Pediatric Infectious Diseases specialists, Pediatric & Newborn Hospitalists, Neonatologists, Infection Prevention & Control, and Chicago Department of Public Health (CDPH). The intervention components included 1) formalize expectation to page Pediatric ID on-call team all infants with concern for maternal syphilis exposure, 2) create an Epic Smart Phrase to standardize data presentation for clinical and reporting purposes, 3) standardize ICD-10 diagnosis coding practices, and 4)email reminders monthly to teams involved. Results 154 infants were identified who had a CDC case definition of CS and received penicillin administration therapy. Infants with CS from 2011-2022 showed 107/154 (69.4%) were RPR- and 41/154 (26.6%) were RPR- and received > 1 day of penicillin. At the end of the first PDSA cycle, a total of 22 infants were reported to CDPH with 36% (n=8) being RPR-. Conclusion Our Quality Improvement project identified a large percentage of infants diagnosed and treated with CS who were not reported to the CDPH with our previous RPR-positive – based reporting strategy. We implemented an intervention that successfully improved reporting of this specific type of patient. Disclosures Allison H. Bartlett, MD, MS, CVS/Caremark: Advisor/Consultant

P-2273. Latent Tuberculosis and Strongyloidiasis Screening in Patients with Hematologic Malignancy Prior to Cytotoxic Therapy in Boston, Massachusetts

Abstract Background Latent tuberculosis infection (LTBI) affects roughly one quarter of the world’s population and Strongyloides stercoralis (SS) affects approximately 100 million people worldwide. Individuals with hematologic malignancy receiving chemotherapy and systemic steroids are at increased risk of reactivation of LTBI and SS dissemination, which are associated with significant morbidity and mortality. However, LTBI and SS screening are not uniformly performed. Methods We conducted a quality improvement intervention of universal screening for LTBI and SS for one year (March 2023-March 2024) amongst patients initiating chemotherapy in the hematology clinic at Boston Medical Center, an urban academic safety net hospital with a large immigrant patient population. Screening was encouraged via integration into electronic medical record chemotherapy care plans and by lectures with hematology providers. Results 876 pre-intervention and 83 post-intervention patients were included. Mean age was 61-63 years (pre- vs post-intervention groups). Plasma cell malignancy was most common (∼46%) followed by B-cell lymphoma (22-32%). Over 90% of individuals received systemic steroids, 2-3% were HIV+, and 2% were HTLV-1+. Between 33-40% of individuals immigrated from countries with high TB incidence rates > 40 per 100,000 people and SS prevalence >10%. The intervention increased LTBI and SS screening rates [TB: 337/876 (38%) pre- vs 49/83 (59%) post-intervention, SS: 159/876 (18%) pre- vs 49/83 (59%) post-intervention], but universal screening was not achieved. Among those screened for LTBI, 73/337 (22%) pre- versus 9/83 (18%) post-intervention were positive. Among those screened for SS, 4/159 (3%) pre- versus 2/49 (4%) post-intervention were positive. Conclusion These preliminary findings demonstrate a patient population with risk factors for reactivation and/or dissemination of LTBI and SS. Enhancing screening rates for LTBI and SS may prevent serious complications of these infections and there is a need to improve screening guidelines in these high-risk individuals. Disclosures Daniel Bourque, MD, Kephera Diagnostics: Grant/Research Support J. Mark Sloan, MD, Nuvectis pharmaceuticals: Advisor/Consultant

176. A Quality Improvement Endeavor to Improve Antibiotic Prescribing for Children with Acute Otitis Media in Emergency and Urgent Care Settings

Abstract Background Acute otitis media (AOM) self-resolves without antibiotics in 60-75% of cases. This study evaluates the impact of a quality improvement intervention on antibiotic prescribing for pediatric AOM.Figure 1.Proportion of antibiotics prescribed per all AOM diagnoses in patients 61 days to 18 years old. Methods A bundled intervention for AOM included (1) an electronic health record (EHR) order set that preselected a 5-day antibiotic duration for children 24 months and older (April 2021) and (2) creation of a local clinical care pathway (CCP) for AOM (December 2022). The CCP encouraged observation and pain management in children 24 months and older, as well as children 6-23 months with unilateral, non-severe AOM. A retrospective review of patients 61 days to 18 years old presenting to emergency and urgent care centers between January 2019 through September 2023 was conducted. Outcomes were (1) rates of antibiotic prescribing (enteral or ceftriaxone) in patients 61 days to 18 years old, (2) treatment duration of 5 or fewer days (excluding azithromycin) in patients 24 months to 18 years old, and (3) first-line antibiotic choice (amoxicillin) in patients 61 days to 18 years old. Statistical process control charts with upper and lower control limits and “special cause” variation by standard definitions were used to analyze outcomes.Figure 2.Proportion of patients with duration of 5 or fewer days compared to all duration in patients 2 years to 18 years old. Results A total of 34,324 patients were included. Rates of antibiotic prescribing remained high throughout the study (88 to 93%), with special cause variation detected (Figure 1). After EMR order-set development, increased compliance with recommended duration of 5 or fewer days was observed (3% to 83%), with special cause variation throughout the study (Figure 2). Rates of amoxicillin prescribing decreased throughout the study (77 to 74%), with special cause variation detected (Figure 3).Figure 3.Proportion of amoxicillin prescribed per all antibiotics in patients 61 days to 18 years old. Conclusion Implementation of an EHR order set resulted in shorter durations of prescribed antibiotics for AOM in patients older than 24 months. Antibiotic prescribing rates increased, and amoxicillin prescribing decreased throughout study period. The effect of the amoxicillin shortage, which started in October 2022, likely played a role in decreased amoxicillin prescribing rates. This project indicated that further dissemination of the new CCP and de-implementation of previous practices is needed to achieve improvement in antibiotic prescribing and first line antibiotic use. Disclosures All Authors: No reported disclosures

Peer Audit and Feedback: A Documentation-Focused Quality Improvement Project.

Nurses' documentation of communication, including notification of critical laboratory results (CLR), is important to ensure safe, high-quality care. Evidence supports peer audit with feedback as a quality improvement (QI) intervention to improve documentation. Nursing compliance with CLR documentation requirements was below goal for several years in an intensive care unit. To address this problem, a peer audit and feedback intervention was implemented and evaluated. Compliance with CLR documentation requirements was evaluated pre- and postintervention, for a total of 12months. The evaluation also included data from the peer audits and a survey to assess nurses' perceptions. The 5-month intervention was a timely peer audit and feedback of CLR events. CLR documentation compliance improved from 6.4% to 9.6% (50% improvement), which was clinically meaningful but not statistically significant. Nurses had overall positive perceptions of the peer audit and feedback as a QI tool, perceiving it as nonpunitive and helpful for improving practice. Results support continued examination of peer audit and feedback to improve nursing documentation. Future projects should address the limited time for nurses to engage in QI projects.

Validation of the NICHD Bronchopulmonary Dysplasia Outcome Estimator 2022 in a Quaternary Canadian NICU—A Single-Center Observational Study

Background/Objectives: The numerical risk of bronchopulmonary dysplasia (BPD) and/or death could be estimated using the National Institute of Child Health and Human Development (NICHD) BPD outcome estimator 2022 in extremely low gestational age (ELGA) infants during the first 4 weeks of life to facilitate prognostication, and center-specific targeted improvement interventions. However, the 2022 NICHD BPD outcome estimator’s performance in the Canadian setting has not been validated. Our objective is to validate the NICHD BPD outcome estimator 2022 in predicting death and or moderate to severe BPD at 36 weeks in infants less than 29 weeks admitted to NICU. Methods: A retrospective observational study (March 2022–August 2023) was conducted on both inborn and outborn preterm infants excluding neonates with major congenital anomalies. Infants were classified into six groups based on the predicted risk of death or Grade 2 or 3 BPD (<10%, 10–20%, 20–30%, 30–40%, 50–59%, ≥60%) followed by noting observed outcomes from the unit’s database. A receiver operating characteristics (ROC) curve was used to assess the accuracy of the NICHD BPD outcome estimator 2022, with an area under curve (AUC) > 0.7 defined a priori as an acceptable predictive accuracy for local use. Results: Among 99 infants included, 13 (13.1%) died, and 40 (40.4%) developed BPD. Median gestational age was 26 weeks, and median birth weight was 914 g. Twenty-three infants (23.2%) received postnatal steroids. The AUC values for death or moderate to severe BPD on days 1, 3, 7, 14, and 28 were 0.803, 0.806, 0.837, 0.832, and 0.843, respectively. The AUC values for moderate to severe BPD alone on those days were 0.766, 0.746, 0.785, 0.807, and 0.818 respectively. Conclusions: The 2022 BPD estimator adequately predicted the death and/or moderate to severe BPD on days 1, 3, 7, 14, and 28 of life. This tool could serve as a valid adjunct to facilitate discussion between clinicians and families on initiating time-sensitive targeted interventions to prevent or alter the course of BPD.

Discrimination of Radiologists' Experience Level Using Eye-Tracking Technology and Machine Learning: Case Study.

Perception-related errors comprise most diagnostic mistakes in radiology. To mitigate this problem, radiologists use personalized and high-dimensional visual search strategies, otherwise known as search patterns. Qualitative descriptions of these search patterns, which involve the physician verbalizing or annotating the order he or she analyzes the image, can be unreliable due to discrepancies in what is reported versus the actual visual patterns. This discrepancy can interfere with quality improvement interventions and negatively impact patient care. The objective of this study is to provide an alternative method for distinguishing between radiologists by means of captured eye-tracking data such that the raw gaze (or processed fixation data) can be used to discriminate users based on subconscious behavior in visual inspection. We present a novel discretized feature encoding based on spatiotemporal binning of fixation data for efficient geometric alignment and temporal ordering of eye movement when reading chest x-rays. The encoded features of the eye-fixation data are used by machine learning classifiers to discriminate between faculty and trainee radiologists. A clinical trial case study was conducted using metrics such as the area under the curve, accuracy, F1-score, sensitivity, and specificity to evaluate the discriminability between the 2 groups regarding their level of experience. The classification performance was then compared with state-of-the-art methodologies. In addition, a repeatability experiment using a separate dataset, experimental protocol, and eye tracker was performed with 8 participants to evaluate the robustness of the proposed approach. The numerical results from both experiments demonstrate that classifiers using the proposed feature encoding methods outperform the current state-of-the-art in differentiating between radiologists in terms of experience level. An average performance gain of 6.9% is observed compared with traditional features while classifying experience levels of radiologists. This gain in accuracy is also substantial across different eye tracker-collected datasets, with improvements of 6.41% using the Tobii eye tracker and 7.29% using the EyeLink eye tracker. These results signify the potential impact of the proposed method for identifying radiologists' level of expertise and those who would benefit from additional training. The effectiveness of the proposed spatiotemporal discretization approach, validated across diverse datasets and various classification metrics, underscores its potential for objective evaluation, informing targeted interventions and training strategies in radiology. This research advances reliable assessment tools, addressing challenges in perception-related errors to enhance patient care outcomes.

Intervention to systematize fall risk assessment and prevention in older hospitalized adults: a mixed methods study

BackgroundFall-prevention interventions are efficient but resource-requiring and should target persons at higher risk of falls. We need to ensure that fall risk is systematically assessed in everyday practice. We conducted a quality improvement (QI) intervention to systematize fall risk assessment and prevention in older adults hospitalized on general internal medicine wards. We evaluated the efficacy of the intervention in a pre-post intervention study and assessed its feasibility and acceptability through a mixed methods process evaluation, which results are reported in here.MethodsThe QI intervention was conducted between 09/2022 and 10/2023 and targeted the nursing staff and residents in two tertiary hospitals of two different language and cultural regions of Switzerland. The intervention comprised an oral presentation, an e-learning, and reminder quizzes. We conducted a process evaluation including 25 interviews and a survey sent to all participants to assess feasibility and acceptability of the intervention. Quantitative data were analyzed descriptively and qualitative data with a mixed deductive and inductive approach. Results were integrated through meta-inferences.ResultsAmong 544 clinicians, 59% completed the e-learning, 74% found the intervention useful, and 25% reported an increase in interprofessional team working. A rewarding system was deemed motivating by 33% of clinicians. Main implementation barrier was the high workload. A concise and clear content as well as regular reminders were perceived as facilitators.ConclusionsA concise and multimodal QI intervention with regular reminders seemed to be feasible and well-accepted. Future QI intervention projects should consider the barriers and facilitators identified in this project to improve quality of care in older hospitalized adults.Trial registrationThe conducted research was not pre-registered.

A Protocol for AI-Powered Tools to Enhance Mobility and Function in Older Adults: An Evidence and Gap Map.

Introduction: Artificial intelligence (AI) is transforming healthcare by enhancing diagnostic accuracy, treatment, and patient monitoring, benefiting older adults by offering personalized care plans. AI-powered tools help manage chronic conditions and maintain independence, making them a valuable asset in addressing aging challenges. Objectives: The objectives are as follows: 1. To identify and describe AI-power-based exercise programs for older adults. 2. To highlight primary evidence gaps in AI interventions for functional improvement and mobility. 3. To evaluate the quality of existing reviews on this topic. Methods: The evidence gap map (EGM) will follow the five-step method, adhering to the Campbell Collaboration guidelines and, if available at the time of reporting, PRISMA-AI standards. Guided by the Metaverse Equitable Rehabilitation Therapy framework, this study will categorize findings across domains like equity, health service integration, interoperability, governance, and humanization. The study will include systematic reviews, randomized controlled trials, and pre-and post-intervention designs. Results will be reported following PRISMA-AI guidelines. We will use AMSTAR-2 Checklist for Analyzing Systematic Reviews on AI Interventions for Improving mobility and function in Older Adults to evaluate the reliability of systematic reviews and focus on internal validity. Conclusions: This comprehensive analysis will act as a critical resource for guiding future research, refining clinical interventions, and influencing policy decisions to enhance AI-driven solutions for aging populations. The EGM aims to bridge existing evidence gaps, fostering a more informed, equitable, and effective approach to AI solutions for older adults.

Implementation of a data-driven quality improvement program in primary care for patients with coronary heart disease: a mixed methods evaluation of acceptability, satisfaction, barriers and enablers.

Background The study aimed to understand the acceptability, satisfaction, uptake, utility and feasibility of a quality improvement (QI) intervention to improve care for coronary heart disease (CHD) patients in Australian primary care practices and identify barriers and enablers, including the impact of COVID-19. Methods Within the QUality improvement for Effectiveness of care for people Living with heart disease (QUEL) study, 26 Australian primary care practices, supported by five Primary Health Networks (PHN) participated in a 1-year QI intervention (November 2019 - November 2020). Data were collected from practices and PHNs staff via surveys and semi-structured interviews. Quantitative and qualitative data were analysed with descriptive statistics and thematic analysis, respectively. Results Feedback was received from 64 participants, including practice team members and PHN staff. Surveys were completed after each of six workshops and at the end of the study. Interviews were conducted with a subgroup of participants (n =9). Participants reported positive satisfaction with individual QI features such as learning workshops and monthly feedback reports. Overall, the intervention was well-received, with most participants expressing interest in participating in similar programs in the future. COVID-19 and lack of time were identified as common barriers, whereas team collaboration and effective leadership enabled practices' participation in the QI program. Additionally, 90% of the practices reported COVID-19 effected their participation due to vaccination rollout, telehealth set-up, and continuous operational review shifting their focus from QI. Conclusion Data-driven QI programs in primary care can boost practice staff confidence and foster increased implementation. Barriers and enablers identified can also support other practices in prioritising effective strategies for future implementation.

Impact of Massive Transfusion Activation on Time to Delivery of the First Cooler and Patient Survival: A Study of 4,313 Consecutive Activations.

In 2012, TQIP guidelines for massive transfusion protocols (MTP) recommended delivery of blood product coolers within 15 minutes. Subsequent work found that every minute delay in cooler arrival was associated with a 5% increased risk of mortality. We sought to assess the impact and sustainability of quality improvement (QI) interventions on time to MTP cooler delivery and their association with trauma patient survival. In 2009, a quality improvement (QI) process was initiated to improve MTP activation and delivery of blood (QI #1). In 2012, TQIP Best Practice Guidelines were implemented at our facility (QI #2). In 2016, we implemented measures to activate our MTP based off prehospital ABC score >1 or any prehospital blood transfusion (QI #3). All patients receiving MTP from 01/2009 and 12/2022 were included. Patients were compared by year and their respective QI interventions. Primary outcome was time from MTP activation to delivery of the first cooler. A regression model was then constructed to evaluate time to first cooler on outcomes. During the study period, 52,328 trauma patients were admitted, with 4,313 MTP trauma activations. With each subsequent QI intervention, time to first MTP cooler and mortality both decreased, while injury severity increased. Multivariate regression noted that when time to first cooler could be kept to 8 minutes or less, mortality was reduced by 35% (OR 0.64, 95% C.I. 0.44-0.92; p=0.019). With increased MTP activations, delivery of the first cooler was faster and mortality improved. Keeping cooler times under 8 minutes was associated with increased survival. The measurement and monitoring of "Door-to-cooler" time should be considered as a metric to assess performance and delivery of institutional MTP.