Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience.

Sustained low-efficiency dialysis (SLED) is usually performed over 6-12 h among hemodynamically unstable patients. Conduction of 4-h SLED may spare time and manpower during hospitalization. Therefore, we conducted a retrospective observational study to explore the appropriateness and clinical outcomes of 4-h SLED among critically ill patients admitted to our center from 1/06/2016 to 1/06/2020. Renal parameters including blood urea nitrogen, serum creatinine, sodium, phosphorus, potassium, and bicarbonate were determined on the day of dialysis before SLED and within 24 h after SLED, and clinical outcomes including, acute kidney injury (AKI) recovery, in-hospital mortality, 30-day mortality, 180-day mortality, and re-admission with AKI, were evaluated. Of the 304 patients included, 69.4% were male. The majority of patients were from the Middle East (65.8%), followed by 28.6% from Asia. Four-hour SLED resulted in a significant improvement in the renal parameters. Recovery from AKI was observed in 25.4%, in-hospital mortality rate was 48.7%, while the 30- and 180-day mortality outcomes were 3.2 and 9.6%, respectively, and re-admission with AKI was observed in 16.9%. Our findings suggest that 4-h SLED significantly improved renal parameters and was associated with favorable clinical outcomes in terms of survival and AKI recovery, suggesting possible utilization of SLED shorter than 6 h in the acute settings to preserve time and manpower for procedures.

Acute Lymphoblastic Leukemia Presenting with Acute Decompensated Cardiac Failure.

We report the case of acute lymphoblastic leukemia (ALL) in a 29-year-old male with no past medical history who presented with symptoms and signs of heart failure due to possible infiltrative cardiomyopathy as suggested by echocardiography. Workup including different imaging modalities confirmed the diagnosis of ALL. The patient completed his treatment course with a resolution of heart failure symptoms and normalization of cardiac function which was confirmed by different imaging modalities.

Reducing catheter-associated urinary tract infections in the cardiac intensive care unit with a coordinated strategy and nursing staff empowerment.

BACKGROUND: Catheter-associated urinary tract infection (CAUTI) is one of the most common hospital-acquired infections. The use of urinary catheters is associated with several complications and increased mortality and morbidity. At the coronary intensive care unit (CICU) of a tertiary cardiac care facility, the CAUTI rate was 7.6/1000 catheter days in January 2017. In collaboration with the Institute for Healthcare Improvement, we implemented evidence-based practices in the form of bundles based on the value improvement methodology to eliminate CAUTIs in the CICU. METHODS: This initiative aimed to reduce the CAUTI rate using a multifaceted approach. The key interventions were empowering front-line nurses for automatic stop orders and ensuring compliance to the catheter insertion and maintenance bundles. We used a model for improvement and tested the changes using small plan-do-study-act cycles. Surveillance methods and CAUTI definitions proposed by the National Healthcare Safety Network were used to monitor the outcomes. Monthly rates of CAUTIs 24 months before the intervention were compared with those 44 months after the intervention using an independent t-test. Statistical significance was set at p<0.05. RESULTS: The rate of CAUTIs dropped from 7.6 per 1000 catheter days in January 2017 to 0 from October 2021 to August 2022. The unit had achieved 280 calendar days free of CAUTI untill August 2022. CONCLUSIONS: Behavioural changes, including empowerment of nurses and adherence to all elements of the care bundle, led to significant and sustained improvement in reducing the CAUTI rate in the adult CICU.

Value improvement at the point of care: engaging and empowering front-line teams with a new quality improvement methodology.

BACKGROUND: Healthcare organisations require systems to consistently meet the needs of their patients while providing excellent quality of care. The value improvement (VI) approach was developed by the Institute for healthcare improvement and successfully piloted at Raigmore Hospital, Scotland. It showed positive results in improving outcomes and reducing costs. Our multidisciplinary team from a tertiary care cardiac hospital in Doha, Qatar wanted to see if we could improve value in a clinically and geographically distinct context. We sought to understand the effectiveness of this approach as an integrative management philosophy that aims for continuous improvement in the quality of services by increasing efficiency and reducing waste. METHODS: This study evaluates the outcomes achieved from applying the VI methodology. The method is rooted in a framework that emphasises standardisation, continuous process improvement and rightsizing capacity to demand. The main tools include a data box score, a visual management board and weekly communication huddles. RESULTS: As a result of the VI methodology, our team achieved improvements across performance, staff capacity and cost domains. Compared with the 4-8 weeks baseline data collection period, these improvements included an increase in discharges before 13:00 hour by 61%, a reduction in the number of blood samples per patient per day by 20%, an increase in nursing time spent in direct patient care by 18%, and an increase in staff satisfaction to 40%. CONCLUSIONS: We found that the VI approach offered a systematic method for continuously improving the quality of care by focusing attention each week on safety, efficiency and patient experience. The team improved numerous processes and outcomes resulting in a positive impact on patients and families and increased the engagement of staff in continuous improvement. In this way, we improved our capacity to undertake and complete quality projects.

Bundle approach used to achieve zero central line-associated bloodstream infections in an adult coronary intensive care unit.

BACKGROUND: Central venous catheterisation is commonly used in critical patients in intensive care units (ICU). It may cause complications and attribute to increase mortality and morbidity. At coronary ICU (CICU) of cardiac hospital, central line-associated bloodstream infection (CLABSI) rate was 2.82/1000 central line days in 2015 and 3.11/1000 central line days in 2016. Working in collaboration with Institute for Healthcare Improvement (IHI), we implemented evidence-based practices in the form of bundles in with the aim of eliminating CLABSI in CICU. METHODS: In collaboration with IHI, we worked on this initiative as multidisciplinary team and tested several changes. CLABSI prevention bundles were tested and implemented, single kit for line insertion, simulation-based training for line insertions, standardised and real-time bundle monitoring by direct observations are key interventions tested. We used model for improvement and changes were tested using small Plan-Do-Study-Act cycles. Surveillance methods and CLABSI definition used according to National Healthcare Safety Network. RESULTS: The CLABSI rate per 1000 patient-days dropped from 3.1 per 1000 device-days to 0.4 per 1000 device-days. We achieved 757 days free of CLABSI in the unit till December 2018 when a single case happened. After that we achieved 602 free days till July 2020 and still counting. CONCLUSIONS: Implementation of evidence-based CLABSI prevention bundle and process monitoring by direct observation led to significant and subsequently sustained improvement in reducing CLABSI rate in adult CICU.

The Impact of COVID-19 Outbreak on Cardiovascular Admissions.

BACKGROUND: The COVID-19 pandemic has caused major disruption in the health care deliveries and activities worldwide including hospital admission. METHOD: We used hospitals discharged coded data from January 1, 2019 to June 30, 2020 to examine the impact of COVID-19 outbreak on the pattern of cardiovascular admission among Hamad Medical Corporation hospitals in the State of Qatar. RESULTS: In this retrospective observational study, we documented significant changes in the pattern of cardiovascular admissions in our hospitals. There was a significant reduction in hospitalizations of various subsets of cardiac disease. Admissions for acute myocardial infarction dropped by 31%, acute decompensated dropped by 48%, unstable angina dropped by 79% and arrythmia by 80%. Primary percutaneous coronary intervention procedures declined briefly. However, the total deaths remained the same despite the increase in mortality rate due to reduced admissions number. CONCLUSION: We postulate the fear of contracting the disease and the lock-down mentality during COVID-19 outbreak contribute to reduction of cardiovascular admission to our hospital.

Isolation Unit: A New Way to Practice at Heart Hospital, Qatar during the Corona Virus -2019 Pandemic.

BACKGROUND: The novel coronavirus disease-2019 (COVID-19) spread rapidly around the world and was declared as the second pandemic of the 21st century. The first case was detected in Qatar on February 29, 2020. In order to protect patients and staff in Heart Hospital, the only tertiary cardiac center in Qatar, new measures were implemented to reduce the spread of infection in our hospital. METHODOLOGY: A 13-bed high dependency isolation unit was allocated to receive cardiac patients with appreciate infection control measures. Another isolation unit was also established in coronary care unit for critical patients. All patients admitted to Heart Hospital were tested for COVID-19 on admission. Patients were transferred out of isolation, if result was negative. Patients with positive results were either transferred to a COVID facility before or after planned cardiac procedure depending on their cardiovascular disease risk. RESULTS: Six hundred and seven patients were admitted to both the isolation units, most of them were men (89%). Forty-four percent were diagnosed with ST elevation myocardial infarction, 22% were non-STEMI or unstable angina, 17% were decompensated heart failure, 7% were elective cases for coronary angiography or electrophysiology procedures, 8% for other diagnosis, and 1% for both cardiac arrest and post cardiac surgery. 85.2% of the patients admitted to isolation units were tested negative and transferred to normal wards to complete their treatment. Eighty percent of the patients tested positive or reactive for COVID-19 had epidemiological risk, 8.4% had suggestive symptoms, and 11.6% had abnormal chest X-ray. CONCLUSION: This study demonstrated the importance of the isolation unit with infection control measures in controlling the transmission of COVID-19 in a hospital setting such as the Heart Hospital. Epidemiological risk factors including recent travel, close contact with suspected or confirmed cases within 14 days or less, living in shared accommodation or living in lockdown area were the main risk factors for spreading COVID-19 infection which can be managed by minimizing social activities.