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1.
PLoS One ; 19(6): e0304159, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38870215

RESUMO

INTRODUCTION: Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported. AIM: SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events. METHODS: We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices. DISCUSSION: The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.


Assuntos
Segurança do Paciente , Assistência Perioperatória , Melhoria de Qualidade , Humanos , Assistência Perioperatória/normas , Segurança do Paciente/normas , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Europa (Continente)
2.
PLoS One ; 19(6): e0298777, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38833486

RESUMO

BACKGROUND: This study evaluates primary care practices' engagement with various features of a quality improvement (QI) intervention for patients with coronary heart disease (CHD) in four Australian states. METHODS: Twenty-seven practices participated in the QI intervention from November 2019 -November 2020. A combination of surveys, semi-structured interviews and other materials within the QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with heart disease (QUEL) study were used in the process evaluation. Data were summarised using descriptive statistical and thematic analyses for 26 practices. RESULTS: Sixty-four practice team members and Primary Health Networks staff provided feedback, and nine of the 63 participants participated in the interviews. Seventy-eight percent (40/54) were either general practitioners or practice managers. Although 69% of the practices self-reported improvement in their management of heart disease, engagement with the intervention varied. Forty-two percent (11/26) of the practices attended five or more learning workshops, 69% (18/26) used Plan-Do-Study-Act cycles, and the median (Interquartile intervals) visits per practice to the online SharePoint site were 170 (146-252) visits. Qualitative data identified learning workshops and monthly feedback reports as the key features of the intervention. CONCLUSION: Practice engagement in a multi-featured data-driven QI intervention was common, with learning workshops and monthly feedback reports identified as the most useful features. A better understanding of these features will help influence future implementation of similar interventions. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12619001790134.


Assuntos
Doença das Coronárias , Atenção Primária à Saúde , Melhoria de Qualidade , Humanos , Austrália , Doença das Coronárias/terapia , Feminino , Masculino , Gerenciamento Clínico
4.
Br J Nurs ; 33(11): 515-521, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38850139

RESUMO

BACKGROUND: The NHS is the first public body globally to commit to net zero. AIM: This study aimed to explore the environmental sustainability impact of a hospital scholarship programme. METHOD: A sustainable quality improvement value framework was used to measure the programme's environmental, social and financial effects. RESULTS: The social impact through face-to-face contact was most valued by scholars; there were also savings in carbon emissions and costs. DISCUSSION: Training in sustainability is essential for the workforce but little infrastructure and expertise are available within organisations to support staff to provide sustainable healthcare in day-to-day practice. CONCLUSION: Sustainable healthcare should be supported by education and national guidance and implementation plans should be drawn up to this end. The social impact of the framework used is often seen as less important than its environmental and financial components; however, as its value to scholars illustrates, the components are intertwined and should be considered of equal importance.


Assuntos
Bolsas de Estudo , Medicina Estatal , Humanos , Pesquisa sobre Serviços de Saúde , Reino Unido , Melhoria de Qualidade , Avaliação de Programas e Projetos de Saúde
5.
BMC Health Serv Res ; 24(1): 708, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38840245

RESUMO

BACKGROUND: Intensive Care Unit (ICU) capacity management is essential to provide high-quality healthcare for critically ill patients. Yet, consensus on the most favorable ICU design is lacking, especially whether ICUs should deliver dedicated or non-dedicated care. The decision for dedicated or non-dedicated ICU design considers a trade-off in the degree of specialization for individual patient care and efficient use of resources for society. We aim to share insights of a model simulating capacity effects for different ICU designs. Upon request, this simulation model is available for other ICUs. METHODS: A discrete event simulation model was developed and used, to study the hypothetical performance of a large University Hospital ICU on occupancy, rejection, and rescheduling rates for a dedicated and non-dedicated ICU design in four different scenarios. These scenarios either simulate the base-case situation of the local ICU, varying bed capacity levels, potential effects of reduced length of stay for a dedicated design and unexpected increased inflow of unplanned patients. RESULTS: The simulation model provided insights to foresee effects of capacity choices that should be made. The non-dedicated ICU design outperformed the dedicated ICU design in terms of efficient use of scarce resources. CONCLUSIONS: The choice to use dedicated ICUs does not only affect the clinical outcome, but also rejection- rescheduling and occupancy rates. Our analysis of a large university hospital demonstrates how such a model can support decision making on ICU design, in conjunction with other operation characteristics such as staffing and quality management.


Assuntos
Unidades de Terapia Intensiva , Melhoria de Qualidade , Unidades de Terapia Intensiva/organização & administração , Humanos , Simulação por Computador , Hospitais Universitários , Tempo de Internação/estatística & dados numéricos , Tomada de Decisões , Tomada de Decisões Gerenciais
6.
PLoS One ; 19(6): e0300977, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38843178

RESUMO

INTRODUCTION: The Rural Surgical Obstetrical Networks (RSON) initiative in BC was developed to stabilize and grow low volume rural surgical and obstetrical services. One of the wrap-around supportive interventions was funding for Continuous Quality Improvement (CQI) initiatives, done through a local provider-driven lens. This paper reviews mixed-methods findings on providers' experiences with CQI and the implications for service stability. BACKGROUND: Small, rural hospitals face barriers in implementing quality improvement initiatives due primarily to lack of resource capacity and the need to prioritize clinical care when allocating limited health human resources. Given this, funding and resources for CQI were key enablers of the RSON initiative and seen as an essential part of a response to assuaging concerns of specialists at higher volume sites regarding quality in lower volume settings. METHODS: Data were derived from two datasets: in-depth, qualitative interviews with rural health care providers and administrators over the course of the RSON initiative and through a survey administered at RSON sites in 2023. FINDINGS: Qualitative findings revealed participants' perceptions of the value of CQI (including developing expanded skillsets and improved team function and culture), enablers (the organizational infrastructure for CQI projects), challenges in implementation (complications in protecting/prioritizing CQI time and difficulty with staff engagement) and the importance of local leadership. Survey findings showed high ratings for elements of team function that relate directly to CQI (team process and relationships). CONCLUSION: Attention to effective mechanisms of CQI through a rural lens is essential to ensure that initiatives meet the contextual realities of low-volume sites. Instituting pathways for locally-driven quality improvement initiatives enhances team function at rural hospitals through creating opportunities for trust building and goal setting, improving communication and increasing individual and team-wide motivation to improve patient care.


Assuntos
Hospitais Rurais , Melhoria de Qualidade , Serviços de Saúde Rural , Humanos , Serviços de Saúde Rural/normas , Serviços de Saúde Rural/organização & administração , Hospitais Rurais/organização & administração , Feminino , Gravidez , Obstetrícia/normas , Obstetrícia/organização & administração , Inquéritos e Questionários
8.
Clin J Oncol Nurs ; 28(3): 263-271, 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38830244

RESUMO

BACKGROUND: Managing antineoplastic orders, side effects, and symptoms is a primary role of oncology advanced practice providers (APPs). Antineoplastic management (ANM) is complex because of risk of medication errors, narrow therapeutic range of agents, frequent dose adjustments, and multiple drug regimens. OBJECTIVES: This article describes an academic institution's review of current practice for ANM privileging and employing Plan-Do-Study-Act (PDSA) cycles to develop a revised process relevant to APP practice, addressing efficiency, accessibility, and cost-effectiveness. METHODS: Using consecutive PDSA cycles, the team revised the didactic portion of the ANM privileging process and collaborated with nurses, pharmacists, and physicians for mentoring expertise. FINDINGS: The revised process resulted in increased relevance of ANM didactic content while requiring 75% less time to complete. To date, all ANM-privileged APPs at the institution (N = 49) have completed the revised ANM privileging process, with a 100% pass rate on the competency assessment.


Assuntos
Antineoplásicos , Humanos , Antineoplásicos/uso terapêutico , Antineoplásicos/economia , Melhoria de Qualidade , Neoplasias/tratamento farmacológico , Feminino , Masculino , Prática Avançada de Enfermagem , Oncologia , Enfermagem Oncológica/normas
9.
Clin J Oncol Nurs ; 28(3): 297-304, 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38830246

RESUMO

BACKGROUND: Patients with cancer are at high risk for infection-related morbidity and mortality; vaccinations reduce this burden. In 2021, vaccination documentation rates were low at an academic medical center breast clinic. OBJECTIVES: The purpose of this pilot quality improvement project was to evaluate an education intervention to increase vaccination documentation among patients with breast cancer. METHODS: During a 16-week period, the 4 Pillars™ Practice Transformation Program was implemented. The oncology nurse navigator assessed and documented vaccination history, discussed recommendations with the provider, and recommended concurrent vaccinations. Within a two-week period, the oncology nurse navigator completed and documented vaccination follow-up via telephone. FINDINGS: Vaccination follow-up and documentation for influenza, shingles, and pneumococcal vaccines increased substantially. Findings indicate that an education and outreach program can increase vaccination documentation rates among patients with breast cancer.


Assuntos
Neoplasias da Mama , Documentação , Melhoria de Qualidade , Vacinação , Humanos , Feminino , Documentação/normas , Documentação/estatística & dados numéricos , Pessoa de Meia-Idade , Vacinação/estatística & dados numéricos , Adulto , Idoso , Projetos Piloto , Enfermagem Oncológica/normas , Idoso de 80 Anos ou mais
10.
Am J Occup Ther ; 78(4)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38836792

RESUMO

IMPORTANCE: Clinicians and researchers can leverage clinical documentation of therapy services for quality improvement and research purposes. However, documentation is often institution specific and may not adequately capture the dose of therapy delivered, thus limiting collaboration. OBJECTIVE: To implement documentation of pediatric occupational and physical therapy dose from one institution to another institution. Dose documentation includes the frequency, intensity, time, and type of interventions delivered (FITT Epic® Flowsheet) at each session. DESIGN: Prospective time-series quality improvement study. SETTING: Two large urban pediatric hospitals. PARTICIPANTS: Occupational and physical therapy staff members. INTERVENTION: Staff training and feedback loops utilizing existing groups. OUTCOMES AND MEASURES: The process measure (number of available staff trained and using the FITT Epic Flowsheet over time) and the outcome measure (percentage of FITT Epic Flowsheets used for treatment visits each month) were analyzed using a statistical process control chart. The balancing measure (percentage of notes closed before 7 p.m. on the same day as the encounter) was analyzed using mean per month across three time periods. RESULTS: Fifty-seven staff members (68%) attended formal training. On average, clinicians documented 90% of sessions using the FITT Epic Flowsheet after implementation. There was no change observed in the balancing measure. CONCLUSIONS AND RELEVANCE: Documentation of dose was spread from one institution to another. Shared documentation will facilitate future collaboration for quality improvement and research purposes. Occupational therapy practitioners and leaders should consider implementing documentation with common dose elements. Plain-Language Summary: Occupational therapy documentation is often institution specific and may not adequately capture the dose of therapy (frequency, intensity, time) or types of interventions that were delivered, thus limiting opportunities for collaboration between institutions. This article adds to the literature on administrative supports for clinical and quality improvement research by illustrating a specific example of how documentation of dose can be shared from one institution to another. The data show that clinicians at one institution started using a new style of documentation using the FITT Epic® Flowsheet and shared discrete dose elements with another institution, creating new opportunities for collaboration. Shared documentation can facilitate future collaboration for quality improvement and research purposes.


Assuntos
Documentação , Terapia Ocupacional , Melhoria de Qualidade , Humanos , Terapia Ocupacional/métodos , Terapia Ocupacional/normas , Estudos Prospectivos , Criança , Modalidades de Fisioterapia/normas , Hospitais Pediátricos
11.
S Afr J Surg ; 62(2): 68, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38838124

RESUMO

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor survival rates. Timeously introduced palliative care (PC) improves the quality of life (QoL) for patients with terminal diseases. In 2020, an in-patient PC-quality improvement (QI) programme was implemented for PDAC patients. This study compared PC outcomes before and after the introduction of the PC-QI programme. METHODS: A focus group identified five critical intervention areas that could improve care. These were in-patient PC referral, pain and symptom control, shared decision-making, interdisciplinary collaborative care, and continuity of care. A hospital record audit of PDAC patients was conducted in pre- and post-implementation cohorts, and the results were compared. RESULTS: A total of 68 (2017 pre-PC-QI) and 39 (2022 post-PC-QI) patient records were audited. Demography, symptom duration, referral delay, and clinical findings were similar in both cohorts. In-patient PC referrals improved significantly from 54.4% in 2017 to 82.1% in 2022 (p = 0.0059). Significant improvements were also recorded in shared decisionmaking, collaboration, and continuity of care, while the reassessment of pain and symptoms after treatment improved. Fewer invasive procedures were done in the 2022 cohort (p = 0.0056). The delay from admission to an invasive diagnostic procedure decreased from a mean of 8.7 to 1.5 days (p = 0.0001). The duration of hospital admission, overall survival (OS), and readmissions during the final 30 days of life were similar. CONCLUSION: The QI programme resulted in improved use of the in-hospital PC service and made better use of scarce resources. Increasing patient and family participation and feedback will further inform the development of the quality of PC services.


Assuntos
Carcinoma Ductal Pancreático , Hospitais de Ensino , Cuidados Paliativos , Neoplasias Pancreáticas , Melhoria de Qualidade , Humanos , África do Sul , Masculino , Feminino , Carcinoma Ductal Pancreático/terapia , Carcinoma Ductal Pancreático/mortalidade , Neoplasias Pancreáticas/terapia , Neoplasias Pancreáticas/mortalidade , Pessoa de Meia-Idade , Idoso , Encaminhamento e Consulta , Qualidade de Vida , Auditoria Médica , Continuidade da Assistência ao Paciente , Grupos Focais , Tomada de Decisão Compartilhada
12.
JCO Clin Cancer Inform ; 8: e2300157, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38838280

RESUMO

PURPOSE: Identification of those at risk of hereditary cancer syndromes using electronic health record (EHR) data sources is important for clinical care, quality improvement, and research. We describe diagnostic processes, previously seldom reported, for a common hereditary cancer syndrome, Lynch syndrome (LS), using EHR data within a community-based, multicenter, demographically diverse health system. METHODS: Within a retrospective cohort enrolled between 2015 and 2020 at Kaiser Permanente Northern California, we assessed electronic diagnostic domains for LS including (1) family history of LS-associated cancer; (2) personal history of LS-associated cancer; (3) LS screening via mismatch repair deficiency (MMRD) testing of newly diagnosed malignancy; (4) germline genetic test results; and (5) clinician-entered diagnostic codes for LS. We calculated proportions and overlap for each diagnostic domain descriptively. RESULTS: Among 5.8 million individuals, (1) 28,492 (0.49%) had a family history of LS-associated cancer of whom 3,635 (13%) underwent genetic testing; (2) 100,046 (1.7%) had a personal history of a LS-associated cancer; and (3) 8,711 (0.1%) were diagnosed with colorectal cancer of whom 7,533 (86%) underwent MMRD screening and of the positive screens (486), 130 (27%) underwent germline testing. One thousand seven hundred and fifty-seven (0.03%) were diagnosed with endometrial cancer of whom 1,613 (92%) underwent MMRD screening and of the 195 who screened positive, 55 (28%) underwent genetic testing. (4) 30,790 (0.05%) had LS germline genetic testing with 707 (0.01%) testing positive; and (5) 1,273 (0.02%) had a clinician-entered diagnosis of LS. CONCLUSION: It is feasible to electronically characterize the diagnostic processes of LS. No single data source comprehensively identifies all LS carriers. There is underutilization of LS genetic testing for those eligible and underdiagnosis of LS. Our work informs similar efforts in other settings for hereditary cancer syndromes.


Assuntos
Neoplasias Colorretais Hereditárias sem Polipose , Testes Genéticos , Melhoria de Qualidade , Humanos , Neoplasias Colorretais Hereditárias sem Polipose/diagnóstico , Neoplasias Colorretais Hereditárias sem Polipose/genética , Neoplasias Colorretais Hereditárias sem Polipose/epidemiologia , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Testes Genéticos/métodos , Adulto , Registros Eletrônicos de Saúde , Idoso , Predisposição Genética para Doença , California/epidemiologia
13.
Niger J Clin Pract ; 27(5): 557-564, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38842703

RESUMO

The aim of the study is to determine whether the assessment of postoperative pain and timely measures to control it improve the quality of medical care in intensive care units (ICUs). To develop an improvement model with a focus on pain assessment and control. 151 patients were included in the study, divided into two groups: a retrospective group (RG)-60 patients and a prospective group (PG)-91 patients. A multimodal approach to pain control was applied to all patients. We administered the Critical Care Pain Observational Tool (CPOT) to PG upon admission to the ICU. Visual analog scale (VAS) for pain assessment was used in all non intubated patients in 6 hours intervals. In the PG, а model for improvement was applied using a PDSA (Plan, Do, Study/ Check, Act) cycle. The following indicators have been used: process, outcome, and balancing indicators. A survey of the PG was also conducted. The developed Model of improvement increased the VAS score reporting success rate from 40 to 95%, which allowed significantly better pain control. In PG the registered CPOT score was 1.71 ± 0.73. 90% of patients in PG have an average VAS score below 5 after the improvement model, while in RG-50% of patients, which is statistically significant (P < 0.001). There was no statistically significant difference in balancing indicators between the two groups. Conclusion: The conducted survey confirmed the positive effect of the model. Quality improvement in the ICU depends on accurate assessment of postoperative pain and timely and adequate treatment.


Assuntos
Unidades de Terapia Intensiva , Manejo da Dor , Medição da Dor , Dor Pós-Operatória , Melhoria de Qualidade , Humanos , Medição da Dor/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/diagnóstico , Estudos Retrospectivos , Estudos Prospectivos , Adulto , Manejo da Dor/métodos , Manejo da Dor/normas , Cuidados Críticos/normas , Cuidados Críticos/métodos , Idoso , Anestesiologia/normas
14.
J Med Econ ; 27(1): 797-799, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38847361

RESUMO

AIMS AND BACKGROUND: The current report details transition of outsourced conventional dialysis therapy in the ICU services to an in-house prolonged intermittent renal replacement therapy (PIRRT) service model as a quality improvement project using the Tablo Hemodialysis System, Outset Medical, Inc. The goals were aimed at maintaining or improving clinical outcomes, while also reducing dialysis-related nursing staff burden and dialysis-related treatment costs. METHODS: A descriptive comparative analysis was conducted of renal replacement therapy (RRT) of ≥6 hours in duration performed in the 1 year prior and 1 year after the ICU's in-house program launch using a PIRRT model including sequential 24-h treatments when medically necessary. RESULTS: Overall, there were 145 intensive care unit (ICU) stays among 145 patients with 13,641 h of conventional ICU dialysis in the year prior to program transition. In the year post, there were 116 ICU stays among 116 patients with 5,098 h of PIRRT. By employing a PIRRT and sequential 24-h treatment strategy vs. the prior outsourced model, the mean dialysis treatment hours per patient were reduced (Pre, 94.1 h with 214 treatment starts; Post, 43.9 h with 370 treatment starts), increasing ICU nurse productivity by 50.2 h per patient. Overall, ICU length of stay and ICU mortality declined post-service transition by 4.8 days and 9.8 percentage points (pp), respectively, overall, and in the non-COVID subset by 1.6 days and 3.1 pp, respectively. CONCLUSIONS: Insourcing RRT with an innovative technology that can provide both PIRRT and 24-h sequential treatments can maintain or improve clinical outcomes in critically ill patients requiring RRT in the ICU, while reducing dialysis-related costs.


Assuntos
Unidades de Terapia Intensiva , Tempo de Internação , Melhoria de Qualidade , Humanos , Unidades de Terapia Intensiva/economia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Diálise Renal/economia , Qualidade da Assistência à Saúde , Terapia de Substituição Renal Intermitente , Controle de Custos/métodos , Adulto
15.
Gastroenterol Nurs ; 47(3): 171-176, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38847426

RESUMO

Although nurses and other healthcare professionals play a key role in preventing hospital-associated infections, studies show that infection control compliance rates have remained low. The purpose of this quality improvement project was to increase infection control compliance of hand hygiene and procedure room disinfection among endoscopy staff at a large urban medical center in Cincinnati, Ohio. This quality improvement project provided an education session on current evidence-based infection control guidelines to 20 participants, including registered nurses and technicians within the endoscopy department. Direct observational audits were conducted 4 weeks before and 4 weeks after the education session, measuring compliance with hand sanitizer, soap and water, and procedure room disinfection, over a period of 150 days. The project goals were met, as hand sanitizer compliance improved by 12%-83%; overall soap and water compliance improved by 20%-75%; and endoscopy procedure room disinfection compliance improved by 14%-92%.


Assuntos
Infecção Hospitalar , Fidelidade a Diretrizes , Hospitais Urbanos , Controle de Infecções , Melhoria de Qualidade , Humanos , Fidelidade a Diretrizes/estatística & dados numéricos , Controle de Infecções/normas , Infecção Hospitalar/prevenção & controle , Ohio , Desinfecção/métodos , Desinfecção/normas , Endoscopia
16.
Glob Health Action ; 17(1): 2358633, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38828509

RESUMO

BACKGROUND: Quality healthcare is a global priority, reliant on robust health systems for evidence-based medicine. Clinical laboratories are the backbone of quality healthcare facilitating diagnostics, treatment, patient monitoring, and disease surveillance. Their effectiveness depends on sustainable delivery of accurate test results. Although the Strengthening Laboratory Management Towards Accreditation (SLMTA) programme has enhanced laboratory quality in low-income countries, the long-term sustainability of this improvement remains uncertain. OBJECTIVE: To explore the sustainability of quality performance in clinical laboratories in Rwanda following the conclusion of SLMTA. METHODS: A quasi-experimental design was adopted, involving 47 laboratories divided into three groups with distinct interventions. While one group received continuous mentorship and annual assessments (group two), interventions for the other groups (groups one and three) ceased following the conclusion of SLMTA. SLMTA experts collected data for 10 years through assessments using WHO's StepwiseLaboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. Descriptive and t-test analyses were conducted for statistical evaluation. RESULTS: Improvements in quality were noted between baseline and exit assessments across all laboratory groups (mean baseline: 35.3%, exit: 65.8%, p < 0.001). However, groups one and three experienced performance declines following SLMTA phase-out (mean group one: 64.6% in reference to 85.8%, p = 0.01; mean group three: 57.3% in reference to 64.7%, p < 0.001). In contrast, group two continued to enhance performance even years later (mean: 86.6%compared to 70.6%, p = 0.03). CONCLUSION: A coordinated implementation of quality improvement plan that enables regular laboratory assessments to pinpoint and address the quality gaps is essential for sustaining quality services in clinical laboratories.


Main findings: We found that continuous laboratory quality improvement was achieved by laboratories that kept up with regular follow-ups, as opposed to those which phased out these followups prematurely.Added knowledge: This study has affirmed the necessity of maintaining mentorship and conducting regular quality assessments until requisite quality routines are established to sustain laboratory quality services.Global health impact for policy and action: These findings emphasise the significance of instituting a laboratory quality plan, with regular assessments, as policy directives to uphold and enhance quality standards, which benefits both local and global communities, given the pivotal role of laboratories in patient treatment, disease prevention, and surveillance.


Assuntos
Acreditação , Laboratórios Clínicos , Melhoria de Qualidade , Ruanda , Humanos , Melhoria de Qualidade/organização & administração , Acreditação/normas , Laboratórios Clínicos/normas , Países em Desenvolvimento , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/organização & administração
17.
BMJ Open Qual ; 13(2)2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38830729

RESUMO

BACKGROUND: The demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll. OBJECTIVE: The aim was to achieve adequate personal protective equipment (PPE) use in 90% of patient encounters, to reach 90% compliance with objectives of patient flow (OPF) and to provide emotional support tools to 90% of healthcare workers (HCWs). METHODS: We conducted a quasi-experimental study with an interrupted time-series design in 14 ICUs in Argentina. We randomly selected adult critically ill patients admitted from July 2020 to July 2021 and active HCWs in the same period. We implemented a quality improvement collaborative (QIC) with a baseline phase (BP) and an intervention phase (IP). The QIC included learning sessions, periods of action and improvement cycles (plan-do-study-act) virtually coached by experts via platform web-based activities. The main study outcomes encompassed the following elements: proper utilisation of PPE, compliance with nine specific OPF using daily goal sheets through direct observations and utilisation of a web-based tool for tracking emotional well-being among HCWs. RESULTS: We collected 7341 observations of PPE use (977 in BP and 6364 in IP) with an improvement in adequate use from 58.4% to 71.9% (RR 1.2, 95% CI 1.17 to 1.29, p<0.001). We observed 7428 patient encounters to evaluate compliance with 9 OPF (879 in BP and 6549 in IP) with an improvement in compliance from 53.9% to 67% (RR 1.24, 95% CI 1.17 to 1.32, p<0.001). The results showed that HCWs did not use the support tool for self-mental health evaluation as much as expected. CONCLUSION: A QIC was effective in improving healthcare processes and adequate PPE use, even in the context of a pandemic, indicating the possibility of expanding QIC networks nationwide to improve overall healthcare delivery. The limited reception of emotional support tools requires further analyses.


Assuntos
COVID-19 , Unidades de Terapia Intensiva , Melhoria de Qualidade , SARS-CoV-2 , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Argentina , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Feminino , Equipamento de Proteção Individual/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Atenção à Saúde/normas , Adulto , Saúde Pública/métodos , Pessoal de Saúde/estatística & dados numéricos , Pessoal de Saúde/psicologia , Análise de Séries Temporais Interrompida/métodos
18.
BMC Med Educ ; 24(1): 610, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38831388

RESUMO

OBJECTIVE: To address the gap in effective nursing training for quality management, this study aims to implement and assess a nursing training program based on the Holton Learning Transfer System Inventory, utilizing action research to enhance the practicality and effectiveness of training outcomes. METHODS: The study involved the formation of a dedicated training team, with program development informed by an extensive situation analysis and literature review. Key focus areas included motivation to transfer, learning environment, and transfer design. The program was implemented in a structured four-step process: plan, action, observation, reflection. RESULTS: Over a 11-month period, 22 nurses completed 14 h of theoretical training and 18 h of practical training with a 100% attendance rate and 97.75% satisfaction rate. The nursing team successfully led and completed 22 quality improvement projects, attaining a practical level of application. Quality management implementation difficulties, literature review, current situation analysis, cause analysis, formulation of plans, implementation plans, and report writing showed significant improvement and statistical significance after training. CONCLUSION: The study confirms the efficacy of action research guided by Holton's model in significantly enhancing the capabilities of nursing staff in executing quality improvement projects, thereby improving the overall quality of nursing training. Future research should focus on refining the training program through long-term observation, developing a multidimensional evaluation index system, exploring training experiences qualitatively, and investigating the personality characteristics of nurses to enhance training transfer effects.


Assuntos
Melhoria de Qualidade , Humanos , Educação Continuada em Enfermagem/organização & administração , Pesquisa sobre Serviços de Saúde , Avaliação de Programas e Projetos de Saúde , Feminino , Desenvolvimento de Programas , Adulto , Masculino
19.
Afr J Prim Health Care Fam Med ; 16(1): e1-e9, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38832376

RESUMO

BACKGROUND:  Few interventions are documented to meet person-centred needs of older people with serious multimorbidity in low- and middle-income countries where access to palliative care is limited. Most of the care in these settings is delivered by primary care health workers. AIM:  This study reports the development and acceptability testing of a communication skills training and mentorship intervention for primary health care workers in Malawi. SETTING:  This study was conducted at Mangochi District Hospital in the south-eastern region of Malawi. METHODS:  Twelve primary health care workers (four clinical officers and eight nurses) working in the primary care clinics received the intervention. The intervention was designed using modified nominal group technique, informed by stakeholder interviews and a theory of change workshop. Acceptability is reported from thematic analysis of a focus group discussion with primary health care workers who received the intervention using NVivo version 14. RESULTS:  Older persons with serious multi-morbidity and their caregivers identified a need for enhanced communication with their healthcare providers. This helped to inform the development of a communication training skills and mentorship intervention package based on the local best practice six-step Ask-Ask-Tell-Ask-Ask-Plan framework. Primary health care workers reported that the intervention supported person-centred communication and improved the quality of holistic assessments, although space, workload and availability of medication limited the implementation of person-centred communication. CONCLUSION:  The Ask-Ask-Tell-Ask-Ask-Plan framework, supported person-centered communication and improved the quality of holistic assessment.Contribution: This intervention offers an affordable, local model for integrating person-centered palliative care in resource-limited primary healthcare settings.


Assuntos
Países em Desenvolvimento , Grupos Focais , Multimorbidade , Assistência Centrada no Paciente , Atenção Primária à Saúde , Humanos , Malaui , Idoso , Feminino , Masculino , Comunicação , Pessoal de Saúde/educação , Adulto , Pessoa de Meia-Idade , Melhoria de Qualidade , Cuidados Paliativos
20.
Br Dent J ; 236(11): 900-906, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38877261

RESUMO

The practice of dentistry contributes to 3% of the carbon footprint of the NHS. As awareness and concern about climate change increases, all dental care professionals must play their part in reducing the environmental impact of the care they provide. This paper aims to describe a novel method of teaching, both the theory and practical application of sustainable dentistry, by integrating sustainable quality improvement methods into the existing management and leadership requirements of dental core training.


Assuntos
Melhoria de Qualidade , Humanos , Reino Unido , Educação em Odontologia/métodos , Educação em Odontologia/normas , Medicina Estatal , Mudança Climática , Conservação dos Recursos Naturais , Odontologia Estatal , Pegada de Carbono , Liderança
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