Home About us Contact
|
Home About us Contact | ||
|
|
||
Quality Improvement Project (quality + improvement_project)
Selected AbstractsEmployer-sponsored occupational therapy professional development in a multicampus facility: A quality projectAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 4 2009Anne Cusick Aim:,To critically assess and develop recommendations for professional development (PD) for occupational therapists in a multisite specialist cerebral palsy occupational therapy service. Method:,Quality improvement project based on principles of participatory action research: audit of PD resources/activity; stakeholder consultations and literature review. Results:,The PD program goal, resources, strategies, activities and evaluations conducted at the centre were identified and described. Areas for improvement were identified by critically considering the PD program in the context of reviewed literature. There was an assumption that personal change through PD would help attain the organisational goal of clinically competent practitioners who use evidence-based practice in a family-centred context. Recommendations:,Future PD plans and evaluations need to explicitly address this assumption. The use of structured reflection and the ,clinical reasoning' conceptual framework was recommended as one way to help personal change from PD to have workplace impact. This project provides a precedent and guide to occupational therapy PD planners regarding a whole-of-organisation approach to developing and maintaining competence through PD. [source] Researching Quality in Emergency MedicineACADEMIC EMERGENCY MEDICINE, Issue 11 2002Kenneth E. Bizovi MD Research aimed at promoting quality of medical care must be quality research. This paper addresses issues of study design that can affect the validity of such research. The authors draw on previous research about medical errors,recognizing that issues of study design pertaining to medical errors apply to other research on quality of care and, indeed, to clinical research in general. The November 2000 Special Issue of Academic Emergency Medicine addressed medical errors in emergency medicine. In that issue, Kyriacou and Coben described three categories of research on medical errors: 1) research aimed at describing the magnitude of the problem; 2) research identifying causal factors for medical errors; and 3) research evaluating interventions aimed at improving quality of care. These three categories correspond to research methodologies that are, respectively, 1) descriptive; 2) qualitative; and 3) analytic. This article discusses challenges to the validity of each type of research and suggests some possible solutions to these problems. In addition, the article reviews projects that illustrate important issues in research quality. Three research projects are discussed: 1) a published project evaluating an intervention aimed at improving quality; 2) a quality improvement project that is transformed into a research project; and 3) a quality monitoring research project that exemplifies how a statistical technique borrowed from industry can offer a unique solution to quality challenges in medicine. Each of these projects demonstrates some of the challenges in researching quality and their solutions. [source] Portfolios: Possibilities for Addressing Emergency Medicine Resident CompetenciesACADEMIC EMERGENCY MEDICINE, Issue 11 2002Patricia O'Sullivan EdD Portfolios are an innovative approach to evaluate the competency of emergency medicine residents. Three key characteristics add to their attractiveness. First, portfolios draw from the resident's actual work. Second, they require self-reflection on the part of the resident. Third, they are inherently practice-based learning since residents must review and consider their practice in order to begin the portfolio. This paper illustrates five different applications of portfolios. First, portfolios are applied to evaluating specific competencies as part of the training of emergency physicians. While evaluating specific competencies, the portfolio captures aspects of the general competencies. Second, the article illustrates using portfolios as a way to address a specific residency review committee (RRC) requirement such as follow-ups. Third is a description of how portfolios can be used to evaluate resident conferences capturing the competency of practice-based learning and possibly other competencies such as medical knowledge and patient care. Fourth, the authors of the article designed a portfolio as a way to demonstrate clinical competence. Fifth, they elaborate as to how a continuous quality improvement project could be cast within the portfolio framework. They provide some guidance concerning issues to address when designing the portfolios. Portfolios are carefully structured and not haphazard collections of materials. Following criteria is important in maintaining the validity of the portfolio as well as contributing to reliability. The portfolios can enhance the relationship between faculty and residents since faculty will suggest cases, discuss anomalies, and interact with the residents around the portfolio. The authors believe that in general portfolios can cover many of the general competencies specified by the ACGME while still focusing on issues important to emergency medicine. The authors believe that portfolios provide an approach to evaluation commensurate with the self-evaluation skills they would like to develop in their residents. [source] Brief Report: Quality Improvement in Critical Access Hospitals: Addressing Immunizations Prior to DischargeTHE JOURNAL OF RURAL HEALTH, Issue 4 2003Edward F. Ellerbeck MD These hospitalizations may represent a missed opportunity to address immunizations. Addressing these missed immunizations could provide an opportunity for CAHs to gain practical experience in data-driven quality improvement. Purpose: To improve documentation and delivery of influenza and pneumococcal immunizations prior to hospital discharge and provide CAHs with quality improvement experience. Methods: We recruited 17 CAHs in Kansas to participate in a rapidcycle quality improvement project to address inpatient immunizations. Each hospital identified patient discharges on a monthly basis and abstracted medical records to see if the patient's immunization status had been assessed and if patients had been vaccinated prior to discharge. Findings: Documentation of influenza immunization status improved from 17% of admissions at baseline to 62% at follow-up (P<0.001). Documentation of pneumococcal immunization status increased from 36% at baseline to 51% at follow-up (P<0.001). Documentation of immunizations was significantly higher among the 8 hospitals that developed standard charting forms for recording immunization status (P<0.01). Despite improved documentation of immunization status, at remeasurement only 3.4% received an influenza vaccination and 1.3% received a pneumococcal vaccination prior to discharge. Conclusions: Critical access hospitals can effectively participate in quality improvement activities, but increased involvement of medical staff or standing immunization orders may be needed to improve actual vaccine administration prior to discharge. [source] Global oximetry: an international anaesthesia quality improvement projectANAESTHESIA, Issue 4 2010H. Adams No abstract is available for this article. [source] Global oximetry: an international anaesthesia quality improvement projectANAESTHESIA, Issue 10 2009I. A. Walker Summary Pulse oximetry is mandatory during anaesthesia in many countries, a standard endorsed by the World Health Organization ,Safe Surgery Saves Lives' initiative. The Association of Anaesthetists of Great Britain and Ireland, the World Federation of Societies of Anaesthesiologists and GE Healthcare collaborated in a quality improvement project over a 15-month period to investigate pulse oximetry in four pilot sites in Uganda, Vietnam, India and the Philippines, using 84 donated pulse oximeters. A substantial gap in oximeter provision was demonstrated at the start of the project. Formal training was essential for oximeter-naïve practitioners. After introduction of oximeters, logbook data were collected from over 8000 anaesthetics, and responses to desaturation were judged appropriate. Anaesthesia providers believed pulse oximeters were essential for patient safety and defined characteristics of the ideal oximeter for their setting. Robust systems for supply and maintenance of low-cost oximeters are required for sustained uptake of pulse oximetry in low- and middle-income countries. [source] Using Data from Hospital Information Systems to Improve Emergency Department CareACADEMIC EMERGENCY MEDICINE, Issue 11 2004Gregg Husk MD Abstract The ubiquity of computerized hospital information systems, and of inexpensive computing power, has led to an unprecedented opportunity to use electronic data for quality improvement projects and for research. Although hospitals and emergency departments vary widely in their degree of integration of information technology into clinical operations, most have computer systems that manage emergency department registration, admission,discharge,transfer information, billing, and laboratory and radiology data. These systems are designed for specific tasks, but contain a wealth of detail that can be used to educate staff and improve the quality of care emergency physicians offer their patients. In this article, the authors describe five such projects that they have performed and use these examples as a basis for discussion of some of the methods and logistical challenges of undertaking such projects. [source] Statistical Efficiency: The Practical PerspectiveQUALITY AND RELIABILITY ENGINEERING INTERNATIONAL, Issue 4 2003Ron S. Kenett Abstract The idea of adding a practical perspective to the mathematical definition of statistical efficiency is based on a suggestion by Churchill Eisenhart who, years ago gave, in an informal ,Beer and Statistics' seminar, a new definition of statistical efficiency. Later Bruce Hoadley from Bell Laboratories picked up where Eisenhart left off and added his version nicknamed ,Vador'. Blan Godfrey, former CEO of the Juran Institute, more or less used Hoadley's idea during his Youden Address at the Fall Technical Conference of the American Society for Quality Control. We expand on this idea adding an additional component, the value of the data actually collected, which we believe is critical to the overall idea. The concept of Practical Statistical Efficiency (PSE) derived from these developments is introduced and demonstrated using five case studies. We suggest that PSE be considered before, during and after undertaking any quality improvement projects. Copyright © 2003 John Wiley & Sons, Ltd. [source] Impact of Human Factor Design on the Use of Order Sets in the Treatment of Congestive Heart FailureACADEMIC EMERGENCY MEDICINE, Issue 11 2007Stewart Reingold MD Background Although standardized physician order sets are often part of quality improvement projects, the specific design elements contributing to increased adoption and compliance with use often are not considered. Objectives To evaluate the impact of human factor design elements on congestive heart failure (CHF) order set utilization, and compliance with recommended CHF clinical practice guidelines (CPG). Methods This was a descriptive retrospective medical record review of adult patients who were admitted from our emergency department with the primary diagnosis of CHF. We collected data on acuity and CPG parameters before and after the introduction of a new CHF order set. The new orders were succinct and visually well organized, with narrative information to encourage use of CPG. Results Eighty-seven patients were studied before, and 84 after, the introduction of new orders. There were no differences in the use of the order sets based on patient acuity before or after the intervention. Order set use significantly increased by the first postintervention interval (POST) and reached 72% (95% confidence interval [CI] = 52% to 86%) during the third POST, compared with a baseline utilization of 9% (95% CI = 5% to 17%; p < 0.001). Compliance with CPG for angiotensin-converting enzyme reached significance in the second POST and was maintained in the third at 83% (95% CI = 61% to 94%), compared with a baseline value of 25% (95% CI = 7% to 59%; p = 0.008). Intravenous nitroglycerin also increased significantly from the first POST and reached 78% (95% CI = 55% to 91%) in the third POST, compared with baseline of 12% (95% CI = 2% to 47%; p < 0.003). Furosemide dosing, systolic blood pressure reduction, and urine output did not significantly change. Conclusions Introduction of an order set for CHF with attention to human factor design elements significantly improved utilization of the orders and compliance with CPG. [source] | ||||||||||