Improving patient education in hospitalized patients with chronic obstructive pulmonary disease: A quality improvement initiative using LEAN methodology.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a costly chronic disease affecting more than 15 million Americans. The prevalence among US veterans is 3 times higher than the general population. LOCAL PROBLEM: The Veteran Health Administration developed a standardized, evidence-based COPD educational tool called Green Light to Go (GLTG) designed to educate patients on managing their COPD symptoms at home. Despite the availability of this resource, inpatient education on COPD self-management practices is highly variable across different medical teams. This quality improvement (QI) initiative sought to standardize inpatient COPD patient education using the GLTG tool. This initiative also assessed whether patients receiving standardized patient education during their index hospitalization had lower COPD 30-day readmission rates. METHOD: The QI initiative followed the LEAN methodology and the A3 framework. The team performed rapid tests of change (plan-do-study-act cycles) to increase the percentage of veterans receiving COPD education. INTERVENTIONS: The interventions implemented for this QI initiative focused on clinical, patient, and system improvements. RESULTS: This initiative standardized COPD patient education and increased the percentage of veterans receiving (a) daily COPD education from 0% to 66%, (b) verbal COPD education on discharge from a baseline of 20% to 100%, (c) receipt of written educational material on discharge from 20% to 100%, and (d) the cohort all-cause 30-day readmission rate declined from 19.3% to 14.3%. CONCLUSIONS: Given the substantial economic burden of COPD readmissions on the health care system and patients, evidence-based educational interventions may potentially improve outcomes and reduce hospital readmissions in this veteran population.

A Multi-Site Evaluation of A National Employee Wellness Initiative at the Department of Veterans Affairs.

Background: The Department of Veterans Affairs (VA) seeks to transform its health care delivery from disease-centered, episodic care to a holistic and patient-centered model known as the Whole Health System (WHS) of care. Employee engagement and buy-in are crucial to this cultural transformation. The VA aspires to provide employees with opportunities to experience whole health in their personal and professional lives through a national Employee Whole Health (EWH) program. Although there are national recommendations, different local facilities may have unique strategies and challenges as they implement this program. Objective: This study aimed to conduct a program evaluation of EWH at three different VA facilities across the United States in order to identify facilitators and barriers to the implementation of EWH. Methods: The team used the RE-AIM framework to develop an interview guide to assess various domains of implementation. Quantitative data on whole health offerings at each site were gauged using a national employee education platform. Standardized employee-related metrics at each site were assessed using the annual, national VA employee survey. Results: EWH has had variable implementation at the three sites. Sites noted main facilitators as employee interest as well as available skills and expertise for delivering complementary and integrative care to employees. Limited staffing for EWH and a lack of dedicated employee time were cited as barriers. The infrastructure to perform local program evaluations to demonstrate effectiveness and impact were missing. Conclusion: Employee engagement in whole health activities has the potential to support the VA's mission to transform its health care delivery model. Currently, the use of EWH and its potential impact are difficult to discern based on available information. Local sites need guidance to conduct program evaluations and find creative solutions to enhance employee participation. A robust measurement system to demonstrate effectiveness is paramount to ensure the success of this initiative.

Does Root Cause Analysis Improve Patient Safety? A Systematic Review at the Department of Veterans Affairs.

BACKGROUND AND OBJECTIVES: While root cause analysis (RCA) is used to analyze medical errors with a systems approach, evidence demonstrating its effectiveness in reducing patient harm remains sparse. The heterogeneity of the RCA methodology at different health care organizations has posed challenges to studying its value. The Department of Veterans Affairs (VA) has an established and standardized RCA approach, making it an ideal context to study RCA's impact. This review assessed whether implemented interventions recommended by RCAs were effective in mitigating preventable adverse events at the VA. METHODS: PubMed, Web of Science, CINAHL and Business Source were searched for studies on RCAs performed at the VA that evaluated effectiveness of interventions and were published between 2010 and 2020. The Appraisal Tool for Cross-sectional Studies (AXIS) was used to assess bias of bias. RESULTS: The majority of studies eliminated during our eligibility process reported on RCAs without attention to their specific impact on patient safety. Ten retrospective studies met inclusion criteria and were part of the final review. Studies were grouped into adverse events related to incorrect surgical/invasive procedures, suicides, falls with injury, and all-cause adverse events. Six studies reported on effectiveness by demonstrating quantitative changes in adverse events over time or by location following a specific intervention. Four studies reported on the effectiveness of implemented interventions using a facility-based rating of "much better" or "better." CONCLUSIONS: Of the studies included in this review, all reported improvements following interventions implemented after RCAs, but with variability in study definitions and methodology to assess effectiveness. Increased reporting of outcomes following RCAs, with an emphasis on quantitative patient-related outcome measures, is needed to demonstrate the impact and value of the RCA.

Cultivation of Nannochloropsis oceanica biomass rich in eicosapentaenoic acid utilizing wastewater as nutrient resource.

The eicosapentaenoic acid rich marine eustigmatophyte Nannochloropsis oceanica was grown in wastewaters sampled from four different industries (i.e. pesticides industry, pharmaceutical industry, activated sludge treatment plant of municipality sewage and petroleum (oil) industry). Under the wastewater based growth conditions used in this study, the biomass productivity ranged from 21.78±0.87 to 27.78±0.22mgL(-1)d(-1) in relation to freeze dried biomass, while the lipid productivity varied between 5.59±0.02 and 6.81±0.04mgL(-1)d(-1). Although comparatively higher biomass, lipid and EPA productivity was observed in Conway medium, the %EPA content was similarly observed in pesticides industry and municipal effluents. The results highlight the possibility of selectively using wastewater as a growth medium, demonstrating the elevated eicosapentaenoic acid content and biodiesel properties, that complies with the European standards for biodiesel.