Green Cross method in a postanaesthesia care unit: a qualitative study of the healthcare professionals' experiences after 3 years, including the COVID-19 pandemic period.

OBJECTIVES: Unsafe medical care causes morbidity and mortality among the hospital patients. In a postanaesthesia care unit (PACU), increasing patient safety is a joint effort between different professions. The Green Cross (GC) method is a user-friendly incident reporting method that incorporates daily safety briefings to support healthcare professionals in their daily patient safety work. Thus, this study aimed to describe healthcare professionals' experiences with the GC method in a PACU setting 3 years after its implementation, including the period of the coronavirus disease 2019 pandemic's three waves. DESIGN: An inductive, descriptive qualitative study was conducted. The data were analysed using qualitative content analysis. SETTING: The study was conducted at a PACU of a university hospital in South-Eastern Norway. PARTICIPANTS: Five semistructured focus group interviews were conducted in March and April 2022. The informants (n=23) were PACU nurses (n=18) and collaborative healthcare professionals (n=5) including physicians, nurses and a pharmacist. RESULTS: The theme 'still active, but in need of revitalisation' was created, describing the healthcare professionals' experiences with the GC method, 3 years post implementation. The following five categories were found: 'continuing to facilitate open communication', 'expressing a desire for more interprofessional collaboration regarding improvements', 'increasing reluctance to report', 'downscaling due to the pandemic' and 'expressing a desire to share more of what went well'. CONCLUSIONS: This study offers information regarding the healthcare professionals' experiences with the GC method in a PACU setting; further, it deepens the understanding of the daily patient safety work using this incident reporting method.

Lessons from the Field. Continuous Quality Improvement: A multiyear HMRF case study of best practices in outreach program excellence

Objective Background Method Results Conclusions and Implications We describe the process and outcomes of developing continuous quality improvement (CQI) procedures for a multiyear, multimillion‐dollar healthy marriage and responsible fatherhood (HMRF) relationship enhancement education program. We present lessons learned, including adaptations used to move all programming online due to the COVID‐19 pandemic.Continuous quality improvement (CQI) is a set of best practices that are often neglected in outreach programming due to challenges associated with funding, available expertise, and fear of underwhelming results. However, this practice provides valuable insight and benefits to programs and participants and can be implemented without interrupting program delivery.We developed a "living” CQI plan over the course of 5 years using three sources of data to track, evaluate, and inform CQI high‐performance decision‐making: program data, fidelity data, and outcome data.A sample of the preliminary descriptive quantitative results is presented including program registrations and show rates, facilitator effectiveness scores, intervention outcomes, and participant responses to online delivery to illustrate how the three types of data collected are used in the SMART Couples Project to support CQI efforts.Our study demonstrates the benefits of using CQI as a powerful tool for program improvement, with staff and participants alike. It is the nature of the CQI process to be amenable to changes, including unforeseen disruptions in program delivery. Implementing an intentional formative and summative CQI strategy provides benefits to social outreach and family life education programs across delivery formats and contexts. [ FROM AUTHOR]

Development of a respiratory quality improvement faculty in an acute hospital using QI methodology.

National Health Service (NHS) clinical staff are required to demonstrate involvement in quality improvement (QI) and patient safety. Clinicians are often best placed to identify problems and design solutions for their own clinical environments, yet the rotational nature of training can impact on the design, implementation and sustainability of projects.The In-hospital Quality Improvement for Respiratory team was created in August 2020 within a busy respiratory department to inspire a culture of continuous improvement and provide a sustainable infrastructure to support and progress QI projects (QIPs).The trust uses the LifeQI platform which provides a change score from 0.5 (intention to participate) to 5.0 (outstanding sustainable results) as a representation of a QIP's progress.We aimed to increase the number of QIPs in the respiratory department registered on the LifeQI platform from 1 to at least 10 projects by September 2021.A QI framework was used to identify and address four primary improvement drivers: (1) QI understanding/training, (2) QI faculty communication, (3) QI participation, and (4) QIP completion using multiple Plan-Do-Study-Act cycles. Data were collected on the number of active respiratory projects registered within the LifeQI platform, mean LifeQI change score and the number of projects with a change score ≤1.Twenty-four new QIPs were initiated in the first 12 months, with a number of projects leading to sustainable change. The largest improvements were seen in autumn 2020 as the faculty's multidisciplinary membership expanded.We achieved our aim of increasing the number of registered QIPs, sustaining the QI faculty throughout the COVID-19 pandemic. Our multidisciplinary membership continues to increase and the faculty has improved access, organisation and project progression across a large department with an established process for rotating staff to join existing QIPs. Our model has the potential to be replicated in other clinical departments within NHS organisations.

Compliance to donning and doffing of personal protective equipment among dental healthcare practitioners during the coronavirus pandemic: a quality improvement plan, do, study and act (PDSA) Initiative.

INTRODUCTION: With the emergence of SARS-Cov-2, the Centers for Disease Control and Prevention (CDC) defined mandatory guidelines for donning and doffing personal protective equipment (PPE) among dental healthcare professionals. The study's objective was to improve the compliance of the donning and doffing protocols for PPE among dental practitioners by the Plan, Do, Study, and Act (PDSA) cycle. MATERIALS AND METHODS: A quasi-experimental study was conducted on a sample of dental healthcare professionals using the non-probability purposive technique. In the first planning stage, compliance with CDC-approved donning and doffing was assessed on the clinical premises. In the second stage, an educational session was arranged with all the healthcare professionals to explain stepwise guidelines of donning and doffing to improve the quality of donning and doffing compliance. In the third stage, improvement in the quality outcome was then assessed after the session. Data were normally distributed. Qualitative variables for all the steps of donning and doffing are reported as frequency and percentages. Pareto charts were made to assess the non-compliance rate for donning and doffing protocols among dental healthcare professionals. RESULTS: There was an improvement of 44.55% in the hand hygiene practices before wearing the PPE after the second step of the PDSA cycle. A percentage improvement of 7.4% was recorded for removing jewellery, wearing the gown and wearing a surgical cap. No improvement was seen in securing the mask/ respirator ties, washing hands after wearing the respirator, placing the goggles or face shield practices. CONCLUSIONS: PDSA cycle improved the overall compliance to PPE donning and doffing practices. Most of the protocols were followed by the dental healthcare professionals; however, some of them remained the same or worsened due to ease in SARS-CoV 2 restrictions.

Studying the implementation of Zero Suicide in a large health system: Challenges, adaptations, and lessons learned.

Background: Suicide remains the 10th leading cause of death in the United States. Many patients presenting to healthcare settings with suicide risk are not identified and their risk mitigated during routine care. Our aim is to describe the planned methodology for studying the implementation of the Zero Suicide framework, a systems-based model designed to improve suicide risk detection and treatment, within a large healthcare system. Methods: We planned to use a stepped wedge design to roll-out the Zero Suicide framework over 4 years with a total of 39 clinical units, spanning emergency department, inpatient, and outpatient settings, involving ∼310,000 patients. We used Lean, a widely adopted a continuous quality improvement (CQI) model, to implement improvements using a centralize "hub" working with smaller "spoke" teams comprising CQI personnel, unit managers, and frontline staff. Results: Over the course of the study, five major disruptions impacted our research methods, including a change in The Joint Commission's safety standards for suicide risk mitigation yielding massive system-wide changes and the COVID-19 pandemic. What had been an ambitious program at onset became increasingly challenging because of the disruptions, requiring significant adaptations to our implementation approach and our study methods. Conclusions: Real-life obstacles interfered markedly with our plans. While we were ultimately successful in implementing Zero Suicide, these obstacles led to adaptations to our approach and timeline and required substantial changes in our study methodology. Future studies of quality improvement efforts that cut across multiple units and settings within a given health system should avoid using a stepped-wedge design with randomization at the unit level if there is the potential for sentinel, system-wide events.

Through the eyes of hospital-based healthcare professionals: exploring their lived experience during the COVID-19 pandemic.

OBJECTIVE: The spread of the COVID-19 virus has caused an unforeseen strain on the healthcare system and particularly on healthcare workers (HCW). In this study, 1 year after the COVID-19 pandemic began, we used photovoice, a visual photographic approach, to understand HCW needs, concerns and resilience and to determine improvement strategies aligned with the HCW-described challenges. METHODS: Using a qualitative design, HCW were recruited from a single Western Canadian hospital, voluntarily submitting a photographic image and narrative that depicts their experiences. An artist artistically enhanced the photovoice submissions, which were then displayed at the hospital-based art gallery for public display. A survey was used to collect feedback from gallery viewers. Inductive thematic analysis was completed identifying themes from the photovoice narratives and survey comments, aiding the identification of recommendations. RESULTS: There were 25 submissions, and 1281 individuals viewed the art exhibit. Six themes emerged: (1) hopeful and resilient, (2) pandemic fatigue-negative mental and physical states, (3) personal protective equipment is our armour but masks who we are, (4) human connection, (5) responsibility, preparation and obligation and (6) technology surge. According to survey results from the art exhibit, the use of photovoice was a creative method that personalised the HCW experience and validated viewers' perceptions of the difficulties faced by HCW. Ten improvement strategies that were aligned with the described challenges were identified. CONCLUSION: The ongoing COVID-19 pandemic continues to strain HCW. Photovoice has great potential in the professional clinical setting to provide unique insights that narrative language alone cannot capture. Future research exploring the longitudinal impact of COVID-19, reviewing photographs at different timepoints could be beneficial. Using this method as a creative outlet intervention and evaluating participation artistic experience may offer additional insights to further support both HCW and patients.

Effectiveness of a multifaceted quality improvement intervention to improve patient outcomes after total hip and knee arthroplasty: a registry nested cluster randomised controlled trial.

OBJECTIVE: To assess the effectiveness of a prospective multifaceted quality improvement intervention on patient outcomes after total hip and knee arthroplasty (THA and TKA). DESIGN: Cluster randomised controlled trial nested in a national registry. From 1 January 2018 to 31 May 2020 routinely submitted registry data on revision and patient characteristics were used, supplemented with hospital data on readmission, complications and length of stay (LOS) for all patients. SETTING: 20 orthopaedic departments across hospitals performing THA and TKA in The Netherlands. PARTICIPANTS: 32 923 patients underwent THA and TKA, in 10 intervention and 10 control hospitals (usual care). INTERVENTION: The intervention period lasted 8 months and consisted of the following components: (1) monthly updated feedback on 1-year revision, 30-day readmission, 30-day complications, long (upper quartile) LOS and these four indicators combined in a composite outcome; (2) interactive education; (3) an action toolbox including evidence-based quality improvement initiatives (QIIs) to facilitate improvement of above indicators; and (4) bimonthly surveys to report on QII undertaken. MAIN OUTCOME MEASURES: The primary outcome was textbook outcome (TO), an all-or-none composite representing the best outcome on all performance indicators (ie, the absence of revision, readmissions, complications and long LOS). The individual indicators were analysed as secondary outcomes. Changes in outcomes from pre-intervention to intervention period were compared between intervention versus control hospitals, adjusted for case-mix and clustering of patients within hospitals using random effect binary logistic regression models. The same analyses were conducted for intervention hospitals that did and did not introduce QII. RESULTS: 16,314 patients were analysed in intervention hospitals (12,475 before and 3,839 during intervention) versus 16,609 in control hospitals (12,853 versus 3,756). After the intervention period, the absolute probability to achieve TO increased by 4.32% (95% confidence interval (CI) 4.30-4.34) more in intervention than control hospitals, corresponding to 21.6 (95%CI 21.5-21.8), i.e., 22 patients treated in intervention hospitals to achieve one additional patient with TO. Intervention hospitals had a larger increase in patients achieving TO (ratio of adjusted odds ratios 1.24, 95%CI 1.05-1.48) than control hospitals, a larger reduction in patients with long LOS (0.74, 95%CI 0.61-0.90) but also a larger increase in patients with reported 30-day complications (1.34, 95%CI 1.00-1.78). Intervention hospitals that introduced QII increased more in TO (1.32, 95%CI 1.10-1.57) than control hospitals, with no effect shown for hospitals not introducing QII (0.93, 95%CI 0.67-1.30). CONCLUSION: The multifaceted QI intervention including monthly feedback, education, and a toolbox to facilitate QII effectively improved patients achieving TO. The effect size was associated with the introduction of (evidence-based) QII, considered as the causal link to achieve better patient outcomes. TRIAL REGISTRATION NUMBER: NCT04055103.

Initiative to improve quality of paediatric ward-round documentation by application of 'SOAP' format.

BACKGROUND: Audits on record keeping practices at our multidisciplinary hospital revealed unstructured ward-round notes which were dissimilar from each other on aspects of patient information. Written as per the discretion of the rounding physician, the practice compromised team communication and medicolegal safety and risked patient harm. Paediatricians decided to address this concern for their department and proposed to improve the quality of documentation by structuring their notes using subjective, objective, assessment and planning (SOAP) format. On observing only 13% compliance with SOAP use despite education and training to use it, a series of interventions were explored to increase its application. METHODS: Brainstorming sessions with the paediatricians provided practical solutions. These were tested one by one using plan-do-study-act cycles to understand their impact. Team feedback was pursued towards the end of each cycle to understand the opinion of each team member. INTERVENTIONS: Interventions included verbal reminders, individual feedback and SOAP acronym display. Each of these were tested singularly and serially. Acronym display proved successful until the arrival of COVID-19, which disrupted its implementation and redirected paediatricians' work priorities. This led to exploration of a new solution, and paediatricians recommended use of visual reminders at the handover site. Quantitative information was analysed to reject or retain the ideas. RESULTS: Verbal reminders and individual feedback made no difference to SOAP usage. Acronym display improved compliance from 13% to 90% but it fell to 45% during COVID-19. Its replacement with visual reminders during pandemic times reinstated the compliance to a median of 84%. CONCLUSIONS: Selection of a change idea that respected front liner's constraints and suited local work environment proved valuable. Both acronym display and visual reminders served as visual reinforcements towards embracing a note format and proved effective. Perceived benefits from methodically written notes encouraged paediatricians to re-establish simpler measures to retain SOAP application, otherwise disrupted during the COVID-19 pandemic.

Improving the quality and content of discharge summaries on acute medicine wards: a quality improvement project.

Discharge summaries are important medical documents that summarise a patient's hospital admission. The Royal College of Physicians provides standardised guidance on the content of discharge summaries, given their important role as a handover document to general practitioners (GPs). Our project started in June 2020 on an acute medical ward, where significant variation had been noted in the quality and content of discharge summaries. A multidisciplinary team (MDT) was formed including doctors, nurses and hospital/community pharmacists, as well as a patient representative, to ensure active patient co-design. The problem was scoped by asking GPs to provide feedback via surveys and process mapping. Our aim was to increase the compliance of discharge summaries with 10 core criteria from a baseline of 55% to 95% by June 2021. Change ideas were developed by the MDT and were tested using plan-do-study-act (PDSA) cycles that included additional pharmacy support, a discharge summary template and individualised feedback. The project reached its goal of 95% compliance in January 2021, 5 months ahead of the target date, and this improvement has been sustained since. The project expanded to a second acute medical unit ward in May 2021. The expanded project reached its goal of 90% compliance within 6 weeks and maintained sustained improvement with further PDSA cycles. A standard operating procedure has been created to help embed the changes on these wards. Our future aims are to redesign and improve the current electronic system and to help spread positive changes throughout the Trust.

Increasing the uptake in a general practice prostate cancer screening programme.

BACKGROUND: Prostate cancer (PC) is the second most common cause of cancer deaths among males worldwide. Prostate-specific antigen (PSA) is a predictive indicator of prostate pathology. Men with elevated PSA levels are at increased risk of developing PC. There is currently no UK national PC screening programme, therefore patients often present to general practices (GPs) at later stages of pathology, worsening patient prognosis and outcomes. LOCAL PROBLEM: The location of the GP surgery had a large patient population at increased risk of PC, namely Afro-Caribbean/Asian males. METHODS: We conducted baseline measurements to identify male patients over the age of 65 and/or male patients who were at high risk of developing PC. These included previous referred patients or patients with a PSA over 10.0. We then implemented three plan-do-study-act (PDSA) cycles and measured their effect after 2 weeks of starting the respective intervention. INTERVENTIONS: PDSA1: Generating a list of target patients who have not had repeat/follow-up/referral and directly contacting by telephone to invite them for a blood test.PDSA2: Creating patient-specific electronic pop-up reminders on the electronic-patient-record system for PSA follow-up/referral/repeat test.Planned PDSA3: Patient education of prostate health and general self-checking, as well as benefits/risks of undergoing PSA screening in the form of patient focus groups and informative leaflets. RESULTS: We identified 220 male patients over 65 registered at a large South London GP surgery. 77.7% of eligible patients had a PSA measurement since 1 April 2019. Our results showed an overall increase in screening of 13.5% from baseline. CONCLUSIONS: Our project identified patients that may potentially have undiagnosed prostate pathology. However, a key factor for not reaching our goal was blood test refusal. This was further exacerbated by the COVID-19 pandemic, impacting the capacity to disseminate appropriate information to the local population on the importance of PSA screening.

Applying Lean principles to create a high throughput mass COVID-19 vaccination site.

A high throughput COVID-19 vaccination site was created using Lean principles and tools. Mass-vaccination sites can achieve high output by creating a standard physical design for workspaces and standardised work protocols, and by timing each step in the vaccination process to create a value stream map that can identify and remove all wasteful steps. Reliability of the vaccination process can be assured by creating a visual checklist that monitors the individual steps as well as by building in second checks by downstream personnel. Finally, productivity can be closely monitored by recording the start and completion time for each vaccination and plotting run charts. With 78 personnel working efficiently and effectively together, a maximum throughput of 5024 injections over 10 hours was achieved. As compared with other published COVID-19 mass-vaccination sites, our site attained threefold-fourfold higher productivity. We share our approach to encourage others to reproduce our vaccination system.

Taming the chaos: NHS professionals' perspective of using video consulting during COVID-19 in Wales.

The use of video consulting (VC) in the UK has expanded rapidly during the COVID-19 pandemic. Technology Enabled Care (TEC) Cymru, the Welsh Government and Local Health boards began implementing the National Health Service (NHS) Wales VC Service in March 2020. This has been robustly evaluated on a large-scale All-Wales basis, across a wide range of NHS Wales specialities. AIMS: To understand the early use of VC in Wales from the perspective of NHS professionals using it. NHS professionals were approached by TEC Cymru to provide early data. METHODS: Using an observational study design with descriptive methods including a cross-sectional survey, TEC Cymru captured data on the use, benefits and challenges of VC from NHS professionals in Wales during August and September 2020. This evidence is based on the rapid adoption of VC in Wales, which mirrors that of other nations. RESULTS: A total of 1256 NHS professionals shared their VC experience. Overall, responses were positive, and professionals expressed optimistic views regarding the use and benefit of VC, even when faced with challenges on occasions. CONCLUSIONS: This study provides evidence of general positivity, acceptance and the success of the VC service in Wales. Future research studies will now be able to explore and evaluate the implementation methods used within this study, and investigate their effectiveness in being able to achieve better outcomes through VC.

Mass production methods for mass vaccination: improving flow and operational performance in a COVID-19 mass vaccination centre using Lean.

The COVID-19 pandemic has infected tens of millions of people worldwide causing many deaths. Healthcare systems have been stretched caring for the most seriously ill and lockdown measures to interrupt COVID-19 transmission have had adverse economic and societal impacts. Large-scale population vaccination is seen as the solution.In the UK, a network of sites to deploy vaccines comprised National Health Service hospitals, primary care and new mass vaccination centres. Due to the pace at which mass vaccination centres were established and the scale of vaccine deployment, some sites experienced problems with queues and waiting times. To address this, one site used the Lean systematic improvement approach to make rapid operational improvements to reduce process times and improve flow.The case example identifies obstacles to flow experienced by a mass vaccination centre and how they were addressed using Lean concepts and techniques. Process cycle times were used as a proxy metric for efficiency and flow. Based on daily demand volume and open hours, takt time was calculated to give a process completion rate to achieve flow through the vaccination centre.The mass vaccination centre achieved its aim of reducing process times and improving flow. Administrative and clinical cycle times were reduced sufficiently to increase throughput and the number of queues and queueing time were reduced improving client experience.The design and operational management of vaccination centre processes contribute to client experience, efficiency and throughput. Lean provides a systematic approach that can improve operational processes and facilitate client flow through mass vaccination centres.

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.

Education and training as key drivers for improving the quality of fluid balance charts: findings from a quality improvement project.

Reviewing fluid balance charts is a simple and effective method of assessing and monitoring the hydration status of patients. Several articles report that these charts are often either inaccurately or incompletely filled thereby limiting their usefulness in clinical practice. We had a similar experience in our practice at Kettering General Hospital and conducted a quality improvement project with a goal to increase the number of charts that were completely and accurately filled by a minimum of 50% in a 1-month period and to reassess the sustainability of this improvement after 6 months. Data from baseline measurements showed that only 25% of the charts in the ward had accurate measurements, 20% had correct daily totals and 14% had complete records of all intakes and losses. We collected feedback from nursing staff in the ward on what challenges they faced in using these charts and how best to support them. Corroborated by evidence from the literature, we discovered that inadequate training was a major factor responsible for the poor quality of documentation in these charts. Using simultaneous plan-do-study-act cycles, we designed and delivered personalised teaching on fluid balance chart documentation to the nursing staff. Subsequent data showed remarkable improvements in all the parameters we assessed. For instance, the proportion of charts with accurate measurements increased by 55% and those with complete entries by 122%. Unfortunately, we were unable to demonstrate sustainability of these improvements as our second set of data collection coincided with the SARS-CoV-2 outbreak. In this project, we were able to demonstrate that simple and cost-efficient measures such as adequate training of nursing staff could remarkably improve the quality of fluid balance charts used in our hospitals. We suggest that this training should be included as part of the regular competency assessments for nurses and other healthcare staff.

Operations management on the front line of COVID-19 vaccination: building capability at scale via technology-enhanced learning.

The globe is gripped by the COVID-19 pandemic. Mass population vaccination is seen as the solution. As vaccines become available, governments aim to deploy them as rapidly as possible. It is important, therefore, that the efficiency of vaccination processes is optimal.Operations management is concerned with improving processes and comprises systematic approaches such as Lean. Lean focuses explicitly on process efficiency through the elimination of non-value adding steps to optimise processes for those who use and depend on them.Technology-enhanced learning can be a strategy to build improvement capability at scale. A massive online programme to build capability in Lean has been developed by the regulator of England's National Health Service. Beta testing of this programme has been used by some test sites to refine their COVID-19 vaccination processes. The paper presents a case example of massive online learning supporting the use of Lean in the day-to-day operations management of COVID-19 vaccine processes.The case example illustrates the challenges that vaccination processes may present and the need for responsive and effective operations management. Building capability to respond rapidly and systematically in dynamic situations to optimise flow, safety and patient experience may be beneficial.Given the national imperative to achieve mass vaccination as rapidly as possible, systematic improvement methods such as Lean may have a contribution to make. Massive online programmes, such as that described here, may help with this effort by achieving timely knowledge transfer at large scale.

ABET Accreditation During and After COVID19 - Navigating the Digital Age.

Engineering accreditation agencies and governmental educational bodies worldwide require programs to evaluate specific learning outcomes information for attainment of student learning and establish accountability. Ranking and accreditation have resulted in programs adopting shortcut approaches to collate cohort information with minimally acceptable rigor for Continuous Quality Improvement (CQI). With tens of thousands of engineering programs seeking accreditation, qualifying program evaluations that are based on reliable and accurate cohort outcomes is becoming increasingly complex and is high stakes. Manual data collection processes and vague performance criteria assimilate inaccurate or insufficient learning outcomes information that cannot be used for effective CQI. Additionally, due to the COVID19 global pandemic, many accreditation bodies have cancelled onsite visits and either deferred or announced virtual audit visits for upcoming accreditation cycles. In this study, we examine a novel meta-framework to qualify state of the art digital Integrated Quality Management Systems for three engineering programs seeking accreditation. The digital quality systems utilize authentic OBE frameworks and assessment methodology to automate collection, evaluation and reporting of precision CQI data. A novel Remote Evaluator Module that enables successful virtual ABET accreditation audits is presented. A theory based mixed methods approach is applied for evaluations. Detailed results and discussions show how various phases of the meta-framework help to qualify the context, construct, causal links, processes, technology, data collection and outcomes of comprehensive CQI efforts. Key stakeholders such as accreditation agencies and universities can adopt this multi-dimensional approach for employing a holistic meta-framework to achieve accurate and credible remote accreditation of engineering programs.