Quality Improvement Workshops Research Articles

Improving knowledge of quality and safety among general and acute care medicine advanced trainees through a brief quality improvement workshop

Introduction: Quality and safety is a core competency, yet there are limited formalised quality improvement (QI) courses for physician trainees offered in Australia. Methods: An introductory QI workshop was conducted for trainees at the Internal Medicine Society of Australia and New Zealand (IMSANZ) Conference 2022. The workshop covered principles of improvement science, QI tools and plan-do-study-act (PDSA) cycles. The contents were delivered through a small-group experiential learning format. Pre- and post-workshop surveys were administered to evaluate the participants’ perceptions and improvement in QI knowledge domains. Results: Thirty-five trainees attended the workshop. Of all respondents, none had received formal QI training previously. Statistically significant improvements in nearly all QI knowledge domains were noted in the post-workshop evaluation along with improvement in participants’ motivation to further learn QI processes relevant to their vocation. Conclusion: An introductory workshop can significantly improve knowledge and motivation to further learn QI amongst physician trainees.

263 Improving nutritional Care for Older Adults with hip fractures: insights from a multidisciplinary quality improvement workshop

Abstract Background Enhancing nutrition is a crucial element of hip fracture care, as malnutrition poses increased mortality risk within the initial 120 days post-hip fracture. Aiming to address key considerations and potential challenges, the National Office of Clinical Audit Orthogeriatric Network conducted a quality improvement workshop focusing on nutrition. Methods A workshop exploring various elements of Orthogeriatric care was conducted in September 2022. Over 30 multidisciplinary stakeholders from various hospitals and clinical programs engaged in a survey and workshops exploring key components of Comprehensive Geriatric Assessment (CGA), including nutrition. Results Survey results indicated strong consensus on the inclusion of nutritional assessment and monitoring within the CGA for hip fracture patients. Focused small-group discussions highlighted the adverse effects of inadequate nutrition on wound healing, bone health, energy levels, the catabolic process, and frailty. The under-recognition of nutrition was highlighted. Identified barriers to optimal nutritional care included limited dietetic support, portion sizes, modified diets, repeated fasting, unclear guidance, literacy levels, and the availability of dementia-friendly equipment. Facilitators included access to dietetics support, involving family members and catering staff, enhanced oral hydration plans, protected meal times, proactive protein-based supplements, using ‘red trays’ for assistance, and ‘sip til send’ initiatives. This topic was further explored at the subsequent online network last March with a view to developing guidance on nutritional management of older hip fractures patients. Conclusion To optimise clinical outcomes, individualised nutritional interventions should be tailored to patients’ specific needs, considering local resources. The development of national consensus guidance aims to provide valuable information to enhance patient outcomes.

9th International Conference On Sustainable Agriculture, Food and Energy (SAFE2022)

October 17, 2022 – Istanbul, Turkey Preface SAFE is BACK! After two years of virtual engagements, we are excited to see you in person. Hence, we are happy to invite you to the International Conference on Sustainable Agriculture, Food, and Energy (SAFE2022: International Conference on Sustainable Agriculture, Food, and Energy (SAFE2022): Circular Economy Implementation in Agri-food Energy Production for Community Empowerment which will be held on October 17, 2022, in Istanbul, Turkey. The co-host institution is ISTANBUL University, Turkiye, and Andalas University, INDONESIA. This conference is the ninth conference after the 1st International Conference on Sustainable Agriculture, Food, and Energy (SAFE2013) in Padang, Indonesia (12-14 May 2014), the second conference SAFE2014 in Bali, Indonesia (17-19 September 2014). The third conference, SAFE2015, in Ho Chi Minh City, Vietnam (17-19 November 2015); the fourth conference SAFE2016, Colombo, Sri Lanka (October 20-22, 2016); the 5th conferenceSAFE2017, Malaysia, August 22-24, 2017; the sixth conference of SAFE2018, Manila. Philippines [October 19-21, 2018], the seventh conference of SAFE2019, Phuket. Thailand (October 19-21, 2019), and the 8th conference of SAFE2020 in Jeju, Korea (October 21, 2020).The objectives of the conference are:1) To provide a forum for the international researcher’s community to exchange and share experiences, new ideas, sustainability concepts, and research results on sustainable agriculture, food, and energy.2) To promote collaboration in sustainable agriculture, foods, and energy production research.3) To establish regional networking among participants on sustainable agriculture, food, and energy.4) To increase awareness of the importance of living and working in a manner that enhances our community’s economic, environmental, and social well-being through research, education, regional partnerships, and community engagement.SAFE2022 received 146 full papers from conference participants. After going through the review process carried out by the scientific committee, the committee invited 84 manuscripts to take part in the manuscript quality improvement workshop, which was a side event of SAFE2022. All workshop participants were invited to submit their manuscripts to Morressier to be reviewed again by four reviewers. After going through the review process, 61 manuscripts were selected, ready to be submitted IOPOn this occasion, SAFE Network would like to thank Istanbul University for providing the venue for this conference. We also would like to thank Istanbul Technical University, the institution that supports this conference.Thank you very much to IOP Publisher for constantly supporting our conference every year since 2018List of Committee is available in this pdf.

New approach to undergraduate quality improvement.

While quality improvement (QI) is an essential component to modern day clinical practice, some foundation doctors fail to engage. This is compounded by a lack of formalised undergraduate QI teaching. We trial an undergraduate active learning workshop and evaluate it using a concurrent triangulation mixed methods design. We constructed a 2-hour interactive QI workshop utilising near-peer educators for third year undergraduate medical students. Our workshop demonstrated an exemplary project and a template featuring evidenced-based QI tools to grasp key concepts. Informal support was provided for student QI projects, undertaken in small peer groups. Utility was assessed using linked pre-and-post event questionnaires with Likert scales, free text thematic analysis and project completion rates. We recruited 74 students to attend our workshops delivered over 3 months. We achieved high event satisfaction and significant improvements on baseline confidence. Free text comments suggested students perceive QI as an important part of the undergraduate curriculum, described barriers to engagement and the value they place on project autonomy. The workshop eased student feelings of anxiety and intimidation regarding change ideas. Nine projects were completed with one winning a poster prize at a regional conference. We demonstrate a popular resource light model that can be scaled up to a variety of centres. Targeting QI teaching at the undergraduate level may be instrumental in developing QI culture in health care systems and address barriers to postgraduate involvement. Our study furthers the understanding of undergraduate students' perspectives of QI and demand for further sessions.

Curriculum Management Development Strategy in Madrasah (Visionary Studies in Educating Students at the Elementary Education Level)

The curriculum contains indicators of the success of the learning process, starting from aspects of planning, implementation (core activities) and closing. For this reason, the curriculum requires effective management and development strategies, so that it is adaptive to the times and in accordance with the needs of students. This study aims to analyze curriculum management and development strategies at MTsN 4 Mandailing Natal. This study uses a qualitative approach with descriptive analytical study method. Data collection was carried out systematically through interview, observation and documentation studies. Furthermore, the data were analyzed using reduction techniques (data sorting), data presentation, and drawing conclusions. The results of this study conclude that the development of curriculum management in madrasas is optimized by the Head of MTsN 4 Mandailing Natal through 4 madrasa internal strategies, namely (1) curriculum development based on teaching materials must be equipped with references (books) as teaching companions; (2) teachers are required to be proactive in facilitating student learning processes and connecting students with various learning resources; (3) providing adequate teaching aids; and (4) providing direct guidance from the head of the madrasa to teachers in training activities or quality improvement workshops.

Assessment of quality improvement priorities to improve care delivery for patients with ovarian cancer.

307 Background: In the US, more than 12,000 people die from ovarian cancer annually. Although new treatments have recently become available, ovarian cancer care delivery remains suboptimal. The Association of Community Cancer Centers (ACCC) developed a series of initiatives to improve the quality of care for patients with ovarian cancer. In Phase I, ACCC evaluated the needs of cancer programs, conducted 3 quality improvement (QI) workshops, and developed expert-driven Quality of Care recommendations to aid cancer programs in self-assessment and quality improvement. In Phase II, ACCC invited programs to self-assess their level of care using the Quality of Care recommendations. Methods: In 2022, ACCC surveyed 7 ovarian cancer programs across the US. Developed by a multidisciplinary expert steering committee, the 26-question survey assessed the patient populations served, services provided, diagnostic evaluations performed, access to molecular testing, and a self-assessment of quality care delivery and interest in conducting QI projects related to self-identified needs. The survey was administered in Qualtrics and summarized using descriptive statistics. Results: Surveys were completed by 1 community, 2 comprehensive community, 2 hospital-associated, 1 academic comprehensive, and 1 NCI-designated comprehensive cancer programs. The median annual ovarian cases was 40 [range: 2 to 68]. The 7 programs serve diverse racial/ethnic distribution of patients with ovarian cancer ranging from 55% Black to 60% Asian and 30% Pacific Islander. Five programs have a multidisciplinary team for ovarian cancer. All 5 multidisciplinary teams included gynecologic oncology and pathology; 3 teams also included medical oncology and or radiology colleague(s). Sites assessed their level of care for 7 domains of quality care from 1 (lowest) to 5 (highest). The average score was 4.0 for Care Coordination and Patient Education, Treatment Planning, and Disease Surveillance. Diagnosis and Initial Management scored on average 3.8, Equity in Care 3.25, Prevention and Screening 3.25, and Quality of Life 3.2. Sites ranked areas of interest for future QI projects (1 = area of most interest, 7 = area of least interest). The highest ranked domains were Care Coordination and Patient Education as well as Diagnosis and Initial management (average rankings 2.8). These were followed by Quality of Life (average 3.0), Prevention and Screening (Average 3.8), Treatment Planning (Average 4.4), Equity in Care (Average 5.0), and Disease Surveillance (Average 6.2). Conclusions: This assessment will be used to identify 4 additional sites for Phase II QI workshops. Findings from these projects will be combined, summarized, and disseminated to inform future education opportunities and QI initiatives. This initiative aims to help organize and standardize the care of patients with ovarian cancer and improve patient care coordination.

Maximizing the Academic Conference Experience: Tips for Your Career Toolkit.

Maximizing the Academic Conference Experience: Tips for Your Career Toolkit.

Increasing Faculty Participation and Mentorship in Quality Improvement with an Experiential Four-Hour Workshop.

BackgroundGraduate medical education programs lack enough faculty trained in quality improvement (QI). A major barrier to increasing the number of faculty competent in QI is insufficient time to engage in training. Research is missing on the effectiveness of short faculty development workshops to teach academic faculty QI principles and promote participation and mentorship in QI projects.ObjectiveThe authors assessed the ability of a four-hour experiential QI workshop to increase faculty proficiency in QI principles, enhance faculty involvement in QI, and improve resident mentorship in QI.MethodsFrom 2016 to 2017, the authors conducted seven QI faculty development workshops at a large academic medical center with 12 ACGME training programs. We evaluated the workshop using pre- and post-workshop surveys, as well as six- and twelve-month follow up surveys.ResultsSixty-five faculty participated in seven workshops over 13 months. All participants completed pre- and post-workshop surveys, while 38% (n = 25) responded to the six- and twelve-month follow up surveys. Overall, the workshop significantly increased confidence to lead and mentor residents on a QI project (25% pre vs. 72% post, p < .001), increased ability to teach QI (8% pre vs. 36% post, p < .001), increased participation in planning and decision making on a QI team (32% pre vs. 50% post, p = .002), and increased the mean number of QI projects implemented (.45 pre vs. 1.24 post; p < .05).ConclusionA four-hour QI workshop is a quick and effective training method to develop academic faculty to teach and mentor residents in QI. The principles taught increased perceived knowledge, confidence in mentorship, and participation in QI.

Sustainability in Quality Improvement (SusQI): challenges and strategies for translating undergraduate learning into clinical practice

BackgroundThe healthcare sector is a major contributor to climate change and there are international calls to mitigate environmental degradation through more sustainable forms of clinical care. The UK healthcare sector has committed to net zero carbon by 2040 and sustainable healthcare is a nationally mandated outcome for all UK graduating doctors who must demonstrate their ability to address social, economic, and environmental challenges. Bristol Medical School piloted successful Sustainability in Quality Improvement (SusQI) workshop, but identified challenges translating classroom learning into clinical practice. This paper aims to identify and address those challenges.MethodsWe conducted five focus groups that identified and iteratively explored barriers and facilitators to practice among medical students, comparing a range of experiences to generate a conceptual model. We then combined our findings with behaviour change theory to generate educational recommendations.ResultsStudents that applied their learning to the clinical workplace were internally motivated and self-determined but needed time and opportunity to complete projects. Other students were cautious of disrupting established hierarchies and practices or frustrated by institutional inertia. These barriers impacted on their confidence in suggesting or achieving change. A minority saw sustainable healthcare as beyond their professional role.ConclusionsWe present a series of theoretically informed recommendations. These include wider curricular engagement with concepts of sustainable clinical practice; supportive workplace enablement strategies such as workplace champions and co-creation of improvement goals; and time and headspace for students to engage through structured opportunities for credit-bearing project work.

FEASIBILITY, DELIVERY, AND IMPLEMENTATION OF A REMOTE CRITICAL CARE TRAINING PROGRAM IN CHINA: THE CERTAIN APPROACH

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: To describe the development, implementation, and learner engagement in a longitudinal international remote critical care continuing medical education program in China. METHODS: Based on the Mayo Clinic Checklist for Early Recognition and Treatment of Acute and Illness and iNjury (CERTAIN) program, we designed and delivered a longitudinal 40-week remote coaching program for a community-based teaching hospital in Shandong Province, China. Based on a mixed-methods needs assessment that included learner feedback using an exploratory sequential design and ICU process and outcomes data, we developed a curriculum that included asynchronous, online learning modules with multiple language captions and weekly remote education sessions using a blend of didactic presentations on common critical care syndromes, virtual simulation, journal club, and case-based discussions. Faculty included a diverse group of critical care experts and bilingual facilitators. The program also included clinical research and quality improvement workshops to facilitate implementation of key concepts identified during these activities. Participants completed a survey using a 5 point anchored Likert scale after each educational activity to provide feedback and guide course improvement. RESULTS: Twenty-two Chinese clinicians (18 physicians, 4 nurses) enrolled in this CERTAIN longitudinal program. Learners completed a total of 163 hours (mean 7.4 hr/learner) asynchronous online learning, and to date have completed 23 weekly education sessions (total 28 hours, including an extended virtual simulation experience). Survey response rate was 56%. Learners reported a high rate of overall satisfaction with the course (112, 61% Excellent; 55 (30%) Very Good) and specific topic discussions (110,60% Excellent; 57, 31% Very Good), with steady improvement over time. Perceived practice relevance was also high (110, 59% Excellent; 55,30% Very Good), and this effort has informed ongoing local performance improvement initiatives. CONCLUSIONS: Remote delivery of longitudinal critical care continuing education program in China using asynchronous learning, case-based discussion, and virtual simulation is feasible, associated with a high rate of learner satisfaction, and increases engagement in quality improvement initiatives. This innovative global education initiative offers an important potential solution to strengthen critical care services in remote, resource-limited settings at low cost, especially during the ongoing COVID-19 pandemic. CLINICAL IMPLICATIONS: The World Health Organization has identified remote education programs as a priority to strengthen international critical care services and better meet growing global clinical demand. The best method to effectively deliver continuing medical education to international healthcare providers with unique cultural, organizational, and practice backgrounds is not well defined. DISCLOSURES: no disclosure on file for Wenjuan Cui; No relevant relationships by Yue Dong, source=Web Response Patent/IP rights for a licensed product relationship with Ambient Clinical Analytics Please note: From 2016 Added 05/23/2021 by Ognjen Gajic, source=Web Response, value=Royalty No relevant relationships by Heyi Li, source=Web Response No relevant relationships by Alexander Niven, source=Web Response no disclosure on file for Lujun Qiao; No relevant relationships by Yuqiang Sun, source=Web Response no disclosure on file for Qingzhong Yuan

The Pediatric Palliative Improvement Network: A national Healthcare Learning Collaborative

Context and objectivesAlthough multiple national organizations have created consensus guidelines and metrics for pediatric palliative care (PPC), standardized implementation and measurement has been challenging. In 2016, 6 PPC physician-experts in program development and quality improvement (QI) formed a healthcare learning collaborative network entitled the Pediatric Palliative Improvement Network (PPIN). MethodsThe primary drivers identified were 1) Feasibility of a national learning network demonstrated through the completion of one small QI project, 2) Standard education in QI methodology and 3) Salient pediatric palliative care operational, clinical and satisfaction metrics clearly defined. ResultsPPIN now includes146 members representing 51 organizations. In 2019 the group completed a national collaborative QI project focused on pain assessment at the time of initial consult, demonstrating a national increase in pain assessment from 75.8% to >90% over 12 months. PPIN has hosted two national QI workshops training more than 50 PPC clinicians in QI, with a 2-hour webinar provided in 2020 due to COVID. Monthly calls since 2017 provide QI methods “refreshers”, share local works in progress, and provide infrastructure for future collaborative projects. ConclusionsPPIN has become a sustainable organization which improves the quality of PPC through focus on national QI methods training, successful collaborative projects, and the creation of a learning and peer support community with regular calls. With the advent of the Palliative Care Quality Collaborative in 2020, PPIN provides critical educational and organizational infrastructure to inform ongoing quality efforts in PPC, now and in the future.

Dr QI - A quality improvement (QI) approach to designing and delivering QI training

AimsTo develop and implement a QI training programme for trainees, Trust grade doctors and Consultants in Nottinghamshire Healthcare NHS Trust (NHFT) to enable them to deliver change in practice through acquisition of new knowledge and practical application of skills in QI projects using Model for Improvement.BackgroundQI is crucial to improve patient care. Doctors are uniquely placed to input into patient safety and service delivery of healthcare. The skills required to be future clinical leaders and undertake improvement work are not innate and formal teaching and support is required.What is DrQI?DrQI is a trainee-led QI teaching programme developed in collaboration with Trainees improving patient safety through QI (TIPSQI) in North West deanery.MethodA pre-implementation survey amongst doctors in NHFT in February 2019 (33 responses) suggested that 90% of doctors were interested in learning QI and about 48% preferred face-face workshops with support from the QI team.A list of change ideas were created using a driver diagram with QI education and project support identified as key primary drivers.PDSA cyclesNine interactive workshops teaching key QI concepts (based on model for improvement) in NHFT, training more than 100 doctors. A workshop in Derbyshire Healthcare NHS Foundation Trust (70 doctors) and Nottingham University Hospital (20 doctors). Workshops were continually adapted based on qualitative and quantitative feedback. Different formats were tried including virtual sessions, game-based and problem-based learning approaches using small group activities.ResultPre-course and post-course questionnaires were used to assess change in understanding of individual components of QI methodology (SMART Aim, Driver diagram, PDSA cycles, outcome and process measures and run charts). Mean pre-course self-assessment score collated from seven QI workshops in NHFT (2019-2020) was 3.3 and mean post-course score was 7.68, showing an improvement in understanding of QI methodology.Participants were asked to score the relevance (8.4) and quality of teaching (8.4) and the support from the QI team (7.4) on a scale of 1-10 (1 = poor and 10 = excellent). Additional free text feedback was obtained to help us improve the teaching programme.ConclusionCollaborative leadership trainee-led initiative to increase the QI capacity. A bottom up approach to complement the top down approach from the Trust QI team. Future steps include further collaboration and expansion of the scheme to other Trusts, Train the trainer sessions and building a network of QI champions.

Do Quality Improvement Workshops Improve Health Professionals’ Knowledge on Implementing Change for Patients With Coronary Heart Disease in Primary Care?

Educational workshops are an integral part of quality improvement (QI) collaboratives; however, there has been limited research in understanding the most effective delivery of such workshops. The study aims to determine the impact of an evidence-based QI workshop on health professionals’ knowledge and confidence in coronary heart disease (CHD) management in primary care.

Quality of English inpatient mental health services for people with anxiety or depressive disorders: Findings and recommendations from the core audit of the National Clinical Audit of Anxiety and Depression

BackgroundClinical audit is a sustained cyclical quality improvement process seeking to improve patient care and outcomes by evaluating services against explicit standards and implementing necessary changes. National audits aim to improve population-level clinical care by identifying unwarranted variations and making recommendations for clinicians, managers and service commissioners. The National Clinical Audit of Anxiety and Depression aimed to improve clinical care for people admitted to English hospitals for treatment of anxiety and depression, to provide comparative data on quality of care, and to support local quality improvement initiatives by identifying and sharing examples of best practice. ProceduresThirteen standards were developed based on NICE guidelines, literature review and feedback from a steering committee and reference group of service users and carers. All providers of NHS inpatient mental health services in England were asked to submit details of between 20 and 100 eligible service users/patients admitted between April 2017 and September 2018. To ascertain data reliability, participating services re-audited 5 sets of case-notes with a second auditor, and the coordinating team checked 10 randomly-selected sets of case-notes from 3 services, also selected at random. The reference group and steering committee identified key findings and developed a series of recommendations, which were discussed in regional quality improvement workshops and on-line webinars. FindingsData from 3795 case notes were analysed. A sizeable proportion of records indicated that at least one important aspect of initial assessment was not documented. Many service users/patients who could have benefited from an intervention targeted at optimising physical health did not receive it. Only a minority (39%) were referred for psychological therapy. Use of outcome measures varied considerably but no single outcome measure was being used routinely. Most individuals had a care plan recorded in the notes, but a review date was documented in only two-thirds, and almost half of individuals had not received a copy. ConclusionsThere was considerable variation between English mental health services across many variables, and much scope for improvement. Clinicians should ensure that care plans are developed collaboratively with service users/patients and identified carers should be provided with information about support services. Health services should investigate the reasons for low referral rates for psychological therapies. Clinicians should ensure all service users have jointly developed crisis plans in place at discharge. Service managers should agree outcome measures to evaluate the treatment provided and clinicians should use these measures at initial assessment and review appointments. The implementation of such changes provides an opportunity for collaborative research into mental health service delivery and quality.

Interactive videoconferencing in the redesign of a health-care quality improvement workshop for the coronavirus disease 2019 pandemic

Introduction: The Blended Quality Improvement (QI) Workshop is a programme designed to provide learners with basic tools and techniques in QI using a combination of e-learning and face-to-face classroom interactions. To adapt to the coronavirus disease 2019 (COVID-19) situation for safe social distancing since the end of January 2020, SingHealth Duke-NUS Institute for Patient Safety &amp; Quality (IPSQ) suspended all face-to-face workshops. However, the need for effective QI training remains. Objective: The aim was to develop an effective virtual interactive Blended QI Workshop through videoconferencing. Methods: The workshop was redesigned by reviewing the curriculum and incorporating the use of interactive functions. The new workshop took place virtually via a video conferencing platform and incorporated the use of interactive polling, game, videos and case study. A total of 23 learners attended the two pilot runs that took place on 28 April 2020 and 22 May 2020. A survey assessed learners’ reactions and satisfaction with the training and preference in using video conferencing tools during disease and non-disease outbreak situations, while the quizzes assessed learners’ learning in QI knowledge. The results on the improvement in QI knowledge were compared to the original blended e-learning and face-to-face workshop ( n=63) that took place before the COVID-19 pandemic. Results: The gain in QI knowledge from virtual and from face-to-face Blended QI Workshops was statistically significant ( p&lt;0.01, n=86). However, there was no statistically significant difference in the gain in QI knowledge with both content delivery approaches ( p=0.13). All 23 learners agreed that the video conferencing platform was convenient, 20 (87.0%) felt that the platform was effective in delivering content and 18 (78.3%) were keen to use video conferencing tools for QI workshops during disease outbreak situations. Remarkably, a substantial number of learners ( n=11; 47.8%) preferred the use of interactive video conferencing to supplement face-to-face classroom-based Blended QI Workshops for non-disease outbreak situations. Conclusion: The virtual interactive Blended QI Workshop was as effective as the face-to-face Blended QI Workshop based on learners’ views and gains in QI knowledge post workshop. The success of virtual QI workshops makes them a new norm in the post-COVID-19 environment.

1176-P: The Value of Quality Improvement Programs in Diabetes Care: Experience from the Prime Program

The quality of diabetes care is suboptimal worldwide. The Joslin PRIME program assists healthcare professionals (HCPs) with improving diabetes outcomes using scalable quality improvement (QI) methodology. We present findings from a large-scale PRIME implementation focused on A1c reduction. An invitation was sent to 29 HCPs within a large multi-specialty medical group in Springfield, IL. Seventeen HCPs enrolled in the program. Each HCP identified a medical assistant or nurse within the practice to serve as the Diabetes Care Coordinator (DCC) and assist with leading QI activities. Following a live QI workshop, each team (HCP and DCC) learned how to create plan-do-study-act (PDSA) cycles, received a diabetes registry on patients with diabetes and established a plan to decrease the proportion of patients with A1c&amp;gt;9%. Teams were offered online CME, weekly support calls and guidance to implement QI activities using PDSA cycles. De-identified data including clinical metrics on all patients with diabetes, based on ICD-10 codes, cared for by 17 enrolled HCPs (EG) and 12 unenrolled HCPs (UG) were evaluated before and 5 months after institution of the program. Differences in proportion of patients with A1c&amp;gt;9% before the program (P1) and at 5 months (P2) were compared using Chi-square. Twelve participants completed at least one PDSA cycle and saw 39% of their patients with diabetes in 5 months, compared to 21% in the remaining participants. In the EG, P1 was 12% and P2 was 10% (p=0.037). In the UG, P1 was 11% and P2 was 10%, (p=0.136). The odds ratio of having A1c&amp;gt;9% was 0.79 (95% CI 0.63-0.99, p=0.037) in the EG and 0.86 (95% CI 0.71-1.05, p=0.136) in the UG. The proportion of patients with A1c&amp;gt;9% in the EG was significantly lower 5 months after institution of the program. Based on these preliminary data, the PRIME QI program, which is mostly delivered remotely, has the potential to assist HCPs to enhance the quality of diabetes care if applied at a larger scale. Disclosure J. Mitri: Consultant; Spouse/Partner; Janssen Pharmaceuticals, Inc., kymera. Consultant; Self; national dairy council/local dairy council. Research Support; Spouse/Partner; AbbVie Inc., beigene, Janssen Pharmaceuticals, Inc. Research Support; Self; Kowa Pharmaceuticals America, Inc., national dairy council. Research Support; Spouse/Partner; pharma cyclic, TG therapeutics. W. Charlot: None. B.L. Zanger: None. A. Millan-Ferro: None.

Efficacy of quality improvement and patient safety workshops for students: a pilot study

BackgroundWhile the Association of American Medical Colleges encourages medical schools to incorporate quality improvement and patient safety (QI/PS) into their curriculum, medical students continue to have limited QI/PS exposure. To prepare medical students for careers that involve QI/PS, the Institute for Healthcare Improvement chapter at an allopathic medical school and school of allied health professions initiated self-directed learning by offering student-led workshops to equip learners with skills to improve the quality and safety of healthcare processes.MethodsIn this prospective cohort study, workshops were hosted for medical students between 2015 and 2018 on five QI/PS topics: Process Mapping, Root-Cause Analysis (RCA), Plan-Do-Study-Act (PDSA) Cycles, Evidence Based Medicine (EBM), and Patient Handoffs. Each workshop included a hands-on component to engage learners in practical applications of QI/PS skills in their careers. Change in knowledge, attitudes, and behaviors was assessed via pre- and post-surveys using 5-point Likert scales, and analyzed using either the McNemar test or non-parametric Wilcoxon signed-rank test. Surveys also gathered qualitative feedback regarding strengths, future areas for improvement, and reasons for attending the workshops.ResultsData was collected from 88.5% of learners (n = 185/209); 19.5% of learners reported prior formal instruction in these topics. Statistically significant improvements in learners’ confidence were observed for each workshop. Additionally, after attending workshops, learners felt comfortable teaching the learned QI/PS skill to colleagues (mean pre/post difference 1.96, p < 0.0001, n = 139) and were more likely to pursue QI/PS projects in their careers (mean pre/post difference 0.45, p < 0.0001, n = 139). Lastly, learners demonstrated a statistically significant increase in knowledge in four out of five skills workshop topics.ConclusionFew medical students have formal instruction in QI/PS tools. This pilot study highlights advantages of incorporating an innovative, student-directed modified ‘flipped classroom’ methodology, with a focus on active experiential learning and minimal didactic instruction.

Abstract TP386: National Institute of Health Stroke Scale Completion Improved in Hyperacute Stroke Unit; Quality Improvement Strategy for Implementation of the Australian Stroke Foundation 2017 Clinical Guidelines for Stroke Management

Background and Purpose: In September 2017, a new Hyperacute Stroke Unit (HASU) was opened in a metropolitan hospital with over 400 acute stroke admissions per year, offering endovascular clot retrieval (ECR) and IV thrombolysis; 185 ECR procedures completed in 2018. The HASU opening coincided with publication of the 2017 Australian Clinical Guidelines for Stroke Management. The Guidelines state stroke severity be assessed using a validated tool, such as the National Institute of Health Stroke Scale (NIHSS). A Quality Improvement workshop, March 2018, identified attendance of correct and reliable assessment for stroke severity as a service gap. Goal = Improve NIHSS completion on all stroke patients on presentation to hospital and 24hours post endovascular clot retrieval. This was to be achieved within 90 days of project implementation with the focus on nursing education; a new skill addition to the ward environment. Methods: Education workshops (August-September 18) were implemented with the goal of building knowledge, skills and confidence along with gaining NIHSS certification. All clinical and registered nurses were provided designated time to attend workshops. Workshops were also provided to Medical officers (January 2019) allocated to the Stroke team. Cognitive aids to assist with reducing variability in application of the NIHSS were created. These included NIHSS navigation aids to the electronic medical record, NIHSS app upload to mobile phones, paper based NIHSS assessment to assist the bedside nurses and ward round note templates with auto text for NIHSS completion. Data from three months pre and post implementation was collected and compared using the Australian Stroke Clinical Registry (AuSCR). All patients admitted with stroke were included in this analysis (Jan 18-April 19). Results: NIHSS completion on patient presentation increased by 12% (n=325). NIHSS completion at 24hrs for patients post ECR increased by 22% (n=163). 31 registered nurses trained; 8 medical officers trained. Conclusions: Targeted, multimodal strategies improved completion of NIHSS on presentation and particularly, 24hrs post ECR. Further implementation in the emergency department is required to gain improvements in NIHSS completion on presentation.

Quality Improvement Basics: A Crash Course for Pediatric Cardiac Care.

Lack of knowledge of quality improvement (QI) methodology and change management principles can explain many of the difficulties encountered when trying to develop effective QI initiatives in health care. An interactive QI workshop at the 14th Annual Meeting of the Pediatric Cardiac Intensive Care Society provided an overview of the role of QI in health care, basic QI frameworks and tools, and leadership and organizational culture pitfalls. The top five QI projects submitted to the meeting were later presented to an expert QI panel in a separate session to illustrate examples of QI principles. Workshop presenters introduced two major QI methodologies used to design QI projects. Important first steps include identifying a problem, forming a multidisciplinary team, and developing an aim statement. Key driver diagrams were highlighted as an important tool to develop a project's framework. Several diagnostic tools used to understand the problem were discussed, including the "5 Why's," cause-and-effect charts, and process flowcharts. The importance of outcome, process, and balancing measures was emphasized. Identification of interventions, the value of plan-do-study-act cycles to fuel continuous QI, and use of statistical process control, including run charts or control charts, were reviewed. The importance of stakeholder engagement, transparency, and sustainability was discussed. Later, the top five QI projects presented highlighted multiple "QI done well" practices discussed during the preconference QI workshop. Understanding QI methodology and appropriately applying basic QI tools are pivotal steps to realizing meaningful and sustained improvement.

Improving Newborn Care in Ethiopia: Evaluation of a Quality Improvement Workshop

Introduction: Almost 3 million neonates die annually, making up nearly 50% of under-5 mortality, with 98% of these deaths occurring in low and lower-middle income countries (LMICs). With the goal of reducing neonatal mortality, the American Academy of Pediatrics (AAP) developed Helping Babies Survive (HBS), an educational program to teach evidence-based newborn practices in low-resource settings. While HBS has been widely disseminated in LMICs, barriers to implementation often challenge translation of this knowledge into practice. To address these barriers, the AAP and partners developed a simplified guide, …