Post Implementation Research Articles

Impact of Lean Strategy on Gram Staining Procedure in Microbiology Laboratory

Background: The Gram staining procedure, a fundamental microbiological technique established in 1884, is crucial for bacterial identification and classification. Despite its significance, there is an ongoing need to enhance laboratory efficiency and reduce diagnostic turnaround times. Lean strategies, originating from Taiichi Ohno's work with Toyota, emphasize waste elimination and process improvement, offering a promising approach to optimizing laboratory operations. Objective: This study aims to evaluate the impact of implementing Lean strategies on the efficiency of Gram staining procedures within a microbiology laboratory, focusing on reducing turnaround times and improving diagnostic precision without compromising quality. Methods: A cross-sectional comparative study was conducted at the Department of Pathology, Combined Military Hospital, Lahore, from September to December 2022. Utilizing a non-probability convenience sampling technique, 122 samples were analyzed pre and post Lean implementation. Lean methodologies, including Just-In-Time inventory management and standardized work procedures, were applied to optimize sample transport, accessioning, processing, and staining phases. The study employed SPSS version 25 for statistical analysis, using the chi-square test to compare efficiencies, with a significance level set at p<0.05. Results: Post-implementation of Lean strategies, significant reductions in non-value-added times were observed across all stages of the Gram staining process. Transport and accessioning times were reduced from 20 and 48 minutes to 15 and 30 minutes, respectively. The staining process time decreased from 121 to 104 minutes, and microscopy time was reduced from 201 to 56 minutes. Overall, the study reported a drastic decrease in non-value-added time from 825 to 56 minutes, maintaining the quality of staining results. Conclusion: The application of Lean strategies to the Gram staining procedure significantly enhances laboratory efficiency by minimizing waste and optimizing process times. This approach not only improves diagnostic turnaround times but also maintains high-quality standards, suggesting a scalable model for broader healthcare system improvements.

Abstract TMP38: Enhancing Door-In-Door-Out Time in a Rural Primary Stroke Center: Early Activation of a Large Vessel Occlusion Alert/Bundle of Care Utilizing EMS Pre-Alert, Parallel System Processing and Auto-Launch of Transfer Resources

Background: Thrombectomy has become the primary treatment in the management of acute stroke Large Vessel Occlusions (LVO). For a rural primary stroke center that does not have in house thrombectomy services, expedited transfer to a Comprehensive Stroke Center is imperative. The purpose of this quality improvement initiative is aimed at optimizing the Door-In-Door-Out (DIDO) time for stroke patients at a Rural Primary Stroke Center, with a specific goal of DIDO time of <90 minutes, 50% of the time and <120 minutes, 75% of the time. Methods: System inefficiencies in serial event processing, radiology interpretation, teleneurology application and activation of transferring Emergency Medical Services (EMS) were identified. We implemented several systematic changes utilizing multiple Plan Do Study Act cycles. The final implementation was an “LVO-Alert” process, which utilized parallel event processing of emergency medicine, teleneurology, radiology, and transfer center auto-lance of EMS transfer resources. This process is activated based on a positive prehospital modified Rapid Arterial Occlusion Evaluation score prior to the patient’s hospital arrival rather than a positive Computed Tomography Angiogram and can be cancelled in the case of negative imaging or declination of transfer. Pre and post metrics were compared. Results: Pre LVO-Alert implementation, DIDO time averaged 184 minutes (n=21) over 2 years, and anterior circulation LVO’s achieved a <90-minute DIDO time 5% of the time. Post implementation, DIDO averaged 109 minutes (n=21) and anterior circulation LVOs achieved a <90-minute DIDO 48% of the time. Post implementation, anterior circulation LVOs went from 19% to 90% transferred in <120 minutes. Pre implementation, posterior circulation LVO’s achieved a <120-minute DIDO time 0% (n= 2) of the time while post implementation, posterior circulation LVOs achieved a <120-minute DIDO 50% (n=4) of the time. Among LVO alert activations over the post-implementation period, 27.4% resulted in transfer for thrombectomy. Conclusion: The application of a parallel process bundle of care model with early activation from a prehospital positive LVO scale may help to improve DIDO times in this patient population.

Abstract WMP25: Implementing a Rapid Response Model to Improve Efficiency of In-Hospital Stroke Code Processes

Introduction: In-hospital stroke (IHS), which occurs during hospitalization for other conditions, presents unique challenges and complexities. Studies have shown IHS is associated with worse patient outcomes, e.g., higher morbidity and mortality, compared to community-onset stroke treated in the emergency department. Time from initial symptom recognition to diagnostic imaging is critical for implementing first line therapy. During IHS, efficient and consistent performance of time-sensitive treatments relies on well-defined roles and parallel processing of tasks. Method: A QI initiative aimed at reducing time from initial stroke symptom recognition to initiation of a non-contrast CT (NCCT) scan was implemented at the start of FY 2022 at our CSC. Focus included broad education of all hospital personnel and their defined role in IHS recognition and care. Program analysis included retrospective and prospective data collected from patients’ electronic health records (EHR) and daily EHR audits for comparison of pre- and post-implementation data (FY 2021 and FY 2022, respectively). Data collection included time of stroke code call (symptom recognition), time of NCCT, and compliance of turn-around-time (TAT) between data points, with a goal of < 20 minutes. Results: An overall increase in the number of IHS code calls between FY 2021 and FY 2022 (n=82 vs. n=106, respectively) was appreciated, with an overall decrease in mean time from stroke recognition to NCCT ( M =22 vs. M =18.3 minutes, respectively). Overall compliance of TAT between these two data points increased from 53% to 73% post QI implementation. Additionally, we experienced an improvement in IHS activation time to IV thrombolytics administration time with a median time of 64.5 minutes (FY 2021, n=8) to median time of 59 minutes (FY 2022). Conclusion: Implementing a system wide QI initiative for IHS with well-defined roles and expectations, and parallel processing of tasks can lead to early recognition and activation of IHS code calls. Improved symptom recognition, code activation, and coordinated response efforts improved time and compliance to initial imaging as well as time to thrombolytic administration in our patient population.

Abstract TP51: Improving Prescriptions of Cardiovascular-Effective Anti-Diabetic Medications in Patients With Stroke and Type 2 Diabetes

Background and Issue: Type 2 diabetes (DM2) and cardiovascular (CV) disease pose significant risks for ischemic stroke, with a heightened impact on marginalized and under-resourced communities. Despite known CV benefits of newer anti-diabetic medications like glucagonlike peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose co-transporter-2 (SGLT2) inhibitors, these medications are under prescribed. To improve utilization, we conducted a quality improvement (QI) project to enhance prescription rates for these medications. The QI initiative focused on improving diabetes education and ensuring appropriate hypoglycemic medications were provided at discharge, with an aim of reducing the incidence of recurrent strokes. Purpose: The goal of this QI initiative was to improve prescription rates of GLP-1 R or SGLT2 inhibitors in eligible patients with stroke. Method: An assessment of current diabetic referral practices and medical therapy management were conducted, and an algorithm aimed at streamlining referrals for diabetic consults for patients with stroke developed. A diabetic educator or advanced practice nurse was consulted for patients with stroke and elevated A1c. Patients were then evaluated for qualification and use of GLP-1 RA or SGLT2 inhibitors, and discharge recommendations provided. A stroke registry was used to conduct a retrospective analysis of cases with stroke and DM2 for discharged prescriptions of GLP-1 R or SGLT2 inhibitors. Pre-implementation data from October 2021 to March 2022 were compared to post-implementation data from October 2022 to March 2023. Results: A review of 273 cases was completed. Prior to the QI implementation, 14.2% (19 of 134) of cases admitted for stroke with a secondary diagnosis of DM2 and elevated A1c were discharged home on a GLP-1 RA or SGLT2 inhibitor compared with 28.8% (40 of 139) of cases post implementation. Conclusion: Implementation of a QI process aimed at increasing the number of written discharge prescriptions for DM2 medications with proven CV benefits demonstrated a substantial increase in the number of written prescriptions for these medications at discharge.

Abstract TP62: Stroke Triage Checklist Decreases Door to Treatment

Background and Issue: Studies have shown that patients who arrive at the Emergency Department (ED) by privately operated vehicle (POV) vs. an ambulance have longer door to needle times. At a comprehensive stroke center, patients who arrived by POV experienced longer times from arrival to activation and door to needle than those arriving to the ED by ambulance. Purpose: To implement a standardized objective assessment triage checklist and evaluate its effectiveness of decreasing arrival to activation and door to needle times. Methods: This quality improvement (QI) project was guided by PDSA methodology. In 02.2023, a stroke nurse champion QI team was formed. Barriers to timely treatment were identified through the use of case timelines and a stroke nurse champion focus group. Patients arriving by POV and treated with a thrombolytic also had low NIHSS (1-4). During root cause analysis, triage nurses expressed a lack of confidence in calling a stroke alert for patients with mild symptoms. To address this barrier, a structured triage checklist was adapted to include the B.E.F.A.S.T. acronym, symptoms easily missed (e.g., difficulty walking, dizziness, headache), posterior stroke symptoms (e.g., diplopia, dysphagia), and a note to prompt activation from the triage room. The checklist was implemented on 04.15.2023. Data collected included patients who arrived by POV and were administered a thrombolytic. Door to alert and door to needle times were derived from a quality database and analyzed pre (01.2023-03.2023)and post implementation (05.2023-07.2023). Results: When comparing pre and post implementation data, there was a 5 min decrease in door to activation time (n=4, 10 min vs. n=3, 5 min) and a 23 min decrease (n=4, 58 min vs. n=3, 35 min) in door to needle time in patients who arrived by POV and received a thrombolytic. All patients treated with a thrombolytic in the ED, regardless of mode of arrival, saw a 26 min reduction in door to needle during this time period (n=15, 69 min vs. n=17, 43 min). Conclusion: Use of a standardized and objective triage checklist empowered nurses to activate a stroke alert prior to receiving provider input on patients arriving by POV with mild symptoms. Enabling quick allocation of resources to expedite thrombolytic administration.

Abstract TP67: Know Your Numbers: Refining the Stroke Alert Process for Hospitalized Patients

Background and Issues: Patients who experience an in-hospital stroke often have delayed treatment compared with patients presenting to the ED. AHA Scientific Statement on Best Practices to Improve Management of In-Hospital Stroke recommends a targeted QI team to address barriers to treatment. Purpose: To establish a targeted QI team to evaluate in-hospital stroke alert (SA) response times, identify performance opportunities and develop an improvement plan. Methods: A QI team was formed in Jan 2023. Data were collected from the EHR and analyzed (i.e., symptom discovery to SA, SA to response team arrival, arrival of response team to imaging, imaging to treatment). Barriers to timely treatment were identified through the use of case timelines and stroke nurse champion focus groups. One barrier identified was the use of a non-emergent operator vs. the emergency hotline to activate a SA. Use of the non-emergent line left staff placed on hold, resulting in a delay of SA activation. In March 2023, PDSA cycle #1, use of the emergent hotline, was implemented and house wide staff education were administered addressing the process change. Results: Data were collected between Dec 2022-June 2023. There were a total of 64 SA activations, 53% were activated on a non-neuroscience unit, and 33% were diagnosed with a stroke. Three patients were treated with a thrombolytic (n=2, avg. 47 min) or thrombectomy (n=1, 55 min). Prior to implementation (Dec-Feb 2023) symptom discovery to SA averaged 8 minutes (n=28) and remained unchanged post implementation (April-June 2023, avg. 8 min, n=36). Conclusion: A targeted QI team focused on in-hospital SA processes showed benefit by identifying opportunities to decrease time to treatment. No change was seen in the avg time from symptom discovery to activation. Future areas of opportunity include focused education on non-neuroscience units and strategies aimed at decreasing the time from SA to imaging interpreted.

Effect of Saudi's updated health insurance policy: 4‐Year comparative study pre and post implementation

AbstractThis study examines the impact of Saudi Arabia's updated Unified Health Insurance Policy, implemented in 2018, over a 4‐year period. The objective is to assess its effects on key indicators in the health insurance sector, including gross written premiums (GWPs), insurance penetration, gross claims paid by health insurance, and insurance density. Quantitative data from official sources, including the Saudi Central Bank and the Council of Health Insurance (CHI), were analyzed. A two‐sample t‐test was employed to compare pre implementation (2014–2017) and post implementation (2019–2022) periods for selected indicators. The study found a significant increase in GWPs, suggesting heightened revenue generation for insurers, likely due to increased demand, adjusted pricing strategies, and expanded coverage. Insurance penetration notably widened, indicating improved accessibility, driven by awareness campaigns and subsidies. Gross claims paid by health insurance increased significantly, showing insurers disbursing more funds to cover healthcare costs. However, there was no significant impact on insurance density, highlighting the need for additional strategies to extend coverage. Saudi Arabia's updated Unified Health Insurance Policy has yielded transformative effects, enhancing accessibility and affordability. It has increased revenue generation, improved insurance penetration, and raised the amount paid by insurers to cover healthcare costs. The policy's impact on insurance density is limited, necessitating further efforts to extend coverage. These findings have significant policy implications, urging policymakers to refine healthcare policies and insurers to adapt to new revenue prospects, promising better overall health outcomes for the population. Further comprehensive research is essential to validate these conclusions and explore broader policy impacts.

Effect of Training Program on Emotional Intelligence of Nurses Caring for Patients with Alzheimer’s Disease

Context: Nurses are the cornerstone of the health care systems, and their work is associated with great pressure, and nurses are often overwhelmed. Emotional intelligence and its significance to nursing have been increasingly emphasized throughout the last few years. Emotional intelligence comprises a deposit of interrelated skills involving a capability to appraise one's emotions and those of others, utilization and regulation of one's emotions, and social skills.
 This study aimed to evaluate the effect of training program on the emotional intelligence of nurses caring for patients with Alzheimer's.
 Methods: A quasi-experimental (pre/post-test) design was used. The study was conducted at the geriatric units of Ain Shams University Hospitals and the geriatric department of Abassia Hospital, affiliated with the Ministry of Health. A study employs convenience sampling with a total number of 70 nursing staff who are working in the mentioned setting. Tools used for data collection were a self-administered questionnaire including two parts; part one concerned with sociodemographic characteristics of the studied nurses, and part two included the Emotional Intelligence Scale (EIS) to assess emotional intelligence in managing the workplace.
 Results: The current study reveals that pre-program, 5.7% of the studied nurses have a high level of EI scores compared to about one quarter (22.9%) of the studied nurses who had a high level at post implementation of the program and increased to less than three quarters (71.4%) at follow up the program with a highly statistically significant difference between the levels of nurses’ emotional intelligence (p<0.001) comparing between pre-intervention and follow-up.
 Conclusion: Emotional intelligence training program positively improves emotional intelligence levels among nurses caring for patients with Alzheimer’s disease. The study recommended that hospitals provide continuous in-service training, education, and awareness programs for nursing staff to enhance their skills regarding emotional intelligence. Nursing emotional intelligence skills should be included in undergraduate and postgraduate nursing curricula.

Effectiveness of scientific research education programme on the attitudes of nursing students towards research methods course: a pre and post-implementation study

Background Nursing research is the key to building an evidence-based practice for nursing. It is a necessity for nursing students to be professionals and to be encouraged to conduct research. Aims This research was conducted to determine the effectiveness of a scientific research education program on the attitudes of nursing students towards research methods. Design A single group pre and post implementation study. Methods The sample was composed of the third-year nursing students (n = 196). A questionnaire, and the Scientific-Research-Methods-Course-Attitude-Scale (SRMC-AS) were used for the data collection. The intervention consisted of theoretical education, group discussions, and research project writing practices lead by the researchers. Results The difference between mean scores of the SRMC-AS baseline measurement (85.18 ± 9.09), 3rd month (91.20 ± 7.59), and 6th month (90.68 ± 11.16) was statistically significant (p < 0.05). Conclusion The scientific research education program was found effective about positively increasing the attitudes of the students towards the course.

Effect of Practicing Deep Breathing and Kegel Exercises on Menopausal Urinary Incontinence at Beni-Suef

Background: Urinary incontinence (UI) is one of the most common problems in menopausal women; it is defined by the International Continence Society (ICS) as the complaint of any involuntary loss of urine and its classification according to the presence of symptoms and pathophysiological mechanisms of occurrence. The Kegel Breathing technique combines breathing and pelvic floor contraction patterns to increase pelvic floor muscular strength while performing daily activities regularly. Normal breathing occurs when the pelvic floor muscles and the breathing muscle (diaphragm) move up and down in harmony manner. Aim of the study: The study aimed to evaluate menopausal women's urinary incontinence before and after practice of deep breathing and Kegel exercise. Design: A quasi-experimental study design was utilized in this study (one group pre and post-test). Sample: A purposive sample of 100 Menopausal women diagnosed with stress urinary incontinence. Setting: gynecological and urological outpatient clinics Beni-Suef university hospital. Tools: 1) a structure interviewing questionnaire schedule, 2) The International Consultation on Incontinence Modular Questionnaire 3) Pelvic floor muscles exercises checklist. Results: about 45% of the studied women reported that their frequency of urination is several times per day preprogram but it became only 19% post program implementation. Only 32% of the studied women can accurately detect the right muscle group at the 1st week of the 1st month. However, at the end of the 1st month; 82% of them can do. Moreover, at the end of the 2nd month; 90% can do. Additionally, at the end of the 3rd month; 93% of the studied women can accurately detect the right muscle group. Conclusion: Deep breathing and kegel exercise had positive effect on women's urinary incontinence. Recommendations: disseminate brochures and booklet about kegal and breathing exercise to enhance awareness program regarding stress urinary incontinence reliving measures for elderly women.

The Report from the 2023 annual meeting of thoracic radiologists in Thailand: The development and reviews of the standards, guidelines, and advice concerning diagnostic radiology of thoracic disorders in Thailand

The rising issues in practice related with thoracic diagnostic imaging in both private and public sectors were presented to a panel consisting of thoracic radiologist experts from all parts of Thailand in a meeting held on 20 October 2023 by the Royal College of Radiologists of Thailand (RCRT) in collaboration with Foundation of Orphan and Rare Lung Disease (FORLD) at Asoke Conference Room on the fourth floor of Eastin Grand Hotel, Phaya Thai, Bangkok. The issues were grouped into 3 agendas: a post implementation review of the National HRCT Protocol, the safety and effectiveness of the diagnostic imaging, the standard report of HRCT in patients with fibrotic lung disease, and the recommended CT protocol for patients with thoracic malignancy in the public health universal coverage system.

Evaluation of an emergency department opt-out provider-driven HIV and syphilis screening and linkage-to-care program

ObjectiveWhile the effectiveness of emergency departments (ED) in screening for HIV and syphilis is understood, less is known about dual screening programs. We aim to evaluate the impact of an opt-out provider-initiated HIV and syphilis program on screening, diagnosis, and linkage to care outcomes. MethodsWe performed a retrospective review of patients screened pre (2014–2017) and post (2017–2021) program implementation. Primary outcomes include HIV and syphilis screening, incidence of positive tests, and proportion of patients linked to care. Secondary outcomes included pre-exposure prophylaxis (PrEP) referral and successful linkage rates for HIV-negative syphilis-positive patients. ResultsPre-implementation, 882 HIV tests were performed, of which 22 (2.49%) were new cases and 18 (81.82%) were linked to care; 754 syphilis tests were performed, of which 33 (4.38%) were active infections and 30 (90.91%) were treated. No eligible patients received PrEP referral. Post-implementation, 12,999 HIV tests were performed, of which 73 (0.56%) were new cases and 55 (75.34%) were linked to care; 10,885 syphilis tests were performed, of which 216 (1.98%) were active infections and 188 (87.04%) were treated. 25 (9.09%) eligible patients were referred for PrEP, and four (16.0%) attended their appointment. ConclusionsPost-implementation, there was a 1373.81% and 1343.63% increase in screening, and a 231.82% and 554.55% increase in positive cases of HIV and syphilis, respectively. Dual screening programs can be successfully implemented within the existing ED framework to increase screening and early detection for HIV and syphilis.

Impact of a Parent Education Program Delivered by Nurses and Health Care Providers in Reducing Infant Physical Abuse Hospitalization Rates in British Columbia, Canada.

The Period of PURPLE Crying Program® (PURPLE) is a universal parent education program that is delivered by nurses and health care providers to all parents/caregivers of newborns in British Columbia (B.C.). The aim of the program is to reduce the incidence of Traumatic Head Injury -Child Maltreatment (THI-CM), a form of child physical abuse. To determine if the PURPLE program had an impact on the rate of physical abuse hospitalizations for children less than or equal to 24 months of age in B.C. since implementation in 2009. The analysis measured physical abuse hospitalization rates for the period January 1, 1999 to December 31, 2019 and excluded any cases of confirmed Traumatic Head Injury-Child Maltreatment. Data were divided into pre-implementation period January, 1999 to December, 2008, and post-implementation period January, 2009 to December, 2019. Data were obtained from the Discharge Abstract Database and B.C. THI-CM Surveillance System to capture information on infant child abuse. Poisson regression and ANCOVA was applied to model the change in rates pre and post program implementation. Physical abuse hospitalization rates decreased by 30% post-implementation period (95% CI: -14%, 57%, p = 0.1561). The decreasing linear trend in the post-implementation period was significantly different than the increasing linear trend in the pre-implementation period (F1,17 = 4.832, p = 0.042). Nurses' role in engaging parents in conversations about PURPLE messages over multiple timepoints within a structured universal program model resulted in a decrease in physical abuse hospitalization rates since the implementation of PURPLE.

Separate rooms for patient induction, case set-up and breakdown: Innovative operating room turnover through quality management

Turnover time (TT) is the time it takes to prepare an operating room (OR) between consecutive surgeries. Short TT improves OR efficiency, while maintaining patient and staff safety and satisfaction. Yet the multitude of staff involved and steps required creates process complexity that can hinder this goal. Leveraging a unique case study setting, this study deploys a collection of quality management tools to investigate how the use of separate support rooms for patient induction (the administration of anesthesia), case set-up, and case breakdown can reduce OR TT while maintaining safety and satisfaction. Key results show that separate rooms for patient induction and case breakdown can enable parallel processing, improve patient and staff safety, and patient experience. We use post implementation observations to measure TT reduction when using an induction room, which allows time for an extra case per day. We develop decision-support models practitioners can use to identify the potential benefits of separate support rooms during the OR turnover, based on operating conditions and surgical characteristics. We provide considerations from buffer theory and coordination theory for the separation of physical space, proposing a novel view of the OR turnover process as a set of service modules and interfaces.

Is stroke knowledge retained? Four-year longitudinal data of FAST Heroes campaign

IntroductionEducational stroke programs seem to increase awareness about stroke management. However, there is a speculation that actual stroke knowledge post mass campaign implementation remains poor. The aim of the present study was to evaluate stroke knowledge retention four years post Fast Heroes program implementation, an interactive stroke educational program, in school-aged children without any follow up during this time.MethodsSeventy-eight (n = 47 had attended the program four years ago and n = 31 had never attended the program) school-aged children completed the age-adjusted online preparedness questionnaire during class four years post program implementation. The variables used to measure campaign effectiveness were knowledge of: i) stroke symptoms described in the FAST acronym (Face-Arm-Speech), ii) appropriate course of action (i.e., calling an ambulance), and iii) the European emergency number (i.e., 112).ResultsIn all questions, children that had attended the program had 14–81% greater chances to answer correctly.DiscussionThere is still knowledge gain even four years post program implementation with no follow up during that time. The design of the campaign (i.e., 5-week duration, age-appropriate exercises, cartoon animations, song and dance elements, sentimentally driven activities and 3-layer education dissemination) facilitates long-term knowledge retention and may have led to the knowledge gains observed. Broad implementation potentially as part of the annual curriculum in schools can impact community stroke knowledge and should be considered.

Yarning to reduce take own leave events in First Nations patients presenting to the Emergency Department-presenting the qualitative themes and co-design of the Deadly RED project.

The Deadly RED redesign and implementation research aimed to improve take own leave (TOL) rates within a Queensland emergency department by providing a culturally competent care pathway. A mixed methods pre/post evaluation of the feasibility, acceptability and usability of the Deadly RED pathway for First Nations patients presenting to ED was performed. This pathway combined early welcome and information sharing, introduction of screening and follow up for patients who TOL and enhanced access to alternative community healthcare. Yarning circles facilitated co-design of research protocols and tools while a purposefully designed research Yarn enhanced understanding of the 'story' of the people. Qualitative analysis of Yarns allowed deductive themes to be extracted. A Participatory Action Research (PAR) approach and Indigenous research methodology involving First Nations people in design, knowledge sharing and joint ownership of results was used. Common themes from the 85 yarns included the negative impact of long waiting times and positive impact from wholistic care. Unique themes identified included interpretation of waiting room placement and paracetamol prescription as a dismissal. Knowledge dissemination from yarning drove improvements in communications and processes to promote treatment completion resulting in elimination of these themes in post implementation yarns. Eighteen patients who had TOL were included in the post implementation yarns, however only eight of these believed that their treatment was incomplete. The use of yarning for consumer engagement has allowed deeper understanding of the reasons for TOL in First Nations emergency patients. The reciprocal knowledge sharing has guided targeted improvements in wholistic emergency care and communication resulting in First Nations patients feeling their care is complete even when the 'number' reports otherwise. SO WHAT?: Indigenous Research methodology including yarning with First Nations patients suggests alternative engagement methods to guide enhanced quality of care monitoring for ED presentations.

Acute kidney injury surveillance in the high-risk neonatal population following implementation of creatinine screening protocol.

Acute kidney injury (AKI) in neonates is associated with longer hospital stays and higher mortality rates. However, there is significant variability in prevalence rates of AKI and the true burden is incompletely understood. In November 2020, the University of Iowa Stead Family Children's Hospital Neonatal Intensive Care Unit implemented a creatinine screening protocol to enhance kidney function monitoring. We sought to evaluate adherence to the protocol to determine if increased surveillance led to increased detection of AKI events. A retrospective chart review was conducted for neonates born at <30 weeks' gestation admitted between 2015 and 2020. We reviewed 100 charts in both the pre (2015-2016) and post (2020-2021) implementation era of the AKI surveillance protocol. AKI was defined according to neonatal modified KDIGO criteria. Following implementation of the protocol, neonates were significantly more likely to have creatinine checked (p < 0.001). Serum creatinine was drawn according to protocol guidelines 68% of the time, and 42% of patients (34/82) had an 80% or higher adherence to the protocol. There was a significant increase in detection of AKI in the post-protocol cohort (13/82, incidence of 16%) compared to the pre-protocol cohort (5/83, incidence of 6%), (p = 0.047). The implementation of a serum creatinine screening protocol increased the frequency of creatinine draws and detection of AKI.

P011 Completion audit on the accuracy of temporal artery biopsy referrals post protocol implementation

P011 Completion audit on the accuracy of temporal artery biopsy referrals post protocol implementation

Examining the Impact of Dedicated Missing Person Teams on the Multiagency Response to Missing Children

Some police forces are investing resources into dedicated missing person teams (MPTs) to improve risk assessment and responsibility sharing across partner agencies. This study used police records and interviews with representatives from police and partner agencies in one UK region to provide the first systematic evaluation of the impact of implementing a dedicated MPT on the response to missing children. Results revealed a reduction in reports and change in risk assessment practices post implementation, along with suggestions that the MPT brought about more of a child-centred approach, a pushing back of responsibility to care providers, and greater personalised communication with children and care providers. However, improvements needed to be made to intra- and inter-agency communication, and consideration of resources across shift patterns. Findings pose important implications for informing decisions regarding allocation of finite resources and improving multiagency response to missing children.

Service evaluation of the implementation of SGLT-2 Inhibitor checklist on information communicated and documented to patients and transfer of care-records

Abstract Introduction Sodium Glucose Co-Transporter 2 (SGLT-2) Inhibitors’ therapeutic role has evolved1 as recent clinical trials showed they have beneficial effects across all stages of the cardio-renal metabolic spectrum2. There are different indications and specialities responsible for the initiation of these medications, so communication from health professionals to patients and documentation of this on transfer of care records is paramount3. It is important all health-care professionals ensure their clinical knowledge is current and updated to be able to communicate accurate and correct information to patients on their medications. A SGLT-2 Inhibitor counselling checklist was developed and approved for implementation in The Trust to promote awareness of new clinical guidelines and support the counselling provided to patients. The checklist included recommendations of the information to communicate and document on patient care records. Aim The aim was to assess the impact of the SGLT-2 Inhibitor counselling checklist on the information provided to patients and to identify if the indication and speciality responsible were recorded on transfer of patient care records for patients newly prescribed SGLT-2 inhibitors. Methods Ethical approval was not required for this quantitative research service evaluation. A data collection tool designed in Excel Microsoft 365 was used to collect data. Data was collected manually by the lead author retrospectively (pre-implementation of the checklist) from 1st January – 30th March 2022, and prospectively (post-implementation) from 1st July – 30th September 2022 from discharge prescriptions detailing newly prescribed SGLT-2 Inhibitors related to patients from four selected wards (A- D). Descriptive statistical analysis was carried out to compare the pre and post implementation data. Results Over the 6 month study period, a total of 110 patients were newly prescribed a SGLT-2 Inhibitor (63 pre- implementation and 47 post implementation). There was increased information communicated to patients in the post implementation group when compared to the pre implementation group. The percentage of patients provided with medicine information books and ‘protect my kidney’ cards increased from 25% to 70% and the proportion that received counselling increased from 27% to 70%. The indication and speciality involved with initiation and prescribing of SGLT-2 Inhibitors was well communicated and documented from 3% unknown in the pre group compared to 0% in the post implementation group. Discussion/Conclusion Despite this study being limited to a short collection period and a small sample size, the data collected demonstrates that the SGLT-2 inhibitor counselling checklist can increase the information communicated to patients and improve information included on transfer of care records, which is paramount between healthcare professionals to ensure a seamless transfer of care3. A key implication is the need to ensure use of counselling checklists as part of the discharge process.