Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 43
Filter
1.
BMJ Open Qual ; 11(2)2022 May.
Article in English | MEDLINE | ID: covidwho-1874570

ABSTRACT

BACKGROUND: Preterm infants may remain in neonatal intensive care units (NICUs) to receive proper nutrition via nasogastric tube feedings. However, prolonged NICU stays can have negative effects for the patient, the family and the health system. AIM: To demonstrate how a patient-centred, design thinking informed approach supported the development of a pilot programme to enable earlier discharge of preterm babies. METHOD: We report on our design thinking-empathy building approach to programme design, initial outcomes and considerations for ongoing study. RESULTS: Through the use of design thinking methods, we identified unique needs, preferences and concerns that guided the development of our novel early discharge programme. We found that stable, preterm infants unable to feed by mouth and requiring nasogastric tubes can be cared for at home with remote patient monitoring and telehealth support. In addition, novel feeding strategies can help address parental preferences without compromising infant growth. CONCLUSION: A patient-centred, design thinking informed approach supported the development of a pilot programme to enable earlier discharge of preterm babies. The programme resulted in a reduced length of stay, thereby increasing NICU bed capacity and limiting hospital turn-aways.


Subject(s)
Intensive Care Units, Neonatal , Patient Discharge , Hospitals , Humans , Infant , Infant, Newborn , Infant, Premature , Parents
2.
BMJ Open Qual ; 11(2)2022 May.
Article in English | MEDLINE | ID: covidwho-1865184

ABSTRACT

Teledermatology is an important subspecialty of telemedicine that continues to evolve with advances in telecommunication and mobile phone technology. A 19-week primary care quality improvement project collected baseline data and tested three change ideas, using the Model for Improvement method, with primary and secondary aims: to increase the weekly percentage of remote dermatological consultations with supporting images that were successfully concluded remotely to greater than 80% and to reduce the weekly percentage of dermatological face-to-face consultations to less than 50%. We hypothesised that by improving the quality of patient images and the confidence of reception staff in triaging skin complaints, there would be a decrease in the weekly number of face-to-face dermatological appointments, thereby decreasing the risk of COVID-19 transmission within the practice and community. Two change ideas focused on supporting patients to improve image quality by introducing '4 Key Instructions' and a patient information leaflet (PIL). The third focused on increasing reception staff confidence in triaging skin complaints by introducing a triage pathway guidance tool. A total of 253 dermatological consultations were analysed: 170 of these were telephone consultations with 308 supporting images. Process measures showed clear improvements in the quality of images provided by patients which likely contributed to an increase in completed remote consultation. Our primary outcome measure was achieved. Our secondary outcome measure suggested that in the absence of high-quality images, it might not be possible to reduce dermatological face-to-face consultations much below 50% in primary care. Process measures showed clear improvements in the quality of images provided by patients which likely contributed to the increase in remote consultation. The implications of these findings for the theory of change are discussed.


Subject(s)
COVID-19 , General Practice , Remote Consultation , Humans , Pandemics/prevention & control , Quality Improvement , Remote Consultation/methods
3.
BMJ Qual Saf ; 2022 May 12.
Article in English | MEDLINE | ID: covidwho-1846527

ABSTRACT

BACKGROUND: High-quality antenatal care is important for ensuring optimal birth outcomes and reducing risks of maternal and fetal mortality and morbidity. The COVID-19 pandemic disrupted the usual provision of antenatal care, with much care shifting to remote forms of provision. We aimed to characterise what quality would look like for remote antenatal care from the perspectives of those who use, provide and organise it. METHODS: This UK-wide study involved interviews and an online survey inviting free-text responses with: those who were or had been pregnant since March 2020; maternity professionals and managers of maternity services and system-level stakeholders. Recruitment used network-based approaches, professional and community networks and purposively selected hospitals. Analysis of interview transcripts was based on the constant comparative method. Free-text survey responses were analysed using a coding framework developed by researchers. FINDINGS: Participants included 106 pregnant women and 105 healthcare professionals and managers/stakeholders. Analysis enabled generation of a framework of the domains of quality that appear to be most relevant to stakeholders in remote antenatal care: efficiency and timeliness; effectiveness; safety; accessibility; equity and inclusion; person-centredness and choice and continuity. Participants reported that remote care was not straightforwardly positive or negative across these domains. Care that was more transactional in nature was identified as more suitable for remote modalities, but remote care was also seen as having potential to undermine important aspects of trusting relationships and continuity, to amplify or create new forms of structural inequality and to create possible risks to safety. CONCLUSIONS: This study offers a provisional framework that can help in structuring thinking, policy and practice. By outlining the range of domains relevant to remote antenatal care, this framework is likely to be of value in guiding policy, practice and research.

4.
BMJ Qual Saf ; 31(5): 409-414, 2022 May.
Article in English | MEDLINE | ID: covidwho-1807445
7.
BMJ Qual Saf ; 31(5): 337-339, 2022 May.
Article in English | MEDLINE | ID: covidwho-1807442
8.
BMJ Open Qual ; 11(2)2022 Apr.
Article in English | MEDLINE | ID: covidwho-1784847

ABSTRACT

During the COVID-19 pandemic, patients were apprehensive to seek acute care resulting in delayed diagnoses of serious conditions and reduction in emergency room (ER) visits by 50% in the Fraser Health Authority. Patients who did present to the ER left prior to their results being available and some refused admission and critical treatments.At the Chilliwack General Hospital ER, a virtual care clinic was established to follow-up on patients after their initial ER visit, providing test results and ensuring patients are not clinically deteriorating at home. Specific criteria were created for safe referral to virtual follow-up. For 2 hours daily, an ER physician contacts selected patients by telephone to provide a virtual follow-up based on the patients' needs.Through the emergency department virtual care (EVC) pilot project, from May 14 to August 31, 2020, on average 58 telehealth visits were conducted weekly, with 19% of visits reaching unattached patients without a regular primary care provider. A patient survey revealed that 75% of respondents were very satisfied or satisfied with telephone virtual care as a follow-up to their emergency department (ED) visit, while 95% would like to continue to receive telephone follow-up care. Additionally, based on a physician survey, 80% of providers were satisfied or very satisfied with the overall EVC experience. The majority (80%) would like to continue to provide the service. One patient was referred for a virtual care follow-up for imaging results that did not meet the referral criteria; the patient was diagnosed with a perforated appendicitis. They had an atypical presentation of abdominal pain and their care was delayed by several hours than if they were to present to the ED for in-person follow-up. The process and referral criteria may require minor modification and must be followed strictly to ensure safety and efficiency in providing telehealth follow-up in the acute care setting.


Subject(s)
COVID-19 , Quality Improvement , Aftercare , Emergency Service, Hospital , Hospitals, Community , Humans , Pandemics , Pilot Projects
9.
BMJ Open Qual ; 11(1)2022 03.
Article in English | MEDLINE | ID: covidwho-1765131

ABSTRACT

BACKGROUND: On 3 August 2020, Public Health Scotland commenced a prospective surveillance study to monitor the prevalence of COVID-19 among asymptomatic outpatients attending dental clinics across 14 health boards in Scotland. OBJECTIVES: The primary aim of this quality improvement project was to increase the number of COVID-19 tests carried out in one of the participating sites, Glasgow Dental Hospital and School. The secondary aim was to identify barriers to patient participation and staff engagement when implementing a public health initiative in an outpatient setting. METHOD: A quality improvement working group met weekly to discuss hospital findings, identify drivers and change ideas. Details on reasons for patient non-participation were recorded and questionnaires on project barriers were distributed to staff. In response to findings, rapid interventions were implemented to fast-track increases in the numbers of tests being carried out. RESULTS: Over 16 weeks, 972 tests were carried out by Glasgow Dental Hospital and School Secondary Care Services. The number of tests per week increased from 19 (week 1) to 129 (week 16). This compares to a similar 'control' site, where the number of tests carried out remained unchanged; 38 (week 1) to 36 (week 16). The most frequent reason given for non-participation was fear that the swab would hurt. For staff, lack of time and forgetting to ask patients were identified as the most significant barriers. CONCLUSION: Public health surveillance programmes can be integrated rapidly into outpatient settings. This project has shown that a quality improvement approach can be successful in integrating such programmes. The key interventions used were staff engagement initiatives and front-line data collection. Implementation barriers were also identified using staff questionnaires.


Subject(s)
COVID-19 , Outpatients , Humans , Patient Participation , Prospective Studies , Quality Improvement
10.
BMJ Open Qual ; 11(1)2022 03.
Article in English | MEDLINE | ID: covidwho-1759373

ABSTRACT

BACKGROUND: Hip and knee total joint arthroplasty (TJA) procedures are two of the most common inpatient surgical procedures worldwide. Outpatient TJA has emerged as a feasible option. COVID-19 caused significant constraints on inpatient surgical resources and contributed to a growing surgical backlog. We present a quality improvement (QI) initiative aimed at adding an outpatient TJA pathway to our pre-existing inpatient TJA programme, with the target of performing 25% of our primary TJA as outpatients. METHODS: This was a QI study at a tertiary level arthroplasty centre. To achieve our aim, a patient-centred needs analysis revealed the need to develop patient selection criteria, perform a specific and tailored anaesthetic, provide patient education and conduct virtual care follow-up. Based on these findings, an outpatient TJA intervention bundle was developed and implemented. RESULTS: After implementing the outpatient pathway, 65 patients were scheduled for outpatient TJA. Fifty-five (84.6%) patients were successfully discharged home on the day of surgery. Successful outpatient TJA accounted for 33.3% of all primary TJAs performed at our intuition throughout the study period. There was excellent adherence to the intervention protocols, with the success hinging on multidisciplinary team and supported QI culture. Thirty-day emergency department visits for inpatient and outpatient TJAs were 8.93% and 6.15%, respectively. No outpatient TJA patients required hospital readmission within 30 days. CONCLUSION: Our study demonstrates that implementation of an outpatient TJA pathway in response to inpatient resource constraints during the COVID-19 pandemic is feasible. The findings of this report will be of interest to surgical centres facing surgical backlog and constraints on inpatient resources during and after the pandemic.


Subject(s)
Arthroplasty, Replacement, Hip , COVID-19 , Critical Pathways , Humans , Outpatients , Pandemics , Quality Improvement
12.
BMJ Open Qual ; 11(1)2022 03.
Article in English | MEDLINE | ID: covidwho-1741646

ABSTRACT

Breast pain has no association with breast cancer yet is a frequent reason for referral from Primary to Secondary Care, often on an urgent (2-week wait) referral. The referral often causes significant patient anxiety, further heightened by screening mammograms and/or ultrasound scans in the absence of an associated red flag symptom or finding by the patient or general practitioner. This paper reports the pilot implementation of a specialist Primary Care Breast Pain Clinic in Mid-Nottinghamshire where patients were seen, examined without any imaging and assessed for their risk of familial breast cancer: numerous studies have reported 15%->30% of patients with breast pain only have a family history of breast cancer.177 patients with breast pain only were seen in this clinic between March, 2020 and April, 2021 with a 6-month interim suspension due to COVID-19. The mean age of patients was 48.4 years (range: 16-86). 172/177 (97.2%) patients required no imaging although there were three (1.7%) inappropriate referrals and two additional abnormalities (1.1%-hamartoma, thickening/tethering) that were referred onward. There were no cancers. 21 (12.4%) patients were identified to have an increased familial risk of breast cancer and were referred to the specialist familial cancer service. 170/177 patients completed an anonymous questionnaire on leaving the clinic. 167/169 (99%) were reassured regarding their breast pain, 155/156 (99%) were reassured of the Familial Risk Assessment, 162/168 (96%) were reassured regarding their personal risk assessment while 169/170 (99%) were 'extremely likely/likely to recommend the service'.This specialist Primary Care Breast Pain Clinic provides service improvement across all levels of care (Primary, Secondary and Tertiary). Patients were successfully managed in the community with high levels of patient satisfaction and together this obviated referral to secondary care. The familial breast cancer risk assessment also helped identify unmet need in the community.


Subject(s)
Breast Neoplasms , COVID-19 , Mastodynia , Adolescent , Adult , Aged , Aged, 80 and over , Breast Neoplasms/complications , Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , Female , Humans , Middle Aged , Primary Health Care , Referral and Consultation , Young Adult
13.
BMJ Qual Saf ; 31(5): 379-382, 2022 May.
Article in English | MEDLINE | ID: covidwho-1638648

ABSTRACT

The COVID-19 pandemic burdens hospitals, but consequences for quality of care outcomes such as healthcare-associated infections are largely unknown. This cohort included all adult hospital episodes (n=186 945) at an academic centre between January 2018 and January 2021. Data were collected from the hospitals' electronic health record data repository. Hospital-onset bloodstream infection (HOB) was defined as any positive blood culture obtained ≥48 hours after admission classified based on microbiological and hospital administrative data. Subgroup analyses were performed with exclusion of potential contaminant bacteria. The cohort was divided into three groups: controls (prepandemic period), non-COVID-19 (pandemic period) and COVID-19 (pandemic period) based on either PCR-confirmed SARS-CoV-2 infections from respiratory samples or International Classification of Diseases 10th Revision diagnoses U071 and U72 at discharge. Adjusted incidence rate ratios (aIRR) and risk of death in patients with HOB were compared between the prepandemic and pandemic periods using Poisson and logistic regression. The incidence of HOB was increased for the COVID-19 group compared with the prepandemic period (aIRR 3.34, 95% CI 2.97 to 3.75). In the non-COVID-19 group, the incidence was slightly increased compared with prepandemic levels (aIRR 1.20, 95% CI 1.08 to 1.32), but the difference decreased when excluding potential contaminant bacteria (aIRR 1.15, 95% CI 1.00 to 1.31, p=0.04). The risk of dying increased for both the COVID-19 group (adjusted odds ratio (aOR) 2.44, 95% CI 1.75 to 3.38) and the non-COVID-19 group (aOR 1.63, 95% CI 1.22 to 2.16) compared with the prepandemic controls. These findings were consistent also when excluding potential contaminants. In summary, we observed a higher incidence of HOB during the COVID-19 pandemic, and the mortality risk associated with HOB was greater, compared with the prepandemic period. Results call for specific attention to quality of care during the pandemic.


Subject(s)
COVID-19 , Cross Infection , Sepsis , Adult , Cohort Studies , Cross Infection/epidemiology , Hospitals , Humans , Incidence , Pandemics , SARS-CoV-2
14.
BMJ Open Qual ; 11(1)2022 01.
Article in English | MEDLINE | ID: covidwho-1613015

ABSTRACT

BACKGROUND: The COVID-19 pandemic has put health systems across the world under significant pressure. In March 2020, a national directive was issued by the National Health Service (NHS) England instructing trusts to scale back face-to-face outpatient appointments, and rapidly implement virtual clinics. METHODS: A multidisciplinary team of change managers, analysts and clinicians were assembled to evaluate initial implementation of virtual clinics at Guy's and St Thomas' NHS Foundation Trust. In-depth interviews were conducted with clinicians who have delivered virtual clinics during the pandemic. An inductive thematic approach was used to analyse clinicians' early experiences and identify enablers for longer term sustainability. RESULTS: Ninety-five clinicians from specialist services across the trust were interviewed between April and May 2020 to reflect on their experiences of delivering virtual clinics during Wave I COVID-19. Key reflections include the perceived benefits of virtual consultations to patients and clinicians; the limitations of virtual consultations compared with face-to-face consultations; and the key enablers that would optimise and sustain the delivery of virtual pathways longer term. CONCLUSIONS: In response to the pandemic, outpatient services across the trust were rapidly redesigned and virtual clinics implemented. As a result, services have been able to sustain some level of service delivery. However, clinicians have identified challenges in delivering this model of care and highlighted enablers needed to sustaining the delivery of virtual clinics longer term, such as patient access to diagnostic tests and investigations closer to home.


Subject(s)
COVID-19 , Pandemics , Humans , Outpatients , SARS-CoV-2 , State Medicine
15.
BMJ Open Qual ; 10(4)2021 12.
Article in English | MEDLINE | ID: covidwho-1594508

ABSTRACT

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.


Subject(s)
COVID-19 , State Medicine , Cross-Sectional Studies , Humans , Pandemics , SARS-CoV-2
16.
BMJ Open Qual ; 10(4)2021 12.
Article in English | MEDLINE | ID: covidwho-1583088

ABSTRACT

A treatment escalation plan (TEP) enables timely and appropriate decision making in the management of deteriorating patients. The COVID-19 pandemic precipitated the widespread use of TEPs in acute care settings throughout the National Health Service (NHS) to facilitate safe and effective decision making. TEP proformas have not been developed for the inpatient psychiatric setting. This is particularly concerning in old age psychiatry inpatient wards where patients often have multiple compounding comorbidities and complex decisions regarding capacity are often made. Our aim for this quality improvement project was to pilot a novel TEP proforma within a UK old age psychiatry inpatient hospital. We first adapted a TEP proforma used in our partner acute tertiary hospital and implemented it on our old age psychiatry wards. We then further refined the form and gathered data about uptake, length of time to complete a TEP and the ceiling of care documented in the TEP. We also explored staff, patient and family views on the usefulness of TEP proformas using questionaries. TEP decisions were documented in 54% of patient records at baseline. Following revision and implementation of a TEP proforma this increased to 100% on our two wards. The mean time taken to complete a TEP was reduced from 7.1 days to 3.2 days following inclusion of the TEP proforma in admission packs. Feedback from staff showed improvements in understanding about TEP and improved knowledge of where these decisions were documented. We advocate the use of TEP proformas on all old age psychiatry inpatient wards to offer clear guidance to relatives and treating clinicians about the ceilings of care for patients. There are potentially wider benefits to healthcare systems by reducing inappropriate transfers between psychiatry and acute NHS hospitals.


Subject(s)
COVID-19 , Psychiatry , Hospitals , Humans , Inpatients , Pandemics , SARS-CoV-2 , State Medicine
17.
BMJ Qual Saf ; 30(12): 986-995, 2021 12.
Article in English | MEDLINE | ID: covidwho-1526510

ABSTRACT

BACKGROUND: The impact of a pandemic on unplanned hospital attendance has not been extensively examined. The aim of this study is to report the nationwide consequences of the COVID-19 pandemic on unplanned hospital attendances in Denmark for 7 weeks after a 'shelter at home' order was issued. METHODS: We merged data from national registries (Civil Registration System and Patient Registry) to conduct a study of unplanned (excluding outpatient visits and elective surgery) hospital-based healthcare and mortality of all Danes. Using data for 7 weeks after the 'shelter at home' order, the incidence rate of unplanned hospital attendances per week in 2020 was compared with corresponding weeks in 2017-2019. The main outcome was hospital attendances per week as incidence rate ratios. Secondary outcomes were general population mortality and risk of death in-hospital, reported as weekly mortality rate ratios (MRRs). RESULTS: From 2 438 286 attendances in the study period, overall unplanned attendances decreased by up to 21%; attendances excluding COVID-19 were reduced by 31%; non-psychiatric by 31% and psychiatric by 30%. Out of the five most common diagnoses expected to remain stable, only schizophrenia and myocardial infarction remained stable, while chronic obstructive pulmonary disease exacerbation, hip fracture and urinary tract infection fell significantly. The nationwide general population MRR rose in six of the recorded weeks, while MRR excluding patients who were COVID-19 positive only increased in two. CONCLUSION: The COVID-19 pandemic and a governmental national 'shelter at home' order was associated with a marked reduction in unplanned hospital attendances with an increase in MRR for the general population in two of 7 weeks, despite exclusion of patients with COVID-19. The findings should be taken into consideration when planning for public information campaigns.


Subject(s)
COVID-19 , Pandemics , Emergency Service, Hospital , Hospitals , Humans , Incidence , SARS-CoV-2
18.
Antimicrob Resist Infect Control ; 10(1): 159, 2021 11 08.
Article in English | MEDLINE | ID: covidwho-1505725

ABSTRACT

BACKGROUND: In the COVID-19 pandemic context, a massive shortage of personal protective equipment occurred. To increase the available stocks, several countries appealed for donations from individuals or industries. While national and international standards to evaluate personal protective equipment exist, none of the previous research studied how to evaluate personal protective equipment coming from donations to healthcare establishments. Our aim was to evaluate the quality and possible use of the personal protective equipment donations delivered to our health care establishment in order to avoid a shortage and to protect health care workers throughout the COVID-19 crisis. METHODS: Our intervention focused on evaluation of the quality of donations for medical use through creation of a set of assessment criteria and analysis of the economic impact of these donations. RESULTS: Between 20th March 2020 and 11th May 2020, we received 239 donations including respirators, gloves, coveralls, face masks, gowns, hats, overshoes, alcohol-based hand rubs, face shields, goggles and aprons. A total of 448,666 (86.3%) products out of the 519,618 initially received were validated and distributed in health care units, equivalent to 126 (52.7%) donations out of the 239 received. The budgetary value of the validated donations was 32,872 euros according to the pre COVID-19 prices and 122,178 euros according to the current COVID-19 prices, representing an increase of 371.7%. CONCLUSIONS: By ensuring a constant influx of personal protective equipment and proper stock management, shortages were avoided. Procurement and distribution of controlled and validated personal protective equipment is the key to providing quality care while guaranteeing health care worker safety.


Subject(s)
COVID-19/prevention & control , Eye Protective Devices/supply & distribution , Health Personnel/psychology , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Masks/supply & distribution , Personal Protective Equipment/supply & distribution , Protective Clothing/supply & distribution , Safety Management , COVID-19/epidemiology , Humans , Infection Control , Pandemics , Personal Protective Equipment/statistics & numerical data , Protective Clothing/statistics & numerical data , Quality Improvement , SARS-CoV-2
19.
BMJ Open Qual ; 10(4)2021 10.
Article in English | MEDLINE | ID: covidwho-1495479

ABSTRACT

BACKGROUND: High-risk patients account for a disproportionate amount of healthcare use, necessitating the development of care delivery solutions aimed specifically at reducing this use. These interventions have largely been unsuccessful, perhaps due to a lack of attention to patients' social needs and engagement of patients in developing solutions. METHODS: The project team used a combination of administrative data, information culled from charts and interviews with high-risk patients to understand social needs, the current experience of addressing social needs in the hospital, and patient preferences and identified opportunities for improvement. Interviews were conducted in March and April 2020, and patients were asked to reflect on their experiences both before and during the COVID-19 pandemic. RESULTS: A total of 4579 patients with 26 168 visits to the emergency department and 2904 inpatient admissions in the previous year were identified. Qualitative analysis resulted in three themes: (1) the interaction between social needs, demographics, and health; (2) the hospital's role in addressing social needs; and (3) the impact of social needs on experiences of care. Themes related to experiences before and during COVID-19 did not differ. Three opportunities were identified: (1) training for staff related to stigma and trauma, (2) improved documentation of social needs and (3) creation of navigation programmes. DISCUSSION: Certain demographic factors were clearly associated with an increased need for social support. Unfortunately, many factors identified by patients as mediating their need for such support were not consistently captured. Going forward, high-risk patients should be included in the development of quality improvement initiatives and programmes to address social needs.


Subject(s)
COVID-19 , Patient Participation , Hospitals , Humans , Pandemics , SARS-CoV-2
20.
BMJ Qual Saf ; 30(11): 921-926, 2021 11.
Article in English | MEDLINE | ID: covidwho-1476692
SELECTION OF CITATIONS
SEARCH DETAIL