Quality Improvement Study Research Articles

Temperature Excursion of Intravitreal Anti-VEGF Agents During Home Storage

ImportanceSome patients worldwide are asked to acquire an anti–vascular endothelial growth factor (anti-VEGF) agent from a pharmacy, store it, and then bring it to a physician for intravitreal injection (IVT). Anti-VEGF agents must be stored in the refrigerator to avoid bacterial contamination or denaturation. Some cases of severe intraocular inflammation have been reported following IVT of more recently approved anti-VEGF agents, which might be explained by thermal instability.ObjectiveTo investigate whether patients followed the storage temperature guidelines for intravitreal anti-VEGF agents in daily clinical practice.Design, Setting, and ParticipantsThis quality improvement study, performed between May 27 and June 7, 2024, at the Ophthalmology Department of Dijon University Hospital in Dijon, France, included all consecutive patients with new or renewed prescriptions for intravitreal anti-VEGF agents for any macular disease.Main Outcomes and MeasuresAll participants were given a time-temperature indicator that changed color according to brief (2-12 hours), moderate (12-48 hours), and prolonged (≥48 hours) exposure over 8 °C. The indicator was activated at the time of the anti-VEGF agent delivery to the participant in community pharmacies.ResultsDuring the study period, 50 participants were prescribed intravitreal anti-VEGF agents and were given a time-temperature indicator. A total of 38 participants (24 [63.2%] female; median age, 79.3 [IQR, 74.3-86.3] years) returned for their IVT with an analyzable indicator. Of the 38 analyzable indicators, all showed temperature excursions above the threshold of 8 °C, including 26 (68.4%) for 12 to 48 hours and 11 (28.9%) for 48 hours or longer. Following anti-VEGF agent IVT, no participant experienced any ocular adverse effect that might be associated with severe intraocular inflammation.Conclusions and RelevanceIn this quality improvement study, temperature excursions of anti-VEGF agents above 8 °C for 48 hours or longer were recorded for 28.9% of participants during home storage. While it is unknown how these 38 participants relate to other patients worldwide who are required to obtain their own anti-VEGF agents, these findings suggest that patients need education about the importance of rigorous maintenance of cold storage of their anti-VEGF agents.

Multicomponent Deimplementation Strategy to Reduce Low-Value Preoperative Testing.

Routine preoperative blood tests and electrocardiograms before low-risk surgery do not prevent adverse events or change management but waste resources and can cause patient harm. Given this, multispecialty organizations recommend against routine testing before low-risk surgery. To determine whether a multicomponent deimplementation strategy (the intervention) would reduce low-value preoperative testing before low-risk general surgery operations. This study had a pre-post quality improvement interventional design using interrupted time series and difference-in-difference analytic approaches. The setting was a single academic, quaternary referral hospital with 2 freestanding ambulatory surgery centers and a central preoperative clinic. Included in the study were adult patients undergoing nonurgent outpatient inguinal hernia repairs, lumpectomy, or laparoscopic cholecystectomy between June 2022 and August 2023. Eligible clinicians included those treating at least 1 patient during both the preintervention and postintervention periods. All clinicians were exposed to the multicomponent deimplementation intervention, and their testing practices were compared before and after the intervention. The strategy components were evidenced-based decisional support, multidisciplinary stakeholder engagement, educational sessions, and consensus building with surgeons and physician assistants staffing a preoperative clinic. The primary end point of the trial was the rate of unnecessary preoperative tests across each trial period. A total of 1143 patients (mean [SD] age, 58.7 [15.5] years; 643 female [56.3%]) underwent 261 operations (23%) in the preintervention period, 510 (45%) in the intervention period, and 372 (33%) in the postintervention period. Unnecessary testing rates decreased over each period (intervention testing rate, -16%; 95% CI, -4% to -27%; P = .01; postintervention testing rate, -27%; 95% CI, -17% to -38%; P = .003) and within each test category. The decrease in overall testing was not observed at other hospitals in the state on adjusted difference-in-difference analysis. In this quality improvement study, a multicomponent deimplementation strategy was associated with a reduction in unnecessary preoperative testing before low-risk general surgery operations. The resulting changes in testing practice patterns were not associated with temporal trends within or outside the study hospital. Results suggest that this intervention was effective, applicable to common general surgery operations, and adaptable for expansion into appropriate clinical settings.

Carbon Footprint Analysis of an Outpatient Dermatology Practice at an Academic Medical Center

There is growing awareness of the US health sector's substantial contribution to the country's greenhouse gas (GHG) emissions, exacerbating the health threats from climate change. Reducing health care's environmental impact requires understanding its carbon emissions, but there are few published audits of health systems and fewer comprehensive emissions analyses at the clinic or department level. To quantify the annual GHG emissions from a large outpatient dermatology practice, compare relative sources of emissions, and identify actionable targets. This quality improvement study involving a comprehensive carbon footprint analysis (scopes 1-3) of a large (nearly 30 000 visits/y), outpatient medical dermatology practice within the University of Pennsylvania's academic medical complex was conducted following the GHG Protocol Corporate and Corporate Value Chain reporting standards for fiscal year 2022 (ie, July 2021 through June 2022). Data were obtained through energy metering, manual audits, electronic medical records, and administrative data. Data were converted into metric tons of carbon dioxide equivalent (tCO2e), allowing comparison of global-warming potential of emitted GHGs. Primary outcomes were tCO2e by scope 1 (direct emissions), scope 2 (indirect, purchased energy), and scope 3 (indirect, upstream/downstream sources), as well as by individual categories of emission sources within each scope. Scope 3 contributed most to the clinic's carbon footprint, composing 165.5 tCO2e (51.1%), followed by scope 2 (149.9 tCO2e [46.3%]), and scope 1 (8.2 tCO2e [2.5%]). Within scope 3, the greatest contributor was overall purchased goods and services (120.3 tCO2e [72.7% of scope 3]), followed by patient travel to and from the clinic (14.2 tCO2e [8.6%]) and waste (13.1 tCO2e [7.9%]). Steam and chilled water were the largest contributors to scope 2. Clinic energy use intensity was 185.4 kBtu/sqft. In this quality improvement study, the composition of emissions at the clinic level reflects the importance of scope 3, paralleling the health sector overall. The lower-resource intensity of the clinic compared to the average energy requirements of the total clinical complex led to a relatively large contribution from scope 2. These findings support efforts to characterize high-yield emissions-reduction targets and allow for identification of actionable, clinic-level steps that may inform broader health system efforts.

Implementation of O-RADS Ultrasound Reporting System: A Quality Improvement Initiative.

Objectives: To determine the feasibility of implementing Ovarian-Adnexal Reporting & Data System (O-RADS) ultrasound (US) for reporting of adnexal masses at our institution, with a specific goal of increasing the use of O-RADS from a baseline of <5% to at least 75% over a 16-month period. Methods: A prospective interrupted time series quality improvement study was undertaken over a 16-month period. Plan, do, study, act cycles included: (1) Engagement of interested parties, (2) Targeted educational sessions, (3) Development of reporting templates, (4) Weekly audit-feedback. Inter-reader variability assessment was performed on 70% of O-RADS risk-category 2 to 5. The primary outcome was the reporting of an O-RADS risk category. Results: A total of 635 female pelvic US were performed at our centre between July 2022 and April 2023. An O-RADS risk category was provided on the final radiology report by the radiologist for 489/635 (77%) US. From November 2022 to April 2023, the weekly rate of O-RADS risk category reporting reached 88%. The O-RADS score was concordant between readers for 83/103 (81%) of US reports with kappa score of 0.69 corresponding to good agreement. Conclusions: The reporting of O-RADS risk category increased from <5% to 88% over a 16-month period with a high level of agreement among readers in assigning O-RADS risk category. Implementation of a standardizing reporting ultrasound system at a tertiary cancer centre is feasible with rapid learning and uptake curves.

Evaluating an urgent care antibiotic stewardship intervention: a multi-network collaborative effort.

Urgent care centers (UCCs) have reported high rates of antibiotic prescribing for acute respiratory tract infections. Prior UCC studies have generally been limited to single networks. Broadly generalizable stewardship efforts targeting common diagnoses are needed. This study examines the effectiveness of an antibiotic stewardship intervention in reducing inappropriate prescribing for bronchitis and viral upper respiratory tract infections (URTIs) in UCCs. A quality improvement study comparing inappropriate antibiotic prescribing rates in UCCs after the introduction of an antibiotic stewardship intervention. Forty-nine UCCs in 27 different networks from 18 states, including 1 telemedicine site. Urgent care clinicians from a national collaborative of UCCs, all members of the Urgent Care Association. The intervention included signing a commitment statement and selecting from 5 different intervention options during 3 plan-do-study-act cycles. The primary outcome was the percentage of urgent care encounters for viral URTIs or bronchitis with inappropriate prescribing, stratified by clinician engagement and diagnosis. A 3-month baseline and 9-month intervention period were compared using a regression model using a generalized estimating equation. Among 15,385 encounters, the intervention was associated with decreases in inappropriate antibiotic prescribing for bronchitis (48% relative decrease, aOR = 0.52; 95% CI, 0.33-0.83) and viral URTIs (33%, aOR = 0.67; 95% CI, 0.55-0.82) among actively engaged clinicians compared to baseline. The intervention did not result in significant changes for clinicians not actively engaged. This intervention was associated with reductions in inappropriate prescribing among actively engaged clinicians. Implementing stewardship interventions in UCCs may reduce inappropriate antibiotic prescriptions for common diagnoses; however, active clinician engagement may be necessary.

National Telehealth Contingency Staffing Program and Primary Care Quality in the VHA

The Veterans Health Administration (VHA) launched the Clinical Resource Hub (CRH), a national telehealth contingency staffing program, to address primary care staffing shortages and improve veteran access to primary care. How this large-scale telehealth intervention affects quality of care is unknown. To assess the quality of care for chronic disease management among US veterans receiving high vs low levels of CRH-delivered primary care services and whether racial and ethnic minority veterans experience outcomes similar to those of White veterans when receiving CRH-delivered care. This retrospective quality improvement study was conducted using VHA administrative data. Veterans receiving primary care services from CRH clinicians between October 1, 2022, to September 30, 2023, were included. Low, medium, and high tertiles of CRH intensity, defined as the proportion of a veteran's CRH primary care visits to their total primary care visits within the study period. The main outcomes were chronic disease quality measures for 2 common conditions in ambulatory care: diabetes and hypertension. Logistic regression models were used to estimate the association between individual-level receipt of care from a CRH clinician and the study outcomes. This study included 71 508 veterans (mean [SD] age, 66 [15] years; 91.4% were male). Veterans who received a higher proportion of care from CRH clinicians were more likely to have improved blood pressure control compared with those who received a lower proportion of care. Higher vs lower CRH intensity was associated with improved blood pressure control among veterans with diabetes (79.5% [95% CI, 78.5%-80.4%] vs 76.6% [95% CI, 75.7%-77.5%]) and veterans with hypertension (76.8% [95% CI, 76.0%-77.5%] vs 73.9% [95% CI, 73.2%-74.7%]). Among racial and ethnic minority veterans, no association between CRH intensity and clinical quality was observed. In this large retrospective cohort study among veterans receiving primary care services through a national telehealth contingency staffing program, veterans with a higher proportion of care from CRH clinicians had improvement in blood pressure outcomes. These findings suggest that the CRH program may be helpful in addressing veteran primary care needs without introducing or worsening disparities in ambulatory quality measures among racial and ethnic minority veterans. As health systems face staffing shortages in primary care, these findings can inform strategies for equitable implementation of large-scale telehealth initiatives to fill these gaps and maintain timely access to primary care.

Reassessing the Inclusion of Race in Prenatal Screening for Open Neural Tube Defects

This quality improvement study explores whether the benefit of detecting open neural tube defects outweighs the harms of practicing race-based medicine.

Using behavioural science to improve antibiotic stewardship in Canadian long-term care homes: Protocol for a multi-center cluster randomized quality improvement study.

Antimicrobial resistance (AMR) is associated with significant human and financial costs, particularly among vulnerable populations like older adults living in long-term care homes (LTCHs). Urinary tract infection (UTI) is the leading indication for antibiotic use in this population, with some estimates suggesting that up to 70% of these prescriptions may be avoidable. The purpose of this study is to develop and test novel behavioural science-informed antimicrobial stewardship (AMS) quality improvement strategies in Canadian LTCHs, which aim to decrease unnecessary testing and treatment for residents who lack the minimum clinical signs and symptoms of UTI. The quality improvement strategy is a two-pronged approach that includes 1) targeted education for essential care providers (family and friends of LTCH residents) about UTI and benefits of AMS, which strives to outline a positive role for this group in UTI management, and 2) monthly feedback to LTCH staff on their facility's urine culture ordering rates. The protocol was piloted in a single LTCH; a process evaluation of the pilot implementation served to refine the research protocol, which is being implemented in eight LTCHs across Canada using an eight-month stepped wedge randomized cluster design. This protocol represents a behavioural science-informed intervention to improve AMS across LTCHs. If successful, this model of care could be scalable across Canadian LTCHs, offering an inclusive approach that aims to empower clinicians, non-regulated healthcare staff, residents and their family and friends to improve health outcomes as antibiotic stewards.

Assessing the Use and Acceptability of Virtual Reality to Assist Coping in Children Undergoing Clinical Procedures.

Virtual reality is used as a distraction tool during medical procedures that can cause anxiety and pain. We assessed the usefulness, engagement, value and feasibility of virtual reality to help children cope with routine clinical procedures. Quality improvement study. Children, 4-16 years old, were given the option to use virtual reality during their procedure in oncology, immunology or diabetes clinics, or during an induction of general anesthesia. The emotional state of the child was documented using the children's emotional manifestation scale. We assessed feedback from patients, parents, and clinicians. Across all clinics, children responded positively to the virtual reality and 80% would choose to use virtual reality again for health-related procedures. Parents and clinicians, respectively, reported that virtual reality helped children tolerate the procedure (82% and 87%), engaged children well (82% and 89%) and was a valuable tool (85% and 98%). Clinicians (90%) endorsed the feasibility of using virtual reality during procedures. This project demonstrated that virtual reality can be implemented as a useful, engaging and feasible tool to help children tolerate a variety of routine medical procedures. However, ensuring comfortable fit of virtual reality devices and diversifying the visual content is necessary.

Patient and Caregiver Perceptions of Caregiving Contributions During Cancer Clinical Trials: A Mixed-Methods Study.

Caregivers play crucial roles in cancer treatment and outcomes. However, little is known regarding how caregivers support patients during cancer clinical trials. The aim of this study was to gain insight into the caregiver experience of rural and urban patients enrolled in cancer clinical trials. As part of a quality improvement study, 21 patient-caregiver dyads were interviewed using closed and open-ended interview questions. We analyzed quantitative and qualitative data on patient and caregiver perceptions of caregiver contributions and explored differences in the reported caregiving experience between rural and urban participants. While patient-caregiver dyads showed significant disagreement in the symptoms/medication management domain, with caregivers tending to acknowledge the contribution while patients did not (χ2 (1, 21) = 5.82, p = 0.016), both groups generally showed agreement in their perceptions of caregiver involvement and reported similar levels of involvement across the other six assessed domains. Qualitative analysis revealed three themes: patient independence, invisible support, and accepted forms of support. Despite patients valuing independence, patients benefited from caregivers' unseen support, and providing emotional support and attending appointments were widely accepted forms of support among patients. No meaningful differences in caregiver contributions were found between rural and urban patient-caregiver dyads. Our study revealed that caregivers are assisting patients in often unseen and underestimated ways during cancer clinical trials, highlighting their multifaceted role. Cancer clinical trials should implement a family-centered approach, especially for rural caregivers, to enhance patient retention and outcomes.

PERSONALIZED MUSIC PLAYLISTS FOR HOSPITALIZED OLDER ADULTS: CREATING AND REVISING VOLUNTEER WORKFLOW

Abstract Personalized music has been shown to decrease the incidence of neuropsychiatric symptoms among hospitalized older adults. As part of the “Creativity in Aging” project at Yale Geriatrics, this quality improvement study aims to evaluate the process and feasibility of a personalized music program in an inpatient geriatrics unit. We collaborated with the hospital volunteer department to credential and train five undergraduate volunteers in building personalized music playlists for hospitalized older adults to listen to during their stay. From October 2023 to February 2024, 88 patients were referred to the program by hospital staff, and 57 patients participated. Here we describe the process of developing and revising the pilot. Following “test” sessions led by a medical student and resident physician familiar with the unit, an initial protocol was developed. Volunteers used REDCap and paper spreadsheets to organize HIPAA-secure patient data including referrals, linkage to personalized playlists stored on iPads, and brief pre- and post-listening surveys. Volunteers filled out feedback forms after each weekly shift to identify workflow issues and suggest improvements. Challenges included 1) identification of appropriate patients and 2) hand-off of patient referrals, notes, and next steps between shifts. Consultation with multiple stakeholders including volunteers, nursing managers, and attending physicians, led to solutions: 1) recruitment of nursing staff and creation of resident physician training module, after which nurses and resident physicians became key patient referral sources, and 2) remodeling of REDCap to manage volunteer “hand-off” communication, replacing the physical note-keeping system. We aim to make this a sustainable volunteer program.

Accuracy of Arterial Blood Gas: Quality Improvement Study

Background: Arterial blood gas (ABG) is indicated in almost all presenting problems in the emergency department (ED). When the clinical diagnosis does not match the ABG diagnosis, particularly in multiorgan failure, physicians level it as inaccurate. With the passage of time the role of ABG has been narrowed to the ICU as a monitor in ventilated patients. The accuracy of ABG can be tested by knowing and comparing the values of Hb% measured though ABG and CBC and by oxygen saturation measured though ABG and pulse oximetry. Method: This was a prospective observational cohort quality improvement study and ABG vs. CBC hemoglobin and ABG vs. pulse-oximeter oxygen saturation in over 74 adult patients admitted to the ED were evaluated in a tertiary care center. Arterial blood was collected properly and ABG-Hb/ABG-SO2 was measured at point-of-care testing with an ABG machine. Venous samples were collected at the same time and properly transported to the laboratory for CBC measurement. SpO2 was measured at bedside through pulse oximeter. Data were entered into a specifically designed database and analyzed statistically. Result: There was a strong positive correlation between ABG-Hb and CBC-Hb (p&lt;0.001). The correlation between ABG-SO2 and pulse-oxi-SpO2 was also significant (p&lt;0.001). Conclusion: Both the ABG-Hb vs. CBC-Hb and ABG-SO2 vs. pulse-oxi-SpO2 methods can be used as tools for testing accuracy and improving the quality of ABG. Confident use of ABG in the management of severely ill patients significantly improves outcomes [3]. Keyword: ABG (arterial blood gas); ED (emergency department); CBC (complete blood count); Pulse-Oxi (pulse oximeter); PI (perfusion index).

Improving Firearm Screening and Safe Storage Counseling in a Primary Care Pediatric Practice

We conducted a quality improvement (QI) study to increase rates of firearm screening/safety counseling by 25% over 10 months for children (4-18 years) at preventive visits in an academic continuity clinic. Plan-Do-Study-Act (PDSA) cycles consisted of 1) (January 2023) educating providers about best practices for screening, safe storage counseling, and use of cable firearm locks; 2) (May 2023) revising the preventive visit note template to prompt providers on best practices; and 3) (September 2023) providing caregiver educational resources to support safe storage practices. The baseline firearm screening rate was 38%. After PDSA 1, screening rates were 34%; following PDSA 2, screening rates increased to 82.5%; after PDSA 3, rates were 95%. This QI intervention increased provider screening for firearms, confidence in safety counseling, and confidence in the use of cable firearm locks during preventive visits. Revising the note template had the largest effect on increasing screening rates.

Enhancing Workplace Wellness: A Comprehensive Approach to Sleep Apnea Screening in Onsite Health.

This quality improvement project aimed to increase the screening rate for OSA in individuals aged 18 and above with obesity (body mass index [BMI] ≥30). This quality improvement study occurred from March 2023 to August 2023 using a two-independent pre-implementation post-implementation design. The STOP-Bang Questionnaire (SBQ) was implemented during annual exams, chronic disease management visits, and Department of Transportation (DOT) physicals. There were 946 patients involved in the study, including 471 in the pre-implementation group and 475 in the post-implementation group. OSA screening increased from 14.1% to 71.6% after implementing the screening protocol in the general population and 26.7% to 90.4% in the commercial driver's license (CDL) holder population. Of the CDL holders screened in the pre-intervention group, 15 (65.2%) were at intermediate to high risk for OSA (SBQ ≥3), and in the post-intervention group, 33 (50%) had an SBQ score of ≥3. Standardized OSA screening is crucial because it is common but underdiagnosed. Screening for OSA during DOT exams promotes community safety. Earlier identification of at-risk patients leads to earlier diagnosis and treatment of OSA to prevent long-term complications, reduce healthcare costs, improve patient outcomes, and improve community safety.

Leveraging Lean Methodology to Improve Compliance With Work-Hour Restrictions

Since work-hour restrictions were instituted in 2003, sustainably complying with duty-hour regulations remains a challenge for general surgery residency programs across the nation. To determine whether industry-based process improvement techniques could be leveraged to increase compliance with work-hour restrictions within a general surgery residency. This quality improvement project using Lean methodology was conducted from October to November of the 2021 to 2022 academic year. The setting was a university-based general surgery residency program in southern California with rotations across 5 regional hospitals. The program trains 7 categorical general surgery residents per postgraduate year (PGY) and offers an optional 1 to 3 years for research and career development. Programmatic structures were examined, current and target states were analyzed, opportunities for improvement were identified, root-cause analyses were conducted, and targeted interventions were developed. Resident time logs and annual Accreditation Council for Graduate Medical Education resident and faculty surveys were reviewed from academic years 2019/2020 to 2022/2023. Attending faculty were surveyed on resident preparedness using a 5-point Likert scale. Differences between means and proportions were calculated with corresponding 95% CIs. The web-based survey responses of 29 residents (residents per PGY, 7 [PGY1], 14 [PGY2/3], 8 [PGY4/5]; 17 female [54.7%]) were included in this study. Root causes included maxed baseline schedules, late in shift work, culture, service variability, clinical volume, and inefficient workflows. Fifteen multifactorial interventions impacting call and weekend scheduling, work practices and efficiencies, intern and service orientations, and faculty and cultural expectations were implemented. The mean number of residents per block who logged more than 80 hours per week decreased by 3.6 violations per block (95% CI, 2.98-4.22), from 4.4 (12.4%) to 0.8 (2.2%) for a difference of 10.2% (95% CI, 8.4%-16.2%). On the annual resident survey, perceived compliance with 80 hours was 72%, 83%, 83%, and 88%, respectively, over the following study periods: 2019 to 2020, 2020 to 2021, 2021 to 2022, and 2022 to 2023. Faculty perception of resident preparedness for the case increased from a mean (SD) of 2.6 (0.8) to 3.0 (0.5), with a difference of 0.47 (95% CI, -0.52 to 0.68). There were no statistically significant differences in technical skill, clinical judgment, sense of responsibility, efficiency, or sense of well-being. Results of this quality improvement study suggest that through Lean methodology, surgical residency programs can improve working environments. This novel approach can increase compliance with resident work hours by engaging front line trainees in the process.

Ambient artificial intelligence scribes: utilization and impact on documentation time.

To quantify utilization and impact on documentation time of a large language model-powered ambient artificial intelligence (AI) scribe. This prospective quality improvement study was conducted at a large academic medical center with 45 physicians from 8 ambulatory disciplines over 3 months. Utilization and documentation times were derived from electronic health record (EHR) use measures. The ambient AI scribe was utilized in 9629 of 17428 encounters (55.25%) with significant interuser heterogeneity. Compared to baseline, median time per note reduced significantly by 0.57 minutes. Median daily documentation, afterhours, and total EHR time also decreased significantly by 6.89, 5.17, and 19.95 minutes/day, respectively. An early pilot of an ambient AI scribe demonstrated robust utilization and reduced time spent on documentation and in the EHR. There was notable individual-level heterogeneity. Large language model-powered ambient AI scribes may reduce documentation burden. Further studies are needed to identify which users benefit most from current technology and how future iterations can support a broader audience.

Donning of personal protective equipment under direct supervision- A quality improvement study in COVID-ICUs of a tertiary care facility, South India

: Personal protective equipment has a major role in reducing the transmission of infections to healthcare workers despite the fact that improper doffing techniques can pose a threat of acquiring nosocomial infections. Compliance to donning or doffing is an all or none phenomenon where lack of adherence to sequence or technique can result is transmission of infections. Conducting doffing audit with the help of trained supervisors (dofficers) can significantly improve compliance with doffing guidelines. : This quality improvement study, was conducted at a large-scale tertiary care hospital located in South India, for a one-year period in COVID-ICUs. Doffing audit was conducted by trained dofficers in designated doffing areas for proper technique &amp; sequence of doffing and disposal all through the shifts.: 5834 health care professionals were supervised over 8760 hours with a total doffing compliance of 66.6%. Nurses had better overall and individual component doffing compliance. Biomedical waste segregation compliance was also high among nurses (90.4%). Most common breach is with mask removal.: Nosocomial transmission of infections can be controlled with adherence to proper doffing techniques. Auditing and on spot interventions will help improve the compliance to doffing.

Surge of healthcare associated infections in COVID intensive care units

: Healthcare-associated infection played a vital role in determining the patient’s outcome during the COVID pandemic. However, the data on HAI rates is largely unavailable in COVID locations. This is because conducting HAI surveillance inside COVID ICUs is a big challenge. Therefore, we conducted this unique quality improvement study which aims at comparing the trends of HAI rates in COVID and non-COVID ICUs during the ongoing pandemic.: The aim of the study was to compare the HAI rates in COVID and non COVID ICUs with the baseline HAI rates in pre COVID era.: The HAI surveillance was carried out during April 2020-December 2020 in the COVID ICUs (test group) and non-COVID ICUs (control group) and compared with ICUs from January 2019 to March 2020 (pre COVID baseline group). Then HAI data was analysed and the HAI rates were calculated based on national healthcare safety network guidelines. Overall, the HAI rates were higher in COVID time in comparison to pre COVID time. During the COVID period, higher HAI rates were seen in the COVID ICUs than in the non COVID ICUs. CLABSI rate had the highest occurrence followed by VAE, CAUTI, and SSI.: Higher HAI rates in COVID time indicates that there is need of serious infection control intervention thereby reducing the HAIs associated in COVID patients. Strict compliance to hand hygiene and other transmission-based precautions are to be followed in order to enhance the overall safety of patients.

Improving inpatient paediatric de-labelling of allergies to beta-lactams: a quality improvement study

ObjectiveTo evaluate the implementation of an antimicrobial stewardship programme-led inpatient beta-lactam allergy de-labelling programme using a direct oral provocation test (OPT).DesignOne-year quality improvement study using a before–after design.SettingFree-standing tertiary care...

Enhancing representativeness of patient-reported outcomes in routine radiation oncology care: a quality improvement protocol to address non-response

IntroductionNon-response significantly undermines the representativeness of patient-reported outcome (PRO) data, thereby compromising its utility for facilitating high-value, equitable, patient-centred care in cancer clinics. Quality improvement studies are needed to assess...