Overall Quality Of Patient Care Research Articles

A nomogram for predicting postoperative delirium in pediatric patients following cardiopulmonary bypass: A prospective observational study

ObjectivesTo create a nomogram for early delirium detection in pediatric patients following cardiopulmonary bypass. Research Methodology/DesignThis prospective, observational study was conducted in the Cardiac Intensive Care Unit at a Children's Hospital, enrolling 501 pediatric patients from February 2022 to January 2023. Perioperative data were systematically collected through the hospital information system. Postoperative delirium was assessed using the Cornell Assessment of Pediatric Delirium (CAPD). For model development, Least Absolute Shrinkage and Selection Operator (LASSO) regression was employed to identify the most relevant predictors. These selected predictors were then incorporated into a multivariable logistic regression model to construct the predictive nomogram. The performance of the model was evaluated by Harrell's concordance index, receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. External validity of the model was confirmed through the C-index and calibration plots. ResultsFive independent predictors were identified: age, SpO2 levels, lymphocyte count, diuretic use, and midazolam administration, integrated into a predictive nomogram. This nomogram demonstrated strong predictive capacity (AUC 0.816, concordance index 0.815) with good model fit (Hosmer-Lemeshow test p = 0.826) and high accuracy. Decision curve analysis showed a significant net benefit, and external validation confirmed the nomogram's reliability. ConclusionsThe study successfully developed a precise and effective nomogram for identifying pediatric patients at high risk of post-cardiopulmonary bypass delirium, incorporating age, SpO2 levels, lymphocyte counts, diuretic use, and midazolam medication. Implications for Clinical PracticeThis nomogram aids early delirium detection and prevention in critically ill children, improving clinical decisions and treatment optimization. It enables precise monitoring and tailored medication strategies, significantly contributes to reducing the incidence of delirium, thereby enhancing the overall quality of patient care.

Knowledge and Practices of Nurses Regarding Aseptic Techniques for Infection Prevention in Operating Room at Tertiary Care Hospital

Background: Surgical site infections (SSIs) remain a significant concern in operating rooms, largely influenced by the adherence to aseptic techniques by healthcare professionals. Despite the critical role of operating room nurses in preventing these infections, gaps in knowledge and practice persist, affecting the overall quality of patient care in tertiary healthcare settings. Objective: This study aimed to assess the knowledge and practices of operating room nurses regarding aseptic techniques for infection prevention in tertiary care hospitals. Methods: A descriptive cross-sectional study was conducted at a tertiary care hospital in Lahore, involving 130 operating room nurses with over a year of service. The study employed purposive sampling to administer a validated questionnaire assessing demographic data, knowledge, and practices related to aseptic techniques. Data were collected from January to March 2023 and analyzed using SPSS version 25, employing descriptive and inferential statistics to explore the relationship between demographic factors and knowledge/practices of aseptic techniques. Results: The study found that 60% of nurses were aware that a gown is considered sterile in specified areas, and 54.6% understood the contamination risks of dropped sterile packages. Approximately 62.3% recognized the importance of maintaining a safe distance during procedures. Despite these knowledge indicators, 94% of nurses routinely practiced sterile techniques, and 91% adhered to proper handwashing protocols. However, the overall level of knowledge concerning aseptic techniques was low, with significant gaps that could potentially impact patient safety. Conclusion: The study highlights a discrepancy between the knowledge and practices of operating room nurses regarding aseptic techniques, indicating a critical need for enhanced training and continuous education to bridge these gaps and improve infection control measures in surgical settings.

Nurses' perspectives on shared decision-making in the daily care of hospitalized patients with dementia: An exploratory qualitative study.

Gain insight into the process of shared decision-making (SDM) in daily hospital care for patients with dementia from nurses' perspectives. Explorative qualitative design. In-depth digital interviews were conducted with 14 registered nurses between June and November 2022. A phenomenological approach was applied using Colaizzi's seven-step method. Five themes were identified in the data: (1) SDM in daily care: How shared decision-making is applied; (2) Nurses' perceptions and competence: How nurses perceive and manage SDM; (3) Nurses' roles and advocacy: The evolving roles of nurses and their advocacy efforts, (4) Recognition of dementia and its impact: How nurses recognize and manage dementia; and (5) Interventions to support SDM: Strategies and interventions to facilitate SDM. This study highlights the complexity of SDM in patients with dementia. It demonstrates the importance of the involvement of relatives, omission of patient goals in discussions and perceived deficiencies of nurses. The early identification of dementia, evaluation of nuanced capacity and targeted communication are essential. Further research and enhanced training are required to improve care in this context. Potential areas for further research on SDM in nurses involving patients with dementia include investigating the effects of integrating goal discussions into SDM training for nurses, overcoming barriers to SDM competence, and challenging the idea that SDM is solely the responsibility of physicians. These findings highlight the need for policies that encourage interdisciplinary collaboration, address misconceptions and recommend training programmes that focus on applying SDM to the daily care of patients with dementia, thereby improving the overall quality of patient care. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used for reporting. No patient or public contribution.

Cancer Risk Identification using Machine Learning

In this comprehensive study, we explore the SEER (Surveillance, Epidemiology, and End Result) dataset to meticulously craft a predictive model aimed at understanding patient survivability, focusing keenly on outcomes like patient survival diagnosis and treatments. Employing a good approach involving rigorous data cleaning, intricate feature extraction, and detailed correlation analysis, we identify the dominant attributes that significantly influence patient outcomes. Our methodology integrates classical machine learning models, including decision trees and random forests, with modern techniques such as neural networks. This mix of methodologies allows us to accurately predict patient survivability. Furthermore, our study delves into the intricate relationships between attributes, models, and algorithms, aiming to identify the dominant factors that influence the outcomes. Our groundbreaking findings underscore the enormous potential of integrating these dominant attributes, paving the way for the creation of exceptionally robust predictive models. These models will substantially enhance medical decision-making processes and, in turn, elevate the overall quality of patient care. Keywords - SEER dataset, patient survivability, machine learning, decision trees, random forests, neural networks, data cleaning, feature extraction, clinical data, medical decision-making.

COMMENTARY: The Consumer Protection Act, 2019: A critical analysis from a medical practitioner's perspective.

The landmark judgment in the case of Indian Medical Association v VP Shantha in 1995 brought the medical profession under the ambit of the Consumer Protection Act, 1986. The Consumer Protection Act, 1986, was later repealed and replaced by the Consumer Protection Act, 2019. This article delves into the implications of the 2019 Act, highlighting significant changes in its scope, including the expansion of the definition of "consumer" and the incorporation of telemarketing and e-commerce within its ambit. Moreover, the amendments affect pecuniary jurisdiction, grounds for litigation, and introduce mediation cells, and the Central Consumer Protection Authority (CCPA). This article underscores concerns related to an increase in frivolous cases against medical practitioners and in defensive practice, ultimately impacting the overall quality of patient care. Recommendations for timely redressal and safeguards against unwarranted litigation are proposed to mitigate the adverse implications of the amended Act and ensure the well-being of both healthcare providers and patients.

Prevalence of hypersensitive pneumonitis specific IgG antibodies in the Indian population: A retrospective study

Identifying the underlying antigen responsible for Hypersensitivity Pneumonitis (HP) in patients poses a significant challenge within the confines of a typical clinical environment. Our primary objective in this study was to investigate the distribution and prevalence of G antibodies among individuals diagnosed with HP, taking into account factors such as age, gender, and geographical location.A retrospective study spanning 5 years (from January 2018 to June 2023) was conducted, involving patients over the age of 18 who had undergone screening for HP. Data collected from 1087 patients was analysed, and the patients were categorized based on age, gender, location, and their antibody status.Out of the total cohort of 1087 patients, 62.47% were female, while 37.53% were male. The overall positivity rate for HP panel testing was determined to be 49.22%. Among the patients subjected to testing, 174 individuals (16.01%) tested positive for at least one specific antibody. Notably, among patients aged 18 to 30 years, Penicillium emerged as the most prevalent (48.28%), closely followed by fumigatus Fumigatus (44.83%). In contrast, for patients aged 31 to 45 years, Pigeon serum feathers exhibited the highest prevalence (39.69%). Moreover, the positivity rates varied across different regions in India.HP can be attributed to an array of agents commonly encountered in both workplace and home settings, encompassing microorganisms, animal and plant proteins, as well as organic and inorganic chemicals. Discerning the causative antigen not only holds immense value for physicians in optimizing patient treatment but also plays a pivotal role in pinpointing the source of exposure. Armed with this knowledge, physicians can provide patients with tailored advice to minimize their exposure risk, potentially leading to disease stabilization or even reversal. In summary, the successful identification of the etiologic antigen emerges as a formidable tool for enhancing the overall quality of patient care.

Death education for undergraduate nursing students in the China Midwest region: An exploratory analysis.

The purpose of this study was to comprehend the need for incorporating death education within the curriculum of undergraduate nursing students and to assess the factors that impact the desire for such education. We enlisted undergraduate nursing students from several nursing colleges located in the central and west region of China. Undergraduate students who fulfilled the eligibility criteria between January and February 2021 were chosen to participate. Data were collected via an online platform called Questionnaire Star. The survey encompassed a general information questionnaire and a scale for assessing the need for education on the topic of death. Descriptive statistical analysis was performed using the SPSS 20.0 software, while multivariate stepwise regression was employed for more complex analysis. Statistical significance was indicated when the p-value was below 0.05, and high statistical significance was noted when the p-value fell below 0.01. We designed a descriptive quantitative approach to investigate the need for death education and its associated factors. The research involved 907 undergraduate nursing students from the central and west region of China. The data collection was done through the Questionnaire Star platform. Following the collection of completed surveys, individuals displaying contradictory responses were omitted. Out of 911 surveys disseminated, 907 were successfully collected, resulting in a recovery rate of 99.6%. Among the participants, 769 identified as female, constituting 84.8% of the total, while 138 identified as male, making up 15.2%. The survey findings indicated that factors such as residency, parental educational history and exposure to hospice care education significantly impacted the need for death education among undergraduate nurses (p < 0.05). Among students pursuing a nursing degree at the undergraduate level, there was a pronounced need for education related to the topic of death. Offering such education to these students is essential, as it helps cultivate a proper understanding of death. This, in turn, contributes to enhancing the overall quality of patient care throughout their life journey. A total of 907 nursing undergraduates from central and western China participated in the questionnaire.

IoT-enabled solutions for Alzheimer's disease management: innovations and opportunities

Alzheimer's disease (AD) is a common neurological disorder characterised by the progressive shrinkage of brain tissue and the death of cells. Understanding how genetic and environmental factors interact to cause AD is challenging but crucial for effectively managing and treating this disease. Many personal, social, and economic impacts can be attributed to AD, making it a crucial area for research. This paper proposes using Internet of Things (IoT) technologies to assist people with Alzheimer's disease. IoT can potentially enhance people's quality of life and simplify daily activities. IoT applications in healthcare, smart homes, and patient tracking have been explored. Various sensors, devices, and software can be utilised to monitor patients' health status. By leveraging IoT, we can develop innovative solutions to address AD management challenges and improve the overall quality of patient care.

Antibiotic Utilization and Prophylaxis in Paediatric Cardiac Surgery: A Retrospective Observational Study at a Rural Tertiary Care Hospital in India.

Introduction Antimicrobial prophylaxis, involving short antibiotic courses preceding surgical procedures, is recommended to minimize postoperative infections. Paediatric cardiac surgeries are classified as clean procedures, though infection challenges persist due to illness severity and extended ICU stays. Antimicrobial prophylaxis varies, ranging from single doses to extended administration until catheters are removed. Typically lasting 24 to 48 hours, it has proven infection-reduction benefits. Despite these practices, uncertainties surround the optimal nature, timing, and duration of administration. This concern is amplified by escalating antimicrobial resistance driven by antibiotic overuse. Vulnerable paediatric populations bear heightened consequences of irrational antimicrobial use, contributing to global resistance trends. Yet, a defined optimal prophylaxis schedule for paediatric cardiac surgery is lacking. Importing adult guidelines may be inadequate due to paediatric research complexities and population diversity. Developing effective prophylaxis protocols is crucial for children undergoing cardiac surgery, given global antibiotic overuse and evolving drug resistance. Establishing an optimal prophylactic strategy remains a challenge, necessitating further research for evidence-based protocols to mitigate infections in this vulnerable patient cohort. Methods This study investigates antibiotic use in paediatric cardiac surgery. A retrospective analysis of 100 patients from a rural Indian hospital (2017-2018) assesses antibiotic patterns, including type, dose, duration, and adherence to prophylaxis protocols. Results In the studied cohort of paediatric cardiac surgery patients, complete compliance (100%) with antibiotic prophylaxis was observed. However, deviations were identified: 30% received antibiotics prematurely, and 30% did not align with institutional protocol criteria. Concerning antibiotic selection, 87% followed hospital policy with the recommended cefoperazone and sulbactam combination plus amikacin, while 9% received piperacillin/tazobactam + amikacin due to sepsis. Irregular use (22%) based on clinical records occurred. Furthermore, 4% received piperacillin/tazobactam + teicoplanin, with one instance of inappropriate higher antibiotic use. Regarding prophylaxis duration, only 27% adhered to the appropriate timeline, with 40% exceeding 48 hours, indicating extended use. Upon discharge, a notable proportion (45 patients) received antibiotic prescriptions. Among them, 73% were prescribed rationally, while 27% exhibited irrational antibiotic use. Conclusion The findings of this study shed a significant light on the issue of antibiotic misuse within the context of paediatric cardiac surgery. It underscores the pressing need for more stringent measures to regulate and address this concerning trend. The study underscores the pivotal importance of adhering rigorously to established protocols and guidelines for antibiotic prophylaxis. This adherence not only holds the potential to elevate the overall quality of patient care but also plays a critical role in combating the escalating challenge of antibiotic resistance. Through a concerted effort to optimize antibiotic usage, we can simultaneously enhance patient outcomes and contribute to the ongoing fight against the emergence of antibiotic-resistant strains, thus preserving the efficacy of these vital medications for future generations.

The Practice of Teaching and Scientific Research on Cadaveric Material Remains Crucial for Medical Education.

The practice of teaching and scientific research on cadaveric material remains crucial for medical education, especially in surgical disciplines. However, in Italy, this practice has been neglected due to legislative insufficiency and financial constraints. Although innovative methods and tools like simulators and e-learning have been adopted, direct hands-on experience with human cadavers remains irreplaceable for medical and surgical education. The absence of clear legislation governing cadaveric dissection has limited availability for teaching and research, resulting in economic burdens for universities and individuals seeking proper surgical training. To address this issue, Law No. 10/2020 and the recent implementing decree were introduced in Italy, providing detailed legislation on the donation of bodies for educational and research purposes. The law emphasizes the importance of respecting the donor's specific choices and aligns with constitutional principles promoting culture, research, and health protection. However, some critical issues related to consent procedures, duration of body availability, and preservation of anatomical parts remain. Additionally, the law's dissemination among the population needs improvement. Future optimization could include allowing donors to choose the timing of body donation and considering different timeframes for body availability. Furthermore, the implementation of consent procedures could be simplified to increase donations. The law should also address the need for appropriate reception centers and allocate resources for effective dissemination. Despite these challenges, Law No. 10/2020 represents a significant step forward in enhancing medical-surgical training, scientific research, and the overall quality of patient care in Italy.

Effect of clinical practice stress, stress coping style and empathy on clinical competence of nursing students

Background: This cross-sectional survey aimed to explore the influence of clinical practice stress, stress coping, and empathy on the clinical competence of nursing students. Additionally, it aimed to compare the effectiveness of multiple regression analysis and quantile regression analysis in identifying the factors influencing clinical competence. Methods: Data was collected from 201 nursing students between June 15th and August 1st, 2016, and analyzed using several statistical methods, including descriptive statistics, t-tests, ANOVA, Pearson correlation, multiple linear regression, and quantile regression, using SPSS 21.0 and STATA 14.0 software. Results: The results demonstrated positive correlations among clinical competence and stress coping (r= .52, p &lt; .001) and empathy (r= .39, p &lt; .001). Variables like clinical learning environment (β= -.18, p=.007), practice workload (β= .22, p &lt; .001), and active stress coping (β= .57, p &lt; .001) were found to explain 50% of the variance in clinical competence. After quantile regression, affecting factors for clinical competence were active stress coping for all quantiles, clinical learning environment from 15% to 60% quantile, practice workload for 15~75% quantile, and nursing major satisfaction for 15% quantile. Conclusion: This study highlights the importance of stress coping abilities, empathetic skills, and a supportive clinical environment in fostering the clinical competence of nursing students. These findings can serve as a foundation for designing targeted strategies and educational programs to enhance nursing students' clinical competence effectively, considering various levels of clinical competency. The study results offer valuable insights into developing interventions to improve nursing education and enhance the overall quality of patient care delivered by future nursing professionals.

The practice environment of primary care nurses: A cross-sectional study of five health care districts in San Paulo, Brazil

BackgroundPrimary care is a fundamental component of healthcare in Brazil. Often provided by nurses, little is known about the practice environment of nurses in primary care and if nurses are satisfied with their role in the primary care setting. ObjectiveThe purpose of this study was to determine if aspects of the primary care practice environment in Brazil are associated nurse reported outcomes of job satisfaction, intention to stay on the job, and the quality of care. DesignA cross-sectional survey that included a randomized cluster stratified sample of nurses who provided primary care services. Settings55 health centers within five health districts located in Campinas, São Paulo, Brazil. Participants148 primary care nurses who completed and returned a survey MethodsThe paper-based survey was made available to nurse participants. Nurses were queried on demographic and practice characteristics. Specific measures included the Practice Environment Scale-Brazilian, the job satisfaction subscale of the Safety Attitudes Questionnaire, and single items that assessed intention to stay on the job and the perceived quality of care. Generalized linear and Poisson regression models were used to estimates outcomes of interest. ResultsSlightly more than half (56.5%) of the nurses reported a favorable practice environment and they provided on average a high score of 75.29 (SD = 21.03) on job satisfaction. High scores were also reported on intention to stay on the job (mean = 8.08; SD = 2.91) and the quality of patient care (mean = 7.68; SD = 1.38). In a fully adjusted regression model, a favorable practice environment was significantly associated with a 2.15 (p <0.0001) increase in job satisfaction, a 1.72 (p = 0.0003) increase in the intention to stay on the job and a 1.16 (p < 0.001) increase in the nurse reported quality of patient care. ConclusionOverall, our sample of Brazilian nurses that work in primary care reported a favorable perception of their practice environment. This likely contributed to their high scores on intention to stay on the job and the overall quality of patient care. Nurse managers and administrators should focus their attention on aspects of the practice environment as a low cost means to attract and retain nurses in primary care and to improve the overall quality of care.

The Incidence of burnout among Surgery, Orthopedics and Medicine residents in a Public sector Hospital of Punjab.

Introduction: Burnout among healthcare professionals is a growing concern worldwide, affecting both their well-being and the quality of patient care.Objective: This study aims to assess the occurrence and influence of burnout among surgery, orthopedics and medicine residents at a public sector hospital in Punjab, Pakistan, over a 6-month period.Methods: In this observational cross sectional study the levels of burnout were assessed using the American Public Welfare Association (APWA) inventory to measure the levels of burnout among the study participants. This study was conducted over the period of 3 months (Sept - Oct 2022) and data was collected from the residents of surgery and medicine department.Results: This study provides important insights into the well-being of surgery, orthopedics and medicine residents in a tertiary care hospital setting and highlights the need for effective burnout prevention and intervention programs. The findings of this study inform the development of strategies to support the well-being of healthcare professionals and to improve the quality of patient care.Conclusion: It underscores the need for proactive measures to support the well-being of healthcare professionals and improve the overall quality of patient care in public sector hospitals.

Role of Primary Care Physicians in management of Schizophrenia in Low and Middle Income Countries (LMIC): A systematic review.

Many people with Schizophrenia lack the resources and access to mental health services especially in low and middle income countries. Integration of mental health into primary care services can be a cost effective way of reducing the disability associated with Schizophrenia. Our aim was to review the studies conducted on role of Primary care physicians in management of Schizophrenia in low and middle income countries. PRISMA guidelines were followed and we registered the study protocol at PROSPERO. Four Electronic Databases (Medline, Psycinfo, CINAHL and Embase) were searched in May 2022. Relevant articles after search were 504 of which 61 full text were examined. A total of 20 studies were included in the final review comprising of observational, experimental and qualitative studies. Most studies reported on abilities of Primary care physicians including their knowledge, perceptions, skills and competencies in identifying and management of Schizophrenia and related Psychosis. Findings suggest that there is considerable amount of stigma, lack of awareness and social support about people diagnosed with Schizophrenia. Significant improvement was observed in diagnosis and management of schizophrenia by Primary care physicians who received appropriate training by experts in the field. This review suggests that appropriate training of General practitioners in diagnosing and treating schizophrenia can help in reduction of huge Treatment Gap in Schizophrenia. They can also be utilised in delivering psycho social interventions to improve overall quality of patient care.

Data-Centric AI for Healthcare Fraud Detection.

Automated methods for detecting fraudulent healthcare providers have the potential to save billions of dollars in healthcare costs and improve the overall quality of patient care. This study presents a data-centric approach to improve healthcare fraud classification performance and reliability using Medicare claims data. Publicly available data from the Centers for Medicare & Medicaid Services (CMS) are used to construct nine large-scale labeled data sets for supervised learning. First, we leverage CMS data to curate the 2013-2019 Part B, Part D, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Medicare fraud classification data sets. We provide a review of each data set and data preparation techniques to create Medicare data sets for supervised learning and we propose an improved data labeling process. Next, we enrich the original Medicare fraud data sets with up to 58 new provider summary features. Finally, we address a common model evaluation pitfall and propose an adjusted cross-validation technique that mitigates target leakage to provide reliable evaluation results. Each data set is evaluated on the Medicare fraud classification task using extreme gradient boosting and random forest learners, multiple complementary performance metrics, and 95% confidence intervals. Results show that the new enriched data sets consistently outperform the original Medicare data sets that are currently used in related works. Our results encourage the data-centric machine learning workflow and provide a strong foundation for data understanding and preparation techniques for machine learning applications in healthcare fraud.

Indications for hand and glove disinfection in Advanced Cardiovascular Life Support: A manikin simulation study.

There are no investigations on hand hygiene during cardiopulmonary resuscitation (CPR), even though these patients are at high risk for healthcare-associated infections. We aimed to evaluate the number of indicated hand hygiene per CPR case in general and the fraction that could be accomplished without delay for other life-saving techniques through standardized observations. In 2022, we conducted Advanced Cardiovascular Life Support (ACLS) courses over 4 days, practicing 33 ACLS case vignettes with standard measurements of chest compression fractions and hand hygiene indications. A total of nine healthcare workers (six nurses and three physicians) participated. A total of 33 training scenarios resulted in 613 indications for hand disinfection. Of these, 150 (24%) occurred before patient contact and 310 (51%) before aseptic activities. In 282 out of 310 (91%) indications, which have the highest impact on patient safety, the medication administrator was responsible; in 28 out of 310 (9%) indications, the airway manager was responsible. Depending on the scenario and assuming 15 s to be sufficient for alcoholic disinfection, 56-100% (mean 84.1%, SD ± 13.1%) of all indications could have been accomplished without delaying patient resuscitation. Percentages were lower for 30-s of exposure time. To the best of our knowledge, this is the first study investigating the feasibility of hand hygiene in a manikin CPR study. Even if the feasibility is overestimated due to the study setup, the fundamental conclusion is that a relevant part of the WHO indications for hand disinfection can be implemented without compromising quality in acute care, thus increasing the overall quality of patient care.

Exploration of In-Service Training Needs for Nurses Implementing the Nursing Process at Regional Hospitals of Limpopo Province, South Africa

Background: In-service training of the nursing employees plays an eminent role in developing the empowerment of nurses and the promotion of the overall quality of patient care in hospitals. Nurses with constant attendance of training on the nursing process show improved quality of patient care in most clinical health care settings. Nurses in hospitals in Limpopo province experience challenges regarding in-service training on the nursing process approach during patient care. The current study is imperative to the nursing practice; hence, in-service training remains one of the workplace activities that keep the nurses abreast with the latest development in their profession. Objectives: The purpose of this study is to explore and describe the in-training needs for nurses implementing the nursing process at regional hospitals of Limpopo province, South Africa. Methods: A qualitative explorative, descriptive, phenomenological and contextual research design was applied in the study. A nonprobability purposive sampling method was utilised to select professional nurses at the regional hospitals. Semi structured in-depth interviews using an interview guide was consumed to collect data from eighteen participants, then the data was analysed by means of phenomenological reduction method where themes and sub-themes were established. Results: The study discovered that there was no in-service training for professional nurses on the nursing process and there was a lack of management support to nurses implementing the nursing process. Conclusion: The study recommended the need to develop a training programme to enhance continuous in-service training on the nursing process in hospitals of Limpopo province.

Lean Six Sigma Methodologies to Reduce the Cardiac Troponin Turnaround Time in the Core Laboratory.

Measurement of cardiac biomarker troponin T plays a vital role in the diagnosis of myocardial infarction. A quick turnaround time (TAT) for cardiac troponin T is crucial in managing patients in the emergency department and critical care unit. The goal of the study was to implement Lean Six Sigma methods to improve stat troponin T TAT compliance rate (the time specimen received in the laboratory to the reporting of results through the laboratory information system [LIS]) from 86% to 95% in an 8-month period. We conducted a quality and process improvement project to reduce stat troponin T TAT in the core laboratory. We used a 5-stage Six Sigma methodology to simplify the laboratory work process and decrease the TAT by eliminating non-value-added steps. Data from April 2021 (baseline) and January 2022 (improved) are included in the analysis. In the core laboratory, we improved the TAT for the preanalytical and analytical process by eliminating the batch processing and prioritizing the stat samples. We improved the TAT for the postanalytical process by replacing manual result verification with auto result verification via an LIS. Improved stat troponin T TAT compliance rate has the potential to enhance the overall quality of patient care, especially in the emergency and critical care departments. Using Lean Six Sigma methodologies in the core laboratory, we successfully improved the stat troponin T TAT compliance rate from 86% to 95% in an 8-month period.

108 Improving the Quality of General Surgery Operation Notes

Abstract Introduction As outlined in Good Surgical Practice by the Royal College of Surgeons (RCS), accurate, comprehensive, legible, contemporaneous, and preferably electronic operation notes are fundamental in maintaining effective communication, patient safety and overall quality of patient care. Aim To improve the quality of general surgery operation notes by increasing the documentation of the 18 key criteria recommended by the RCS, and increasing the quantity of operation notes completed electronically. Method Operation notes were reviewed for the documentation of the 18 key criteria. Initial audit aimed to gather baseline after which five actions aimed to increase the use of electronic notes were undertaken (including implementation of electronic operation notes proforma, presentation in the surgical morbidity and mortality meeting). Thereafter, a re-audit reviewed operation notes for the documentation of the same 18 criteria. As handwritten notes continued to be used in the re-audit, we took the initiative to also compare documentation between handwritten and electronic notes. For this purpose, 158 operation notes were randomly selected (80 handwritten, 78 electronic) and documentation of key criteria were compared. Results Use of electronic notes increased by 59%. There was an overall increase in documentation between the initial audit and the re-audit. On comparison of handwritten vs electronic notes, the total relative risk of not completing key criteria 0.461 (95%CI 0.417-0.509), p&amp;lt;0.0001. Conclusions The audit was successful in increasing the documentation of key criteria. When comparing handwritten vs electronic notes, the data show that electronic notes significantly reduce the risk of not completing key criteria.

Triad of rubric assessment, constructive feedback and video recorded surgeries key assessment for competent ophthalmic surgeon

Ophthalmic surgery involves very precise surgical skill, which is difficult to teach and even more cumbersome in assessment of resident’s surgical skill. Hence it’s a need of time to adopt newer tool for transferring as well as assessing surgical skill. With this concept in mind International Council of Ophthalmology (ICO) has developed various tools for assessing surgical skills. If we use this tool not only as learning tool but also to give constructive feedback on the surgical skills of resident doctors it will help in creating a competent ophthalmic surgeon and eventually help society in general. 1To develop more standardized surgical training; 2. To assess efficacy and feasibility of new tool in improving surgical skills of Post Graduate(PG) student; 3. To know the effect of constructive feedback on surgical performance. Small incision cataract surgery training is done by Rubric designed by ICO- OSCAR. The same tool was used to assess video recorded cataract surgery of residents by different faculties and assess their surgical skill. The assessor simply circled the observed performance description at each step of the procedure. The ICO-OSCAR score was completed. At the end of the case assessor immediately discussed operated case with student to provide timely, structured, specific performance feedback. Oscar score was recorded and analysed with inter rater agreement. OSCAR TOOL has very good inter rater agreement i.e.(0.96). Analysis of student &amp; Observer feedback infers that OSCAR Tool is best tool for learning as well as assessment tool and is easy to use. Recorded surgeries &amp; constructive feedback from assessor helped Post Graduate students to improve surgically. This resulted in best outcome for patient in terms of good visual acuity post operatively. The formative assessment of surgical skills becomes an integral part of our formal residency, training framework, it would be in the interest of our trainees and trainers that we should adopt the OSCAR tools to train and assess. These tools can add immense value to our residency as well fellowship surgical training and possibly help create a generation of competent trainee.Formative Assessment and constructive feedback in surgical training will improve the competency of new ophthalmic surgeons.Structured surgical training will be relatively easy to observe and perform, as trainee learns what is required to be competent.This will ultimately improve the overall quality of patient care.