Rationalisation of laboratory tests ordering and consumption at Armed Forces Hospital, Jazan.

Laboratory testing is one of the major and important component of medical diagnosis. However, unrationalised laboratory test ordering may lead to misdiagnosis of diseases which would delay treatment of the patients. It would also lead to wasting the laboratory resources that adversely impact the hospital budget. The aim of this project was to rationalise laboratory tests ordering and ensure effective utilisation of resources at Armed Forces Hospital Jizan (AFHJ). This study included two major steps: (1) the development and implementation of quality improvement interventions to reduce the unnecessary and abuse of laboratory testing in the AFHJ and (2) evaluation of the effectiveness of these interventions. In order to determine the possible causes of the problem, fishbone diagram was used to structure a brainstorming session. Pareto analysis was used to prioritise the causes so that the emphasis can be laid on most significant one. After interventions implementation, the data analysed and found that there was significant differences between 2019 and 2021 of total patients percentage and distribution that was revealed by box plot, who had a request of Hemoglobin A1c (HbA1c) (p=0.002), Thyroid Stimulating Hormone (TSH) (p=0.002), Free Thyroine (FT4) (p=0.002), Free Triiodothyronine (FT3) (p=0.001), Follicle-Stimulating Hormone (FSH) (p=0.002), Luteinizing Hormone (LH) (p=0.002) and Prolactin (PRL) (p=0.001). We achieved a 33% reduction in total laboratory tests cost and the total laboratory budget decreased from 6 000 000 SR in 2019 to about 4 000 000 Saudi Riyals (SR) in 2021. A change in laboratory resource consumption requires changes in physicians awareness. A modification of the electronic ordering system applied more restrictions to the ordering physicians. Extending these measures to the entire hospital might lead to significant reduction in the healthcare costs.

Improving awareness of blood culture indication, procedure and resource Utilization at Armed Forces Hospital Jizan, Saudi Arabia.

Blood culture contamination (BCC) is a significant quality and safety issue in hospitals, as it leads to increase in unnecessary testing, admissions, antibiotic exposure and cost. This study is the first study on the BCC rates in Armed Forces Hospital Jizan (AFHJ), Saudi Arabia. The main goal of our quality improvement (QI) project was to reduce BCC rate in AFHJ from 7.5% to international benchmark (<3%) after January 2021 as well as to reduce the negativity rate. This study was conducted in AFHJ (KSA) including two major steps: first, development and implementation of QI interventions to reduce BCC and negativity rate in the AFHJ. Second, evaluation of the effectiveness of these interventions. The intervention was developed through QI methodologies, including fishbone diagramming and the plan-do-study-act cycle. Intervention effectiveness was evaluated using an interrupted time series analysis. Clear survey questionnaires were made and distributed to participants to get preaudit results.Then we started the education programme depending on the preaudit results. Soft copy of written steps of blood collection procedure and indication was done and sent to nurses and physicians. After that, direct observations of nurses involved in the process were conducted. Finally, post-training assessment using previous survey questionnaires was performed to get postaudit results. During the baseline period (preintervention period), 7.5% from blood culture were contaminated, compared with 1.8% during the intervention period (postintervention period). Rate of negative blood culture was reduced from 96% to 91%. Overall improvement of knowledge and awareness of the nurses and physicians clearly noted after intervention implementation. Fortunately, we have noted that the budget of microbiology would be reduced by 10%-12% as a result of our interventions. By standardising blood culture collection methods, optimising blood volume and nurses' education, we were able to develop a best practice for blood culture collection and to reduce BCC and negativity rate to a sustainable low rate at our hospital.

The Outcome of COVID-19 Infection on Kidney Transplantation Recipients in Southern Saudi Arabia: Single-Center Experience.

BACKGROUND: To report the incidence, risk factors, and outcome of severe COVID-19 disease in kidney transplant recipients attending a Saudi hospital at a single center in the Kingdom of Saudi Arabia. METHODS: A retrospective chart-based cohort study involving all kidney transplant recipients tested for COVID-19 in the Armed Forces Hospital Southern Region, KSA. RESULTS: Of 532 kidney transplant recipients who reported to the center, from March 2020 to June 2022, 180 were tested for COVID-19. Of these recipients, 31 (17%) tested positive. Among the 31 positive recipients, 11 were treated at home, 15 were admitted to the noncritical isolation ward, and 5 were admitted to the intensive care unit (ICU). Older age (P = .0001), higher body mass index (P = .0001), and history of hypertension (P = .0023) were more frequent in the COVID-19-positive recipients. Admission to the ICU was more frequent in older recipients (P = .0322) with a history of ischemic heart disease (P = .06) and higher creatinine baseline (P = .08) presenting with dyspnea (P = .0174), and acute allograft dysfunction (P = .002). In the ICU group, 4 (80%) patients required hemodialysis, and 4 (80%) died. CONCLUSIONS: Kidney transplant recipients with COVID-19 could have a higher risk for developing acute kidney injury, dialysis, and mortality than the general population. ICU admission and renal replacement therapy were more evident in older recipients with a history of ischemic heart disease, presenting with shortness of breath (P = .017) and a higher serum creatinine baseline. Acute allograft dysfunction was the independent predictor of mortality among patients admitted to the ICU.

Recurrent Urinary Tract Infection in Living Donor Renal Transplant Recipients and the Role of Behavioral Education Program in Management: A Single-Center Experience.

BACKGROUND: Urinary tract infections (UTIs) are the most prevalent type of kidney transplant (KT) recipients. We aimed to investigate the incidence, causes, and clinical impact of early recurrent UTI post-living donor KT and to examine the role of behavioral education program in management. METHODS: This retrospective cohort chart-review study included all KT recipients with recurrent UTI necessitating hospital admission between September 2017 and August 2021. All patients with recurrent UTI were subjected to behavioral education for a month. RESULTS: UTI was found in 14 of 145 patients (9.6%), with recurrent UTI in 11 (7.6%). A total of 93% of UTIs occurred during the first 6 months post-transplant and represented 52% of KT readmissions during the same period. A total of 64.3% of patients were older than 50 years. The mean (SD) length of hospital stay was 5 (2.5) days, with an equal incidence in both sexes. The most common bacterial isolates in early recurrent UTI were Escherichia coli in 80.9%. Both Extended-spectrum beta-lactamases and multidrug-resistant organisms (resistance in ≥3 drugs) were seen in 82.4% of isolates. Furthermore, the most effective antibiotic was meropenem, with 86.7% effectiveness. A total of 65% of UTIs were managed with a single antibacterial course. A total of 64.3% of patients were older than 50 years. In patients who developed UTI, the mean (SD) serum creatinine was 1.31 (0.52) mg/dL, with a mean increase in serum creatinine of 0.19 mg/dL on having the episodes; at 1 year post-transplant, serum creatinine declined to 1.23 (0.43) mg/dL. Four patients (36%) had no recurrence of UTI after behavioral education. CONCLUSIONS: The multidrug-resistant bacterial isolates account for 82.4% of the UTIs. Therefore, antibiotic prescription should follow the antimicrobial stewardship guidelines. Behavioral education significantly reduced the incidence of recurrent UTI.