scholarly journals Meeting the challenges of Acute Care Quality Indicators

2011 ◽  
Vol 10 (2) ◽  
pp. 91-94
Author(s):  
Kate Evans ◽  
◽  
Ben Fulton ◽  
Keyword(s):  
Acute Care ◽  
Quality Indicators ◽  
Waiting Times ◽  
Working Hours ◽  
Management Plan ◽  
Care Quality ◽  
Patient Assessment ◽  
Acute Medicine ◽  
Out Of Hours ◽  
Acute Medical Unit

The Royal College of Physicians and Society of Acute Medicine have proposed the introduction of Acute Care Quality Indicators. These include the need for rapid initial patient assessment and instigation of a management plan.1 Reductions in junior doctor working hours may impact on our ability to meet these standards. We present the result of a service review of 297 consecutive admissions to a large acute medical unit. This has identified a marked dichotomy between waiting times during daytime and out-of-hours, despite appropriate response to initial triage. We conclude that further service redevelopment is required to reach the standards proposed in the current Acute Care Quality Indicators.

scholarly journals https://staging.acutemedjournal.co.uk/investigating-for-pulmonary-embolism-in-pregnancy-five-year-retrospective-review-of-referrals-to-the-acute-medical-unit-of-a-large-teaching-hospital/

2016 ◽  
Vol 15 (2) ◽  
pp. 51-57
Author(s):  
T Brougham ◽  
C Gillett ◽  
L Powter ◽  
Keyword(s):  
Data Collection ◽  
Quality Indicators ◽  
Patient Flow ◽  
Waiting Times ◽  
Electronic System ◽  
Acute Medicine ◽  
Bed Management ◽  
Acute Medical Unit ◽  
Large Teaching Hospital ◽  
Medicine Quality

Aims: To create a system to co-ordinate the medical take, bed management and track patient flow. To use the system to continuously audit against Society for Acute Medicine Quality Indicators. To use the data to model patient flow and optimize working patterns to improve waiting times. Method: An online whiteboard and underlying database system were designed, tested and implemented. Data from this system were used to audit against SAM Quality Indicators and then analysed to optimise both trainee and consultant working patterns. Results: The online whiteboard proved effective and popular as a working tool. Data collection improved using the electronic system. Optimising junior doctor working patterns to match demand led to a reduction of average waiting time to see a doctor from 190 minutes to 71 minutes (p < 0.0001), and a reduction in the proportion of patients waiting over 4 hours from 40% to 10% (p < 0.0001). Optimising consultant working patterns did not produced significant changes in waiting times. Conclusions: The online whiteboard improved day-to-day working and data collection, when compared to the previous paper-based system. Better data facilitated analysis of working patterns leading to a significant improvement in patient waiting times.

EDITORIAL VOLUME 19 ISSUE 4: COVID-19: Exemplifying the importance and challenges of Acute Medicine

2020 ◽  
Vol 19 (4) ◽  
pp. 174-175
Author(s):  
Timothy Cooksley ◽  
Keyword(s):  
Medical Care ◽  
Acute Care ◽  
Quality Indicators ◽  
Acute Medicine ◽  
Care Services ◽  
Senior Clinician ◽  
Acute Care Services ◽  
The Impact ◽  
Second Wave ◽  
Acute Medical Care

COVID-19 has challenged healthcare providers and systems. It has dominated the international news agenda for the majority of 2020; arguably opinion becoming more fractured and disparate as the pandemic has evolved. The changing tone of discourse is concerning, although perhaps not surprising. As the majority of the population become increasingly baffled, bored and betrayed desperate for their lives return to “normal”, progressively binary, toxically expressed and opposing scientific views as to how to manage the “second wave” of the pandemic permeate. The initial failings of personal protective equipment (PPE) and a lack of preparedness to face a viral pandemic against the background of a strained acute care sector must not be forgotten and lessons learned. In the UK, COVID-19 has highlighted both the challenges and importance of Acute Medicine. Acute Medicine teams have provided innovative and rapidly adaptive models of care in response to the pandemic. The fundamental tenets of Acute Medicine – MDT working, rapid initiation of treatment, sound use of diagnostics, early senior clinician input and recognition of those in whom ambulatory care is appropriate – are essential components in the management of all acute medical care and demonstrably equally apply to COVID-19. Our increasing global community of Acute Physicians and Acute Medicine teams have once again demonstrated the importance of our specialty. The innovative practice of Acute Medicine teams and the impact of COVID-19 features prominently in this issue of Acute Medicine. There has been wide commentary regarding the impact of COVID-19 on both mental health issues and non-COVID-19 presentations. Riley et al. report an important analysis of presentations to AMU during the first wave of COVID-19 demonstrating a significant change in patient case mix.1 There were increased numbers of presentations potentially associated with social isolation such as falls, alcohol-related pathologies and overdoses alongside smaller numbers of traditionally lower risk presentations, such as non-cardiac chest pain. Ambulatory management of low risk patients with suspected COVID-19 is fundamental to the safety and sustainability of acute care services during the “second wave” and moving forward. Nunan et al. report the experience of the TICC-19 – a virtual ward monitoring oxygen saturations for COVID-19 triaged using a 30 metre rapid walk test.2 This strategy appears safe and feasible with high levels of patient satisfaction and similar models are being utilised across many organisations. The role of POCUS in the diagnosis and management of COVID-19 is increasingly recognised.4 Knight et al. describe a simple aggregated score formed by summating the degree of pleural and interstitial change within six anatomical lung zones showing good discriminatory performance in predicting a range of adverse outcomes in patients with suspected COVID-19.4 This may form an important addition to COVID-19 ambulatory pathways. SAMBA, the Society for Acute Medicine’s Benchmarking Audit, initially focused on the Society’s key quality indicators, continues to flourish and grow. It now not only benchmarks performance but is being used to guide the development of UK clinical quality measures. Colleagues in the Netherlands are commencing similar work and describing international standards of acute medical care, an iterative process, is one of the ultimate goals of this work. SAMBA 19 continues to demonstrate the evolving complexity of acute medical pathways and highlights the need to define optimal quality indicators for acute medical care.5 The inaugural winter SAMBA adds further evidence to the concerns that during this period there is an unfortunate cocktail of both sicker patients and poorer performance.6 Adapting acute medical services to meet this challenge requires innovation and investment. Those working in Acute Medicine should feel proud of their continued contribution to managing the acutely unwell patient and their impact on the sustainability of acute care services, particularly during this most challenging of years. The Society for Acute Medicine has tremendous pride in representing this brilliant workforce. Alongside, the fantastic work of teams this year, there have been multiple emotional and physical stressors. Many AMUs have experienced large numbers of patient deaths, often having to support their loved ones by telephone. The seroprevalence of SARS-CoV-2 was greatest among colleagues working in Acute Medicine.7 Tragically, some AMUs have lost valued colleagues from COVID-19. We remember these friends for their fantastic work they have done, thank them for their contributions to Acute Medicine and on behalf of all the patients they served, we express thanks; their dedication resulted in the ultimate personal sacrifice. They will never be forgotten.

MEETING THE CHALLENGES OF ACUTE CARE QUALITY INDICATORS IN A DISTRICT GENERAL HOSPITAL

2011 ◽  
Vol 22 ◽  
pp. S45-S46
Author(s):  
Manish Kapoor ◽  
Fiona Ritchie ◽  
Waseer Bashir ◽  
Thikra Al-Wattar
Keyword(s):  
General Hospital ◽  
Acute Care ◽  
Quality Indicators ◽  
District General Hospital ◽  
Care Quality

New Post-Acute Care Quality Measures Take Effect Oct. 1

ASHA Leader ◽  
2016 ◽  
Vol 21 (6) ◽  
pp. 34-35
Author(s):  
Sarah Warren ◽  
Tim Nanof
Keyword(s):  
Acute Care ◽  
Quality Measures ◽  
Care Quality ◽  
Post Acute Care

scholarly journals An Environmental Scan of Ambulatory Care Quality Indicators for Patients With Advanced Kidney Disease Currently Used in Canada

2021 ◽  
Vol 8 ◽  
pp. 205435812199109
Author(s):  
Jay Hingwala ◽  
Amber O. Molnar ◽  
Priyanka Mysore ◽  
Samuel A. Silver
Keyword(s):  
Kidney Disease ◽  
Ambulatory Care ◽  
Quality Indicators ◽  
Health Care Quality ◽  
Healthcare Research ◽  
Care Quality ◽  
Institute Of Medicine ◽  
Environmental Scan ◽  
Number Of Patients ◽  
Ambulatory Patients

Background: Quality indicators can be used to identify gaps in care and drive frontline improvement activities. These efforts are important to prevent adverse events in the increasing number of ambulatory patients with advanced kidney disease in Canada, but it is unclear what indicators exist and the components of health care quality they measure. Objective: We sought to identify, categorize, and evaluate quality indicators currently in use across Canada for ambulatory patients with advanced kidney disease. Design: Environmental scan of quality indicators currently being collected by various organizations. Setting: We assembled a 16-member group from across Canada with expertise in nephrology and quality improvement. Patients: Our scan included indicators relevant to patients with chronic kidney disease in ambulatory care clinics. Measurements: We categorized the identified quality indicators using the Institute of Medicine and Donabedian frameworks. Methods: A 4-member panel used a modified Delphi process to evaluate the indicators found during the environmental scan using the American College of Physicians/Agency for Healthcare Research and Quality criteria. The ratings were then shared with the full panel for further comments and approval. Results: The environmental scan found 28 quality indicators across 7 provinces, with 8 (29%) rated as “necessary” to distinguish high-quality from poor-quality care. Of these 8 indicators, 3 were measured by more than 1 province (% of patients on a statin, number of patients receiving a preemptive transplant, and estimated glomerular filtration rate at dialysis start); no indicator was used by more than 2 provinces. None of the indicators rated as necessary measured timely or equitable care, nor did we identify any measures that assessed the setting in which care occurs (ie, structure measures). Limitations: Our list cannot be considered as an exhaustive list of available quality indicators at hand in Canada. Our work focused on quality indicators for nephrology providers and programs, and not indicators that can be applied across primary and specialty providers. We also focused on indicator constructs and not the detailed definitions or their application. Last, our panel does not represent the views of other important stakeholders. Conclusions: Our environmental scan provides a snapshot of the scope of quality indicators for ambulatory patients with advanced kidney disease in Canada. This catalog should inform indicator selection and the development of new indicators based on the identified gaps, as well as motivate increased pan-Canadian collaboration on quality measurement and improvement. Trial registration: Not applicable as this article is not a systematic review, nor does it report results of a health intervention on human participants.

scholarly journals Quality indicators for all dimensions of infertility care quality: consensus between professionals and patients

2013 ◽  
Vol 28 (6) ◽  
pp. 1584-1597 ◽  
Author(s):  
E. A. F. Dancet ◽  
T. M. D'Hooghe ◽  
C. Spiessens ◽  
W. Sermeus ◽  
D. De Neubourg ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Care Quality

scholarly journals Immediate Care of Open Extremity Fractures: Where Can We Improve?

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
R. Walton ◽  
J. Manara ◽  
S. E. Elamin ◽  
I. Braithwaite ◽  
E. Wood
Keyword(s):  
Acute Care ◽  
Bone Fractures ◽  
Working Hours ◽  
District General Hospital ◽  
Open Fractures ◽  
Care Staff ◽  
Long Bone ◽  
Initial Management ◽  
Clinical Consequences

Clear guidelines are set by the British Orthopaedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) on the preoperative management of open fractures. This as well as the clinical consequences of poor management of open fractures means the patient workup for surgery is important as well as the timing of surgery. Experience suggests few patients are managed 100% as per the guidelines and we look to test this hypothesis. A retrospective analysis was undertaken of all open long bone fractures (total 133), excluding hand injuries, which presented to a district general hospital over a 5-year period. The implementation of 7 defined key tasks for initial management was recorded. 101 cases were eligible, with the majority of cases (71.4%) having initial orthopaedic assessment outside normal working hours. The mean number of tasks completed was 3.23/7. Assessment out of hours was associated with less tasks being implemented but doctor seniority and the presence of polytrauma made no difference to the quality of acute care. Staff involved in the acute care of open fractures require targeted education to improve the delivery of initial preoperative care. We recommend that other centres assess their performance against this data.

Attendance rates during working-hours versus out-of-hours otolaryngology clinics

2008 ◽  
Vol 90 (9) ◽  
pp. 316-319 ◽  
Author(s):  
AJ Donne ◽  
D Siau ◽  
R Swindell ◽  
JJ Homer
Keyword(s):  
General Public ◽  
Working Hours ◽  
Social Attitudes ◽  
Attendance Rates ◽  
Out Of Hours

In the foreword to Choice matters: Increasing choice improves patients' experiences, the minister of state for delivery and quality states that patients want and expect convenient services tailored to accommodate their increasingly busy lives. The British Social Attitudes Survey 22nd Report indicated that patients with semi-routine and routine occupations were more interested in choice compared to patients with managerial and professional occupations. However, almost 60% of the latter group were still interested. Clearly a major proportion of the general public are keen to be empowered with greater choice.

Intrapartum care quality indicators: a systematic approach for achieving consensus

2013 ◽  
Vol 166 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Thabani Sibanda ◽  
Robert Fox ◽  
Timothy J. Draycott ◽  
Tahir Mahmood ◽  
David Richmond ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Systematic Approach ◽  
Care Quality ◽  
Intrapartum Care
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