scholarly journals A quality improvement project (QIP) to address communication and safety concerns from the on-call team at the Bethlem Royal psychiatric hospital out-of-hours through the introduction of weekend safety huddles

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S170-S170
Author(s):  
Helen Allis ◽  
Mariam Zahedi ◽  
Thomas Stephenson ◽  
Michael Newson ◽  
Anil Kumar
Keyword(s):  
Quality Improvement ◽  
Psychiatric Hospital ◽  
Positive Impact ◽  
Quality Improvement Project ◽  
Junior Doctors ◽  
Improvement Project ◽  
Out Of Hours ◽  
Team Cohesiveness ◽  
Safety Concerns ◽  
Number Of Patients

AimsThere have been long-standing concerns about communication and safety on the Bethlem site out-of-hours due to its size, acuity and the number of specialist services; these issues were exacerbated by the COVID-19 pandemic. A Quality Improvement Project was designed to address communication and safety concerns from the on-call team at the Bethlem Royal psychiatric hospital out-of-hours through the introduction of weekend safety huddles.MethodDaily weekend safety huddles were introduced to improve communication regarding workload, acuity, new admissions, seclusion reviews, deteriorating patients; and to improve team cohesiveness and trainee support out-of-hours.The QIP team involved the deputy medical director, the associate director for speciality units, consultants, the college tutor, specialty registrars and core psychiatry trainees. Prior to initiating the huddles, the QIP team met to decide which specialties to involve, to agree on an agenda and liaise with other sites regarding existing huddles. Once the huddles began in April 2020, the team met periodically to agree next courses of action and to troubleshoot. The huddles initially involved acute services and eventually included CAMHS, Forensic, Older Adults, Specialist Units, all on-call consultants, the on-call registrar, two core trainees, the psychiatric liaison manager and the duty senior nurse.ResultData were gathered throughout the QIP using Likert scale surveys which were sent to all junior doctors on the out-of-hours rota. Paper surveys were used initially but were later replaced with Microsoft Forms to ensure anonymity.The percentage of respondents who answered “most of the time” or “all of the time” increased across all parameters when comparing data from before and after implementation of the safety huddles.These results included improvement in: understanding of workload and acuity (9% before vs 69% after), discussion of new admissions on site (4% before vs 90% after), discussion of patients with deteriorating mental health (35% before vs 90% after) and physical health (22% before vs 83% after), understanding of number of patients in seclusion (61% before vs 93% after) and feeling part of a cohesive “on-call” team (17% before vs 86% after). In addition, the results suggested a reduction in frequency of safety concerns on site (83% answered at least “sometimes” before vs 62% after).ConclusionThe results of the final survey demonstrated a measurable and positive impact on communications between the out-of-hours team, improved team cohesiveness and a reduction in safety concerns. The lessons learnt also influenced decisions made in formatting safety huddles at other trust sites.

scholarly journals Physical Therapist–Established Intensive Care Unit Early Mobilization Program: Quality Improvement Project for Critical Care at the University of California San Francisco Medical Center

2013 ◽  
Vol 93 (7) ◽  
pp. 975-985 ◽  
Author(s):  
Heidi J. Engel ◽  
Shintaro Tatebe ◽  
Philip B. Alonzo ◽  
Rebecca L. Mustille ◽  
Monica J. Rivera
Keyword(s):  
Quality Improvement ◽  
Physical Therapy ◽  
San Francisco ◽  
Physical Therapist ◽  
Medical Center ◽  
Early Mobilization ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Icu Admission ◽  
Number Of Patients

Background Long-term weakness and disability are common after an intensive care unit (ICU) stay. Usual care in the ICU prevents most patients from receiving preventative early mobilization. Objective The study objective was to describe a quality improvement project established by a physical therapist at the University of California San Francisco Medical Center from 2009 to 2011. The goal of the program was to reduce patients' ICU length of stay by increasing the number of patients in the ICU receiving physical therapy and decreasing the time from ICU admission to physical therapy initiation. Design This study was a 9-month retrospective analysis of a quality improvement project. Methods An interprofessional ICU Early Mobilization Group established and promoted guidelines for mobilizing patients in the ICU. A physical therapist was dedicated to a 16-bed medical-surgical ICU to provide physical therapy to selected patients within 48 hours of ICU admission. Patients receiving early physical therapy intervention in the ICU in 2010 were compared with patients receiving physical therapy under usual care practice in the same ICU in 2009. Results From 2009 to 2010, the number of patients receiving physical therapy in the ICU increased from 179 to 294. The median times (interquartile ranges) from ICU admission to physical therapy evaluation were 3 days (9 days) in 2009 and 1 day (2 days) in 2010. The ICU length of stay decreased by 2 days, on average, and the percentage of ambulatory patients discharged to home increased from 55% to 77%. Limitations This study relied upon the retrospective analysis of data from 6 collectors, and the intervention lacked physical therapy coverage for 7 days per week. Conclusions The improvements in outcomes demonstrated the value and feasibility of a physical therapist–led early mobilization program.

A quality improvement project to reduce restrictive interventions in a mental health service

2021 ◽  
pp. 1-12
Author(s):  
Darren Savarimuthu ◽  
Katja Jung
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Positive Impact ◽  
Essential Elements ◽  
Quality Improvement Project ◽  
Psychiatric Ward ◽  
Quality Improvement Initiative ◽  
Successful Implementation ◽  
Evidence Based ◽  
Improvement Project

Background/aims This article describes a quality improvement project that aimed to reduce restrictive interventions on an acute psychiatric ward. In light of a service level agreement and based on a trust-wide target, the purpose of the project was to reduce restrictive interventions by 20% within a period of 6 months. It was also anticipated that a least restrictive environment could have a positive impact on patient experience. Methods Three evidence-based interventions were introduced to the ward during the quality improvement project. These included positive behaviour support, the Safewards model and the productive ward initiative. Results There was a 63% reduction in restrictive interventions over a 6-month period through the successful implementation of a series of evidence-based interventions to manage behaviours that challenge on the mental health ward. Conclusions The project identified collaborative team working, staff training and adequate resources as essential elements in the success of the quality improvement initiative. However, co-production was found to be crucially significant in bringing sustainable changes in ward environment and in addressing restrictive practices.

524 QUALITY IMPROVEMENT PROJECT: INCORPORATING COMPREHENSIVE GERIATRIC ASSESSMENT INTO COMMUNITY HOSPITAL CLERKING

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
A Oates
Keyword(s):  
Quality Improvement ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Community Hospital ◽  
Quality Improvement Project ◽  
Junior Doctors ◽  
Medical Team ◽  
Improvement Project ◽  
Efficient Detection ◽  
User Friendly

Abstract Elderly patients transferred to community hospitals often have complex medical, social, psychological, functional and pharmacological backgrounds that require careful assessment in order to create and deliver a high quality, patient-centred care plan. Unfortunately, time pressures experienced by staff in acute hospitals can make Comprehensive Geriatric Assessment (CGA) unfeasible for every patient. Moreover, junior members of the medical team may be unsure as to which aspects of a patient’s background and presentation constitute important elements of a CGA. Failure to recognise and document pertinent issues can lead to prolonged admissions, disjointed care and failed discharges. Admission to a community hospital presents a convenient ‘checkpoint’ in the patient’s hospital journey at which to undertake a CGA. Recording the relevant information in an effective clerking proforma when the patient is admitted ensures that this information is displayed clearly and in a way that is accessible to all members of the multidisciplinary team. The pre-existing clerking proforma at Amersham Community Hospital omitted several important elements of CGA (such as examination of feet and gait, assessment of mood, FRAX-UK score, creation of a problem list etc.) The aim of this quality improvement project was to create a thorough, yet user-friendly and time-efficient clerking proforma which incorporated the important components of CGA. Using BGS guidance and NICE quality standards, alongside suggestions from the medical team, the existing clerking proforma was adapted and reformed. After one month, feedback from the team was used to further improve the clerking proforma, ensuring that it was user-friendly, whilst meeting the standards set out by NICE and BGS. This was repeated as part of a second PDSA cycle. The improved clerking proforma enables junior doctors to undertake a thorough and holistic assessment, promoting efficient detection of issues and the delivery of a higher quality of care.

10 Improving Communication About Death Between Primary and Secondary Care: A Quality Improvement Project

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
J Arumugam ◽  
R Laud ◽  
P Naydenova
Keyword(s):  
Quality Improvement ◽  
Discharge Summary ◽  
Quality Improvement Project ◽  
Junior Doctors ◽  
Improvement Project ◽  
Lack Of Information ◽  
Discharge Letter ◽  
Death Notification ◽  
Electronic Discharge Summary ◽  
Hospital Teams

Abstract Introduction Communication between the hospital and primary care regarding the death of a patient is incredibly important. Previous literature surrounding this area has shown that it is often done poorly, resulting in substandard documentation. Furthermore, lack of information for General Practitioners (GPs) means it is difficult for them to enter discussions with families, which can negatively impact on the bereavement process. The previous expectation was that an electronic discharge summary was completed, but that this was not optimally designed to inform GPs about the circumstances surrounding the death. Reasons given that summaries were not completed included: the busy workload of junior doctors and the lack of awareness of their importance. Methods The aim of our quality improvement project was to ensure 80% of GPs received notification and information about a patient’s death by August 2018. Following an initial cycle to assess the baseline notification rates, we developed a standardized death notification letter following feedback from local GPs. This included information such as date of death, if the coroner had been informed and a brief summary of events. Following introduction of the letter, we recorded the uptake and then gained further feedback regarding the ways in which it could be improved. A final cycle was then implemented. Results Baseline data showed an electronic discharge letter was only being completed in 13.3% of cases (n=3/21). Following introduction of the new letter, 83.6% were completed (n=56/67). Conclusions In conclusion, the introduction of a simple and standardized letter template has vastly increased the notification of GPs about a patient’s death from our hospital. Limitations of our project included the varying numbers of deaths in audited periods and some hospital teams having a separate process in place.

scholarly journals 63 Quality Improvement Project: Should We be Doing More or Less Ct Head Scans in the Health Care of Older People Department?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i18-i20
Author(s):  
M Munir ◽  
T Shouter ◽  
H S Tay
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Older People ◽  
Management Plan ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Number Of Patients ◽  
New Findings ◽  
New Finding ◽  
Ct Head

Abstract Introduction Older people are likely to have more CT head scans given their multiple co- morbidities, being on anticoagulants, and increased falls. The aims of this quality improvement project (QIP) were to identify the number of patients who had CT head scan, the reason/indication of it, the number of patients who had new finding/s on it, actions taken on new findings, and whether the management plan was altered because of the CT scan. Methods Medical notes and CT head scan reports of all patients admitted to the Health Care of Older People department from April to September 2018 were reviewed to evaluate the indications of CT head scans, new findings, and management plans following the findings. Results 461 (10.7%) out of the 4323 patients discharged from the healthcare of older people department during April to September 2018 had CT head scans during admission. Frequent indications for CT head scans included delirium, falls and head injury. Only 46 (9.9%) patients had new finding/s on the CT head scan, and action was taken on 26 (56.5%) of these patients. The CT head scan changed the management plan of only 17 (3.6%) patients. Please see Table for more details. Conclusions By using our clinical judgement, following NICE guidelines on head injuries, educating our colleagues on the criteria for requesting a CT head scan, taking collateral histories about patients’ cognition and ascertaining the mechanism of fall, we can lessen the financial burden on the NHS and minimise the radiation exposure to our patients.

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