Process measure aimed at reducing time to haemorrhage control: outcomes associated with Code Crimson activation in exsanguinating truncal trauma

2020 ◽  
Vol 90 (4) ◽  
pp. 481-485 ◽  
Author(s):  
David Tovmassian ◽  
Ahmer M. Hameed ◽  
Jessie Ly ◽  
Nimalan Pathmanathan ◽  
Michael Devadas ◽  
...  
Keyword(s):  
Process Measure ◽  
Haemorrhage Control

Defence Medical Services’ REBOA training course

2021 ◽  
pp. bmjmilitary-2021-001926
Author(s):  
Max E R Marsden ◽  
C Park ◽  
J Barratt ◽  
N Tai ◽  
P Rees
Keyword(s):  
Training Programme ◽  
Balloon Occlusion ◽  
Medical Services ◽  
Skill Retention ◽  
Training Course ◽  
Challenges And Opportunities ◽  
Haemorrhage Control ◽  
Surgical Teams ◽  
The Uk ◽  
First Time

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) enables temporary haemorrhage control and physiological stabilisation. This article describes the bespoke Defence Medical Services (DMS) training package for effectively using REBOA. The article covers how the course was designed, how the key learning objectives are taught, participant feedback and the authors’ perceptions of future training challenges and opportunities. Since the inaugural training course in April 2019, the authors have delivered six courses, training over 100 clinicians. For the first time in the UK DMS, we designed and delivered a robust specialist endovascular training programme, with demonstrable, significant increases in confidence and competence. As a result of this course, the first DMS REBOA-equipped forward surgical teams deployed in June 2019. Looking to the future, there is a requirement to develop an assessment of skill retention and the potential need for revalidation.

scholarly journals Implementation of a Quality Improvement Role for Unlicensed Assistive Personnel and Effects on Infection Prevention

2021 ◽  
Vol 1 (S1) ◽  
pp. s73-s74
Author(s):  
Natalie Schnell ◽  
Lauren DiBiase ◽  
Amy Selimos ◽  
Lisa Stancill ◽  
Shelley Summerlin-Long ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
Patient Care ◽  
Patient Outcomes ◽  
Infection Prevention ◽  
Central Line ◽  
Direct Patient Care ◽  
Evidence Based ◽  
Infection Rates ◽  
Process Measure

Background: Care bundles comprise evidence-based practices and interventions that are easily and consistently implemented while improving patient outcomes. As patient acuity and task overload continue to increase, infection prevention bundle and process measure compliance and data collection may become a lower priority for registered nurses (RNs). In early 2019, a certified nursing assistant (CNA) began full-time quality liaison work on a 53-bed inpatient adult oncology unit at UNC Medical Center to provide targeted compliance data collection and to correct deficits in real time when possible and within the appropriate scope of practice. Methods: The quality liaison CNA is highly motivated, with a relevant clinical background and effective communication skills. After conducting a gap analysis, the unit developed specific responsibilities for several areas of quality improvement, including infection prevention. In addition to rounding on all patients daily, the quality liaison (1) performs direct patient care tasks like Foley catheter care, (2) conducts patient education on topics such as chlorhexidine gluconate treatments, (3) performs all relevant process measure audits, and (4) easily relays missed or needed care to RNs with a door sign created as part of this initiative. High-risk findings, such as a loose central-line dressing, prompt immediate communication to the RN, with follow-up and escalation when necessary. Results: Patients and staff received the quality liaison well, and the increased attention to care bundle components and auditing ensured consistent, evidence-based care along with accurate and reliable data collection. Compared to the previous calendar year, the number of central-line audits on the unit increased by >1,400 by the end of 2019. Patient outcomes improved, and during 1 fiscal year, the unit achieved rate reductions between 40% and 55% for central-line–associated bloodstream infections, catheter-associated urinary tract infections, and healthcare-associated C. difficile infections. Staffing and logistical challenges imposed by the COVID-19 global pandemic have hampered this work because the quality liaison was redeployed to direct patient care intermittently. Correspondingly, from July to October 2020, the same infection rates increased between 30% and 353%. Conclusions: Having a designated quality liaison is an effective means to achieving quality improvements while remaining an integral member of the patient care team. As staffing has improved on this unit, the quality liaison has refocused efforts, and infection rates are beginning to improve. Given the success of the quality liaison role in improving quality outcomes on this unit, the hospital is exploring expansion of this model to additional units.Funding: NoDisclosures: None

Haemorrhage control in severely injured patients

The Lancet ◽  
2012 ◽  
Vol 380 (9847) ◽  
pp. 1099-1108 ◽  
Author(s):  
Russell L Gruen ◽  
Karim Brohi ◽  
Martin Schreiber ◽  
Zsolt J Balogh ◽  
Veronica Pitt ◽  
...  
Keyword(s):  
Severely Injured ◽  
Severely Injured Patients ◽  
Haemorrhage Control ◽  
Injured Patients

Aspects of the Downsizing Process Measure

2014 ◽  
Author(s):  
M. Harvey Brenner ◽  
Elena Andreeva ◽  
Töres Theorell ◽  
Marcel Goldberg ◽  
Hugo Westerlund ◽  
...  
Keyword(s):  
Process Measure

scholarly journals Experimental Optimization of Nimonic 263 Laser Cutting Using a Particle Swarm Approach

Metals ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. 1147 ◽  
Author(s):  
Sibalija ◽  
Petronic ◽  
Milovanovic
Keyword(s):  
Laser Cutting ◽  
Particle Swarm ◽  
Cutting Speed ◽  
Cutting Parameters ◽  
Parameter Tuning ◽  
Pso Algorithm ◽  
Ann Model ◽  
Suggested Approach ◽  
Process Measure ◽  
Control Factors

This paper presents an experimental study carried out on Nimonic 263 alloy sheets to determine the optimal combination of laser cutting control factors (assisted gas pressure, beam focus position, laser power, and cutting speed), with respect to multiple characteristics of the cut area. With the aim of designing laser cutting parameters that satisfy the specifications of multiple responses, an advanced multiresponse optimization methodology was used. After the processing of experimental data to develop the process measure using statistical methods, the functional relationship between cutting parameters and the process measure was determined by artificial neural networks (ANNs). Using the trained ANN model, particle swarm optimization (PSO) was employed to find the optimal values of laser cutting parameters. Since the effectiveness of PSO could be affected by its parameter tuning, the settings of PSO algorithm-specific parameters were analyzed in detail. The optimal laser cutting parameters proposed by PSO were implemented in the validation run, showing the superior cut characteristics produced by the optimized parameters and proving the efficacy of the suggested approach in practice. In particular, it is demonstrated that the quality of the Nimonic 263 cut area and the microstructure were significantly improved, as well as the mechanical characteristics.

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