Prediction of Groundwater Quality Improvement Down-Gradient of In Situ Permeable Treatment Barriers and Fully Remediated Source Zones

2008 ◽  
Author(s):  
Paul C. Johnson
Keyword(s):  
Quality Improvement ◽  
Groundwater Quality ◽  
Treatment Barriers ◽  
Source Zones

scholarly journals A Neonatal Intensive Care Unit’s Experience with Implementing an In-Situ Simulation and Debriefing Patient Safety Program in the Setting of a Quality Improvement Collaborative

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 202
Author(s):  
Mary Eckels ◽  
Terry Zeilinger ◽  
Henry C. Lee ◽  
Janine Bergin ◽  
Louis P. Halamek ◽  
...  
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care ◽  
Quality Care ◽  
Neonatal Resuscitation ◽  
Healthcare Team ◽  
In Situ Simulation ◽  
Implementation Phase

Extensive neonatal resuscitation is a high acuity, low-frequency event accounting for approximately 1% of births. Neonatal resuscitation requires an interprofessional healthcare team to communicate and carry out tasks efficiently and effectively in a high adrenaline state. Implementing a neonatal patient safety simulation and debriefing program can help teams improve the behavioral, cognitive, and technical skills necessary to reduce morbidity and mortality. In Simulating Success, a 15-month quality improvement (QI) project, the Center for Advanced Pediatric and Perinatal Education (CAPE) and California Perinatal Quality Care Collaborative (CPQCC) provided outreach and training on neonatal simulation and debriefing fundamentals to individual teams, including community hospital settings, and assisted in implementing a sustainable program at each site. The primary Aim was to conduct two simulations a month, with a goal of 80% neonatal intensive care unit (NICU) staff participation in two simulations during the implementation phase. While the primary Aim was not achieved, in-situ simulations led to the identification of latent safety threats and improvement in system processes. This paper describes one unit’s QI collaborative experience implementing an in-situ neonatal simulation and debriefing program.

scholarly journals Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre

2019 ◽  
Vol 28 (11) ◽  
pp. 939-948 ◽  
Author(s):  
Soffien Chadli Ajmi ◽  
Rajiv Advani ◽  
Lars Fjetland ◽  
Kathinka Dehli Kurz ◽  
Thomas Lindner ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Outcomes ◽  
Treatment Protocol ◽  
Team Training ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
In Situ Simulation ◽  
Simulation Based ◽  
Stroke Thrombolysis

BackgroundIn eligible patients with acute ischaemic stroke, rapid revascularisation is crucial for good outcome. At our treatment centre, we had achieved and sustained a median door-to-needle time of under 30 min. We hypothesised that further improvement could be achieved through implementing a revised treatment protocol and in situ simulation-based team training sessions. This report describes a quality improvement project aiming to reduce door-to-needle times in stroke thrombolysis.MethodsAll members of the acute stroke treatment team were surveyed to tailor the interventions to local conditions. Through a review of responses and available literature, the improvement team suggested changes to streamline the protocol and designed in situ simulation-based team training sessions. Implementation of interventions started in February 2017. We completed 14 simulation sessions from February to June 2017 and an additional 12 sessions from November 2017 to March 2018. Applying Kirkpatrick’s four-level training evaluation model, participant reactions, clinical behaviour and patient outcomes were measured. Statistical process control charts were used to demonstrate changes in treatment times and patient outcomes.ResultsA total of 650 consecutive patients, including a 3-year baseline, treated with intravenous thrombolysis were assessed. Median door to needle times were significantly reduced from 27 to 13 min and remained consistent after 13 months. Risk-adjusted cumulative sum charts indicate a reduced proportion of patients deceased or bedridden after 90 days. There was no significant change in balancing measures (stroke mimics, fatal intracranial haemorrhage and prehospital times).ConclusionsImplementing a revised treatment protocol in combination with in situ simulation-based team training sessions for stroke thrombolysis was followed by a considerable reduction in door-to-needle times and improved patient outcomes. Additional work is needed to assess sustainability and generalisability of the interventions.

In Situ Neonatal Mock Codes: Assessing the Impact

2020 ◽  
Vol 39 (1) ◽  
pp. 29-34
Author(s):  
Emily K. Rivera ◽  
Leah M. Siple ◽  
Eunice J. Wicks ◽  
Heather S. Johnson ◽  
Caren M. Skov
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Outcome Measures ◽  
Nursing Staff ◽  
Neonatal Resuscitation ◽  
Confidence Levels ◽  
Mock Codes ◽  
The Impact

PurposeTo assess the impact of a quality improvement (QI) project to increase nursing staff confidence in responding to neonatal emergencies.DesignMandatory neonatal emergency in situ scenarios done quarterly.SampleBedside NICU nursing staff and the subset of NICU nurses that attend all high-risk deliveries and neonatal emergencies on the obstetrics unit.Outcome MeasuresConfidence levels in responding to neonatal emergencies, demonstrating neonatal resuscitation skills, and communicating effectively during an emergency.ResultsSixty-eight NICU nurses completed the pre- and postintervention surveys. Self-reported confidence levels increased in all areas measured. Overall, the percentage of nursing staff that reported confidence in being able to participate in a neonatal emergency increased from 48 percent to 77 percent.

scholarly journals Groundwater quality and depletion in the Indo-Gangetic Basin mapped from in situ observations

2016 ◽  
Vol 9 (10) ◽  
pp. 762-766 ◽  
Author(s):  
A. M. MacDonald ◽  
H. C. Bonsor ◽  
K. M. Ahmed ◽  
W. G. Burgess ◽  
M. Basharat ◽  
...  
Keyword(s):  
Groundwater Quality ◽  
In Situ Observations
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