Assessing nuclear medicine practices: a critical evaluation of QUANUM through a quality improvement perspective and its wider relevance.

Quality Management Audits in Nuclear Medicine (QUANUM) is an initiative conceived by the International Atomic Energy Agency to enhance global standards in Nuclear Medicine practices. Acknowledging the intricate regulatory frameworks and the necessity for multidisciplinary collaboration, QUANUM has gained global acceptance, demonstrating widespread implementation and positive impacts on patient care. This manuscript critically evaluates the QUANUM program through the lens of quality improvement (QI), by employing established and validated QI tools. Our analysis identifies areas of conformance, underscores key strengths inherent to QUANUM, and pinpoints further learning opportunities for continuous enhancement. Additionally, we assert that the insights derived from scrutinizing this global project within Nuclear Medicine, have valuable implications for departments aspiring for establishing good quality management systems, thereby contributing to the improvement of patient care.

Construction of cleaner production management system in China: mode innovation of cleaner production.

This study is based on the practice of cleaner production (CP) audits in more than 300 enterprises. After reviewing 1484 CP options, it is found that 82.5% of the options are directly and indirectly related to management. Moreover, there are common problems such as the poor sustainability of CP audit results. This shows that enterprise management plays a significant role in implementing CP options. Based on these, this study proposes a new concept of cleaner production management (CPM) system, and draws lessons from the modern environmental management theory and method to establish the framework of CPM system. This system combines the theory and method of CP with the management system of enterprises and presents the CPM requirements in the current enterprise management system, which mainly includes CPM responsibilities, CP objectives, CPM indexes, CP energy resources management, CP process control, CP product management, CPM inspections, and CP performance evaluation. The characteristic of the proposed system is to construct a modern information-based CPM system. With highly systematic, concise structure, and easy operability, this system not only simplifies and improves the CP work in enterprises and reduces several tedious tasks such as document preparation, but also enhance the enterprise management efficiency and motivate the willingness of employees to participate in CP. Innovated and developed for CP implementation, the system has been implemented and applied in Chinese enterprises, and the implementation and application have obvious effects on improving production level as well as environmental and economic benefits.

Audit of surgical specialty patients and beds at Pietersburg Hospital, Limpopo Province, South Africa in 2021.

BACKGROUND: While the absolute number of hospital beds is usually discussed, adequate utilisation of beds is a far better instrument to measure departmental efficiency. OBJECTIVE: To measure the number of beds for each surgical specialty in Pietersburg Hospital as well as the average length of stay (LoS) to compare bed utilisation. METHOD: We conducted a 1-day descriptive cross-sectional audit of patients admitted to surgical wards on 21 April 2021 at Pietersburg Hospital. RESULTS: There were huge discrepancies in the number of beds per surgical specialty as well as the LoS. Over one-third of surgical beds were occupied by patients waiting for either a computed tomography scan, surgical procedure, or transfer. CONCLUSION: There is a need to address the functioning of the surgical specialties with regards to the number of beds allocated as well as the ideal average length of stay.

Audit of surgical procedures in regional and central hospitals in Limpopo Province, South Africa.

BACKGROUND: There is a paucity of data on the functioning and surgical procedures performed in rural hospitals in South Africa. OBJECTIVE: To determine the category of procedures performed at regional and tertiary hospitals in Limpopo Province, South Africa. METHOD: We conducted a retrospective analysis of surgical procedures performed in the regional and tertiary hospitals in Limpopo Province during a 1-year period from 1 March 2019 to 29 February 2020. RESULTS: A total of 24 263 surgical procedures were performed during the study period. More than half of all cases (50.4%; n=12 252) were operated on at the tertiary hospitals while regional hospitals performed the remaining 12 011 operations. CONCLUSION: There is a great necessity to alleviate the central hospitals from the bulk of surgical procedures.

[Implementation of a quality management system in a central sterilization unit: experience in the Hospital Tahar Sfar, Mahdia, Tunisia]. / Mise en place d´un système de management de la qualité dans une unité de stérilisation centralisée: expérience de l´Hôpital Tahar Sfar de Mahdia en Tunisie.

In Tunisia, Hospital sterilization guidelines recommend the establishment of a quality assurance system. The purpose of this study is to give an overview of the situation in a sterilization unit in order to assess the adherence to good practice criteria and to identify opportunities for improvement. We conducted a prospective study in the sterilization unit of the Hospital Tahar Sfar, Mahdia in 2019. Two internal audits were conducted under the same conditions and were carried out one year apart. The first audit identified failures and malfunctions and the outlining of an action plan. The impact of the measures undertaken was tested using a second audit. Data collection was carried out by direct observation of the existing resources and practices. Compliance rate was calculated taking into account compliant criteria and applicable criteria. The results of the first audit revealed a compliance rate of around 28.1%. The analysis used to observe deviations made it possible to identify 5 axes of improvement, in particular the implementation of a system of documentation and a quality management system. In total, we prepared 14 documents related to the managerial processes, 26 to the operational processes and 41 to the support processes. The actions put in place enabled to achieve a compliance rate of 60.4%. The approach taken to upgrade sterilization processes made it possible to standardize them while ensuring traceability.

Audit of the Sydney Local Health District Public Health Unit notification and contact tracing system during the first wave of COVID-19.

OBJECTIVE: To conduct a real-time audit to assess a Continuous Quality Improvement (CQI) activity to improve the quality of public health data in the Sydney Local Health District (SLHD) Public Health Unit during the first wave of COVID-19. METHODS: A real-time audit of the Notifiable Conditions Information Management System was conducted for positive cases of COVID-19 and their close contacts from SLHD. After recording missing and inaccurate data, the audit team then corrected the data. Multivariable regression models were used to look for associations with workload and time. RESULTS: A total of 293 cases were audited. Variables measuring completeness were associated with improvement over time (p<0.0001), whereas those measuring accuracy reduced with increased workload (p=0.0003). In addition, the audit team achieved 100% data quality by correcting data. CONCLUSION: Utilising a team, separate from operational staff, to conduct a real-time audit of data quality is an efficient and effective way of improving epidemiological data. Implications for public health: Implementation of CQI in a public health unit can improve data quality during times of stress. Auditing teams can also act as an intervention in their own right to achieve high-quality data at minimal cost. Together, this can result in timely and high-quality public health data.

The effect of contextual information on professional judgment: Reliability and biasability of expert workplace safety inspectors.

INTRODUCTION: A critical aspect of occupational safety is workplace inspections by experts, in which hazards are identified. Scientific research demonstrates that expectation generated by context (i.e., prior knowledge and experience) can bias the judgments of professionals and that individuals are largely unaware when their judgments are affected by bias. METHOD: The current research tested the reliability and biasability of expert safety inspectors' judgments. We used a two-study design (Study 1, N = 83; Study 2, N = 70) to explore the potential of contextual, task-irrelevant, information to bias professionals' judgments. We examined three main issues: (1) the effect that biasing background information (safe and unsafe company history) had on professional regulatory safety inspectors' judgments of a worksite; (2) the reliability of those judgments amongst safety inspectors and (3) inspectors' awareness of bias in their judgments and confidence in their performance. RESULTS: Our findings establish that: (i) inspectors' judgments were biased by historical contextual information, (ii) they were not only biased, but the impact was implicit: they reported being unaware that it affected their judgments, and (iii) independent of our manipulations, inspectors were inconsistent with one another and the variations were not a product of experience. CONCLUSION: Our results are a replication of findings from a host of other professional domains, where honest, hardworking professionals underappreciate the biasing effect of context on their decision making. The current paper situates these findings within the relevant research on safety inspection, cognitive bias and decision making, as well as provides suggestions for bias mitigation in workplace safety inspection. Practical Application: Our results have implications for occupational health and safety given that inspection is an integral aspect of an effective safety system. In addition to our findings, this study contributes to the literature by providing recommendations regarding how to mitigate the effect of bias in inspection.

An audit of the editorial process at the Indian Journal of Cancer: Lessons learned, and how to improve chances of acceptance of your paper.

BACKGROUND: The editors of the Indian Journal of Cancer (IJC) have not, so far, objectively analyzed the editorial processes involving author, referee, and editor data of the journal. Hence, we aimed at doing so in this audit. METHODS: We retrospectively analyzed manuscripts submitted to the IJC from April 1, 2020, to May 31, 2020, for data related to the peer-review process. Microsoft Excel was used to enter the retrieved information and to carry out the statistical analysis. RESULTS: Three hundred and nineteen manuscripts were submitted during the study period. Of these, three were excluded from the study. Of the 316, 79 (25%) were articles on laboratory medicine; 182 (57.6%) were original articles. About half of the submitted manuscripts (166, 52.5%) were desk-rejected. Of the remaining 149 manuscripts, 105 did not follow the instructions to contributors (ITC) and required a median number of two revisions (range = 1-5) to satisfy the ITC. To review 107 manuscripts, 536 external referees were invited; of them 306 did not respond, 79 declined the invitation, and 151 accepted the invitation. Of these 151, 132 reverted with comments. Of the 200 Indians who were invited as referees, 118 (59%) accepted the invitation, whereas of the 336 non-Indian referees, only 33 (9.8%) did. Of the 107 Indian and 25 non-Indian referees who sent their comments, 86 (80.4%) and 19 (88%), respectively, offered useful comments. The median number of days to decision: for desk-rejection was 1 day (range = 0 - 42) days, for rejection after peer-review was 67 (range = 4 - 309) days, and for acceptance was 133.5 (range = 42 - 305) days. Decision has not yet been taken for 14 manuscripts. CONCLUSION: The study provides evidence that it is difficult to get referees. Also, a significant number of authors do not read or follow the ITC. We suggest that the time taken for a decision can be appreciably improved if these issues are addressed.

An institutional audit of the use of novel drugs in pediatric oncology.

BACKGROUND: Significant challenges persist in treating children with rare, relapsed, or refractory malignancies. Novel molecularly targeted drugs promise improved outcomes for these children with reduced toxicity. However, there is often limited evidence to substantiate their clinical efficacy and guide their use. This raises issues for clinical decision-making, ethical concerns surrounding equity of access to these often-expensive agents, and the management of families' expectations for cure. This audit evaluated the off-label use of novel drugs and associated clinical outcomes in order to guide the development of future clinical and ethical guidelines. AIM: To evaluate the patterns in the off-label use of novel drugs for treating childhood cancer and the associated clinical outcomes to guide prospective studies and inform ethical and clinical governance protocols for the use of these agents. METHODS: A retrospective audit was performed for all patients who received novel drugs off-label as treatment for their malignancy at an Australian pediatric oncology center between 2010 and 2019. RESULTS: One hundred patients with 32 unique diagnoses received 133 novel drugs across 124 regimens. Eighty-four patients received these drugs at the second line of treatment or greater. Novel drug median cost was $15 521 AUD (Range: $6.53 AUD to $258 339 AUD) and was primarily funded by the hospital (N = 60/133, 45.1%) or compassionate access from pharmaceutical companies (N = 52/133, 39.1%). Decision-making related to novel drugs was inconsistently documented. Ninety-one of 124 treatment regimens commenced between 2010 and 2019 resulted in objective responses (73.4%), but only 35 were still ongoing upon review in June 2020 (38.5%). Median response duration was 12.6 months (Range: 0-93.2 months). CONCLUSIONS: While novel drugs were largely unable to definitively cure patients, most achieved objective responses. Prospective trials and more rigorous documentation are needed to fully inform the future use of these agents given the heterogeneity of their applications.

Audit of NZ COVID Tracer QR poster display and use in Dunedin.

AIMS: To assess how well the NZ COVID Tracer QR (Quick Response) code poster is displayed by Dunedin businesses and other venues in which groups of people gather indoors, and to calculate the proportions of visitors to those venues who scan the QR code poster. METHODS: We randomly selected 10 cafes, 10 restaurants, 10 bars, five churches, and five supermarkets and visited them at their busiest times. We evaluated the display of QR code posters using a six-item assessment tool that was based on guidance provided to businesses and services by the Ministry of Health, and we counted the number of people who entered each venue during a one-hour period and the number who scanned the QR code poster. RESULTS: All six criteria for displaying QR code posters were met at half of the hospitality venues, four of five churches, and all supermarkets. Scanning proportions were low at all venues (median 10.2%), and at 12 (30%) no visitors scanned; eight of these venues were bars. CONCLUSION: This audit provides a snapshot of the display and scanning of QR code posters in a city with no managed isolation and quarantine facilities and where no COVID-19 cases have been detected for 10 months.

Improving Quality of Care Through a Mandatory Provincial Audit Program: Ontario's Emergency Department Return Visit Quality Program.

The Emergency Department Return Visit Quality Program was launched in Ontario, Canada, to promote a culture of quality. It mandates the province's largest-volume emergency departments (EDs) to audit charts of patients who had a return visit leading to hospital admission, including some of their 72-hour all-cause return visits with admission and all of their 7-day ones with sentinel diagnoses (ie, acute myocardial infarction, subarachnoid hemorrhage, and pediatric sepsis), and submit their findings to a governmental agency. This provides an opportunity to identify possible adverse events and quality issues, which hospitals can then address through quality improvement initiatives. A group of emergency physicians with quality improvement expertise analyzed the submitted audits and accompanying narrative templates, using a general inductive approach to develop a novel classification of recurrent quality themes. Since the Return Visit Quality Program launched in 2016, 125,698 return visits with admission have been identified, representing 0.93% of the 86 participating EDs' 13,559,664 visits. Overall, participating hospitals have conducted 12,852 detailed chart audits, uncovering 3,010 (23.4%) adverse events/quality issues and undertaking hundreds of quality improvement provincewide projects as a result. The inductive analysis revealed 11 recurrent themes, classified into 3 groupings: patient characteristics (ie, patient risk profile and elder care), ED team actions or processes (ie, physician cognitive lapses, documentation, handover/communication between providers, radiology, vital signs, and high-risk medications or medication interactions), and health care system issues (ie, discharge planning/community follow-up, left against medical advice/left without being seen, and imaging/testing availability). The Return Visit Quality Program is the largest mandatory audit program for EDs and provides a novel approach to identify local adverse events/quality issues to target for improved patient safety and quality of care. It provides a blueprint for health system leaders to enable clinicians to develop an approach to organizational quality, as well as for teams to construct an audit system that yields defined issues amenable to improvement.

[Assessment model for evaluating the preparedness plan for COVID-19 in a tertiary care hospital]. / Modelo de evaluación del plan de respuesta frente a la pandemia de COVID-19 en un hospital de tercer nivel.

BACKGROUND AND PURPOSE: During the first wave of the epidemic caused by SARS-CoV-2, hospitals have come under significant pressure. This scenario of uncertainty, low scientific evidence, and insufficient resources, has generated significant variability in practice between different health organisations. In this context, it is proposed to develop a standards-based model for the evaluation of the preparedness and response system against COVID-19 in a tertiary hospital. MATERIALS AND METHODS: The study, carried out at the University Hospital of Vall d'Hebron in Barcelona (Spain), was designed in two phases: 1) development of the standards-based model, by means of a narrative review of the literature, analysis of plans and protocols implemented in the hospital, a review process by expert professionals from the centre, and plan of action, and 2) validation of usability and usefulness of the model through self-assessment and hospital audit. RESULTS: The model contains 208 standards distributed into nine criteria: leadership and strategy; prevention and infection control; management of professionals and skills; public areas; healthcare areas; areas of support for diagnosis and treatment; logistics, technology and works; communication and patient care; and information and research systems. The evaluation achieved 85.2% compliance, with 42 areas for improvement and 96 good practices identified. CONCLUSIONS: Implementing a standards-based model is a useful tool to identify areas for improvement and good practices in COVID-19 preparedness and response plans in a hospital. In the current context, it is recommended to repeat this methodology in other non-hospital and public health settings.

Dumpster Diving in the Emergency Department.

INTRODUCTION: Healthcare contributes 10% of greenhouse gases in the United States and generates two milion tons of waste each year. Reducing healthcare waste can reduce the environmental impact of healthcare and lower hospitals' waste disposal costs. However, no literature to date has examined US emergency department (ED) waste management. The purpose of this study was to quantify and describe the amount of waste generated by an ED, identify deviations from waste policy, and explore areas for waste reduction. METHODS: We conducted a 24-hour (weekday) ED waste audit in an urban, tertiary-care academic medical center. All waste generated in the ED during the study period was collected, manually sorted into separate categories based on its predominant material, and weighed. We tracked deviations from hospital waste policy using the hospital's Infection Control Manual, state regulations, and Health Insurance Portability and Accountability Act standards. Lastly, we calculated direct pollutant emissions from ED waste disposal activities using the M+WasteCare Calculator. RESULTS: The ED generated 671.8 kilograms (kg) total waste during a 24-hour collection period. On a per-patient basis, the ED generated 1.99 kg of total waste per encounter. The majority was plastic (64.6%), with paper-derived products (18.4%) the next largest category. Only 14.9% of waste disposed of in red bags met the criteria for regulated medical waste. We identified several deviations from waste policy, including loose sharps not placed in sharps containers, as well as re-processable items and protected health information thrown in medical and solid waste. We also identified over 200 unused items. Pollutant emissions resulting per day from ED waste disposal include 3110 kg carbon dioxide equivalent and 576 grams of other criteria pollutants, heavy metals, and toxins. CONCLUSION: The ED generates significant amounts of waste. Current ED waste disposal practices reveal several opportunities to reduce total waste generated, increase adherence to waste policy, and reduce environmental impact. While our results will likely be similar to other urban tertiary EDs that serve as Level I trauma centers, future studies are needed to compare results across EDs with different patient volumes or waste generation rates.

[Construction of data remote monitoring and auditing system for clinical trials].

Clinical trial management system is independently developed by our hospital, which basically realized the whole process management and data collection of clinical trials. Based on the platform, the functional architecture of data remote monitoring and auditing was established. By desensitizing and encrypting of data, the project and subject hologram were visualized to facilitate to review of data. The data remote monitoring and auditing cloud platform adopts the B/S architecture pattern. Users register to apply for an account through the cloud platform, and access to the account via HTTPS security protocol. The authorized users were able to view the relevant items online to ensure the secure data transmission and easy operating. The electronic management of data is the direction of future efforts. By compliance with laws and regulations, the remote monitoring/auditing can be realized, and the data security and personal privacy can be ensured with the application of information technology. In this paper, the feasibility of remote monitoring/auditing mode is explored, specific technical schemes and system functions are suggested, and the realization scenarios are conceived in case of major public health emergencies.

Incident Reporting System in an Italian University Hospital: A New Tool for Improving Patient Safety.

Clinical risk management constitutes a central element in the healthcare systems in relation to the reverberation that it establishes, and as regards the optimization of clinical outcomes for the patient. The starting point for a right clinical risk management is represented by the identification of non-conforming results. The aim of the study is to carry out a systematic analysis of all data received in the first three years of adoption of a reporting system, revealing the strengths and weaknesses. The results emerged showed an increasing trend in the number of total records. Notably, 86.0% of the records came from the medical category. Moreover, 41.0% of the records reported the possible preventive measures that could have averted the event and in 30% of the reports are hints to be put in place to avoid the repetition of the events. The second experimental phase is categorizing the events reported. Implementing the reporting system, it would guarantee a virtuous cycle of learning, training and reallocation of resources. By sensitizing health workers to a correct use of the incident reporting system, it could become a virtuous error learning system. All this would lead to a reduction in litigation and an implementation of the therapeutic doctor-patient alliance.

Environmental sustainability in neurointerventional procedures: a waste audit.

BACKGROUND: Operating rooms contribute between 20% to 70% of hospital waste. This study aimed to evaluate the waste burden of neurointerventional procedures performed in a radiology department, identify areas for waste reduction, and motivate new greening initiatives. METHODS: We performed a waste audit of 17 neurointerventional procedures at a tertiary-referral center over a 3-month period. Waste was categorized into five streams: general waste, clinical waste, recyclable plastic, recyclable paper, and sharps. Our radiology department started recycling soft plastics from 13 December 2019. Hence, an additional recyclable soft plastic waste stream was added from this time point. The weight of each waste stream was measured using a digital weighing scale. RESULTS: We measured the waste from seven cerebral digital subtraction angiograms (DSA), six mechanical thrombectomies (MT), two aneurysm-coiling procedures, one coiling with tumour embolization, and one dural arteriovenous fistula embolization procedure. In total, the 17 procedures generated 135.3 kg of waste: 85.5 kg (63.2%) clinical waste, 28.0 kg (20.7%) general waste, 14.7 kg (10.9%) recyclable paper, 3.5 kg (2.6%) recyclable plastic, 2.2 kg (1.6%) recyclable soft plastic, and 1.4 kg (1.0%) of sharps. An average of 8 kg of waste was generated per case. Coiling cases produced the greatest waste burden (13.1 kg), followed by embolization (10.3 kg), MT (8.8 kg), and DSA procedures (5.1 kg). CONCLUSION: Neurointerventional procedures generate a substantial amount of waste, an average of 8 kg per case. Targeted initiatives such as engaging with suppliers to revise procedure packs and reduce packaging, digitizing paper instructions, opening devices only when necessary, implementing additional recycling programs, and appropriate waste segregation have the potential to reduce the environmental impact of our specialty.

Informing critical care drug requirements in response to the COVID-19 pandemic.

OBJECTIVES: The main aim was to develop a process to estimate critical care drug requirements to robustly inform regional procurement planning and preparedness in response to the COVID-19 pandemic. The objectives were to identify critical care drugs required, obtain patient usage data and consider current regional practice to establish the requirement. METHOD: Health and Social Care (HSC) Trusts across Northern Ireland (NI) identified critical care drugs required and an estimation of average daily usage data. The Microsoft Excel database was constructed to compile Trust data and establish regional requirement. The database was refined further according to real-world data from NI HSC Trusts, Intensive Care National Audit and Research Centre report on COVID-19 in critical care, daily regional COVID-19 figures and other available National data. Components of a tool originally developed for H1N1 and updated for COVID-19 were adapted to reflect the NI context and used in the regional database. The database was clinically reviewed to ensure that it accurately reflected current regional practice given the evolving nature of the pandemic. RESULTS: The critical care drugs required in the pandemic, usage data and current regional practice were identified to establish requirement. A regional database was constructed and used to produce a model for calculating approximate critical drug requirements. The model was used to map critical drug requirements to available stock in Trusts and wholesalers/suppliers, enabling the identification of treatment capacity for these medicines regionally, both currently and for projected surges. Data have also been used in the preparation of weekly regional situation reports provided to both the HSC Board and the Department of Health. CONCLUSION: The process developed is a robust approach to assist in informing regional critical care drug requirements in response to the COVID-19 pandemic. Further application has been demonstrated in regional procurement planning and preparedness.