Successful reduction of intraoperative transfusions during cardiac surgery
Conclusions
Through introduction and application of basic intraoperative blood conservation modalities, we successfully reduced intraoperative blood utilization during cardiac surgery. Improvements were significant and sustainable over time.
Figure 1Percent of elective cardiac valve replacement cases between the pre- and post- implementation phase in which red cells, plasma, or platelets were transfused during the off-pump period.
Figure 2ARBC Transfusions Units/Case.
Figure 2BPlasma Transfusions Units/Case.
Figure 2CPlatelet Transfusions Units/Case. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Tran, M.-H., Milliken, J., Merrill, D. Tags: Abstracts Source Type: research
Reducing bpd in a level iv nicu
Conclusions
Multiple contextual factors were leading to our high BPD rate, including lack of a burning platform and a sense of "it is someone else's problem". Reducing BPD required addressing the physiologic causes of disease as well as these cultural factors.
Figure 1Key driver diagram.
Figure 2Protocol for ventilation weaning.
Figure 3Days until first extubation attempt.
Figure 4Percent of sat alarms properly set.
Figure 5Rate of "Any BPD" for main campus NICUs.
Figure 6Rate of "Severe BPD" for main campus NICUs. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Bartman, T., Shepherd, E., Nelin, L., Dail, J., Holston, M., Wishloff, E., Keels, E., Thomas, L., Kuehne, B., Larouere, M., Elgin, A., Foor, N. Tags: Abstracts Source Type: research
Improving antipsychotic medication safety in children and adolescents
Conclusions
We have achieved a reliable system for monitoring the use of antipsychotic medication, which has since been spread to other disciplines such as Autism and Developmental Disabilities resulting in the majority of patients being monitored for antipsychotic medication safety and has also resulted in patient care standardization.
Figure 1 Antipsychotic Medication Safety Compliance. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Valleru, J., Axelson, D., Krishna, R. Tags: Abstracts Source Type: research
Managing inpatient pediatric health care with a 24 hour care progression bundle
Conclusions
The Care Progression Bundle safely decreased LOS and time to discharge without increasing utilization of resources. Culture change towards a more unified shared mental model was a challenge but positive results are helping to shift to more acceptance of the 24 hour clinical progression of care. Next steps will be to measure physician and nursing satisfaction, analyze patient experience and perform an accurate cost analysis.
Figure 1Detailed description of the 24 hour care progression bundle.
Figure 2Discharge time (order to depart) pre and post Care Progression Bundle implementation. (Source...
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Hopkins, A., Morrow, M. Tags: Abstracts Source Type: research
Bringing icu care to bedside: have critical care response teams improved the quality of patient care in ontario?
Conclusions
Our results show that intensivist led-CCRTs improve patient outcomes and have strengthened critical care services system. Based on these positive findings, nurse-led model for CCRTs is currently being piloted in community hospitals. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Haque, N., Lawless, B., Kostrzewa, L., Gao, M. Tags: Abstracts Source Type: research
Bundles overcome hurdles in the golden hour for
Conclusions
Next PDSA cycle is transferring administering IVF and Ampicillin to the physician/NNP placing the lines eliminating the need for nursing to become sterile again. We are also implementing a count-down timer as used in trauma medicine as a data tool to the resuscitation team.
Figure 1Drivers.
Figure 2
Figure 3
Figure 4
Figure 5 (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Habib, A., Leukart, R. L., Bartman, T., Schlegel, A. Tags: Abstracts Source Type: research
Implementation of a standardized approach to pediatric postoperative urinary retention decreases rate of intervention
Conclusions
Utilizing quality improvement methods, we implemented a standardized approach to define and manage postoperative urinary retention. Standardization led to decreased interventions such as repeat catheterization for clinically insignificant retention.
Figure 1Key Driver Diagram.
Figure 2Percent Foley removals in postop orthopedic patients. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Meier, K., Benz, L., Greger, S., Zurkuhlen, W., Ninemire, M. R., Churay, K., Gossett, J., Stalets, E. Tags: Abstracts Source Type: research
Effectiveness of a collaborative approach in reducing healthcare-associated infections and improving safety in brazilian icus: the salus vitae story
Conclusions
The BTS approach proved to be effective in reducing HAI in ICUs in Brazil. Based on the results to date, our degree of belief that the Collaborative will achieve its goals for CLABSI and CAUTI is high, but not for VAP. Reducing VAP proved to be more challenging because it demands multidisciplinary teamwork and specific knowledge about certain elements of the bundle such as weaning and sedation. Future collaboratives in these settings might benefit from assessing and closing the gaps in clinical knowledge and infrastructure capacity, and from assessing teams' readiness for quality improvement prior to their impl...
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Lajolo, C., Sardenberg, C., Rooney, K., Petenate, A., Borem, P., Luther, K. Tags: Abstracts Source Type: research
Quality, safety, teamwork and professionalism in gme: validation of the acgme resident survey
Conclusions
Given the IOM findings related to healthcare quality and patient safety, the ACGME CLER program, and a national focus on teaching quality/safety in the context of GME, the ACGME has expanded its annual Resident Survey to include program assessment in the areas of quality and safety. This study is the first to demonstrate validity for several ACGME survey items in these important areas.
Figure 1Comparison of ACGME Survey items to AHRQCPS dimensions and incident reports. AHRQCPS, Agency for Healthcare Quality and Research's Survey on Patient Safety Culture.
Figure 2 Correlation to resident incident...
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Perret, D., Dalal, A. K., Chin, J., Nguyen, J., Miranda-Wood, C., Thompson, C., Grochow, D., Merrill, D. Tags: Abstracts Source Type: research
Where is my ett?: using quality improvement to decrease unplanned extubations in a large nicu setting
Conclusions
Our outcomes identified that the NRP formula can be used as an assessment tool to determine need for an X-ray to check ETT placement and quickly identify ETTs that need adjustment. This has implications for clinical practice to help guide judicious radiation exposure. Ongoing work will be sustainment and growth with the literature (i.e. New NRP formula). With the rich data gained from each UE there are further opportunities for targeted improvement based on theme.
Figure 1Unplanned extubation rate.
Figure 2Themes for each unplanned extubation.
Figure 3UE debrief form.
Figure 4Po...
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Broome, L., Baruah, I., Iniguez, S., Schiff, R. Tags: Abstracts Source Type: research
A lean approach to care transitions reduces readmissions for heart failure patients
Conclusions
Partnering with patients, multidisciplinary collaboration and timely feedback to frontline staff foster improved care transitions and patient outcomes. Tracking data for continuous improvement, we can refine care processes and inform innovative improvements in care across our organization. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Kell, C. Tags: Abstracts Source Type: research
A quality improvement initiative to decrease the rate of solitary sets of blood cultures in the emergency department
Conclusions
The combination of an education intervention and a computerized FF was more effective than education alone in reducing solitary BCs in our ED. FFs can be a powerful tool in modifying behaviours and processes in the clinical setting.
Table 1Visit data during the duration of the study period (November 2014 to July 2016)
MetricSite 1Site 2CombinedTotal ED Visits During Study Period83 747111 621195 368Total ED Ambulatory Visits During Study Period67 04097 538164 578Number of Visits That Had ANY Blood Cultures Sent3 1841 8395 023Blood Cultures (any number of sets) ordered per 100 ambulatory patients4.741.883.0...
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Choi, J., Ensafi, S., Chartier, L., Praet, O. V. Tags: Abstracts Source Type: research
Antibiotic stewardship for acute bronchitis: a quality improvement (qi) study in university healthcare
Conclusions
Antibiotic stewardship related to AUB improved to 95% compliance with clinical guidelines through staff and patient education, and regular peer chart review. This effort is of particular importance in college health as this represents a unique opportunity to educate young adults, often novice consumers of healthcare, on the appropriate use of antibiotics. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Frisina, P., Pletcher, J., Munene, E., Kolligian, J. Tags: Abstracts Source Type: research
Early rehabilitation in the pediatric intensive care unit: a quality improvement project
Conclusions
To date, EM in the PICU has proven to be safe and effective. Detailed data analysis, including analysis of clinical and financial information pending project completion.
Figure 1Percent of PICU Patients Mobilized 18 Hours+ within Established Time Frame.
Figure 2Time From PICU Admission to First Mobilization. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Herbsman, J., Al-Qaqaa, Y., Corcoran, J., Daly, J., Folks, T., Klein, D., O'Donnell, S., Pereira-Argenziano, L., Linder-Perlman, N., Selikoff, L., Sheldon, M. E., Tan, T. Tags: Abstracts Source Type: research
Pediatric emergency department return visits: a proactive approach to quality improvement
Conclusions
Routine monitoring and investigation of ED RVs provides a proactive approach to seeking improvement opportunities. With a better understanding of specific patient and visit-level factors associated with RVs, future system-level quality improvement initiatives can be targeted.
Figure 1
Figure 2
Figure 3 (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Ostrow, O., Shim, A., Azmat, S., Chartier, L. Tags: Abstracts Source Type: research
