Quality Improvement Project Research Articles

A-179 Improving specimen labeling errors in the pediatric emergency department at a tertiary care hospital

Abstract Background Specimen labeling errors, such as unlabeled, mislabeled, or sample-requisition mismatches, pose risks to patient care. Correcting these errors, particularly for pediatric patients, is crucial to avoid unnecessary stress to the family and time spent on follow-up. In 2018, the BCCH Emergency Department (ED) reported the highest labeling error rates among all departments at our tertiary care hospital, accounting for approximately 30% of all errors. Methods To address this issue, a quality improvement project following the Model for Improvement framework was initiated in 2019 at the ED. An interdisciplinary team approach was adopted initially, and a positive patient identification system (PPID) was implemented later in February 2022. Patient Safety Learning System (PSLS) data from January 2019 to November 2023 were analyzed to evaluate the impact of these interventions. Results 1763 (22.6%) of the 7802 PSLS events recorded during this period were sample labeling errors. Ward collections accounted for the majority of labeling errors compared to laboratory collections (20.3% vs 2.4%). In the ED, most of the labeling errors occurred with unspecified samples (25%), swabs (24%), urine (23%), and blood culture (19%). The interdisciplinary team intervention initially reduced labeling errors, but its impact was inconsistent. However, the implementation of PPID in 2022 led to a significant and consistent decrease in labeling errors in the ED (4.51 errors/month vs 1.14 errors/month; p = 0.01) (Figure. 1). Conclusions While the implementation of PPID has notably improved labeling errors in the ED, complete elimination remains challenging. In addition, more specific PSLS filing categories are needed to capture sources of labeling error from unspecified samples. Continued efforts are necessary to achieve the goal of zero labeling errors.

Use of the Electronic Health Record to Improve Nursing Chart Preparation.

In a medical specialty clinic located in a rural community, a nursing team identified an opportunity to decrease the time nursing staff spent preparing charts for patients' upcoming clinical appointments. In collaboration with an informaticist, the nursing project team implemented a quality improvement project with a target goal of decreasing the average time spent preparing charts per patient by 20%, without increasing the number of discrepancies in the chart preparation process. The team used the define, measure, analyze, improve, and control framework to identify two interventions that could decrease time for chart preparation. A standardized chart preparation process was developed, and a condensed nursing view was created within the electronic health record. After the quality improvement project, the average time nurses spent on chart preparation per patient decreased by 18% after the standardized process and 16% after the condensed view was implemented.

Leveraging Quality Improvement and Shared Learning to Improve Infant Well-Child Visit Rates in Texas.

Texas Medicaid improved infant well-child visit rates by participating in a national learning collaborative. The two-year program encouraged creativity and innovation in care for Medicaid recipients through partnerships with managed care organizations (MCOs). The MCO projects discovered valuable practices in member outreach and were disseminated in shared learning experiences. At the completion of the learning collaborative, Texas Medicaid surveyed the MCO participants to assess the impact of their projects on Medicaid beneficiaries in Texas as well as the quality improvement project format. Collectively, the MCOs raised the infant well-child visit rate year-over-year. All of the partner MCOs stated they plan to continue focused work on improving infant well-child visit rates after the learning collaborative.

Benefits of an automated postoperative delirium risk prediction tool combined with non-pharmacological delirium prevention on delirium incidence and length of stay: a before-after analysis based on a quality improvement project.

Postoperative delirium (POD) significantly impacts older surgical patients, necessitating effective prevention strategies. To assess the effectiveness of the Pre-Interventional Preventive Risk Assessment (PIPRA) automated delirium risk prediction tool alongside non-pharmacological prevention strategies on POD incidence, hospital length of stay (LOS) and nursing time. This quality improvement project, set in a 335-bed Swiss private hospital, employed a before-after design to evaluate the impact of PIPRA and preventive measures on POD, LOS and nursing time in non-cardiac and non-intracranial surgery inpatients aged 60 or older. The control phase focused on enhancing POD screening, whilst the intervention phase incorporated PIPRA for risk assessment and staff training to enable targeted non-pharmacological prevention in patients at risk. A total of 866 patients were included; 299 control and 567 intervention. The odds ratio of POD, comparing the intervention group to the control, was 0.71 [95% confidence interval (CI) 0.44-1.16] when adjusting for baseline patient characteristics. The intervention was associated with an LOS 0.94 (95% CI 0.85-1.05) and nursing time 0.96 (95% CI 0.86-1.07) times that of the control, adjusted for baseline patient characteristics. Medium risk patients (21.6% of patients) had an LOS 0.74 (95% CI 0.59-0.92) and required nursing time 0.79 (95% CI from 0.62-1.00) times the control, adjusted for baseline patient characteristics, equivalent to an LOS reduction of 1.36days and nursing time saving of 19.3hours per patient. Medium risk patients in the intervention group had shorter LOS and nursing time compared to the control group, underscoring the importance of targeted prevention.

Improving the assessment of cultural, religious and spiritual needs for patients at the end-of-life within an acute hospital trust

BackgroundCultural, religious and spiritual (CRS) needs become increasingly important to individuals as they approach the end of life. CRS needs often remain unmet for patients dying in an acute hospital...

Improving external fixator pin site care through user involvement: A quality improvement project

IntroductionExternal fixation is widely used in treating complex fractures and limb reconstruction. Pin site infections remain a significant complication, impacting on patients' physical and psychosocial wellbeing. This clinical improvement project at a University Hospital in Denmark aimed to enhance pin site care by involving patients and caregivers throughout the treatment pathway. BackgroundAt our hospital, approximately 55 trauma patients are annually treated with lower limb external fixators. Pin site care is crucial for preventing serious infections/osteomyelitis and involves collaboration between hospital and municipal caregivers. Traditional pin site care in our unit was complex and time-consuming, causing patient anxiety and frequent unplanned clinic visits. MethodsInspired by the Participatory Design research methodology, a quality improvement project was conducted in three phases: (1) identifying users’ needs, (2) developing solutions collaboratively, and (3) testing/evaluating these solutions. Iterative cycles of planning, acting, observing, and reflecting were employed, facilitating mutual learning among participants. Interviews with patients, families and healthcare professionals and field observations both at the hospital and in the municipality were conducted. Inspiration was sought from international literature. ResultsPhase 1 identified the need for improved education about infection recognition, a less painful and time-consuming dressing method, and an assessment tool for pin site infection. Phase 2 involved extensive user input to develop and implement a new dressing procedure using PolyMem™ along with an assessment tool. Phase 3 evaluated the new methods, revealing reduced patient pain, fewer clinic visits, and stable infection rates as well as less time-consuming pin site care. ConclusionThe project successfully enhanced pin site care, involving users in developing a new care process, thus improving patient satisfaction and care efficiency. Implications for future practiceIncorporating patient perspectives and collaborative methods can significantly improve clinical care pathways. Future efforts should focus on further integrating patient centered and participatory approaches in healthcare improvements.

Improving completion rate of advance care planning at a tertiary rheumatological centre in Singapore: a quality improvement project

Advanced care planning (ACP) is a series of ongoing voluntary discussions between patients, families and healthcare professionals to plan for their future healthcare needs. Despite patients with rheumatic diseases having...

Enhancing Sensory Experiences for Infants Born Preterm: A Quality Improvement Project

ObjectiveTo enhance neonatal sensory experiences for infants born preterm: a quality improvement project. DesignThis was a time-interruption quality improvement project. The time-interruption lasted four weeks with an eight-week data collection period before and after. Baseline data were collected on current program use for eight weeks prior to the time-interruption. The NICU occupational therapist provided staff education, training, and modeling of SENSE during the time-interruption. Data were collected for eight weeks following the time-interruption to track improvements. ParticipantsTwenty infants and their families participated as well as NICU nurses who provided positive sensory experiences and completed surveys. Main Outcome MeasuresData related to delivery of, education on, and adherence to SENSE were collected before, during, and after the time-interruption. Staff surveys were completed pre- and post- education, training, and modeling to gather perspectives on program usage. ResultsOn average, parents delivered 43.88 minutes of positive sensory input per day before the time-interruption and increased to 92.7 minutes per day after the time-interruption. Positive tactile recommendations were met, on average, 19% of the time before the time-interruption and 47% of the time after the time-interruption. After education, training and modeling, nursing staff unanimously supported the program according to surveys. ConclusionsWhile a higher percentage of infants received the recommended dosage of positive tactile input after intervention, opportunities still exist to improve and expand implementation.

Implementing a financial toxicity screening program.

275 Background: Financial toxicity (FT) is a well-documented negative side effect of cancer treatment. Routine screening can mitigate FT by proactively connecting at-risk patients to resources and counseling. Herein, we describe implementation of a FT screening quality improvement (QI) program. Methods: At a comprehensive cancer center, an interdisciplinary team explored options for implementation, with consideration for screening content, mechanism for delivery, and clinical workflow. Through consensus, the team agreed to use the 12-item COmprehensive Score for Financial Toxicity (COST) tool, a health-related social risk checklist, patient-self report of cost-related medication non-adherence, and a visual analog quality of life scale. Surveys were sent via portal every four months to patients on active treatment. The QI project was implemented on the breast, gastrointestinal, gynecologic, and thoracic services. COST scores ≤20 or any endorsed social risk (e.g., food, transportation) yielded a positive screen, and nurses placed a financial counseling referral, with counseling dispositions tracked. In March 2023, due to an influx of “unproductive” counseling dispositions (e.g., patient could not be contacted, patient no longer wanted help), machine learning models suggested reducing the screening threshold to COST scores ≤16 and limiting the social risk checklist to four items (food, transportation, medication, and housing insecurity). Results: From 06/2022-12/2023, 196,675 financial toxicity surveys were assigned to 78,289 unique patients: 38% (n=75,526) were completed by 45,003 patients. Of these, 56% have completed one survey, 26% have completed two surveys, and 18% have completed three or more. Since implementation, 9612 financial counseling referrals have been placed, yielding assistance with insurance selection and applications for assistance with co-payments, non-medical expenses, and out-of-pocket costs. During the QI project, several real-time workflow changes were made. On day 1, 519/1811 patients screened positive, yielding an overflow of counseling referrals: an additional question to allow patients to opt into referral, rather than generating an automatic referral, was then added: the following week, 136 referrals were generated. In September 2022, this opt-in was modified to allow patients to directly identify the areas in which they were seeking assistance (e.g., insurance counseling, out-of-pocket expenses). In 2024, the screening was reduced to two COST questions that had a 0.92 correlation with the full-tool. Conclusions: Routine FT screening is feasible during active treatment, although attention is needed to clinical workflows to ensure patients have access to the screening, nurses and other clinical staff are involved in the implementation, and referrals to resources are available for patients who screen positive. Future work will address cadence of delivery and outcomes of interventions.

Implementing a ‘Sip Til Send’ policy at a large tertiary referral centre: a quality improvement project

Implementing a ‘Sip Til Send’ policy at a large tertiary referral centre: a quality improvement project

S2050 Missed Opportunities to Screen for Fatty Liver: Improving Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Screening Through a Quality Assessment and Quality Improvement Project

S2050 Missed Opportunities to Screen for Fatty Liver: Improving Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Screening Through a Quality Assessment and Quality Improvement Project

Optimizing enteral feed initiation: analyzing the influence of nutrition intervention protocol changes on turnaround time in critical care unit–A quality improvement project

Optimizing enteral feed initiation: analyzing the influence of nutrition intervention protocol changes on turnaround time in critical care unit–A quality improvement project

Quality improvement of breast and cervical cancer screening satisfaction rate at a resident-led clinic.

308 Background: In the US, 77.3% of women aged 21-65 years have had a Pap smear within the past three years and around 75.9% of women aged 50-74 years reported having a mammogram within the past two years as recommended according to the U.S. Preventive Services Task Force (USPSTF). In UTRGV Resident-led Clinic located in Hidalgo County, the quality metrics data demonstrated screening satisfactory rate for cervical and breast cancer to be 18% in August 2023. This Quality Improvement project is aimed at enhancing the screening satisfactory rate of breast and cervical cancer by 20% at UTRGV Knapp IM Clinic by December 2023. Methods: First, we focused on the education of the residents through noon conference and 1:1 education. This included comprehensive instruction on latest USPSTF guidelines and proper documentation on the electronic health record system, Athena. Second, we introduced a patient screening questionnaire, available in both English and Spanish. These efforts were evaluated through a pre-and-post-intervention survey designed to assess changes in residents' confidence, aligning with quality metrics data. We obtained and filtered the quality metrics raw data to include all the current residents in PGY1-3 and summed the number of patients who had records of breast and cervical cancer screening and divided the sum of all patients that required the record. The satisfaction rate was rounded to the 2nd decimal place. Results: The raw data from 8/2023 showed screening satisfactory rate for cervical and breast cancer to be 18%. With the initiation of intervention, the data from 9/2023 showed rate of 35%, finally reaching 39% on 12/2023, fulfilling our aim of 20% increase in the screening satisfactory rate. Survey data shows that there was an improvement of confidence observed in both breast and cervical cancer screening. Respectively, 27.5% and 30.9% increase in the residents who responded confident in breast cancer and cervical cancer screening were observed. 84.4% of residents responded that they are less forgetfulness in screening patients after the intervention. There was 22.9% increase in residents who know how to record the cancer screening result in Athena. 87.5% of the residents responded that they experienced improvement in implementing and documenting the breast and cervical cancer screening. Conclusions: Despite several limitations in acquiring and analyzing the data, this QI project positively impacted both subjective and objective data for the improvement of the breast and cervical cancer screening, fulfilling our aim of 20% increase in screening satisfactory rate by December 2023. Breast and cervical screening satisfactory Rate. Month/year Number of patients requiring breast and cervical cancer screening Number of patients with satisfaction in breast and cervical cancer screening Satisfactory rate (%) 08/2023 42 229 18 9/2023 999 2844 35 10/2023 454 1458 31 11/2023 649 1771 37 12/2023 113 287 39

S1877 Adequacy of Hepatitis C Testing in the Outpatient Setting in Accordance With the Latest USPSTF Guidelines: A Cross-Sectional Study and a Quality Improvement Project

S1877 Adequacy of Hepatitis C Testing in the Outpatient Setting in Accordance With the Latest USPSTF Guidelines: A Cross-Sectional Study and a Quality Improvement Project

S1720 Evaluating and Improving the Use of Nutritional Interventions in Hospitalized Patients With Cirrhosis: A Quality Improvement Project.

S1720 Evaluating and Improving the Use of Nutritional Interventions in Hospitalized Patients With Cirrhosis: A Quality Improvement Project.

Improving Dialysis Initiation in Stage 5 CKD: A Quality Improvement Project at a Safety Net Hospital

Improving Dialysis Initiation in Stage 5 CKD: A Quality Improvement Project at a Safety Net Hospital

Significant reduction in full-thickness pressure injuries through the quality improvement project that implements alternating pressure air mattresses.

To assess a quality improvement project using alternating pressure air mattresses' impact on reducing full-thickness pressure injuries by enhancing setting accuracy and device utilization. We retrospectively evaluated adult acute care unit patients with inclusion criteria (Braden scores ≤12 or existing full-thickness pressure injuries) between May 2020 and August 2023. A wound team attempted to enhance the accuracy, utilization and effectiveness of alternating pressure air mattress implementation. The implementation outcomes were setting accuracy and accurate utilization rates. The clinical outcome was the full-thickness pressure injury proportion. Utilization and allocation gaps were also calculated. The setting accuracy and accurate utilization rates increased (0.59 to 0.88 and 0.15 to 0.37, respectively). The full-thickness pressure injury proportion decreased (0.17 to 0.06), with a strong negative correlation coefficient (-0.789) (p < 0.001) with accurate utilization rates. The full-thickness pressure injury proportion declined faster during the project's complete phase than the partial phase (-0.0046 vs. -0.0016; p < 0.05). The utilization gap narrowed (99 to 60); however, the allocation gap increased (1 to 13), suggesting increased alternating pressure air mattress usage among ineligible patients. Targeting high-risk patients for alternating pressure air mattress utilization and ensuring correct settings, both performed by a dedicated team, substantially reduces the full-thickness pressure injury incidence.

S1698 Fibrosis-4 Index Use for Early Detection of Hepatic Fibrosis in Patients With Risk Factors for MASLD: A Quality Improvement Project

S1698 Fibrosis-4 Index Use for Early Detection of Hepatic Fibrosis in Patients With Risk Factors for MASLD: A Quality Improvement Project

Determining factors influencing hospital stay for individuals admitted with diabetes-related ketoacidosis – findings from DEKODE length of stay quality improvement project

There are significant variations in discharge post-diabetes-related ketoacidosis (DKA) hospitalisation, yet there is a paucity of research to understand or minimise the reasons. This quality improvement project (QIP) aimed to identify reasons for post-DKA discharge delays and assess intervention efficacy. Utilising the Digital Evaluation of Ketosis and Other Diabetes-related Emergencies (DEKODE) model, data from 177 DKA episodes from January 2021 to September 2023 across three hospitals were analysed. Factors affecting discharge were investigated through a plan, do, study, act (PDSA) methodology. While interventions focused on optimising data collection and refining discharge guidelines, no significant reduction in DKA duration or length of stay was observed. Findings highlight post-DKA hospitalisation's multifaceted nature and the limited impact of simple interventions. Collaborative efforts and further research are necessary to develop effective strategies for expedited discharge and improved patient care. This study's comprehensive tracking and analysis tool offers valuable insights for future interventions in managing DKA-related hospitalisations.

Opioid stewardship amongst patients undergoing major robotic surgery at Eastbourne District General Hospital: an audit and quality improvement project

Opioid stewardship amongst patients undergoing major robotic surgery at Eastbourne District General Hospital: an audit and quality improvement project