Improvement Project Research Articles

Impact of a Nutrition and Diabetes Continuing Education Program on Primary Care Provider's Knowledge, Attitude, and Clinical Practice.

Diet/nutrition is the first-line non-pharmacological therapy in the treatment of diabetes. Diet/nutrition counseling is infrequently provided by primary care providers (PCPs), who have limited nutrition education in both medical and advanced practice provider curricula. This quality improvement project aimed to improve knowledge and attitude, and frequency of diet/nutrition counseling by PCPs among patients with uncontrolled diabetes (glycosylated hemoglobin A1c ≥8%), by providing an online continuing medical education (CME) program on diabetes diet/nutrition. At a community health center in New England, PCPs attended a live 50-minute online CME program that was developed internally, which taught PCPs current diet/nutrition guidelines and recommendations related to diabetes. Knowledge was assessed prior to and two weeks following the program, utilizing a 10-question tool, the Nutrition Management of Diabetes Assessment (NMDA). Similarly, attitude was evaluated using two subscales of the Nutrition in Patient Care Survey (NIPS): Nutrition in routine care and Physician efficacy. Chart audits of patients with uncontrolled diabetes were evaluated to assess PCPs documentation of diet/nutrition counseling four weeks prior to and six weeks following the CME program. In September 2023, PCPs (n = 29) completed the CME program. There was an improvement in knowledge in the NMDA amongst PCPs (36% difference, p < 0.001). Attitude scores from two subscales of the NIPS were evaluated and both showed improvement, however only physician efficacy was significant (15% difference, p < 0.01). There was a positive difference in the trend of diet/nutrition counseling after the education program (p < 0.05). An online CME program improved diabetes diet/nutrition knowledge and attitude of PCPs and improved counseling practices for patients living with uncontrolled diabetes. The education program provided PCPs current standards of care guidelines/recommendations, which they can utilize when counseling patients with diabetes. PCPs would benefit from dedicated continuing education programs regarding diet/nutrition therapy for chronic illnesses.

Effect of oncology provider conversations on patients’ vaccination decision-making: Patient perspectives at a safety-net system.

266 Background: Low immunization rates among adults are associated with worse outcomes, particularly among immunocompromised individuals, such as those diagnosed with a cancer. To better understand vaccination communication and decision-making experiences among adult cancer patients treated at a safety-net system, we conducted structured interviews to: (1) explore patients’ perceptions of their oncology providers’ role in adult immunization, and (2) understand the potential factors that underlie patients’ hesitancy to receive vaccines. Methods: Parkland Health is the safety-net system for Dallas County, providing care for a primarily minority and un-/under-insured population. Cancer patients who had previously deferred or declined immunization participated in either in-person or telephone interviews in their preferred language (English/Spanish), using a structured 8-question interview guide. Questions centered on oncology providers’ role, vaccine hesitancy, and vaccine decision-making. Interviews averaged 12 minutes and were recorded for transcription. Aggregated interview responses were coded by question and interpreted through content analysis which noted frequency (i.e., times concept stated) and extensiveness (i.e., repetition across questions). Results: Thirteen patients were interviewed – 7 in English, 6 in Spanish. Patient’s perceived their oncology providers as highly important to their vaccination decision-making as they were: (1) more likely to get a vaccine if it is recommended by their provider (P2: Well, if the doctor hadn’t told me I wouldn’t have gotten vaccinated ; P3: If they didn’t recommend it, I would not get it ; P12: If they recommend it, it's worth looking into or thinking about ), and (2) identified their oncology provider as a preferred means for learning about vaccines (P8: Asking the doctor or the doctor communicating with us patients about a vaccine... in my personal opinion, I would say, go ahead and vaccinate me ). Patient-identified reasons for hesitancy included concerns about side effects (P2: “several people told me that is why we got cancer” ), fear of needles, previous negative experiences, and preference for alternative medicine approaches. Conclusions: Results from this preliminary study suggest that while patients may not initiate vaccination conversations with their oncology providers, they do identify their providers as influential in their decision-making. Oncology providers may not consider immunization as their primary responsibility but can be a primary source for effective vaccine communication in conjunction with the oncology care team. Findings from our patient interviews informed interventions in a quality improvement project to increase immunization uptake among cancer patients at our safety-net system.

Quality improvement project to reduce inpatient chemotherapy usage on a solid tumor oncology service.

333 Background: Inpatient chemotherapy is not routinely recommended for patients with solid tumors as administration is associated with increased length of stay (LOS), higher healthcare costs, and higher morbidity; and chemotherapy administration within 14 days of death is considered poor quality care. However, inpatient chemotherapy may sometimes be indicated for toxicity monitoring or due to barriers that limit prompt delivery of medications with clinically meaningful benefit. To ensure judicious use of inpatient chemotherapy we are undertaking iterative Plan, Do, Study, Act (PDSA) cycles involving education and policy initiatives on a solid tumor oncology service at an urban, academic medical center. Methods: PDSA cycles followed standard methodology. The initial goal was to reduce inappropriate inpatient chemotherapy use, which was expected to correspond with a 25% overall reduction. The initial intervention consisted of two main components: 1) division-wide education about the indications for inpatient chemotherapy, and 2) formation of a committee to review all chemotherapy requests for adult inpatients with solid tumors. The committee consists of clinicians within division leadership, including the division chief and representatives from operations, quality and safety, and ethics. Requests are sent from inpatient teams to the committee, who review each case for factors supporting inpatient treatment such as patient stability/performance status, clinically meaningful benefit, and practical barriers to outpatient administration. To evaluate the impact of the intervention, data were extracted from the electronic medical record for all patients admitted to the service for the 8.5 months before (12/1/22-8/15/23) and after (8/16/23-4/30/24) the initiation of the first PDSA cycle. Results: At baseline, prior to PDSA cycle 1, there were 930 admissions (n=606 patients), and 111 (11.9%, n=82 patients) received inpatient chemotherapy. During PDSA cycle 1 there were 889 admissions (n=557 patients), and 57 (6.4%, n=35 patients) received inpatient chemotherapy (p&lt;0.001). There was no significant change in the proportion of patients receiving chemotherapy within 14 days or 30 days of death pre-PDSA cycle and post, 7.5% vs. 6.6% within 14 days of death (p&gt;0.9), and 13.1% vs. 11.5% within 30 days of death (p&gt;0.9). Overall, mean LOS for all admissions decreased from 11.1 days to 8.8 days (p&lt;0.001). Conclusions: Preliminary results of this quality improvement initiative using iterative PDSA cycles to optimize inpatient chemotherapy use suggest a benefit. After the first PDSA cycle, there was a 46.3% decrease in the proportion of admissions receiving inpatient chemotherapy, and an overall decrease in LOS. Future PDSA cycles are aimed at limiting end-of-life chemotherapy and streamlining the transition from inpatient to outpatient chemotherapy to reduce delays and improve the patient experience.

Implementing a letter template to expedite specialty medication appeal letter submission

BackgroundPrior authorizations (PAs) for biologic medications, used to treat inflammatory bowel disease (IBD), are often denied by pharmacy benefits managers and can require a complex appeal process for patients to gain access to medication. ObjectiveThis quality improvement project evaluated the impact of implementing a standardized appeal letter template and customizable clinical rationale letter content on specialty pharmacist workflow and workload in an integrated hospital health system specialty pharmacy (HSSP) IBD clinic. Practice descriptionThis initiative was conducted in an IBD outpatient clinic at a tertiary academic medical center with an integrated HSSP whose specialty pharmacists work collaboratively with providers to manage specialty medications. Practice innovationA letter template was created in the electronic health record (EHR) for pharmacists to use when submitting appeal letters. The template automatically populates patient results from recent labs, imaging, and clinic visit notes as part of the appeal documentation. Clinical rationale letter content was developed for the most common appeal reasons using EHR functionality that allows the creation of standardized notes that can be shared among team members and customized at time of use. Evaluation methodAn analysis of 2 months of data preimplementation/postimplementation was conducted using descriptive statistics to report the number of appeals submitted, time from PA denial to appeal submission, and appeal approval rate. A pharmacist postimplementation satisfaction score was also collected. ResultsThe number of appeals submitted preimplementation (n = 73) and postimplementation (n = 73) was the same. Postimplementation, 89% of appeals were submitted within 3 days of PA denial compared to 29% preimplementation. PA approval rate was high (93%) preimplementation and postimplementation. Overall pharmacist satisfaction was 9.7 out of 10. ConclusionImplementation of an appeal letter template and standardized clinical rationale letter content in the EHR led to decreased time to appeal submission and high specialty pharmacist satisfaction.

Implementing Mental Health Screening for Adolescent Hematology and Oncology Patients: A Quality Improvement Initiative.

Purpose: Adolescents and young adults (AYA) with chronic illnesses experience an increase in mental health concerns. A mental health screening (MHS) process for hematology and oncology patients was implemented in a single institution. The quality improvement project was conducted to integrate a MHS process, educate providers about the importance of mental health in this patient population, and evaluate the process. Methods: The COM-B (capability, opportunity, motivation-behavior) model for behavior change was used to inform strategic planning and Plan-Do-Study-Act (PDSA) methodologies for process improvement. Retrospective chart reviews and surveys were conducted to determine missed screening rates and providers' perceptions, knowledge, attitudes, and skills of the MHS process. Results: Of 334 eligible patient encounters, the missed screening rate was 15.0%, the overall error rate of completing the screening was 3.8%, the error rate of completing the suicide or self-harm indicator was 2.6%, and the missed medical social worker touch point was 4.8%. Conclusion: The rising rates of mental health concerns in AYA hematology and oncology patients call for streamlined MHS processes to improve the identification of patients who may need intervention and services. Processes should be tailored to workflows and available resources. Future PDSA cycles will include providing dedicated nursing education and determining the cost needed to meet the rising mental health needs of the AYA hematology and oncology population.

S394 Interim Analysis of a Quality Improvement Project to Improve Colorectal Cancer Screening and Awareness at a Tertiary Care Center

S394 Interim Analysis of a Quality Improvement Project to Improve Colorectal Cancer Screening and Awareness at a Tertiary Care Center

Enhancing screening for nutritional causes of anemia in hospitalized patients with cancer.

367 Background: Anemia in patients with cancer has been associated with lower quality of life, diminished performance status, and potentially even delays in chemotherapy. Multiple professional societies, including the NCCN and ESMO, recommend routine testing for iron deficiency and iron replacement if deficiency is identified. The aim of this quality improvement project was to increase testing for nutritional causes of anemia, especially iron deficiency, among patients admitted to the onco-hospitalist teaching service at MD Anderson Cancer Center. Methods: A process map was constructed to identify pitfalls with the current process for identifying and ordering testing for nutritional (iron, B12, and folate deficiency) causes of anemia. The primary intervention for our Plan-Do-Study-Act (PDSA) Cycle was creating and implementing an electronic medical record smart phrase to be included in each note prompting consideration of reversible causes of anemia and whether testing was ordered in the last 6 months or needs to be ordered. Education was also provided to residents regarding reversible causes of anemia and appropriate studies to order. Fliers describing the intervention and the recommended testing algorithm were placed in the resident workroom. A retrospective chart review of all patients admitted to the onco-hospitalist teaching service from August 2023 to February 2024 was employed to collect pre- and post-intervention data, and a run chart was created to plot rates of screening over time. Results: Of the pre-intervention cohort (n=263) from August to December 2023, 196 (74.5%) were identified as having anemia; of these patients, 109 (55.6%) underwent screening for nutritional causes of anemia during the admission. After our intervention was implemented, of all patients admitted to the service (n=186), a total of 156 (81.7%) were found to have anemia and 116 (74.3%) were screened for reversible causes of anemia. Almost all reversible causes of anemia were found to be secondary to iron deficiency. Conclusions: Our data shows that anemia is prevalent in our patient population yet inconsistently evaluated at baseline. At the same time, a combination of smart phrase utilization and education successfully increased rates of screening from 55.6% to 74.3% of patients admitted to the onco-hospitalist teaching service. One potential future endeavor is addition of a smartphrase to the admitting H&amp;P templates to prompt teams to consider reversible causes of anemia, especially iron deficiency, during the admission.

An Assessment of Growth Failure Indicators in the Neonatal Intensive Care Unit: A Quality Improvement Project

An Assessment of Growth Failure Indicators in the Neonatal Intensive Care Unit: A Quality Improvement Project

S262 Increasing Gastroenterology Follow-Up and Colonoscopy Completion for Patients With Initial and Complicated Episodes of Diverticulitis: A Quality Improvement Project

S262 Increasing Gastroenterology Follow-Up and Colonoscopy Completion for Patients With Initial and Complicated Episodes of Diverticulitis: A Quality Improvement Project

Quality Improvement Project Addressing Involuntary Discharged Hemodialysis Patients in an Urban, Predominantly Black US Population

Quality Improvement Project Addressing Involuntary Discharged Hemodialysis Patients in an Urban, Predominantly Black US Population

Communication, Shared Decision-making and Goals of Care in the ICU through Electronic Health Records: A Scoping Review.

The care of critically ill patients involves communication and shared decision-making with families and determination of goals of care. Analyzing these aspects through electronic health records (EHRs) can support research in ICUs, associating them with outcomes. This review aims to explore studies that examine these topics. A scoping review was conducted through a systematic literature search of articles in PubMed, Web of Science, and Embase databases using MESH terms up to 2024, conducted in ICU settings, focusing on communication with families, shared decision-making, goals, and end-of-life care. A total of 10 articles were included, divided into themes: Records and family, and records in quality improvement projects. Variables based on records with common characteristics were identified. Outcome analysis was performed through questionnaires to family members, healthcare professionals or by analyzing care processes. The studies revealed associations between family members' perceptions and mental health symptoms and documented elements such as communication, therapeutic limitations, social and spiritual support. Studies evaluating quality communication improvement projects did not show significant impact on documented care, except for those that assessed improvements based on palliative care. The analysis of documented care for critically ill patients can be conducted from various perspectives. Processes amenable to improvement, such as communication with family members, definition of goals of care, limitations, shared decision-making, evaluated through EHRs, are associated with mental health symptoms and perceptions of families of critically ill patients. Documentation-based studies can contribute to improvements in patient- and family-centered care in the ICU. de Aquino VW, da Silveira GF, Boniatti MM, Terres MS. Communication, Shared Decision-making and Goals of Care in the ICU through Electronic Health Records: A Scoping Review. Indian J Crit Care Med 2024;28(10):977-987.

Mitigating data inaccuracy and supply chain challenges in Western Romania's automotive industry

The purpose of this paper was to emphasize the importance of data accuracy within internal logistics systems and their extended influence on supply chains in automotive industry through 6-month multiple case studies conducted on 3 first tier original equipment manufacturers (OEM) based in Western Romania. The study investigates the most common causes of data inaccuracies among automotive suppliers and their approaches to reduce consequential supply chain issues and be more agile. Data collection and analysis revealed that main issues arise due to ordering quantities mismatching actual customer demand, a wide range of order lot sizes, lead times and delivery reliability concerns and the reluctance to shift away from mainstream cost-effectiveness and towards strategic added value thinking. These issues sourced significant other related operational challenges such as excessive inventory, short-term stockouts and subsequent express shipping services or product-related inconveniences (quality and capacity levels, contracted volumes and dedicated lines). The paper sources different logistics and supply chain strategies used by the 3 OEMs, their features and operational performance, as well as their overall effectiveness, which can be applied by other automotive industry suppliers to improve own results. Introducing more reliable real-time data collection tools and performance metrics has started hauling more focus towards solving these prevalent issues with some ongoing improvement projects showing up to 25% better results. For one of the 3 OEMs introducing a new warehouse management system has already sourced an overall quality increase (5 percentage points) due to a 60% higher utilization of its production equipment.

Using Neuropsychological Profiling to Tailor Mental Health Care for Children and Youth: a Quality Improvement Project to Measure Feasibility.

Precision child and youth mental healthcare has great potential to improve treatment success by tailoring interventions to individual needs. An innovative care pathway in a pediatric mental health outpatient clinic was designed to allow for neuropsychology data to be integrated in psychotherapeutic care. This paper describes the feasibility of this new pathway, including implementation outcomes, acceptability, and potential for future integration. The target population was outpatients 6-17years old referred for individual treatment to a tertiary outpatient mental health (OPMH) clinic. The new care pathway was co-developed by neuropsychologists and mental health practitioners. A logic model was created to guide the evaluation, which was informed by the Reach Effectiveness Adoption Implementation Maintenance framework. As part of the logic model, a stepped assessment protocol was implemented, and reports on neuropsychological function were shared with patients, caregivers, and care providers. Evaluation data were collected from phone surveys, questionnaires, a focus group, and administrative records. Forty-two patients scheduled to receive therapy over a 6-month period were offered the opportunity to participate in the new care pathway and 39 (93%) agreed. Self-reported outcome data showed that 83% of patients and 94% of caregivers valued neuropsychology-informed care, with some describing it as transformative. Almost all practitioners (91%) reported that the project added value to their clinical care. There were no adverse effects on participants nor the flow of patients through the system. Neuropsychology-informed pediatric OPMH care was feasible and well-received. Clinical effectiveness should be studied in an experimental trial.

Mobilizing strategic inflection points for sustainment of an effective intervention in an integrated learning health system: an interpretive description

BackgroundInnovative models of care have the potential to improve the sustainability of health systems by improving patient and provider experiences and population outcomes while simultaneously reducing costs. Yet, it is challenging to recognize the distinctive points during research and quality improvement processes that contribute to sustainment of effective interventions. The business concept of an inflection point—the position on the curve of a trajectory where the progress in implementation of an intervention is accelerated or decelerated—may be useful to understand implementation and improve sustainability and ultimately sustainment of effective interventions. The purpose of this study was to retrospectively identify and describe strategic inflection points that accelerated the sustainability process and led to the sustainment of Alberta Family Integrated Care.MethodsThis qualitative study was conducted in Alberta, Canada and employed an interpretive description design. Purposively sampled documents (proposals, project management plans, reports to funders and sponsors, meeting minutes, and fidelity audit and feedback checklists) from the Alberta Family Integrated Care cluster randomized controlled trial and quality improvement project constituted data for this study.ResultsTo accelerate sustainability in the research context, we identified (1) alignment with strategic priorities, (2) iterative, user-centered co-design, and (3) contextualization of implementation as strategic inflection points. To accelerate sustainability in the health system context, we identified (1) the learning health system, (2) enduring partnerships, (3) responsivity to societal and system change, (4) embedded governance, and (5) intentional integration into the health system as strategic inflection points. Capitalizing on these strategic inflection points led to sustainment of Alberta Family Integrated Care in the provincial health system.ConclusionsWe identified key inflection points in the research and health system contexts that led to sustainment of Alberta Family Integrated Care. By anticipating, recognizing, and leveraging inflection points in the sustainability process, researchers may be able to accelerate implementation and achieve sustainment of multi-component interventions in complex systems.Trial registrationClinicalTrials.gov: NCT02879799. Registration date: May 27, 2016. Protocol version: June 9, 2016; version 2. Protocol publication: https://doi.org/10.1186/s13063-017-2181-3.

Remote Diagnosis of Retinal Detachment in an Emergency Department Using Nonmydriatic Hybrid Ocular Imaging.

Background: Ocular emergencies are commonly evaluated in general emergency departments (ED) where ophthalmologists are rarely available. Nonmydriatic ocular imaging combining color fundus photographs and optical coherence tomography (NMFP-OCT) can help with rapid remote triage by ophthalmologists. We evaluated the rate at which retinal detachments (RDs) can be diagnosed with NMFP-OCT in the ED. Methods: Quality improvement project with prospective collection of data on RD patients who had NMFP-OCT obtained by ED staff over 1 year. Photographs were interpreted remotely by ophthalmologists and all patients underwent an in-person ophthalmologic examination in the ED to confirm the presence of a RD. Results: A total of 63 eyes (58 patients) had a RD, among which 53 (84.1%) had strong suggestion of RD on ocular imaging (34 [54%] were seen on both color and OCT nerve/macula; 11 [17.5%] were seen on color but missed on OCT; 8 [12.7%] were missed on color but seen on OCT). Ten RDs (15.9%) were missed on both color and OCT because of peripheral location of the RD (4, 40%), vitreous hemorrhage (4, 40%), or poor image quality (2, 20%). A total of 40 out of 58 patients were not seen by an eye care provider prior to reaching our ED and 10 had an inappropriate stroke workup for acute vision loss of presumed vascular origin. Conclusion: NMFP-OCT of the posterior pole obtained by ED staff revealed the RD in 84.1% of eyes, allowing for rapid remote triage of patients with visual symptoms and avoiding unnecessary testing when the diagnosis of RD is confirmed.

INJECTION OF TWO-COMPONENT GEOPUR RESIN FOR STRENGTHENING SANDY SOILS

The article explores the use of GEOPUR, a two-component polyurethane resin, for strengthening sandy soils. It highlights the process of soil stabilization through high-pressure grouting, which improves water resistance, stabilizes soil structures, and enhances anchoring strength. The research investigates the application of this resin in consolidating weak, loose soils and its effect on their physical and mechanical properties. Laboratory experiments were conducted on sand samples to simulate real-world conditions, testing the resin's effectiveness in improving soil density, compressive strength, and overall stability. The study analyzes how the resin's expansion within the soil structure impacts soil behavior, concluding that the GEOPUR resin significantly enhances the soil's load-bearing capacity. Various parameters, such as the volume of injected resin, consolidation efficiency, and the strength-density relationship, are evaluated to provide practical recommendations for soil stabilization using this innovative material. The findings demonstrate the resin's potential in geotechnical applications, particularly in situations where traditional stabilization methods are not feasible or efficient. The article concludes with suggestions for optimizing the resin injection process to maximize its effectiveness in both laboratory and field conditions, making it a promising solution for future ground improvement projects.

Use of Two Pain Assessment Tools to Improve Pain Recognition in Post Stroke Patients: A Quality Improvement Project

Abstract Background Post stroke patients can suffer from a variety of complex pain syndromes. These are often associated with decline in function, cognitive impairment, impaired quality of life and mood disturbances. Pain identification can be challenging in this population, due to stroke deficits that impair communication, and associated medical conditions that can affect the patient’s ability to self-report pain. This Quality Improvement (QI) project aims at implementing two pain assessment tools to support clinicians assess pain in a structured manner, and thereby improve pain management. Methods An initial audit was performed to identify whether post stroke pain (PSP) was being recorded in a reliable manner in St Mary's hospital. A pain assessment proforma was then designed, incorporated in the admission proforma and rolled-out for use. This included two pain assessment tools: the Numerical Pain Scale for patients who could self-report pain, and the Abbey Pain Scale for patients with communication difficulties. A second audit was performed to analyse the compliance to documentation and a qualitative evaluation of its use was also conducted in semi-structured staff interviews. Results The first audit showed pain being under reported with only 25% of patients having formal pain assessment documented on admission. The second audit showed improvement in pain assessment with 72.7% pain documentation. Qualitative evaluation revealed staff expressing challenges with pain identification in post stroke patients and viewed the proforma as a useful prompt. Limitations to the use of observational tools included time constraints, lack of familiarity with tools and potential inaccuracy of scores. Conclusion Identification of PSP is key to optimising treatment, and hence improving function and quality of life of stroke patients. This QI project shows that the use of pain assessment tools, in combination with detailed clinical assessment can help pain assessment. Clinician awareness and continuous training are required to support this challenging task.

Development and Implementation of a Venous Thromboembolism Prophylaxis Protocol in the Rehabilitation Setting – A Completed Audit Cycle

Abstract Background 63% of all Venous Thromboembolic disease (VTE) is hospital-acquired, and 70% of hospital-acquired VTE is potentially preventable with appropriate prophylaxis. NICE recommends a VTE risk assessment for all patients admitted to acute hospitals within 24 hours. Validated risk assessment models for acute hospitals enhance provision of thromboprophylaxis, but no such protocols exist for the rehabilitation setting. The aims of this audit were to determine if VTE risk assessments are occurring on admission and during acute illness in rehabilitation wards, to assess the proportion of rehabilitation inpatients receiving VTE prophylaxis, and to develop and pilot a VTE Prophylaxis Protocol. Methods An initial audit was carried out on three rehabilitation wards in May/June 2023. A VTE Prophylaxis Protocol was developed based on the HSE VTE Prevention Program template, incorporated into the admission booklet on 3 pilot wards in February 2024, and practice re-audited in April 2024. Results Pre-intervention, 41 patient records were assessed. 0 patients (0%) had a documented VTE risk assessment on admission, 23(56%) had therapeutic anticoagulation continued, and 3(7%) commenced appropriate VTE prophylaxis on admission. 8 eligible at-risk patients did not receive prophylaxis. Post intervention, all patients (n=25) on the three pilot wards were re-audited. 10 patients (40%) had a documented VTE Risk assessment within 24 hours of admission, 9(36%) had therapeutic anticoagulation continued, and 5(20%) received appropriate VTE prophylaxis on admission (2 without a documented risk assessment). 3 at-risk patients did not receive prophylaxis (1 with a completed risk assessment), and 1 risk-assessed patient inappropriately received prophylaxis. Conclusion Implementation of a VTE Prophylaxis Protocol improved VTE risk assessment in rehabilitation. This small sample however did not demonstrate an association between prophylaxis prescription and use of the protocol. Further education and feedback is required to increase use of the protocol as part of this ongoing quality improvement project.

A Quality Improvement Project On The Introduction Of A Nurse-Led, Patient Self-Monitored Blood Pressure Telehealth Platform

Abstract Background Telehealth is a strategy for health and wellbeing promotion. Hypertension is a modifiable risk factor in vascular health. Timely, reliable and accessible identification of this risk is important. Working within an interdisciplinary ambulatory neurovascular hub, a nurse-led model of service provided the opportunity to effectively identify and modify this risk through the secondary prevention measure of hypertension management. Methods An interdisciplinary neurovascular service quality improvement group, the “Stroke Big Room”, evaluated service models and telehealth platforms for patient-self monitoring of hypertension. The telehealth “Florence” platform was introduced. An accompanying Patient Information Leaflet was developed with the Communications Team within the Trust. Patients with a blood pressure of 130/80mmHg and a confirmed diagnosis of minor stroke or transient ischaemic attack were offered the “Flo” platform. Results A 20-patient sample found: 50% required no treatment change, 30% were commenced on antihypertensive treatment and 20% required antihypertensive dose increase. In the 2023/24 financial year, 285 patients participated in the Flo platform. Conclusion Timely identification and modification of hypertension is a reversible risk factor for neurovascular disease. A nurse-led service for the provision of, education on and support in use of a telehealth monitoring platform is an effective approach. This service model allows for effective secondary prevention treatment in a rapid and accessible way. The telehealth platform “Flo” was accessible to patients on the basis of patient reported outcome measures. As a result of the use of the platform, pharmacotherapeutic interventions occurred in 50% of participants in this telehealth programme.

Location, Location, Location- Impact Of Introducing A Local Clinic On Clients’ Waiting Time, Travel Time And Cost

Abstract Background Comprehensive Geriatric Assessment (CGA) is the first, essential step to develop and implement a coordinated and integrated plan for older persons’ care. The National Clinical Programme for Older People recommends that older adults identified as being frail or at risk of frailty should have a timely CGA performed (HSE 2012). This pilot quality improvement project relates to a recently established (June 2023) Integrated Care Programme for Older Persons (ICPOP) team. As our current office lies in a different county to our clients’ homes, all CGAs have been domiciliary to date. This project aims to investigate if running a clinic closer to clients’ homes could result in earlier CGA and reduce travel time and cost. Methods Three CGA-pilot clinics occurred over six weeks (29thFebruary-11thApril 2024 inclusive). Clients’ addresses, Clinical frailty Scale (CFS), average waiting time six weeks prior to and during the CGA-clinic period was recorded. Staffing was unchanged during data collection. Distance between office and clients’ homes was calculated using Google Maps. Travel time was calculated on the same weekday at the same time as CGA-clinics ran. As clinicians tend to conduct consecutive visits, unidirectional distances only were populated. National Integrated Staff Records and Pay Programme system was used to calculate mileage cost. Results Of twelve clients that confirmed their appointment, eleven clients attended clinic (92% attendance rate). All were frail or at risk of frailty (CFS ≥4). Average waiting time reduced from 28 days to 23 days post introduction of CGA-clinic. Clinicians saved a total of 3 hours 38 minutes, and 44.31 euro was saved on mileage. Conclusion Pilot shows the benefits of offering in-clinic CGA closer to home in terms of reducing waiting time, optimising clinician time and reducing cost. Client satisfaction and numbers of clinicians seen will be included in the next steps of this ongoing project.