SP3.2.18 Reducing the negative appendicectomy rate in children as part of the ‘improving emergency surgery’ quality improvement programme: an assessment of outcomes and balancing measures for unintended consequences

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Vivek Chitre ◽  
Robert Woods ◽  
Roshan Lal
Keyword(s):  
Quality Improvement ◽  
District General Hospital ◽  
Unintended Consequences ◽  
Quality Improvement Programme ◽  
Gangrenous Appendicitis ◽  
Reduced Frequency ◽  
Retrospective Audit ◽  
Improvement Programme ◽  
Negative Appendicectomy ◽  
Postoperative Small Bowel Obstruction

Abstract Aim To describe methodology of the quality improvement programme. To assess outcomes and balancing measures. Methods This paper describes how Kotter’s 8-step improvement model was applied in a District General Hospital. The primary outcome (negative appendicectomy rate) was assessed using GIRFT data over 6 years. Reducing negative appendicectomies might conceivably result in delayed surgery (with a potentially increased incidence of perforated/gangrenous appendicitis), increased length of stay (LOS) and increased readmissions due to delay-related complications. These were assessed by a retrospective audit of appendicectomies performed over the same 8-week period in 2016 and 2019. Results The negative appendicectomy rate in children fell from 16% in 2016-2017 (England average 12%) to 4% in 2017-2018. The improvement was sustained at 6% in 2018-2019 (England average 11%). The incidence of perforated/gangrenous appendicitis decreased by 6% from 23% in 2016 to 16% in 2019. Average LOS decreased from 4 days in 2016 to 3 days in 2019. There was 1 (3%) readmission within 7 days in 2016, and 2 (6%) in 2019. Reasons for readmission were postoperative small bowel obstruction due to omental band adhesion(1) and persistent pain (2). None were caused by delayed operation. Conclusions A sustained improvement in negative appendicectomy rate can be achieved by adopting a systematic quality improvement approach. Against expectations, the reduction in negative appendicectomy rate was associated with a slight decrease in average LOS and reduced frequency of perforated/gangrenous appendicitis. There was no significant increase in readmissions, and none were due to delayed operations.

EP.FRI.1012 One plus one equals four: how NELA inspired a quality improvement programme that produced 4 distinct positive outcomes

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Vivek Chitre ◽  
Bence Atkari ◽  
Ari Sivakkolunthu ◽  
Robert Woods ◽  
Roshan Lal
Keyword(s):  
Quality Improvement ◽  
Emergency Surgery ◽  
District General Hospital ◽  
Emergency Laparotomy ◽  
Early Laparoscopic Cholecystectomy ◽  
Quality Improvement Programme ◽  
Nice Guidance ◽  
Improvement Programme ◽  
Negative Appendicectomy ◽  
Surgery Department

Abstract Aim To describe how NELA inspired an ‘improving emergency surgery’ quality improvement programme that produced improvements in 4 distinct areas of surgical practice. Methods This paper describes how Kotter's improvement methodology was implemented in a district general hospital to achieve NELA targets, reduce the negative appendicectomy rate in children, implement NICE guidance on early laparoscopic cholecystectomy for acute cholecystitis and consistently deliver the 'S' and 'A' of SAFER within the surgery department. Results As a result of a systematic quality improvement approach, Conclusions Incorporating NELA into a local 'improving emergency surgery' quality improvement programme has delivered important and wide-ranging benefits beyond emergency laparotomy, and protected the service from 'crowding out behaviour' where focus on a single quality improvement can come at the expense of quality in other areas.

scholarly journals Quality improvement programme reduces errors in oral medication preparation and administration through feeding tubes

2020 ◽  
Vol 9 (1) ◽  
pp. e000882 ◽  
Author(s):  
Rosana Aparecida Pereira ◽  
Fabiana Bolela de Souza ◽  
Mayara Carvalho Godinho Rigobello ◽  
José Rafael Pereira ◽  
Laís Rosa Moreno da Costa ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Phase I ◽  
Phase Ii ◽  
Good Practice ◽  
Unintended Consequences ◽  
Adult Patients ◽  
Oral Medication ◽  
Quality Improvement Programme ◽  
Increased Risk ◽  
Improvement Programme

BackgroundPatients with nasogastric/nasoenteric tube (NGT/NET) are at increased risk of adverse outcomes due to errors occurring during oral medication preparation and administration.AimTo implement a quality improvement programme to reduce the proportion of errors in oral medication preparation and administration through NGT/NET in adult patients.MethodsAn observational study was carried out, comparing outcome measures before and after implementation of the integrated quality programme to improve oral medication preparation and administration through NGT/NET. A collaborative approach based on Plan-Do-Study-Act (PDSA) cycle was used and feedback was given during multidisciplinary meetings.InterventionsGood practice guidance for oral medication preparation and administration through NGT/NET was developed and implemented at the hospital sites; nurses were given formal training to use the good practice guidance; a printed list of oral medications that should never be crushed was provided to all members of the multidisciplinary team, and a printed table containing therapeutic alternatives for drugs that should never be crushed was provided to prescribers at the prescribing room.ResultsImprovement was observed in the following measures: crushing enteric-coated tablets and mixing drugs during medication preparation (from 54.9% in phase I to 26.2% in phase II; p 0.0010) and triturating pharmaceutical form of modified action or dragee (from 32.8 in phase I to 19.7 in phase II; p 0.0010). Worsening was observed though in the following measures: crush compressed to a fine and homogeneous powder (from 7.4%% in phase I to 95% phase II; p 0.0010) and feeding tube obstruction (from 41.8% in phase I to 52.5% phase II; p 0.0950).ConclusionOur results highlight how a collaborative quality improvement approach based on PDSA cycles can meet the challenge of reducing the proportion of errors in oral medication preparation and administration through NGT/NET in adult patients. Some changes may lead to unintended consequences though. Thus, continuous monitoring for these consequences will help caregivers to prevent poor patient outcomes.

scholarly journals Each baby counts: National quality improvement programme to reduce intrapartum-related deaths and brain injuries in term babies

2017 ◽  
Vol 22 (3) ◽  
pp. 193-198 ◽  
Author(s):  
Louise Robertson ◽  
Hannah Knight ◽  
Edward Prosser Snelling ◽  
Emily Petch ◽  
Marian Knight ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Brain Injuries ◽  
Quality Improvement Programme ◽  
National Quality ◽  
Improvement Programme

scholarly journals Identifying effective pathways in a successful continuous quality improvement programme: the GEDAPS study

2014 ◽  
Vol 20 (6) ◽  
pp. 1137-1143 ◽  
Author(s):  
Danielle H. Bodicoat ◽  
Xavier Mundet ◽  
Laura J. Gray ◽  
Xavier Cos ◽  
Melanie J. Davies ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Continuous Quality Improvement ◽  
Quality Improvement Programme ◽  
Continuous Quality ◽  
Improvement Programme

A quality improvement programme to reduce pressure ulcers

2015 ◽  
Vol 29 (46) ◽  
pp. 62-70 ◽  
Author(s):  
Nicola Heywood ◽  
Lisa Brown ◽  
Michaela Arrowsmith ◽  
Alexa Poppleston
Keyword(s):  
Quality Improvement ◽  
Pressure Ulcers ◽  
Quality Improvement Programme ◽  
Improvement Programme

Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis

2021 ◽  
pp. bmjqs-2021-013110
Author(s):  
Sanjay Mahant ◽  
Jun Guan ◽  
Jessie Zhang ◽  
Sima Gandhi ◽  
Evan Jon Propst ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Health System ◽  
Interrupted Time Series ◽  
Improve Quality ◽  
Interrupted Time Series Analysis ◽  
Quality Improvement Programme ◽  
Improvement Programme

BackgroundTonsillectomy is among the most common and cumulatively expensive surgical procedures in children, with known variations in quality of care. However, evidence on health system interventions to improve quality of care is limited. The Quality-Based Procedures (QBP) programme in Ontario, Canada, introduced fixed episode hospital payment per tonsillectomy and disseminated a perioperative care pathway. We determined the association of this payment and quality improvement programme with tonsillectomy quality of care.MethodsInterrupted time series analysis of children undergoing elective tonsillectomy at community and children’s hospitals in Ontario in the QBP period (1 April 2014 to 31 December 2018) and the pre-QBP period (1 January 2009 to 31 January 2014) using health administrative data. We compared the age-standardised and sex-standardised rates for all-cause tonsillectomy-related revisits within 30 days, opioid prescription fills within 30 days and index tonsillectomy inpatient admission.Results111 411 children underwent tonsillectomy: 51 967 in the QBP period and 59 444 in the pre-QBP period (annual median number of hospitals, 86 (range 77–93)). Following QBP programme implementation, revisit rates decreased for all-cause tonsillectomy-related revisits (0.48 to −0.18 revisits per 1000 tonsillectomies per month; difference −0.66 revisits per 1000 tonsillectomies per month (95% CI −0.97 to −0.34); p<0.0001). Codeine prescription fill rate continued to decrease but at a slower rate (−4.81 to −0.11 prescriptions per 1000 tonsillectomies per month; difference 4.69 (95% CI 3.60 to 5.79) prescriptions per 1000 tonsillectomies per month; p<0.0001). The index tonsillectomy inpatient admission rate decreased (1.12 to 0.23 admissions per 1000 tonsillectomies per month; difference −0.89 (95% CI −1.33 to −0.44) admissions per 1000 tonsillectomies per month; p<0.0001).ConclusionsThe payment and quality improvement programme was associated with several improvements in quality of care. These findings may inform jurisdictions planning health system interventions to improve quality of care for tonsillectomy and other paediatric procedures.

scholarly journals Exploring clinicians’ perspectives on the ‘Obstetric Anal Sphincter Injury Care Bundle’ national quality improvement programme: a qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e035674 ◽  
Author(s):  
Posy Bidwell ◽  
Ranee Thakar ◽  
Ipek Gurol-Urganci ◽  
James M Harris ◽  
Louise Silverton ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Focus Groups ◽  
Anal Sphincter ◽  
Implementation Strategies ◽  
Care Bundle ◽  
Quality Improvement Programme ◽  
Anal Sphincter Injury ◽  
National Quality ◽  
Registration Number ◽  
Improvement Programme

IntroductionObstetric anal sphincter injuries (OASI) can have severe debilitating consequences to women and health systems. The OASI Care Bundle quality improvement programme was introduced in 16 maternity units across England, Scotland and Wales (January 2017 to March 2018) to address increasing OASI rates.ObjectivesTo explore clinicians’ (midwives’ and obstetricians’) perspectives of the OASI Care Bundle with respect to (1) acceptability, (2) feasibility, and (3) sustainability.DesignA qualitative exploratory study using focus groups methodology.SettingA total of 16 focus groups were conducted in 16 maternity units in England, Scotland and Wales where the OASI Care Bundle was implemented. Focus groups took place approximately 3 months following initial implementation of the care bundle in each unit.ParticipantsA total of 101 clinicians participated, with an average of six per focus group. Participants volunteered to take part and compromised of 37 obstetricians and 64 midwives (including eight students). The majority were female and the mean age was 36.5 years.ResultsFour main themes emerged: ‘Implementation strategies’, ‘Opportunities to use the OASI Care Bundle’, ‘Does current practice need to change?’ and ‘Perceptions of what women want’. Midwives were more likely than obstetricians to report themes alluding to ‘what women want’ and variations in intrapartum perineal protection techniques. Both professional groups reported similar views of other themes, in particular regarding the supporting clinical evidence. Gaps were identified in clinicians’ knowledge and experience of intrapartum perineal management.ConclusionsAdoption of the OASI Care Bundle was associated with a number of cognitive and interpersonal factors, such as personal values, interprofessional working and how the intervention was launched; which both facilitated and impeded adoption. The ‘what women want’ theme has implications for maternal autonomy and needs further exploration. Our findings can be used by similar initiatives to reduce perineal trauma both nationally and internationally.Trial registration numberISCTRN 12143325; https://doi.org/10.1186/ISRCTN12143325.

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