Quality Of Care Indicators Research Articles

Quality indicators of person-centred and recovery-oriented care for mental health issues

Quality indicators of person-centred and recovery-oriented care for mental health issues

Quality Indicators of pediatric polytrauma care

Quality Indicators of pediatric polytrauma care

СРАВНИТЕЛЬНЫЙ АНАЛИЗ УДОВЛЕТВОРЕННОСТИ ПАЦИЕНТОВ МЕДИЦИНСКОЙ ПОМОЩЬЮ, ОКАЗЫВАЕМОЙ ВРАЧОМ ОБЩЕЙ ПРАКТИКИ И ВРАЧОМ-ТЕРАПЕВТОМ УЧАСТКОВЫМ

Significance. Patient satisfaction with medical care is one of the key performance indicators of the health care system. The purpose of the study: to conduct a comparative analysis of patient satisfaction with primary care provided by general practitioners (GP) and district physicians (DPh) in Russia and identify indicators that can be used to manage accessibility and quality of primary care, using the principles of value-based healthcare. Material and methods. The study used analytical, sociological and statistical methods. The survey was conducted by the method of sampling. The minimum sample size equaled to 400 observation units. The survey bases included medical organizations providing medical care on an outpatient basis in the cities of Moscow, Kemerovo and Belgorod, the places that have undergone reforming and introduced GP practices. Results. The final analysis included 415 questionnaires. Patient satisfaction with medical care, provided by GP equaled to 87.6%, satisfaction with care provided by DPh added up to 73.3% (p<0.001). Patient satisfaction with individual parameters of medical care related to the medical organization, doctor and doctor-patient relationship also turned out to be statistically significantly higher if provided by GP. The average score ranged within 3.8-4.2 and 2.2-2.4, respectively. For both the GP and DPh models of care delivery, the lowest satisfaction was reported for the parameters characterizing its organization. Based on the results of our own research and results of earlier papers, the indicators of primary care accessibility and quality that are of greatest value to the patient were identified. Conclusion. Based on generalization of the study results and data published in scientific literature, a set of indicators has been proposed to ensure continuous monitoring over quality and accessibility of primary care and make organizational and managerial decisions using the principles of value-based healthcare.

Key process and outcome indicators on quality and safety of care for critically ill pediatric patients according to international standard organization protocols: a four-year follow-up study

The European Society of Intensive Care Medicine (ESICM) suggests nine quality and safety indicators of care for critically ill patients. The aim of the present study was to examine the Key Process and Outcome Indicators (KPOIs) chosen according to International Standard Organization (ISO) protocols in a Greek Pediatric Intensive Care Unit (PICU). Two structure, one process, and four outcome indicators were examined in a stepwise approach according to Observe-Plan-Do-Study-Act (OPDSA) cycles, in an observational four-year cohort study (2017–2020). Two structure indicators—that ICUs fulfil national requirements to provide intensive care and 24-h consultant availability were requirements for the creation of the PICU and considered standards of care. One process indicator—Standardized Handover Procedure was transformed from handwritten (2017–2018) into electronic form (2019–2020) and 100% compliance rates throughout the four years were recorded. 96, 85, 103 and 94 patients were admitted in 2017, 2018, 2019 and 2020 with median (IQR) Pediatric Risk of Mortality III-24 h scores of 10 (6.25–17), 10 (6–13), 8 (5–13) and 8 (6.75–12), respectively. Mortality rates were 24%, 11.8%, 17.5%, 16%, and Standardized Mortality Ratio (SMR) were 1.42, 0.92, 1.56 and 1.33, correspondingly. No early (<48 h after PICU discharge) readmissions were recorded for 2017 and 2018, only 1 in 2019 (0.8%) and none in 2020. Catheter Related Bloodstream Infection rates were 1.37:1000, 1.37:1000, 1.26:1000 and 1.39:1000 catheter days, respectively. Unplanned extubation rate was 10.30% in 2019 and 5.72% and 3.91:1000 ventilation days in 2020. In conclusion, ISO implementation of our unit was the trigger for internal PICU audit and external benchmarking. OPDSA cycles, following small steps at a time, in an iterate cycle of evolution, facilitated our actions. The majority of the KPOIs examined in our study was within international PICUs reference values.

Quality of Municipal Long-Term Care in Different Models of Care: A Cross-Sectional Study From Norway.

The quality of care remains a critical concern for health systems around the globe, especially in an era of unprecedented financial challenges and rising demands. Previous research indicates large variation in several indicators of quality in the long-term care setting, highlighting the need for further investigation into the factors contributing to such disparities. As different ways of delivering long-term care services likely affect quality of care, the objectives of our study is to investigate (1) variation in structure, process and outcome quality between municipalities, and (2) to what extent variation in quality is associated with municipal models of care and structural characteristics. The study had a cross-sectional approach and we utilized data on the municipal level from 3 sources: (1) a survey for models of care (2) Statistics Norway for municipal structural characteristics and (3) the National Health Care Quality Indicator System. Descriptive statistics showed that the Norwegian long-term care sector performs better (measured as percentage or probability) on structure (85.53) and outcome (84.86) quality than process (37.85) quality. Hierarchical linear regressions indicated that municipal structural characteristics and model of care had very limited effect on the quality of long-term care. A deeper understanding of variation in service quality may be found at the micro level in healthcare workers' day-to-day practice.

Prenatal care associated with neonatal outcomes in maternity hospitals: a hospital-based cross-sectional study.

To verify the association between prenatal care quality indicators and neonatal outcomes in maternity hospitals. Hospital-based cross-sectional study in four high-risk referral maternity hospitals in the five health macro-regions enabled by the Stork Network in Ceará-Brazil. Between April 2017 and July 2018, 440 puerperal women were interviewed using simple probabilistic sampling and a formula with finite populations and stratification of each maternity hospital. The analysis involved Pearson's Chi-Square, Adjusted Residuals Analysis and Fisher's Exact. There was an association between fewer consultations with prematurity and low birth weight. Delivery in the maternity hospital where the woman lived was associated with low birth weight and the need for ventilatory support. Prenatal care quality indicators influenced neonatal outcomes, which underlines the importance of ensuring access and quality of care as ways of reducing infant morbidity and mortality.

Clarify the Concept of Healthcare Quality

Public confidence is shaken by declining health care quality indicators. Healthcare quality is still conceptually and practically undefined, despite improvements in hospital safety and quality of care. So, the purpose of this analysis is to define the term "healthcare quality." The framework was based on the concept analysis technique developed by Walker and Avant, which is frequently cited in nursing literature. We looked through five academic literature databases, public domain websites, general and medical dictionaries, and dictionaries. Healthcare and quality were search terms, as well as terms related to health care. From 2004 to 2016, peer-reviewed papers and official reports that were published in English were included. Gray literature, discussions of the need for high-quality healthcare, related concepts, and conference proceedings were all excluded. During analysis, similar characteristics were categorized into themes. After removing duplicates and articles that weren't eligible, 42 pertinent articles were examined. Four defining characteristics were found after thematic analysis: (1) effective, (2) safe, (3) culture of excellence, and (4) desired outcomes. Based on these characteristics, the definition of high-quality healthcare is the evaluation and delivery of safe, effective care that is reflected in an excellence-centered culture and leads to the achievement of ideal or desired health. This analysis offers a conceptualization of healthcare quality that clarifies its underlying assumptions and may enhance the delivery of high-quality care. Theoretical and practical implications are provided to support a more thorough and consistent understanding of the elements required to enhance healthcare delivery and maintain public confidence.

The Disease Pattern and Utilisation of Health Care Services in Pakistan

Health is an important aspect of human life. In general terms, better health status of individuals reflects reduced illnesses, low level of morbidity, and less burden of disease in a given population. It is widely recognised that improved health not only lowers mortality, morbidity and level of fertility, but also contributes to increased productivity and regular school attendance of children as a result of fewer work days lost due to illness, which in turn have implications for economic and social well-being of the population at large. Hence investing in health is vital for promoting human resource development and economic growth in a country [World Bank (1993)]. A view of Pakistan’s health profile indicates that the sector has expanded considerably in terms of physical infrastructure and its manpower in both the public and private sector. This has contributed to some improvement in selected health status indicators over the years. However, the public health care delivery system has been inadequate in meeting the needs of the fast growing population and in filtering down its benefits to the gross-root level. As such, Pakistan still has one of the highest rates of infant and child mortality, total fertility and maternal mortality when compared with many other countries in the Asian region [UNDP (2000)]. Due to low priority given to social sector development in the past and low budgetary allocations made to the health sector, the evidence shows that mortality and morbidity indices have not reduced to the desired level and large gaps remain in the quality of care indicators, especially in rural areas [Federal Bureau of Statistics (2000)].

Quality of Sarcoma Care: Longitudinal Real-Time Assessment and Evidence Analytics of Quality Indicators.

Sarcomas represent a large group of rare to very rare diseases, requiring complex management with a transdisciplinary approach. Overall progress has been hampered because of discipline, institution and network fragmentation, and there is no global data harmonization or quality standards. To report on and improve quality, a common definition of quality indicators (QIs) of sarcoma care as well as the capacity to assess longitudinal real-time data is required. An international advisory board of world-renowned sarcoma experts defined six categories of QIs, totaling more than 80 quality indicators. An interoperable (web-based) digital platform was then created combining the management of the weekly sarcoma board meeting with the sarcoma registry and incorporating patient-reported outcome measures (PROMs) into the routine follow-up care to assess the entire care cycle of the patient. The QIs were then programmed into the digital platform for real-time analysis and visualization. The definition of standardized QIs covering all physician- (diagnostics and therapeutics), patient- (PROMS/PREMS), and cost-based aspects in combination with their real-time assessment over the entire sarcoma care cycle can be realized. Standardized QIs as well as their real-time assessment and data visualization are critical to improving the quality of sarcoma care. By enabling predictive modelling and introducing VBHC, precision health care for a complex disease is on the horizon.

Evaluación de desempeño del servicio de dosificación de precisión para vancomicina en un hospital pediátrico de nivel terciario

Plasma level-based therapeutic drug monitoring of vancomycin is recommended in the treatment of complex pediatric infections in order to increase the probability of achieving safe and effective pharmacotherapy. To retrospectively evaluate the activities and performance of pharmacotherapeutic optimization based on vancomycin levels at a tertiary pediatric hospital between 2007 and 2020. Vancomycin levels of pediatric patients were analyzed, assessing care quality indicators and analytical verifications, as well as aspects related to teaching and research. The predictive performance of vancomycin levels was evaluated after adjustment of the therapeutic regimen using a population pharmacokinetic optimization program (BestDose v1.126) considering the coefficient of determination (R2), the mean absolute percentage error (MAPE), and the root mean square error (RMSE). 13269 vancomycin level determinations were analyzed; 70% were trough levels and 81% belonged to patients in the intensive care units. Forty percent of the trough levels were within the therapeutic range when adjusted without software. Three hundred seventy-four pharmacotherapeutic interventions, of which 97% were accepted by the treating physician; 75% of the post-adjustment trough levels were within the therapeutic range, compared to 40% when the approach was empirical, a difference that was statistically significant (p=0.03). The values associated with predictive performance (n subgroup of patients = 91) were: R2=0.61, MAPE=28.16%, and RMSE=3.3, which all showed to be adequate. The performance of therapeutic vancomycin monitoring and related pharmacokinetic clinical activities showed to be good.

RACIAL AND ETHNIC VARIATIONS IN DEMENTIA DIAGNOSIS, SURVIVAL, AND END-OF-LIFE CARE QUALITY

Abstract In the United States most adults have a preference to die at home and is an indicator of good end-of-life care. In the context of dementia, family members and caregivers are decision makers and part of good and equitable care involves understanding cultural variation in attitudes and social norms related to dementia, death and dying, and the meaning of a good death. This symposium explores racial and ethnic variation in lifetime dementia diagnosis and end-of-life care quality indicators. The first presentation examines racial, ethnic, and geographic variation in the rarely discussed lifetime prevalence of dementia and survival time from dementia diagnosis to death using national Medicare data. The second presentation describes the relationship between end-of-life care planning and satisfaction with end-of-life care using data from the Health and Retirement Study. The third presentation describes variation in place of death, a key indicator of end-of-life care quality, by dementia diagnosis and race/ethnicity using national Medicare data. The fourth presentation examines variation in hospice use, another indicator of end-of-life-care quality, and place of death by dementia diagnosis, race, and ethnicity using national Medicare data. The symposium concludes with a presentation examining the relationship between place of death and satisfaction with care received using data from the Health and Retirement Study. The Institute for Healthcare Improvement’s Triple Aim (improving the experience of care, improving the health of populations, and reducing per capita costs of health care) serves as a lens for discussing policy and practice implications of the major findings from each presentation.

970. The Time for Action is Now: The Impact of Timing with Infectious Diseases Consultation for Staphylococcus aureus Bacteremia

Abstract Background Staphylococcus aureus bacteremia (SAB) is one of the leading causes of bloodstream infections complicated by metastatic diseases leading to extended lengths of stay (LOS). Infectious disease (ID) consultation is associated with greater adherence to standards of care and improved clinical outcomes. There are sparse data evaluating the impact of the timing for ID consult on SAB management. The purpose of this study was to compare the difference in clinical outcomes in patients with SAB who received an early (< 5 days) versus late (≥ 5 days) ID consult. Methods This was an IRB-approved, retrospective, cohort study in hospitalized adult patients with SAB who received an ID consultation between 2015 and 2020. The timing of the ID consult was defined from the order of the index positive blood culture to the placement of the consult. The composite primary endpoint included: identifying the source of SAB, follow-up cultures, obtaining an echo, use of parenteral therapy, and treatment duration. Secondary endpoints included mortality, recurrence, LOS, duration of bacteremia, and readmission rates (30, 60, and 90-day). A machine learning algorithm (MLA) was utilized to determine an alternative to the 5 days threshold for early vs late. Results A total of 321 patients with SAB were included with baseline characteristics (Table 1). The early group was more likely to meet the primary endpoint (62.5% vs. 28.3%, p < 0.001). The median duration of bacteremia and length of stay was shorter in the early group (p < 0.001) (Table 2). MLA determined an alternative threshold of ≤ 3.5 days for early ID consult. Multivariable analyses reported early ID consult in ≥ 5 days (adjusted OR: 6.42, 95% CI [3.20, 12.89]; p < 0.001) and ≤ 3.5 days (adjusted OR: 3.47, 95% CI [2.08, 5.81]; p < 0.001) as independent predictors for achieving the five quality care indicators (Table 3). Comparing the predefined definition of early infectious diseases consultation as < 5 days and late infectious diseases consultation as >= 5 days in univariate analyses to baseline and clinical characteristics. A comparison of an alternative threshold of 3.5 days was also performed in univariate analyses. PWID: persons who inject drugs; ESRD: end-stage renal disease; SD: standard deviation; IQR: interquartile range; MRSA: methicillin-resistant Staphylococcus aureus; ICU: intensive car unit. Comparing the predefined definition of early infectious diseases consultation as < 5 days and late infectious diseases consultation as >= 5 days in univariate analyses to primary and secondary endpoints. A comparison of an alternative threshold of 3.5 days was also performed in univariate analyses. Bivariate analyses were performed with covariates of interest that may be associated with five quality indicators of Staphylococcus aureus bacteremia management (composite primary endpoint). Multivariable analysis was performed to control for covariates statistically significant in the bivariate analyses. Early infectious diseases consultation < 5 days was an independent predictor for meeting the five quality indicators of SAB management. Another multivariable analysis confirmed early ID consultation <= 3.5 days as an independent predictor for meeting the five quality indicators of SAB management. Conclusion Patients with SAB who received an early ID consultation were more likely to achieve the quality care indicators and have a shorter duration of bacteremia and LOS. These data suggest that patients with SAB should have an ID consultation < 5 days from index culture acquisition. Future studies should evaluate if an earlier time frame of 3.5 days for ID consultation improves clinical outcomes. Disclosures All Authors: No reported disclosures.

Measuring the quality of life of long-term care service users in Japan: a cross-sectional questionnaire study

BackgroundIn Japan’s super-aging society, the number of long-term care service providers is increasing, and the quality of care is a matter of concern. One aspect of the quality of care is the user’s quality of life. The questionnaires EQ-5D and WHO-5 are representative indicators of quality of life. Herein, we aimed to measure the quality of life in long-term care service users in Japan and to clarify the relationship between quality of life and the level of care required.MethodsA questionnaire study was conducted in 106 facilities of 22 corporations. In addition to the EQ-5D and WHO-5, sex, age, and the level of care required were assessed by descriptive statistics. Bonferroni’s multiple comparison test was used to analyze each quality of life score, and the differences by sex and age were analyzed multiple regression analyses, with each quality of life score as the objective variable.ResultsOf 4647 cases collected, 2830 were analyzed, with no missing data. Both indicators tended to be lower than the general older population. Those scores tended to be higher in females than males (EQ-5D: males, 0.58 ± 0.26; females, 0.60 ± 0.24; P = 0.06 and WHO-5: males, 13.8 ± 5.92; females 14.9 ± 5.70; P < 0.001). In terms of age, those under 65 years old with specific diseases had lower EQ-5D scores than those in other age groups (P < 0.001); however, WHO-5 scores did not differ by age. Multiple regression analysis showed a significant association between the EQ-5D score and level of care required, except for support-required level 1, which tended to worsen as the level of care required increased. Conversely, the WHO-5 score was significantly lower for care need levels 2, 4, and 5.ConclusionsThe quality of life of long-term care service users was worse than that of the general older population, it tended to be low among males and those under 65 years old with specific diseases. Furthermore, it gradually decreased as the level of care required increased. It is important to monitor users’ quality of life as a quality indicator of care, to improve and manage it.

The impact of the COVID-19 pandemic on cancer incidence and cancer care in patients with prostate cancer in the Siberian Federal District

Background. Prostate cancer incidence rates continue to increase every year, therefore, the study of the quality indicators for cancer care, especially during a pandemic, is of great importance.Aim. To analyze prostate cancer incidence rates and quality indicators of cancer care in the Siberian Federal District.Materials and methods. For the calculation of cancer incidence rates, population-bases cancer registry data were used. Quality indicators were calculated according to the methodological recommendations of P.A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center.Results. The implementation of restrictive measures and the suspension of cancer screening programs in 2020 negatively affected the cancer care. The prostate cancer incidence rate decreased from 52.8 per 100 000 population in 2019 to 43.1 per 100 000 population in 2020, especially in the territories of the Republic of Tyva and the Omsk Region. Morphological verification in 2020 decreased compared to 2019 (97.0 % versus 97.8 %), with the exception of the Krasnoyarsk Territory and the Republic of Altai. Early prostate cancer detection increased from 62.9 to 64.0 %, and cancer detection at late stages decreased from 36.3 to 35.0 %. One-year mortality in the region decreased from 8.0 % (2019) to 7,3 % (2020), however, it increased significantly in the Republic of Tyva (from 3.2 to 40.0 %) and the Altai Republic (from 3.7 to 10.7 %). The number of patients who have been followed-up for 5 years or more increased from 40.7 to 42.3 %, except for Republic of Altai (from 32.8 to 25.0 %).Conclusion. Delay in the diagnosis of prostate cancer is associated with advanced stage, poor survival and high cost treatment.

Center-based early care and education programs and quality indicators: A latent class analysis

High quality early educational experiences are essential for young children's academic and social-emotional development. Although there is no one set of quality indicators that exists at a national level to assess center-based early care and education (ECE) program quality, researchers at the National Institute of Early Education Research (NIEER) have developed a set of quality benchmarks for state pre-kindergarten programs. However, patterns in the types of quality indicators ECE programs meet and how program, community, and policy features might be related to which indicators are met is not well understood. In the present study, we conducted a latent class analysis using nationally representative data from the 2012 National Survey of Early Care and Education (NSECE; n = 5,076 ECE centers) to identify subgroups of centers on the basis of the combinations of quality indicators met, which are similar to those developed by NIEER. Descriptive results show the mean number of NIEER benchmarks met was 5.74 out of 9 possible in the NSECE data. Our latent class analysis results reveal five distinct classes: (1) most quality indicators met; (2) smaller classroom ratios, but fewer teacher education and workforce support indicators met; (3) less screening support, but more teacher education and workforce support indicators met; (4) fewest indicators met; and (5) larger classroom ratios. Predictors of class membership were also examined. Findings of this exploratory study reveal heterogeneity in the specific combinations of quality indicators ECE programs meet.

Womenʼs assessment of the quality of hospital‐based perinatal care by mode of birth in Romania during the COVID‐19 pandemic: Results from the IMAgiNE EURO study

To assess women's perceptions of the quality of maternal and newborn care (QMNC) received in hospitals in Romania during the COVID-19 pandemic by mode of birth. A validated anonymous online questionnaire based on WHO quality measures. Subgroup analysis of spontaneous vaginal birth (SVB), emergency cesarean, and elective cesarean and multivariate analyses were performed, and QMNC indexes were calculated. Maternal age, educational level, year of birth, mother born in Romania, parity, type of hospital, and type of professionals assisting the birth were used for multivariate analysis. A total of 620 women completed the survey. Overall, several quality measures suggested gaps in QMNC in Romania, with the lowest QMNC indexes reported for provision of care and availability of resources. Women who had either elective or emergency cesarean compared with those who had SVB more frequently lacked early breastfeeding (OR 2.04 and 2.13, respectively), skin-to-skin contact (OR 1.73 and 1.75, respectively), rooming-in (OR 2.07 and 1.96, respectively), and exclusive breastfeeding at discharge (OR2.27 and 1.64, respectively). Compared with elective cesarean, emergency cesarean had higher odds of ineffective communication by healthcare providers (OR 1.65), lack of involvement in choices (OR 1.58), insufficient emotional support (OR 2.07), and no privacy (OR 2.06). Compared with other modes of birth, a trend for lower QMNC indexes for emergency cesarean was observed for all domains, while for elective cesarean the QMNC index for provision of care was significantly lower. Quality indicators of perinatal care remain behind targets in Romania, with births by cesarean the most affected. NCT04847336.

Patient Satisfaction: Evaluating Nursing Care for Patients Hospitalized with Cancer

Patient’s satisfaction is an indicator of quality care and it encompasses the different aspects of nursing care leading to cancer patient’s satisfaction like information given by nurses. Aim: To assess the level of satisfaction with nursing care among hospitalized cancer patients. Study design: Cross-sectional descriptive study. Methodology: A sample of 158 patients in two hospitals was selected from Jinnah hospital Lahore and INMOL by using method of non-probability convenient sampling. Data was collected by adopted questionnaire. Data was analyzed by SPSS software, version 20. Chi square was used for qualitative variables like satisfaction, educational status. A p-value of ≤ 0.05 was considered as statistically significant. Results: The results of this study indicated that a majority of the cancer patients were satisfied with different aspects of nursing care such as information given by nurses, 60.28% of patients were satisfied but interpersonal relations between nurses and patients were found to have mixed response as only 60.61% patients were satisfied. Regarding the technical quality of nurse 68.07% of patients were satisfied. Practical Implication: This study identified the lacking among health care providers regarding nursing care that make a barrier for patient’s satisfaction and helped in Program planning for monitoring and improving the nursing care services at health care setups. Conclusion: We concluded that majority of the patients were satisfied by the nursing care but there is a need to improve the information given by nurses and interpersonal relationship in the nursing care provided by the selected hospitals to improve patients’ overall satisfaction. Keywords: Patient Satisfaction, Nursing Care and Cancer.

Characteristics Associated With Failure to Rescue After Open Abdominal Aortic Aneurysm Repair

IntroductionFailure to Rescue (FTR), defined as mortality following a complication of care, is an important indicator of hospital care quality. Understanding risk factors associated with FTR in the elective Abdominal Aortic Aneurysm (AAA) population may help surgeons prevent operative mortality. MethodsElective open AAA repairs (2008-2018) were identified from Cerner's HealthFacts database using ICD-9 and ICD-10 diagnosis and procedure codes. Patient, hospital, and encounter characteristics were analyzed. Multivariate logistic regression models determined the relative contribution of patient and encounter characteristics leading to FTR. ResultsFor 1761 patients who underwent open repair for nonruptured AAA, overall mortality was 6.1%. Of patients with one or more complications (40%), mortality was 9.6%, increasing to 21.5% for patients with ≥4 major complications. Complications of care most associated with death were myocardial infarction (MI), gastrointestinal (GI) bleeding, and pulmonary failure. After multivariable adjustment, FTR was associated with advanced age (odds ratio [OR] 1.19 for 5 y, 95% confidence interval [CI] 1.06-1.34); female sex (OR 1.74, 95% CI 1.12-2.70); congestive heart failure (OR 1.65, 95% CI 1.00-2.73); peptic ulcer disease (OR 3.99, 95% CI 1.18-13.5); diabetes (OR 4.90, 95% CI 1.90-12.6), and the number of complications of care. ConclusionsComplications of care were common following open elective AAA repair. The complications with the highest mortality included MI, GI bleeding, and respiratory failure. FTR was associated with female sex, comorbidities, and increasing numbers of complications of care. Often, the lowest occurring complications had the highest FTR. Adopting gender-specific assessment tools, a protocol-driven approach for perioperative GI prophylaxis, and preoperative MI risk mitigation may lead to reduced FTR.

Quality indicators in burn care: An international burn care professionals survey to define them

IntroductionQuality indicators (QIs) are tools for improving and maintaining the standard of care. Although burn injuries are a major global health threat, requiring standardized management, there is a lack of worldwide accepted quality indicators for burn care. This study aims to identify the best burn care-specific QIs as perceived by worldwide burn practitioners. MethodsThe ISBI Burn Care Committee developed a survey to analyze which burn care- specific QIs were relevant to international burn care professionals. The questionnaire was based on the three dimensions of the Donabedian model (i.e., Structure, Process, and Outcome) to evaluate the quality of care. The study was conducted from April to September 2021 and analyzed and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). ResultsAccording to the 124 worldwide respondents, the most relevant QIs were: access to intensive care, burn surgeons, and dedicated burn care nurses (Structure category), 24-hours access to burn services, local protocols based on documented guidelines (Process category), and in-hospital mortality and incidence of severe infections (Outcome category). ConclusionsSpecific QIs related to structures, clinical processes, and outcomes are needed to monitor the treatment of burn patients globally, assess the efficiency of the provided treatment, and harmonize the worldwide standard of burn care.

Parental Satisfaction with Care and Support in Neonatal Care Units of Public Hospitals of Nepal

Introduction: Parental satisfaction is one of the indicators of quality care. An understanding of the satisfying areas would help to identify and prioritize care and support areas for infants and parents. Therefore, this study was conducted to find out the parental satisfaction with care and support in neonatal care units (NCUs). Methods: Cross-sectional descriptive study was conducted in NCUs of five selected public hospitals. The study was conducted among 305 parents of preterm infants (PTIs). After obtaining ethical approval, in-person interviews were conducted with parents using a satisfaction questionnaire. Both descriptive and inferential statistics were used for data analysis. Results: Parents were moderately satisfied with care and support with a median score and interquartile range of 3.4 (3.1- 3.8). They were highly satisfied with the infant care and least satisfied with the attachment and care guidance support with median scores of 4.0 (3.5 - 4.0) and 3.1 (2.6 - 3.8) respectively. Parental satisfaction was significantly associated with parental age, gestational age at birth, and birth weight (P value &lt; 0.05). Conclusions: Parents are moderately satisfied with the care and support received in the NCUs. Their satisfaction is lower with the support for attachment and care guidance. In addition to competent and affectionate care to PTIs, parental support for attachment, guidance, and involvement in care need to be considered by NCU personnel.