Methods to derive composite indicators used for quality and safety measurement and monitoring in healthcare: a scoping review protocol.

INTRODUCTION: Composite indicators of quality and safety in healthcare summarise performance across multiple indicators into a single performance measure. Composite indicators can identify domains and drivers of quality, improve the ability to detect differences, aid prioritisation for quality improvement and facilitate decision making about future healthcare needs. However, the use of composite indicators can be controversial, particularly when used to rank healthcare providers. Many of the concerns around transparency, appropriateness and uncertainty may be addressed by a robust and transparent development and review process.The aim of this scoping review is to describe methodologies used at each of the stages of development of composite indicators of quality and safety in healthcare. This review will provide those tasked with developing or reviewing composite indicators with a valuable consolidated analysis of a substantial and wide-ranging literature. METHODS AND ANALYSIS: The framework proposed by the Joanna Briggs Institute and enhancements proposed by Peters et al (2015, 2017, 2020) will be used in conducting this scoping review, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews will guide the reporting. Grey literature and peer-reviewed documents will be in-scope. Electronic databases (PubMed, Embase, CINAHL, ABI/INFORM and SafetyLit) will be searched, and publications will be screened by two reviewers. Discussion, policy and guidance publications will be included if they discuss any aspect of the methods used in the development of a composite indicator of quality or safety in a healthcare setting. The search period ranges from 1 January 2000 to 31 December 2022. Data extraction will capture information on 11 stages of composite indicator development, augmenting a 10-stage framework developed by the European Commission Joint Research Centre. ETHICS AND DISSEMINATION: Ethical approval is not required. Review findings will be published in a peer-reviewed journal and presented at scientific conferences.

How midwives manage rapid pre-loading of fluid in women prior to low dose epidurals: A retrospective chart review.

AIM: To describe contemporary routine practice regarding rapid pre-loading of intravenous fluid management prior to epidural analgesia during labour and birth. BACKGROUND: Midwives are the key health professionals providing care for women before, during and after an epidural in labour. Part of this management involves maternal hydration; however, how midwives assess and manage maternal hydration and fluid management is not well understood. Prior to the administration of a low dose epidural for pain relief a rapid intravenous pre-loading of between 500-1000 mls of crystalloid fluids is administered to the pregnant women. Currently, there is limited evidence available to assess if intravenous pre-loading reduces maternal hypotension and foetal bradycardia. Anecdotal evidence suggests that wide variation in clinical practice in relation to volume of fluid administered, fluid status assessment and clinical documentation occurs. DESIGN: A retrospective medical health record review, in a regional Australian maternity hospital. METHODS: A retrospective medical health record review chart review from women who received an epidural for pain relief during labour and birth (June-September 2015). RESULTS: Data from 293 charts were collected, including: maternal factors; blood pressure distributions; maternal fluid status; types, concentration and timing of analgesia loading doses; IV fluid loading volumes; maternal hypotension, foetal outcomes and documentation of fluid balance charts. Wide variation in clinical practice was evident with midwives administering pre-loading fluid volumes ranging from 250-1000 ml. Midwifery assessment, documentation and practice pertaining to hydration was inconsistent and lacking. CONCLUSION: Management of intravenous fluids during labour is fragmented. Although fluid balance charts are used internationally to assess maternal hydration, documentation of fluid balance status was poor. Multi-professional collaboration between obstetrics, anaesthetics and midwifery is required to address this wide variation and reach consensus on best practice based on what evidence is currently available.

Computational Tracking of Shear-Mediated Platelet Interactions with von Willebrand Factor.

The imaging of shear-mediated dynamic platelet behavior interacting with surface-immobilized von Willebrand factor (vWF) has tremendous potential in characterizing changes in platelet function for clinical diagnostics purposes. However, the imaging output, a series of images representing platelets adhering and rolling on the surface, poses unique, non-trivial challenges for software algorithms that reconstruct the positional trajectories of platelets. We report on an algorithm that tracks platelets using the output of such flow run experiments, taking into account common artifacts encountered by previously-published methods, and we derive seven key metrics of platelet dynamics that can be used to characterize platelet function. Extensive testing of our method using simulated platelet flow run data was carried out to validate our tracking method and derived metrics in capturing key platelet-vWF interaction-dynamics properties. Our results show that while the number of platelets present on the imaged area is the leading cause of errors, flow run data from two experiments using whole blood samples showed that our method and metrics can detect platelet property changes/differences that are concordant with the expected biological outcome, such as inhibiting key platelet receptors such as P2Y1, glycoprotein (GP)Ib and GPIIb/IIIa. These findings support the use of our methodologies to characterize platelet function among a wide range of healthy and disease cohorts.

The changing birth suite experience for Australian medical students.

Competition with midwifery students, combined with increasing numbers of medical students, has led to declining standards of clinical experience in the birth suite for our senior medical students. In the Australian setting, increased and improved communication and collaboration between the two disciplines is urgently needed to rectify the situation.