B5: QI Abstract Presentations 23 rd March 2019
As part of our extensive program and with CPD hours awarded based on actual time spent learning, credit hours are offered based on attendance per session, requiring delegates to attend a minimum of 80% of a session to qualify for the allocated CPD hours. • Less than 80% attendance per session = 0 CPD hours • 80% or higher attendance per session = full allotted CPD hours ME Forum 2019 Orientation Total CPD hours for the forum are awarded based on the sum of CPD hours earned from all individual sessions. Conflict of Interest The speaker(s) or presenter(s) in this session has/have no conflict of interest or disclosure in relation to this presentation.
Conflict of Interest The speaker(s) or presenter(s) in this session has/have no conflict of interest or disclosure in relation to this presentation.
Learning Objectives At the end of this session, participants will be able to: 1. Learn from presenters how they made the change, achieved success and overcome challenges. 2. Inspired through interaction with the speakers 3. Support the continuous improvement efforts in their organizations 4. Disseminate information and share experience
Reducing Elective General Surgery Cancellations Hamad General Hospital Mr. Belal Salem, Nursing Supervisor- Clinical Bed Management, RN, BSc.
Background and Introduction Cancellations of planned surgical procedures have been a major and long- standing problem for healthcare organisations across the world. They represent a significant loss of revenue and waste of resources, have significant clinical, psychological, social and financial implications for patients and their families. The current paper investigates the reasons for day of surgery cancellations at HGH and proposes strategies to reduce their incidence. In 2017, the overall rate of cancellation of elective operations on the day of surgery ranging from 30%-32% of planned elective operations per month.
Aim and Measures To reduce the percentage of cancellations for all elective General Surgical cases by 5% by the end of November 2018. Outcome Measure Percentage of Cancellation of Elective General Surgical cases Balance Measures Patient satisfaction Efficient utilization of OR slots Process Measure Standardize scheduling and tracking process for all pre-operative elective cases.
PDSAs / Change Ideas q Working closely with STO to schedule the case according the OR slot. q Avoid the schedule of elective admission unless there is urgent indication q Balance the slot between day care and STO cases ( elective procedure) q Follow up with surgical team to adhere with agreed protocol and pathways of elective admission q Continue run the bed management service 24/7 with full capacity. q Develop preoperative committee to streamline the elective surgical admission pathway. q Protected surgical beds as per specialty. q Adapted JCI cohort study 2 in reviewing all STO slots and system to avoid any overbooking in the system. q Review and study all reasons for cancellation and develop an agreed action plans accordingly.
Run Chart
Conclusion q Reduction of planned elective surgery cancellation to 15.65% compared to our benchmark of 7.8%. Perioperative committee remain functioning with frequent meetings and follow up for all the surgical challenges.
Next Steps and Sustainability q Implementation of new STO process mapping in the new Surgical Specialty Center by the end of 2018 q Screening all cases and divert cases that can be done to another facility q Centralize the scheduling system through the STO for elective / Day case General Surgery q Keep scheduling the slots timing of procedure through the system (Cerner). q To maintain a real time operational data- dashboard and generating an efficient reports. q Perioperative committee remain functioning with frequent meetings and follow up for all the surgical challenges
Question and Answer
Developing a Sepsis Screening Tool for a Nurse Led Facility Mobile Healthcare Service – Ambulance Service Group Dan Reynald Borja, Miel Samson, Dr. James Laughton, Gary Kenward, Ronald Ancheta, Dr. Timothy Chetty, Dr. Nicole Anderson, Mohammed Jbeli
Background and Introduction q The Patient Recovery Centre (PRC): • 57 bedded, nurse-led step-down facility • Patients needing ongoing clinical/social support following acute episodes of hospitalization q Adapted UK Community Sepsis Screening tool • Implement QEWS to improve the early recognition of deteriorating patients • Escalate ‘red flag sepsis’ patients promptly to a higher level of care • Collaboration between MHS and Home Health Care Service (HHCS) to test this unified community sepsis screening tool
Aim and Measures To reduce the time between identification of sepsis symptoms to escalation to a higher level of care from 125 minutes to 30 minutes by June 2019 Measures q Time Zero to Time of Escalation q SP01 - Percent with reliable vital signs documented q SP02- Percent of Clinical Review, RRT, SIRS/ Severe Sepsis or equivalent alerts that were appropriately escalated q Clinical Review Time
PDSAs / Change Ideas
Charts
Results q QEWS effectively introduced into the PRC in May 2018 q 100% compliance in recording vital signs on QEWS from September 2018 q Sepsis screening tool adapted for use and then adopted into PRC q Median escalation time (for suspected sepsis cases) decreased by 66.7% from 168.8 minutes to 56.3 minutes following introduction of Sepsis Screening Tool q All 8 cases identified as Red Flag sepsis received IV antibiotics in ED
Next Steps and Sustainability q Test changes to improve: • Escalation time to calling 999 • Improve flagging of sepsis patients sent to ED or Urgent Care q Continue collaboration with Home Healthcare Service and extend to other Community services to align sepsis pathway across Qatar
Question and Answer
SUN: A Quality Improvement Journey: To Stop Unplanned ExtubatioN in NICU Women’s Wellness & Research Center Sashtha Girish, A/Quality Coordinator, NICU Bilal Kanth, Chief Respiratory Therapist, NICU Habeebah Fazlullah, Respiratory Therapist, NICU
Background and Introduction Improving quality of care in NICU is imperative in healthcare. The ultimate goal of every intervention is to improve health & quality of life in all patients. An Unplanned Extubation (UEx) is a significant marker of poor quality of care. There was a trend of increase in events of UEx and this rate was quite alarming with no standardized tool in place, which could have closely monitored the rate and the associated reason(s) for the events neither we were able to compare with international level’s that how good nor how bad is our clinical practice when it comes to managing and preventing the events of UEx. So, we identified UEx as an area of improvement & maintaining UEx rate <1/100 vent days. We continued with RCA for each UEx & regular educational sessions are important aspects for our success. All infants admitted to NICU who requires invasive mechanical ventilation are being monitored as part of this QI project. By reducing UEx in NICU, we improved overall clinical outcomes, reduce length of stay, lowered costs & improved patient satisfaction. Effectively initiated in March 2018 with a tool that includes 24 data collection categories, close monitoring, and documentation & analysis by NICU team, “SUN” project continues to address the key measure of quality with the aim to sustain rate at <1 event/100 vent day.
Aim and Measures To reduce the events of unplanned extubation (UEx) at NICU, WWRC from >1 event/100 ventilator days to <1 event/100 ventilator days (International Benchmark) by end of December 2018. Outcome Measure Percentage of reduction of number of adverse events related to unplanned extubation. Process Measure Percentage of compliance to Monitoring Tool with 24 categories. Balance Measure Percentage of increase in nasal related injuries due to more patients started or weaned earlier to non-invasive ventilation.
PDSAs / Change Ideas q A chart as per latest NRP (Neonatal Resuscitation Program) for ETT (Endotracheal Tube) size and levels were introduced in all resuscitation areas from February 2018. q Introduction of awareness and monthly educational activity and starting to use the Monitoring Tool with 24 categories from March 2018. q Routine Check: security and level of ETT hourly with documentation from March 2018. q Encouraged using NIV (Non-Invasive Ventilation) and early weaning. q Education about patient care procedures was started from April 2018. q All ventilated babies have “High Alert Cards” on the bedside to make teams more vigilant and careful during their care to avoid UEx was implemented from May 2018. q Education sessions promoting Two-to-One care (TTOC) were emphasized to all team members and this was advocated by medical team for multifactorial benefits.
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