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1.
BMJ Open Qual ; 13(1)2024 02 13.
Artículo en Inglés | MEDLINE | ID: mdl-38351032

RESUMEN

The liver transplant assessment process involves a complex set of tests and clinical reviews to determine suitability for liver transplantation. We had an assessment process involving a 3-day inpatient stay and often experienced difficulties admitting patients to the prebooked bed due to a lack of inpatient bed availability.We aimed to change the process from a 3-day and 2-night inpatient stay to a 1-day day-case stay to reduce the demand for inpatient beds.Planning the new assessment process involved negotiations with many department staff to establish prebooked timeslots in 1 day. The improvement project was tested and refined through Plan-Do-Study-Act cycles. The liver transplant assessment team used their established once-a-week meeting to learn what went well and to agree on revisions to the process for further testing. The process involved several adaptations, such as the removal and changing of individual time slots, reinforcement of early notification once patients had finished their tests and scheduling a separate outpatient appointment to provide time for junior doctor clerking and blood tests.The new day-case and outpatient coordinated liver transplant assessment process resulted in a reduction of inpatient hospital bed utilisation from an average of 257-20 inpatient bed days per annum. This reduction in inpatient bed utilisation was maintained for 3 years with a similar level of patient satisfaction. The cost avoidance was calculated at £381.96 per patient, which is a 63% reduction in cost. Assuming an average number of patients being assessed per annum of 110, this would result in an average cost avoidance of £42 016 per annum. The carbon footprint was calculated with an average reduction per patient from 618 kilograms of carbon dioxide equivalent (kgCO2e) to 179 kgCO2e.This project has highlighted how to change a complex inpatient assessment process to an alternative day-case and outpatient approach and could be considered useful learning for other inpatient assessment services, not just liver transplantation.


Asunto(s)
Trasplante de Hígado , Humanos , Pacientes Ambulatorios , Pacientes Internos , Hospitalización , Satisfacción del Paciente
2.
Arch Physiol Biochem ; 124(5): 397-400, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29210290

RESUMEN

OBJECTIVES: To determine the awareness of HbA1c values and correlate this with educational levels, dietary intake and physical activity in type II diabetic population of Trinidad. METHODS: Total of 222 type II diabetic subjects were assessed via questionnaire evaluating their demographics, type and duration of diabetes, type and frequency of glucose testing, dietary intake and physical activity. HbA1c data was coded as patients who were aware versus patients who were not aware. RESULTS: Of the respondents, 41.9% were aware of the term HbA1c while 58.1% were unaware. Statistically, there were positive correlations (p < .05) between HbA1c awareness and level of education received by type II diabetic patients as well as between HbA1c awareness and intensity of exercise performed (p< .05). However, the relationship between dietary breakfast choices and HbA1c awareness was not significant. CONCLUSIONS: A significant correlation was established between HbA1c awareness, intensity of exercise and the level of education obtained.


Asunto(s)
Diabetes Mellitus Tipo 2/terapia , Ejercicio Físico , Hemoglobina Glucada/análisis , Conocimientos, Actitudes y Práctica en Salud , Hiperglucemia/prevención & control , Cooperación del Paciente , Automanejo , Automonitorización de la Glucosa Sanguínea , Terapia Combinada , Complicaciones de la Diabetes/etnología , Complicaciones de la Diabetes/prevención & control , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/etnología , Dieta para Diabéticos/etnología , Dieta Saludable/etnología , Escolaridad , Femenino , Conocimientos, Actitudes y Práctica en Salud/etnología , Estilo de Vida Saludable , Humanos , Masculino , Cooperación del Paciente/etnología , Esfuerzo Físico , Autoinforme , Trinidad y Tobago
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