scholarly journals A quality improvement project to increase patient feedback in the psychotherapy department, Tavistock Clinic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S170-S171
Author(s):  
Avgoustina Almyroudi ◽  
Alan Baban ◽  
Sukhjit Sidhu
Keyword(s):  
Quality Improvement ◽  
Online Survey ◽  
Response Rate ◽  
Feedback System ◽  
Response Rates ◽  
Improvement Project ◽  
Complex Needs ◽  
The Core ◽  
Patient Feedback ◽  
Pdsa Cycle

AimsA rigorous and systematic patient feedback system is important for identifying gaps, improving the quality of care and encouraging patient involvement in service delivery. In the Adult Complex Needs Service of the Tavistock Clinic, a tertiary psychotherapy centre, only 5% of patients have provided feedback when requested. This Quality Improvement (QI) project aimed at improving the return rates of the Experience of Service Questionnaire (ESQ) and the CORE Outcome Measure by 10% within a year.MethodThe QI methodology was used to help identify factors contributing to the low response rate, including views amongst stuff about how such feedback, and the method of its delivery, might affect a psychoanalytically-informed treatment. Previously these forms were posted or handed out in person. In the first Plan-Do-Study-Act (PDSA) cycle, the method of distribution was changed by sending out the questionnaires to patients electronically, using an online survey platform. In the second PDSA cycle, the CORE-34 questionnaire was replaced with a shorter version, the CORE-10. This was in order to test our hypothesis that a shorter questionnaire would result in an increase in the response rates.ResultIn the first cycle of change, 197 patients were emailed for both the CORE-34 and ESQ and a total return rate of 31% was achieved. This signified an increase of 26% in the response rate. Overall more ESQ forms were completed (35% uptake) compared to CORE-34 forms (28% uptake). In the second cycle 199 patients were emailed with the CORE-10 and ESQ forms. The response rate was 21% and 18% respectively. Although the response rates decreased slightly in the second PDSA cycle the results indicated that this method of distribution was capturing a greater range of patients who had not previously provided the service with this sort of feedback.ConclusionSending out the outcome measures electronically and adopting shorter versions of the CORE questionnaire increased the feedback response rate significantly, and provided the service with useful data as to patients' experience of their treatment journey here.

scholarly journals Quality improvement primer part 2: executing a quality improvement project in the emergency department

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 532-538 ◽  
Author(s):  
Lucas B. Chartier ◽  
Antonia S. Stang ◽  
Samuel Vaillancourt ◽  
Amy H. Y. Cheng
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Quality Improvement ◽  
Improvement Project ◽  
Emergency Department Setting ◽  
Pdsa Cycle ◽  
Time To Antibiotics ◽  
Final Article

ABSTRACTThe topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement. We will review what makes a good aim statement, the various categories of measures that can be tracked during a QI project, and the relative merits and challenges of potential change concepts and ideas. We will also present the Model for Improvement’s rapid-cycle change methodology, the Plan-Do-Study-Act (PDSA) cycle. The final article in this series will focus on the evaluation and sustainability of QI projects.

scholarly journals ‘CPR for Feet’ care bundle to improve foot assessment in inpatient diabetes

2018 ◽  
Vol 7 (3) ◽  
pp. e000196 ◽  
Author(s):  
Rhea O’Regan ◽  
Ross MacDonald ◽  
James G Boyle ◽  
Katherine A Hughes ◽  
Joyce McKenzie
Keyword(s):  
Quality Improvement ◽  
Nursing Staff ◽  
Quality Improvement Project ◽  
Care Bundle ◽  
Staff Education ◽  
Pressure Relief ◽  
Improvement Project ◽  
The Third ◽  
Inpatient Diabetes ◽  
Pdsa Cycle

AimsThe Scottish Inpatient Diabetes Foot Audit conducted in 2013 revealed that 57% of inpatients had not had their feet checked on admission, 60% of those at risk did not have pressure relief in place and 2.4% developed a new foot lesion. In response, the Scottish Diabetes Foot Action Group launched the ‘CPR for Feet’ campaign. The aim of this project was to raise awareness of the ‘Check, Protect and Refer’ (CPR) campaign as well as improve the assessment and management of inpatients with diabetes.MethodsA quality improvement project underpinned by Plan-Do-Study-Act (PDSA) methodology was undertaken. The first and second cycles focused on staff education and the implementation of a ‘CPR for Feet’ assessment checklist using campaign guidelines, training manuals and modules. The third and fourth cycles focused on staff feedback and the implementation of a ‘CPR for Feet’ care bundle.ResultsBaseline measurements revealed 28% of patients had evidence of foot assessment. Medical and nursing staff reported to be largely unaware of the ‘CPR for Feet’ campaign (13%). Fifty-two per cent of inpatients with diabetes had their feet assessed and managed correctly following the second PDSA cycle. After completion of the third and fourth PDSA this number improved further to 72% and all staff reported to be aware of the campaign.ConclusionsThe introduction of a ‘CPR for Feet’ care bundle improved the assessment of inpatients with diabetes.

scholarly journals 149 Virtual Care: A Quality Improvement Project on the Experience of Paediatricians during the COVID-19 Pandemic

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e102-e104
Author(s):  
Emma McCrady ◽  
Julie Strychowsky ◽  
Jessica Woolfson
Keyword(s):  
Quality Improvement ◽  
Online Survey ◽  
Local Level ◽  
Standard Of Care ◽  
Subject Area ◽  
Future Research ◽  
Improvement Project ◽  
Diagnostic Uncertainty ◽  
Virtual Care ◽  
Practice Efficiency

Abstract Primary Subject area Practice/Office Management Background Prior to the COVID-19 pandemic, in-person visits were the standard of care for paediatricians at our centre. With the pandemic onset, virtual care (VC) was adopted at an unprecedented scale and pace. Studies have reported positive patient VC experience; however, few have explored physician experience. This quality improvement (QI) initiative sought to qualify the VC experience of local paediatricians during the pandemic, with the intention of implementing VC clinical practice changes at the department level. Objectives To determine key factors that have supported and challenged the adoption of, and that will support integration of, VC in the future. Design/Methods The Donabedian model for healthcare QI was used to evaluate VC experience through an online survey with a focus on structure, process, and outcome measures. All physicians affiliated with the Department of Paediatrics (generalists and subspecialists in medicine and surgery) were invited to participate via email. Three reminder emails were sent at 2-week intervals. Descriptive statistics were reported. Results The response rate was 32.3% (63 of 195 physicians). The majority of respondents were subspecialists (84.1%), and at academic centres (87.5%) (Table 1). Pre-pandemic, only 30.1% used VC and saw <10% of patients virtually. During March-May 2020, 93.8% transitioned to VC, with > 50% seeing over 75% of patients virtually. By summer 2020, VC use declined, but remained higher than pre-pandemic (53.6% seeing < 25% of patients). OTN and telephone were platforms most used (32.8% and 28.6%, respectively). Most conducted visits from their work location (55.2%) versus home (44.8%). VC experience was considered positive by most physicians (73.6%), and only 18.8% found VC difficult to use despite technical difficulties reported by 41.5% (Figure 1). Physicians with ≤ 5 years in practice were most likely to find VC convenient (93.8%). Challenges with VC included lack of physical exam, diagnostic uncertainty, lower patient volumes, and poor patient VC etiquette. Regardless of practice location, specialty, years in practice, and prior experience, 96% would continue VC to 25% of patients, ideally for patients who live far away (26.4%) and for follow-ups of patients with established diagnoses (21.4%). Conclusion A rapid transition to VC during the COVID-19 pandemic was associated with challenges but also positive experiences. Willingness to continue VC was high. VC experience could be improved with greater patient education and focus on select patient populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for VC at a local level.

scholarly journals The factors affecting response rate in survey on well-being among people with foreign origin

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
E Lilja ◽  
A Seppänen ◽  
H Kuusio
Keyword(s):  
Online Survey ◽  
Response Rate ◽  
Age Groups ◽  
Response Rates ◽  
Well Being ◽  
Migrant Population ◽  
Population Surveys ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Face To Face

Abstract Background Previous population surveys among people with foreign background (PFB) in Finland have had successful response rates (62%-66%) when using mainly face-to-face interviews. A cross-sectional population survey (FinMONIK) explored more cost-efficient ways to collect the data on PFB. Methods The data collection was conducted in Finland between May 2018 and January 2019. The random sample consisted of 12 877 (after removing over-coverage) 18-64-year-olds stratified by region. First, a letter containing a link to the online survey with 18 different language options was sent to the participants. After two reminders, the questionnaire was sent twice on paper to the non-respondents. Finally, supplementary phone interviews were carried out by multi-lingual interviewers. All the participants were able to enter in a draw to win gift cards. Results The response rate (RR) for the online survey was 34%. RR was highest for those who had lived in Finland 5 years or less (43%) and lowest among the divorced (23%) and Estonians (27%). The paper questionnaire was mostly preferred by older age groups, increasing the RR of 40-64 year-olds from 31% to 48%. Telephone interviews increased the RR by five percent points, thus making the final RR for the survey 53%. Persons born in the EU and North-America responded the most frequently (58%) whereas RR was lowest amongst the Sub-Saharan African origin migrants (47%). RR was particularly low (42%) for those who had moved to Finland at ages 0-6. Conclusions In surveys conducted amongst PFB, relatively good response rates can be obtained by using alternate methods for gathering data instead of costly and time-consuming face-to-face interview. Age and marital status seemed to affect the preference of survey format. The overall RR varied by country of origin. Key messages A good response rate can be obtained without face-to-face interviews in migrant population surveys. Migrant population surveys can be conducted more efficiently by combining a variety of methods.

scholarly journals Implementing the Patient Health Questionnaire Modified for Adolescents to improve screening for depression among adolescents in a Federally Qualified Health Centre

2020 ◽  
Vol 9 (4) ◽  
pp. e000751
Author(s):  
Mohamed Mansour ◽  
Dharshana Krishnaprasadh ◽  
Janice Lichtenberger ◽  
Jonathan Teitelbaum
Keyword(s):  
Quality Improvement ◽  
Adolescent Depression ◽  
Quality Improvement Project ◽  
Patient Health Questionnaire ◽  
Depression Symptoms ◽  
Health Questionnaire ◽  
Screening Rate ◽  
Improvement Project ◽  
Pdsa Cycle ◽  
Patient Health

BackgroundDepression, which is a serious medical illness, is prevalent worldwide and it negatively impacts the adolescent lifestyle. Adolescent depression is associated with adverse emotional and functional outcomes and suboptimal physical health. Over the last decade, it has been found that approximately 9% of teenagers meet the criteria for depression at any given time, and one in five teenagers have a history of depression during adolescence. Ninety per cent of paediatricians believe that recognition of child and adolescent depression is their responsibility; however, it has been reported that 46% lacked confidence that they could recognise depression.MethodsIn this study, adolescents between 12 and 17 years of age were screened during their well-child visits using the Patient Health Questionnaire Modified for Adolescents. A score of 10 or higher warrants a referral to a social worker and psychiatrist. The goals of this quality improvement project were to implement a standardised questionnaire and to improve the screening, diagnosis and treatment of depression in children from 12 to 17 years of age.ResultsIt was found that the adolescent depression screening rate significantly improved within 6 months of implementing this quality improvement project. The screening rate improved to 50% by mid-cycle (Plan-Do-Study-Act (PDSA) cycle 3) and up to 70% at the end of the 6-month period (PDSA cycle 5). Improvement was noted among all providers, across all age groups, and in both male and female patients by the end of the study period.ConclusionStandardised screening tests with a scoring system help providers to identify and monitor depression symptoms using a common language, especially in the outpatient clinical setting where the patient may be seen by different providers.

Improving time to initiation of bone modifying agents in patients with newly diagnosed multiple myeloma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6528-6528
Author(s):  
Nathaniel Rosko ◽  
Sarah Lee ◽  
Christy Joy Samaras ◽  
Alex V. Mejia ◽  
Faiz Anwer ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Quality Improvement ◽  
Cleveland Clinic ◽  
Institutional Care ◽  
Baseline Data ◽  
Physician Education ◽  
Newly Diagnosed ◽  
Improvement Project ◽  
Pdsa Cycle ◽  
Time To Initiation

6528 Background: Current ASCO and IMWG guidelines recommend that all patients (pts) on active anti-myeloma therapy receive concurrent supportive care treatment with a bone modifying agent (BMA) to decrease the risk of skeletal related events (SRE). Unfortunately, recent data shows only 51% of Medicare pts with myeloma received a BMA within 90 days of first chemotherapy. We implemented a quality improvement project to identify the average time to BMA initiation at all Cleveland Clinic affiliated sites, with the primary goal to improve time to initiation of BMA in newly diagnosed multiple myeloma (NDMM) pts by 4 weeks at Cleveland Clinic Main Campus (MC). Methods: Barriers with BMA initiation were identified using quality improvement tools developed at the ASCO Quality Training Program. The first PDSA cycle was implemented between September 2018 – January 2019 with an emphasis on education. This included review of updated guidelines, literature review of risks and toxicities associated with BMAs, and strategies for choosing BMA based on pt factors. Baseline data on time to start BMA and data to evaluate impact of PDSA intervention was completed via chart review. Results: 161 NDMM pts were evaluated between 2015 to 2018 at all sites. The average time difference between the start of anti-myeloma therapy and the start date of a BMA in NDMM pts was 10.5 weeks. Subset analysis based on whether pts were treated at MC vs affiliate sites was 10.6 weeks vs 9.1 weeks, respectively. During the first PDSA cycle, 14 NDMM pts were treated at MC. 86% (12/14) pts were treated with a BMA. The average time between cycle 1 day 1 of first line treatment and first dose BMA was 4.3 weeks (range 4-12 weeks). Conclusions: With increased physician education and awareness of internal baseline data, we achieved our initial goal and observed a significant improvement in time to initiation of BMA from 10.5 weeks to 4.3 weeks. Obstacles regarding effective communication with patients on the benefit of BMAs as well as need for dental clearance were barriers identified early on. We plan to incorporate BMA guidelines in our institutional care path with the goal to decrease time to initiation at all affiliated practices. Further mechanisms to ensure reinforcement of BMA initiation in NDMM patients is warranted to maintain therapeutic benefit.

Using Lean methodology to improve the time to antibiotics in oncology patients on chemotherapy who present to the ED with neutropenic fever.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 31-31
Author(s):  
Brian J. Byrne ◽  
Frederick Bailey ◽  
Pat Montanaro ◽  
Patricia Anne DeFusco
Keyword(s):  
Quality Improvement ◽  
Substantial Improvement ◽  
Neutropenic Fever ◽  
Medical Emergency ◽  
Antibiotic Administration ◽  
Improvement Project ◽  
The Third ◽  
Pdsa Cycle ◽  
Time To Antibiotics ◽  
American Society

31 Background: Neutropenic fever is a medical emergency. Delays in treatment can lead to increase in morbidity, mortality, and increase length of stay. The American Society of Clinical Oncology currently recommends that antibiotics be prescribed within 60 minutes of triage. Literature review shows through a multidisciplinary effort involving the ED, lab, oncology, and pharmacy significant improvement in time to antibiotics can be achieved. Since many patients with neutropenic fever present with sepsis, these guidelines also will need to be followed. Methods: Three PDSA cycles were conducted. The first involved education of the ED staff on the importance of treating neutropenic fever and using the correct antibiotic. The second PDSA cycle involved the laboratory and the calling of critical white counts and low neutrophil counts. The third PDSA involves patient education on the importance of temperature monitoring and reporting they are on chemotherapy to ED staff. Results: Baseline data show only 33% of patients receive the correct antibiotic and the average time to administration is 3 hours and 41 minutes. Results of the quality improvement project show a substantial improvement in time to antibiotic administration to 1 hour 58 minutes and an increase in the percentage of patients who receive the correct antibiotic. The time from the specimen received in the lab until critical called also improved from 1 hour 14 minutes to 18.5 minutes. Conclusions: This quality improvement led to a significant improvement in time to correct antibiotics, but several additional steps need to be taken to meet ASCO guidelines. [Table: see text]

69 Continuous and Regular Live Feedback is Required to Maintain An Improvement in the Quality of Discharge Summaries. Shop 75 +

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
H Cross ◽  
J Evans ◽  
A Pederson ◽  
D Yidana ◽  
D Carey ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Feedback System ◽  
Poor Quality ◽  
Significant Deterioration ◽  
Improvement Project ◽  
Continuous Quality ◽  
Feedback Interventions ◽  
Discharge Summaries

Abstract Background This quality improvement project aims to improve communication between secondary and primary care at the time of hospital discharge of older patients. Introduction Discharge summaries (DS) are a key component of communication between secondary and primary care. Poor quality DS are associated with poorer outcomes in terms of adverse events [1], readmissions [2] and medication errors [3]. There is NICE and AMRC guidance on what constitutes a good DS [4, 5]. Method Prospective review of DS from a range of wards was completed in August 2017 against a detailed data tool. A random selection of DS from the same wards was audited monthly from November 2017 onwards. A novel live-feedback system was introduced to the same wards in February 2018 so that the teams completing DS received feedback on how well their summaries complied with the recommendations and what areas needed improvement. A change in staffing lead to a break in the delivery of monthly feedback to the ward teams from April to September 2019 when it was re-commenced. Results In the majority of areas there has been an increase in the quality of the DS from the beginning of the project until March 2019 when the regular feedback interventions were suspended. There was a decrease in the quality of summaries in July and August 2019, followed by an increase as regular feedback interventions recommenced in September 2019. The aggregate results of the four main components of DS (follow-up actions, medicines, clinical summary, and functional assessment), scored “good” in 13% of DS at baseline, 40% in March 2019, 20% in July 2019 and 31% in October 2019. Conclusions The suspension of regular direct interventions resulted in a significant deterioration in the quality of discharge summaries, and this improved quickly after reintroduction of PDSA cycles in key areas. Continuous quality improvement requires uninterrupted focus on regular live feedback. References 1. Clegg et al. Lancet 2013; 381: 752–62. 2. Samra et al. Age Ageing 2017; 46: 911–9. 3. Romero-Ortuno et al. Age Ageing 2012; 41: 684–9.

scholarly journals Introducing In-Class Student Activities in a Community Psychology Course: A Quality Improvement Project

2020 ◽  
Author(s):  
Tormod Boe
Keyword(s):  
Quality Improvement ◽  
Active Learning ◽  
Community Psychology ◽  
Response Rate ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Student Activities ◽  
Teaching Tools ◽  
Oral Feedback ◽  
Psychology Course

Lecturing methods centered around teachers may be lesseffective teaching tools than approaches utilizing more student-active learning forms. The current quality improvement project investigates implementationof more active learning forms in selected classes in a community psychology course taught at the Faculty of Psychology, University of Bergen. Methods. Oral feedback, and responses from a quality assurance survey from twosuccessive semesters, one prior to the implementation (nT1 = 25, 57% response rate) and one following the implementation (nT2 = 30, 83% response rate) were used to evaluate how students perceived the changes in learning format.

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