Virtual Care: A Quality Improvement Project on the Experience of Paediatricians During the COVID-19 Pandemic (Preprint)

2021 ◽  
Author(s):  
Emma McCrady ◽  
Julie E Strychowsky ◽  
Jessica P Woolfson
Keyword(s):  
Quality Improvement ◽  
Research Ethics ◽  
Online Survey ◽  
Standard Of Care ◽  
Future Research ◽  
Improvement Project ◽  
Human Research Ethics ◽  
Virtual Care ◽  
Regulatory Guidelines ◽  
Practice Efficiency

BACKGROUND Prior to the COVID-19 pandemic, in-clinic visits were the standard of care for paediatricians at our centre. At the pandemic onset, virtual care (VC) was adopted at an unprecedented scale and pace. OBJECTIVE This quality improvement (QI) initiative explored the VC experience of paediatricians during the pandemic by determining factors that supported and challenged VC adoption. METHODS The Donabedian model was used to evaluate VC experience via online survey. All department-affiliated paediatricians (including generalists and subspecialists in surgery and medicine) were invited to participate via email. Results were collated and descriptive statistics were applied. RESULTS Of 195 paediatric physicians, 63 responded (response rate 32.3%, mostly subspecialists at academic centres (84.1%)). 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. Telephone and OTN were the platforms most used (77.4% and 64.2% respectively). VC experience was considered positive (73.6%), and only 18.8% found VC difficult to use despite 41.5% reporting technical difficulties. Challenges included lack of physical exam, lower patient volumes, and poor patient VC etiquette. Regardless of demographics, 96.4% would continue VC, ideally for patients who live far away (90.2%) and for follow-ups/established diagnoses (73.1%). CONCLUSIONS Transition to VC during COVID-19 was associated with challenges but also positive experiences. Willingness among paediatricians to continue VC was high. Paediatricians’ VC experiences at our centre could be improved with patient education and targeting select populations. Future research is needed to improve practice efficiency, and to inform regulatory guidelines for VC. CLINICALTRIAL Research ethics exemption was granted by The Office of Human Research Ethics (OHRE) on behalf of Western University's REB.

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 &lt;10% of patients virtually. During March-May 2020, 93.8% transitioned to VC, with &gt; 50% seeing over 75% of patients virtually. By summer 2020, VC use declined, but remained higher than pre-pandemic (53.6% seeing &lt; 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.

Barriers to receipt of novel oral oncolytics: A single-institution quality improvement investigation

2019 ◽  
Vol 26 (2) ◽  
pp. 279-285
Author(s):  
Ann A Wang ◽  
Christopher Tapia ◽  
Yasin Bhanji ◽  
Christopher Campbell ◽  
Daniel Larsen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Care Center ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Wait Times ◽  
Prescription Data ◽  
Electronic Prescription ◽  
Improvement Project ◽  
Pharmacy Claims ◽  
Oral Oncolytics

Introduction Novel oral oncolytic agents have become the standard of care and first-line therapies for many malignancies. However, issues impacting access to these drugs are not well explored. As part of a quality improvement project in a large tertiary academic institution, we aim to identify potential barriers that delay treatment for patients who are prescribed novel oral oncolytics. Methods This was a retrospective review of adults who were newly prescribed a novel oral oncolytic for Food and Drug Administration-approved indications at a single tertiary care center. Patients were identified via electronic prescription data (e-Scribe). Demographics, insurance information, and prescription dates were extracted from the electronic medical record and pharmacy claims data. Statistical analyses were performed to determine whether time-to-receipt was associated with insurance category, pharmacy transfers, cost assistance, and drug prescribed. Results Of the 270 successfully filled prescriptions, the mean time-to-receipt was 7.3 ± 10.3 days (range: 0–109 days). Patients with Medicare experienced longer time-to-receipt (9.1 ± 13.1 days) compared to patients with commercial insurance (4.4 ± 3.3). Uninsured patients experienced the longest time-to-receipt (15.7 ± 7.8 days) overall. Pharmacy transfers and cost assistance programs were also significantly associated with longer time-to-receipt. Ten prescriptions remained unfilled 90 days after the study period and were considered abandoned. Conclusion Insurance has a significant effect on the time-to-receipt of newly prescribed novel oral oncolytics. Pharmacy transfers and applying for cost assistance are also associated with longer wait times for patients. Our retrospective analysis identifies areas of improvement for future interventions to reduce wait times for patients receiving novel oral oncolytics.

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 A Nationwide Cross-Sectional Online Survey on the Treatment of COVID-19-ARDS: High Variance in Standard of Care in German ICUs

2021 ◽  
Vol 10 (15) ◽  
pp. 3363
Author(s):  
Steffen Dickel ◽  
Clemens Grimm ◽  
Maria Popp ◽  
Claudia Struwe ◽  
Alexandra Sachkova ◽  
...  
Keyword(s):  
Intensive Care ◽  
Online Survey ◽  
Scientific Literature ◽  
Treatment Strategies ◽  
Standard Of Care ◽  
Future Research ◽  
High Peep ◽  
Care Providers ◽  
Cross Sectional ◽  
German Icus

Introduction: Coronavirus disease (COVID-19) has recently dominated scientific literature. Incomplete understanding and a lack of data concerning the pathophysiology, epidemiology, and optimal treatment of the disease has resulted in conflicting recommendations. Adherence to existing guidelines and actual treatment strategies have thus far not been studied systematically. We hypothesized that capturing the variance in care would lead to the discovery of aspects that need further research and—in case of proven benefits of interventions not being performed—better communication to care providers. Methods: This article is based on a quantitative and qualitative cross-sectional mixed-methods online survey among intensive-care physicians in Germany during the COVID-19 pandemic by the CEOsys (COVID-19 Evidence Ecosystem) network, endorsed by the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) conducted from December 3 to 31 December 2020. Results: We identified several areas of care with an especially high variance in treatment among hospitals in Germany. Crucially, 51.5% of the participating ICUs (n = 205) reported using intubation as a last resort for respiratory failure in COVID-19 patients, while 21.8% used intubation early after admission. Furthermore, 11.5% considered extracorporeal membrane oxygenation (ECMO) in awake patients. Finally, 72.3% of respondents used the ARDS-network-table to titrate positive end-expiratory-pressure (PEEP) levels, with 36.9% choosing the low-PEEP table and 41.8% the high-PEEP table. Conclusions: We found that significant differences exist between reported treatment strategies and that adherence to published guidelines is variable. We describe necessary steps for future research based on our results highlighting significant clinical variability in care.

scholarly journals Care of Transgender Patients: A General Practice Quality Improvement Approach

Healthcare ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 121
Author(s):  
Isabel Boyd ◽  
Thomas Hackett ◽  
Susan Bewley
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Standard Of Care ◽  
Population Based ◽  
Improvement Project ◽  
Gender Minority ◽  
Primary Care Population ◽  
Data Collection Instrument ◽  
Audit Standard ◽  
And Gender

Primary care must ensure high quality lifelong care is offered to trans and gender minority patients who are known to have poor health and adverse healthcare experiences. This quality improvement project aimed to interrogate and audit the data of trans and gender minority patients in one primary care population in England. A new data collection instrument was created examining pathways of care, assessments and interventions undertaken, monitoring, and complications. General practitioners identified a sample from the patient population and then performed an audit to examine against an established standard of care. No appropriate primary care audit standard was found. There was inconsistency between multiple UK gender identity clinics’ (GIC) individual recommended schedules of care and between specialty guidelines. Using an international, secondary care, evidence-informed guideline, it appeared that up to two-thirds of patients did not receive all recommended monitoring standards, largely due to inconsistencies between GIC and international guidance. It is imperative that an evidence-based primary care guideline is devised alongside measurable standards. Given the findings of long waits, high rates of medical complexity, and some undesired treatment outcomes (including a fifth of patients stopping hormones of whom more than half cited regret or detransition experiences), this small but population-based quality improvement approach should be replicated and expanded upon at scale.

scholarly journals Perceived Barriers to Mobility in a Medical ICU: The Patient Mobilization Attitudes & Beliefs Survey for the ICU

2018 ◽  
Vol 35 (10) ◽  
pp. 1026-1031 ◽  
Author(s):  
Carrie M. Goodson ◽  
Lisa Aronson Friedman ◽  
Earl Mantheiy ◽  
Kevin Heckle ◽  
Annette Lavezza ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Internal Consistency ◽  
Nurse Practitioners ◽  
Work Experience ◽  
Online Survey ◽  
Discriminant Validity ◽  
Quality Improvement Project ◽  
Perceived Barriers ◽  
Clinical Role ◽  
Improvement Project

Purpose: Early mobilization in the intensive care unit (ICU) can improve patient outcomes but has perceived barriers to implementation. As part of an ongoing structured quality improvement project to increase mobilization of medical ICU patients by nurses and clinical technicians, we adapted the existing, validated Patient Mobilization Attitudes & Beliefs Survey (PMABS) for the ICU setting and evaluated its performance characteristics and results. Materials and Methods: The 26-item PMABS adapted for the ICU (PMABS-ICU) was administered as an online survey to 163 nurses, clinical technicians, respiratory therapists, attending and fellow physicians, nurse practitioners, and physician assistants in one medical ICU. We evaluated the overall and subscale (knowledge, attitude, and behavior) scores and compared these scores by respondent characteristics (clinical role and years of work experience). Results: The survey response rate was 96% (155/163). The survey demonstrated acceptable discriminant validity and acceptable internal consistency for the overall scale (Cronbach α: 0.82, 95% confidence interval: 0.76-0.85), with weaker internal consistency for all subscales (Cronbach α: 0.62-0.69). Across all respondent groups, the overall barrier score (range: 1-100) was relatively low, with attending physicians perceiving the lowest barriers (median [interquartile range]: 30 [28-34]) and nurses perceiving the highest (37 [31-40]). Within the first 10 years of work experience, greater experience was associated with a lower overall barrier score (−0.8 for each additional year; P = 0.02). Conclusions: In our medical ICU, across 6 different clinical roles, there were relatively low perceived barriers to patient mobility, with greater work experience over the first 10 years being associated with lower perceived barriers. As part of a structured quality improvement project, the PMABS-ICU may be valuable in assisting to identify specific perceived barriers for consideration in designing mobility interventions for the ICU setting.

A quality improvement project to increase compliance with indicated prechemotherapy pneumococcal vaccination.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 218-218
Author(s):  
Wilfred P. Delacruz ◽  
Sandra Terrazzino ◽  
Brian R. Haney
Keyword(s):  
Quality Improvement ◽  
Cancer Patients ◽  
Pneumococcal Vaccination ◽  
Severe Pneumonia ◽  
Standard Of Care ◽  
High Morbidity ◽  
Improvement Project ◽  
Single Person ◽  
Improve Compliance ◽  
Current Guidelines

218 Background: Severe pneumonia is associated with high morbidity and mortality in cancer patients. The most common pathogen is S. pneumoniae, responsible for 2/3 of pneumonia-related deaths. Current guidelines recommend routine use of 13-valent (Prevnar 13) and 23-valent (PPSV23) pneumococcal vaccine for immunocompromised patients (cancer patients). Of the 110 patients younger than 65 years old who started chemotherapy in our clinic from July 2013 to June 2014, only seven patients received the pneumonia vaccine through our clinic. We conducted a quality improvement (QI) project to improve compliance of pneumonia vaccination in patients who will start on chemotherapy in our outpatient clinic. Methods: We reviewed the current guidelines for pneumonia vaccinations in cancer patients with our physicians and encouraged them to prescribe the pneumonia vaccination to their patients prior to therapy. In addition to educating the primary provider, we took a multidisciplinary approach and recruited our clinic nurse practitioner who meets all patients for chemotherapy teaching to prescribe the vaccine to patients less than 65. Results: Of the 90 patients (median age 60, 20-86) who started chemotherapy during the study period, 58 were less than 65 years old of which three patients were already vaccinated prior to their diagnosis. Twenty five (45.5%) patients were vaccinated through our QI project. We have improved our compliance with pneumonia vaccination guidelines by 39%. Conclusions: We have improved compliance of pneumonia vaccination in cancer patients starting chemotherapy in our clinic through a QI project. We found that screening and intervention are best accomplished by a single person who is able to see all patients. This practice is now being conducted as standard of care in our clinic.

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