Quality Improvement Methods Research Articles

Encapsulated donor faeces for faecal microbiota transplantation: the Glyprotect protocol.

Faecal microbiota transplantation (FMT) is a highly effective treatment for Clostridioides difficile infection. Its use is backed by solid evidence, but application methods differ. Encapsulated FMT is a non-invasive, patient-friendly and scalable application method that may be preferred over colonoscopy or nasoduodenal tube application. We describe a detailed protocol, the Glyprotect protocol, for producing glycerol-based capsules to increase FMT accessibility. Using iterative quality improvement methods, we developed and validated the Glyprotect protocol as a reproducible protocol for cryopreserving minimally processed donor faeces in a standard hospital laboratory setting. We describe detailed standard operating procedures for producing glycerol-based capsules, including all necessary materials and troubleshooting guidelines. Capsule integrity was tested at various temperatures and pH levels. Flow cytometry was used to measure microbiota counts and dose accuracy. The Glyprotect protocol has been used for more than 2500 capsule-based FMT treatments and complies with European tissue and cell standards. The protocol is optimised to preserve microbes and minimise modulation of the donated microbiota by removing debris and water, which also reduces the number of capsules needed per FMT treatment. The intestinal microbiota is preserved in glycerol for cryoprotection and to prevent capsule leakage. Each capsule contains 650 µL microbe-glycerol mass, estimated to contain an average of 2.5 × 108 non-specified bacteria. The Glyprotect protocol enables hospitals and tissue establishments to set up capsule production in a standard laboratory, improving patients' access to FMT. The protocol facilitates the scalability of FMT services because capsule FMT is less time-consuming and less expensive than liquid-suspension FMT applied by colonoscopy or nasojejunal tube. Not applicable.

Evaluating theory of change to improve the functioning of the network for improving quality of care for maternal, newborn and child health.

In 2017, WHO and global partners launched 'The Network for Improving Quality of Care for Maternal, Newborn and Child Health' (QCN) seeking to reduce in-facility maternal and newborn deaths and stillbirth by 50% in health facilities by 2022. We explored how the QCN theory of change guided what actually happened over 2018-2022 in order to understand what worked well, what did not, and to ultimately describe the consequences of QCN activities. We applied theory of change analysis criteria to investigate how well-defined, plausible, coherent and measurable the results were, how well-defined, coherent, justifiable, realistic, sustainable and measurable the assumptions were, and how independent and sufficient the causal links were. We found that the QCN theory of change was not used in the same way across implementing countries. While the theory stipulated Leadership, Action, Learning and Accountability as the principle to guide network activity implementation other principles and varying quality improvement methods have also been used; key conditions were missing at service integration and process levels in the global theory of change for the network. Conditions such as lack of physical resources were frequently reported to be preventing adequate care, or harm patient satisfaction. Key partners and implementers were not introduced to the network theory of change early enough for them to raise critical questions about their roles and the need for, and nature of, quality of care interventions. Whilst the theory of change was created at the outset of QCN it is not clear how much it guided actual activities or any monitoring and evaluation as things progressed. Enabling countries to develop their theory of change, perhaps guided by the global framework, could improve stakeholder engagement, allow local evaluation of assumptions and addressing of challenges, and better target QCN work toward achieving its goals.

Implementing Effective Care in a University Population Based on National Vaccination Recommendations.

Vaccines are among the most cost-effective and successful medical interventions, saving approximately 2.3 million lives annually. Unfortunately, vaccination coverage for adults remains low, leading to unnecessary and costly health consequences. An initial chart review revealed that 95% (N = 20) of students were not up to date with vaccines. In a patient survey, 100% of students (N = 21) did not recall receiving useful vaccine information, but 66.7% reported it would be helpful (≥4 of 5 on the Likert scale). Strategies supporting effective care, an Institute of Medicine quality domain, were used to address these gaps. The aim was to increase effective care in university adult students for vaccines by 30% over 90 days. The quality improvement method of Plan-Do-Study-Act cycles was used to evaluate iterative tests of change. Examining contextual elements, team and patient feedback, aggregate data, and run charts informed tests of change over 4 cycles. Core interventions included enhanced screening, vaccine shared decision-making, provider checklists, and a team engagement plan. Greater than 83% (N = 152) of students were not up to date with vaccines as per national guidelines. Over 8 weeks, the team effectively referred students for 265 of the 274 vaccines they were eligible for-an accuracy rate of 95.3%. The aim score, a mean composite score reflecting all 3 interventions, increased from 49% to 95%. Effective care for vaccine uptake increased by 83.8%-far exceeding the goal. Campus health centers and other primary care settings could benefit from adopting a similar strategy that provides clear benefits to patients and the broader community while decreasing health care costs.

Improving maternal update rates within the first hour of NICU admission.

Timely communication is essential in attaining maternal satisfaction, developing an excellent physician-patient rapport, and increasing trust. This study reports a significant improvement in maternal communication rates through the quality improvement method. An educational module was developed, and NICU staff was presented with the slides, followed by a performance questionnaire to demonstrate understanding. The first phase was completed by obtaining feedback from mothers through a questionnaire. The first plan-do-study-act (PDSA) cycle, carried out for eight weeks looking at the rates of the maternal update provided within an hour of admission of their neonates to the NICU, was followed by the second PDSA cycle, carried out for ten weeks. The improvement was calculated using conventional statistics and a statistical process control chart. During the first phase of the study, thirty-six percent of the mothers were updated within an hour of admission of their neonates to the NICU. During the first PDSA cycle, we did not notice a special cause variation or process change. A significant shift, eight consecutive points above the mean, was noted on the control chart during PDSA cycle 2. The mean±SD of the weekly update rate increased significantly during PDSA cycle 2 (76.8±11) compared to PDSA cycle 1 (47.5±14), p-value = 0.0002. We improved the maternal update rates through the educational module following the QI improvement model using the PDSA cycles.

Learning from new colorectal cancers: a qualitative synthesis of significant event reports.

Colorectal cancer is the second leading cause of cancer-related mortality in the UK and a significant contributor to morbidity and mortality worldwide. Early diagnosis provides opportunities for intervention and improved survival. Significant event analysis (SEA) is a well-established quality improvement method for learning from new cancer diagnoses. To provide additional insights into diagnostic processes for colorectal cancer and to identify areas for improvement in patient care pathways. Fifty-three general practices across Pennine Lancashire, England, submitted one or more SEA reports as part of an incentivised scheme. A standardised data collection form was used to collate learning points and recommendations for improvements. In total, 161 reports were analysed using an inductive framework analysis approach. There was an overarching theme of building vigilance and collaboration between and within general practices and secondary care. The following four main sub-themes were also identified: education; individualised and flexible care; ownership and continuity; and communication. These findings provide additional insights into colorectal cancer pathways from a primary care perspective. Practices should be supported in developing protocols for assessment and follow-up of patients with varying presentations. Screening and access to investigations are paramount for improving early diagnosis; however, a flexible diagnostic approach is required according to the individual circumstances of each patient.

Application of failure mode and effect analysis in ICU admission of potentially COVID-19 infected patients

To analyze the admission and treatment process of potentially COVID-19-infected patients in the intensive care unit under normalization, prevention, and control of the pandemic. A multidisciplinary team was assembled to develop a flowchart of potentially COVID-19-infected patients admitted to the intensive care unit and identify potential failure steps and modes throughout the process using the failure mode and effect analysis method. Through risk priority number (RPN) analysis of each failure mode, those with the highest impact on nosocomial infection were identified, and the priority of implementation was determined. Related corrective measures have been developed to continuously improve clinical practice and management. Eighty potential failure modes were identified, and 8 potential failure modes were identified with RPNs greater than 100. These high RPNs of the failure modes were associated with careless inquiries of epidemiological histories by nurses, inadequate implementation of management standards by nursing assistants, and exposure of attending physicians to potentially risky environments. Finally, 18 general corrective measures are proposed. Application of the failure mode and effect analysis method for quality improvement is a powerful tool for predicting potential failures in the process and can suggest corrective measures that could help avoid nosocomial infection during a pandemic.

Abstract C112: Improving breast cancer screening disparities through A3 problem solving: Design of a quality improvement initiative

Abstract Introduction: Extensive research studies on breast cancer disparities have had limited impact on reducing breast cancer disparities. Quality improvement initiatives use data-driven, rigorous approaches to plan, execute, and study the delivery of healthcare services. There have been limited studies using quality improvement methods to address health disparities. The purpose of our study was to describe the design of a quality improvement initiative to address breast cancer disparities using the A3 problem solving method. Methods: A3 problem solving method was used to reduce breast cancer screening disparities. The A3 method is a quality improvement tool used to identify problems, organize and synthesize data, and propose solutions to achieve goals (summarized on one side of a sheet of paper). A3 methods are outlined by the FOCUS-PDCA acronym: F - Find process to improve, O - Organize team of stakeholders, C - Clarify current state, U - Understand sources of variation that contribute to the problem, S - Select change ideas, P - Plan and do the improvement, C - Check the results, A - Act. Quantitative data was derived from the electronic medical record. Qualitative data was derived from divergent thinking exercises asking participants from diverse standing urban stakeholder groups about barriers to cancer screening. Results: Design of the A3 problem solving process was conducted between November 2022 until May 2023 yielding the following FOCUS-PDCA design and initial results. F - Increase the percentage of patients who have undergone mammography screening within the last two years. O - Team includes representative leaders from primary care, community health, ambulatory operations, diversity, equity, and inclusion, radiology, breast center, population health, information services, and federally qualified health centers. C and U - Quantitative data collection revealed that 74% of 37,509 eligible patients (women between 50-74 years old) received a mammogram within the last two years (75% White, 58% Black, 67% Asian, 60% American Indian, 64% Hispanic). Divergent thinking exercises revealed the following root causes for mammography screening disparities: patients don’t know they are due, transportation issues, barriers to scheduling, access to mammography facilities, financial concerns, and fears about returning to clinics during COVID-19. S - Process improvements included multilingual and modality reminders, marketing campaigns, transportation vouchers, co-location of screening centers with federally qualified health centers, expanded access to mammography screening facilities, educational activities for primary care physicians, participation in community events, equity-focused review of screening guidelines. PDCA - Based on selected improvements, changes in breast cancer screening percentages will be displayed using run charts until December 2024, stratified by race and ethnicity. Conclusion: A3 problem solving tools represent structured, scientifically rigorous approaches that cancer centers can use to reduce screening disparities. Citation Format: Nia Foster, Arissa J. Milton, Mai A. Elezaby, Roberta M. Strigel, Meeghan A. Lautner, Ryan W. Woods, Nicci O. Brackett, Noelle K. LoConte, Anand K. Narayan. Improving breast cancer screening disparities through A3 problem solving: Design of a quality improvement initiative [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C112.

Improving Semantic Segmentation Performance in Underwater Images

Nowadays, semantic segmentation is used increasingly often in exploration by underwater robots. For example, it is used in autonomous navigation so that the robot can recognise the elements of its environment during the mission to avoid collisions. Other applications include the search for archaeological artefacts, the inspection of underwater structures or in species monitoring. Therefore, it is necessary to improve the performance in these tasks as much as possible. To this end, we compare some methods for image quality improvement and data augmentation and test whether higher performance metrics can be achieved with both strategies. The experiments are performed with the SegNet implementation and the SUIM dataset with eight common underwater classes to compare the obtained results with the already known ones. The results obtained with both strategies show that they are beneficial and lead to better performance results by achieving a mean IoU of 56% and an increased overall accuracy of 81.8%. The result for the individual classes shows that there are five classes with an IoU value close to 60% and only one class with an IoU value less than 30%, which is a more reliable result and is easier to use in real contexts.

Promotion of school readiness in home visiting: creating a key driver diagram for continuous quality improvement

ABSTRACT School readiness is a topic of great interest to early childhood and maternal child health initiatives, such as the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programme. However, there is a lack of information about best practices or strategies in home visiting and their relative effectiveness in improving school readiness, making this topic appropriate for improvement through Continuous Quality Improvement (CQI) methods. In 2022, Alabama developed a Key Driver Diagram (KDD) for improving school readiness efforts within the home visiting programme using synchronous online focus groups as a method of qualitative data collection with early childhood and home visiting experts. Findings from this study include development of a KDD that includes aims, key drivers, and secondary drivers. The KDD represents the first of many steps toward a unified theory of change. Future efforts will include development of a CQI change package and testing change ideas in the field.

Peer groups for medical professionals in Ukraine: experience of implementing an innovative format of continuing professional development

The training of medical professionals does not end with graduation – continuing professional development (CPD) should be integrated in the professional life of each medical professional. Peer groups, an innovative format of CPD, were launched in the Netherlands in 1979. Subsequently, in 1980-1990, this format spread to other European countries and became an important method of quality improvement in primary health care. Research on peer groups is rare, and especially for Eastern Europe. The purpose of this study, which is unique for the region and Ukraine, is to describe the context and results of implementation and functioning of the first peer groups in Ukraine among doctors, nurses, and primary care managers. The methodology of the study is a case study, which was implemented through (a) data analysis – a description of the experience that was independently prepared by the facilitators of the newly created peer groups, reflected in text and graphic information on posters, and voiced their stories orally during the Congress of Peer Group Facilitators (October 2021), (b) analysis of facilitators’ publications on social media that highlight their experience, (c) analysis of semi-structured interviews during supervision and organizational meetings on the implementation and development of peer groups, (d) analysis of an expert interview with a Swiss medical doctor who was also involved in the development of peer groups in Ukraine. The results of the study are as follows: more than half of the trained facilitators have created their own peer groups; such groups have been functioning for several years despite COVID-19 and Russia’s full-scale invasion of the sovereign territory of Ukraine. Facilitators and participants of peer groups emphasize not only the educational contribution of peer groups to their profession, but also the social and psychological one. Barriers to the creation and sustainability of peer groups include lack of management support, lack of time, motivation and formal incentives (CPD points). Peer groups as one of the approaches to continuous professional development are gradually creating a culture of learning in healthcare facilities, bringing more trust in the interaction of professionals with each other and improving the quality of care provided.

MSME EMPOWERMENT AND DEVELOPMENT PROGRAM TO INCREASE CONSUMER SATISFACTION

The primary aim of this study is to examine the efficacy of an MSME empowerment and development initiative in enhancing consumer satisfaction at the Warung Nasi Hj establishment. Artificial intelligence (AI) is a field of study and research that focuses on the development The approach employed in this service encompasses the utilisation of customer surveys, interviews conducted with store owners, as well as the analysis of both qualitative and quantitative data. Dedication has observed a noteworthy enhancement in consumer satisfaction as a result of the adoption of a complete empowerment programme, encompassing initiatives such as product quality improvement, employee training, and novel marketing methods. The findings of the survey indicate that consumers have observed favourable improvements in various aspects, including product quality, customer service, and overall experience at Warung Nasi Hj. Ai. In addition to this, stall proprietors also observed an increase in revenue and a greater portion of the market. The aforementioned findings demonstrate that the implementation of programmes aimed at empowering and developing micro, small, and medium enterprises (MSMEs) can effectively enhance the quality of MSME operations and yield sustainable profits through the augmentation of consumer happiness and business expansion. This study aims to investigate the relationship between consumer satisfaction, empowerment of micro, small, and medium enterprises (MSMEs), business development, and marketing strategy.

Implementation of an electroencephalogram-guided propofol anesthesia practice in a large academic pediatric hospital: Aquality improvement project.

Propofol-based total intravenous anesthesia is gaining popularity in pediatric anesthesia. Electroencephalogram can be used to guide propofol dosing to the individual patient to mitigate against overdosing and adverse events. However, electroencephalogram interpretation and propofol pharmacokinetics are not sufficiently taught in training programs to confidently deploy electroencephalogram-guided total intravenous anesthesia. We conducted a quality improvement project with the smart aim of increasing the percentage of electroencephalogram-guided total intravenous anesthesia cases in our main operating room from 0% to 80% over 18 months. Balancing measures were number of total intravenous anesthesia cases, emergence times, and perioperative emergency activations. The project key drivers were education, equipment, and electronic health record modifications. Plan-Do-Study-Act cycles included: (1) providing journal articles, didactic lectures, intraoperative training, and teaching documents; (2) scheduling electroencephalogram-guided total intravenous anesthesia teachers to train faculty, staff, and fellows for specific cases and to assess case-based knowledge; (3) adding age-based propofol dosing tables and electroencephalogram parameters to the electronic health record (EPIC co, Verona, WI); (4) procuring electroencephalogram monitors (Sedline, Masimo Inc). Electroencephalogram-guided total intravenous anesthesia cases and balancing measures were identified from the electronic health record. The smart aim was evaluated by statistical process control chart. After the four Plan-Do-Study-Act cycles, electroencephalogram-guided total intravenous anesthesia increased from 5% to 75% and was sustained at 72% 9 months after project completion. Total intravenous anesthesia cases/mo and number of perioperative emergency activations did not change significantly from start to end of the project, while emergence time for electroencephalogram-guided total intravenous anesthesia was greater statistically but not clinically (total intravenous anesthesia without electroencephalogram [16 ± 10 min], total intravenous anesthesia with electroencephalogram [18 ± 9 min], sevoflurane [17 ± 9 min] p < .001). Quality improvement methods may be deployed to adopt electroencephalogram-guided total intravenous anesthesia in a large academic pediatric anesthesia practice. Keys to success include education, in operating room case training, scheduling teachers with learners, electronic health record modifications, and electroencephalogram devices and supplies.

Initiation of Palliative Care Referral from the Intensive Care Unit for Advanced Stage Metastatic Cancer Patients: A Quality Improvement Process from a Tertiary Referral Cancer Institute from South India.

Critically ill cancer patients in the intensive care unit (ICU) did not have any palliative care (PC) intervention as there was no PC referral from the ICU. The project aimed to initiate PC referral for at least 50% of progressive palliative intent cancer patients in intensive care to enhance communication with patients and caregivers. We included PC physicians, oncologists, and psychologists in the team for this project. We used the A3 problem-solving method of quality improvement (QI) and also used the Plan Do Check Act process. The first baseline assessment over 6 months of ICU deaths of patients who could have benefited from PC referral was collected; this made us realise that PC could have been initiated for some patients. Process maps of patient admission into the ICU and the process of their discharge were constructed. Analysis of root causes that were barriers to referral was examined. We made a PC trigger tool after team consultations and consensus and started using it to initiate PC referrals. PC discharge protocol was also initiated. Educational discussions were held with residents and nurses to ensure the continued use of the trigger tool. PC referral from intensive care slowly went up from 0% to beyond 50% by November 2019 and reached over 70% by March 2020; patients getting discharged had details of PC centres near their homes. Structured QI process and introducing the PC trigger tool led to the outcome of 50% PC referral for critically ill patients in ICU.

Multidisciplinary Initiative to Increase Guideline-concordant Antibiotic Prescription at Discharge for Hospitalized Children with Uncomplicated Community-acquired Pneumonia

Background: Clinical practice guidelines recommend using narrow-spectrum antibiotics to treat uncomplicated pneumonia in children. This quality improvement (QI) project aimed to evaluate if QI methods could improve guideline-concordant antibiotic prescribing at hospital discharge for children with uncomplicated pneumonia. Methods: For this single-center QI project, we implemented QI interventions in serial plan-do-study-act cycles, focusing on the key drivers targeting general pediatric inpatient resident teams. Interventions included: (1)Small bimonthly group didactic sessions, (2)Visual job aids posted in resident work areas, and (3) A noon conference session. Balancing measures included postdischarge emergency room visits, readmission and adverse drug reactions. Results: To establish a baseline rate, we conducted a chart review of 112 children diagnosed with uncomplicated community-acquired pneumonia during hospitalization from July 2017 through January 2019. The average monthly percentage of children discharged with guideline-concordant antibiotics was 67%. The intervention period was from February 2019 through February 2020, with 118 children meeting the criteria after a review of 262 charts. After our interventions, the average monthly percentage of children discharged with guideline-concordant antibiotics increased to 87%, with the increase persisting for at least 12 months. There were no significant differences in balancing measures pre- and post-interventions. Conclusions: Our QI initiative sustained increased rates of uncomplicated community-acquired pneumonia guideline-concordant antibiotic prescribing at discharge over 12 months without an increase in balancing measures. The enduring changes in prescribing behavior suggest a lasting impact of our interventions.

Factoring patients' beliefs and values into decisions around anticoagulation: a community-led multi-cycle quality improvement project

Low-molecular-weight heparin (LMWH), prescribed for prophylaxis of venous thromboembolism, is derived from porcine animal products. An audit in our Trust showed that most healthcare professionals (95%, n=58/61) did not consider religious or dietary preferences when prescribing LMWH. Focus groups with local stakeholders helped develop project aims. Quality improvement methods were used to develop, test and optimise interventions over two cycles in our medical unit. Interventions included written and audiovisual information for patients, a staff eLearning module, a policy to guide switching from LMWH to a synthetic alternative and a written prompt reminding doctors to consent patients before prescribing LMWH. The proportion of patients being appropriately consented for LMWH prescriptions increased following our interventions (from <5% at baseline to >80%). Patient and staff feedback was positive, with high demand for a non-animal-derived alternative to LMWH. Simple measures, increasing awareness and knowledge among staff and patients, can improve the number of patients being appropriately consented for LMWH prescriptions.

The quality improvement method of vibroseis records

Vibroseis seismic acquisition technology is a method of acquiring seismic data utilizing correlation technology. Specifically, the seismic single shot record is obtained through correlation between the reference signal and the mother record. Specifically, the seismic single shot record is obtained through correlation between the reference signal and the mother record. Specifically, the seismic single shot record is obtained through correlation between the reference signal and the mother record. In line with pertinent technical regulations, greater correlation between the two signals equates to superior correlation outcomes. The reference signal is transmitted to the surface via the vibration of the vibrating plate. This is achieved using the vibroseis machine. However, due to the coupling relationship between the vibrating plate and the surface, the vibration signal output by the former is not equivalent to the vibration signal received by the latter. Consequently, the correlation between the reference signal and parent record fails to procure the best correlation result. In this paper, a technique is presented for establishing a correlation between the surface vibration signals captured by the geophone in proximity to the vibroseis and the reference record. This approach improves the quality of the correlated single shot, and holds significant potential for broad dissemination.

Using Theories, Models, and Frameworks to Inform Implementation Cycles of Computerized Clinical Decision Support Systems in Tertiary Health Care Settings: Scoping Review.

Computerized clinical decision support systems (CDSSs) are essential components of modern health system service delivery, particularly within acute care settings such as hospitals. Theories, models, and frameworks may assist in facilitating the implementation processes associated with CDSS innovation and its use within these care settings. These processes include context assessments to identify key determinants, implementation plans for adoption, promoting ongoing uptake, adherence, and long-term evaluation. However, there has been no prior review synthesizing the literature regarding the theories, models, and frameworks that have informed the implementation and adoption of CDSSs within hospitals. This scoping review aims to identify the theory, model, and framework approaches that have been used to facilitate the implementation and adoption of CDSSs in tertiary health care settings, including hospitals. The rationales reported for selecting these approaches, including the limitations and strengths, are described. A total of 5 electronic databases were searched (CINAHL via EBSCOhost, PubMed, Scopus, PsycINFO, and Embase) to identify studies that implemented or adopted a CDSS in a tertiary health care setting using an implementation theory, model, or framework. No date or language limits were applied. A narrative synthesis was conducted using full-text publications and abstracts. Implementation phases were classified according to the "Active Implementation Framework stages": exploration (feasibility and organizational readiness), installation (organizational preparation), initial implementation (initiating implementation, ie, training), full implementation (sustainment), and nontranslational effectiveness studies. A total of 81 records (42 full text and 39 abstracts) were included. Full-text studies and abstracts are reported separately. For full-text studies, models (18/42, 43%), followed by determinants frameworks (14/42,33%), were most frequently used to guide adoption and evaluation strategies. Most studies (36/42, 86%) did not list the limitations associated with applying a specific theory, model, or framework. Models and related quality improvement methods were most frequently used to inform CDSS adoption. Models were not typically combined with each other or with theory to inform full-cycle implementation strategies. The findings highlight a gap in the application of implementation methods including theories, models, and frameworks to facilitate full-cycle implementation strategies for hospital CDSSs.

Investigating the Effect of the 7S Technique on Performance Management and Productivity of Operating Room Staff: An Interventional Study

Background: One of the most important issues in a health care system is the performance management and productivity of employees. Sigma technique is a quality improvement method, which has proved effective in many organizations and has recently been used in the health care system, especially in the operating room. The aim of this study was to investigate the effect of the Seven Sigma technique (7S) on performance management and productivity of operating room staff in selected educational and medical centers of Iran University of Medical Sciences. Methods: In this interventional research, the study population consisted of 45 operating room staff including technicians, technologists, and surgeons. Before the intervention, a WhatsApp channel was created to gather group members. Then, over the course of three weeks, the principles of the Seven Sigma technique were gradually sent to the research population, and participants were asked to carefully review the materials. Every three days, after posting a question in the channel to ensure understanding of the previous topic, the next section was also posted in the channel. Then, after three weeks, a productivity questionnaire was sent to the research population, and using a researcher-made checklist, the performance of the employees was evaluated. Standard statistical methods were used to analyze the data in SPSS version 22.0. Results: From a total of 45 staff, 62% were women and 38% were men. The majority of subjects (36%) were between 24 and 28 years old. The majority of personnel (89%) had a university degree in operating room, and most of them (84%) had a bachelor’s degree. Most of the staff (91%) worked rotating shifts during the month. There was a significant difference between the pre-test and post-test mean scores of performance management (P&lt;0.001). There was also a significant difference between the pre-test and post-test mean scores of productivity (P&lt;0.001). Conclusion: The findings indicated the effectiveness of the 7S technique in performance management and productivity of the staff. Therefore, the relevant authorities are requested to increase performance management using the 7S technique to reduce defects and problems limiting the efficiency of personnel in the operating room. This method can also be practical and useful for other wards of hospitals.

Implementation of a Children's Hospital Acute Care Behavior Response Team.

Pediatric patients with behavioral needs are frequently admitted to the hospital for medical care; when behavioral crises occur, patients and staff are at risk for injury. Our aim was to implement a behavior response team (BRT) to increase the days between employee injury due to aggressive patient interactions on the inpatient medical units from 99 to 150 over 1 year. A multidisciplinary team used quality improvement methods to design and implement the BRT system that includes 2 options: huddle to proactively plan for patients exhibiting early signs of escalation and STAT for immediate help for patients with imminent risk of harm to self or others. Using run and statistical process control charts, we tracked events per month, days between Occupational Safety & Health Administration-recordable events, and violent restraint use over time for 1 year after implementation. Staff pre and postimplementation surveys were compared to assess staff perception of safety and support provided by the BRT intervention. The BRT was implemented across the inpatient system in July 2020, with an average number of 13 events per month. Days between Occupational Safety & Health Administration-recordable events remained stable with a maximum of 134 days. Restraint use remained stable at 0.74 per 1000 patient days. The perception of behavioral support available to staff increased significantly pre to postsurvey. The implementation of a BRT can improve staff perception of support and confidence in safely caring for patients with behavior needs on the inpatient medical unit, although additional provider- and system-level improvements are needed to prevent employee injuries.

An Image Quality Improvement Method in Side-Scan Sonar Based on Deconvolution

Side-scan sonar (SSS) is an important underwater imaging method that has high resolutions and is convenient to use. However, due to the restriction of conventional pulse compression technology, the side-scan sonar beam sidelobe in the range direction is relatively high, which affects the definition and contrast of images. When working in a shallow-water environment, image quality is especially influenced by strong bottom reverberation or other targets on the seabed. To solve this problem, a method for image-quality improvement based on deconvolution is proposed herein. In this method, to increase the range resolution and lower the sidelobe, a deconvolution algorithm is employed to improve the conventional pulse compression. In our simulation, the tolerance of the algorithm to different signal-to-noise ratios (SNRs) and the resolution ability of multi-target conditions were analyzed. Furthermore, the proposed method was applied to actual underwater data. The experimental results showed that the quality of underwater acoustic imaging could be effectively improved. The ratios of improvement for the SNR and contrast ratio (CR) were 32 and 12.5%, respectively. The target segmentation results based on this method are also shown. The accuracy of segmentation was effectively improved.