BMJ open quality
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Emergency department (ED) crowding is a critical problem in the delivery of acute unscheduled care. Many causes are external to the ED, but antiquated operational traditions like triage also contribute. A physician intake model has been shown to be beneficial in a single-centre study, but whether this solution is generalisable is not clear. We aimed to characterise the current state of front-end intake models in a national sample of EDs and quantify their effects on throughput measures. ⋯ In this cross section of primarily academic EDs, implementing a physician-driven front-end intake process was feasible and associated with improvement in operational metrics.
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Good communication with families improves safety and drives patient/family satisfaction. Rapid cycle improvement for the communication is difficult in our emergency department as current mailed surveys provide little and delayed data. We had two aims in this quality improvement study: (1) to increase proportion of families responding 'always' when asked if they received consistent communication from nurses and providers from 52% to 80% and (2) increase families reporting their visit as excellent, reflecting higher family satisfaction. ⋯ Iterative processes to improve interprovider communication and inform families about their care led to improvement in families' perceived communication consistency. Improved communication can lead to higher family satisfaction, most affecting those previously feeling neutral about their visit. In-person surveys can inform the real-time improvement efforts.
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Critical incident reporting systems (CIRS) can be an important tool for the identification of organisational safety needs and thus to improve patient safety. In German primary care, CIRS use is obligatory but remains rare. Studies on CIRS implementation in primary care are lacking, but those from secondary care recommend involving management personnel. ⋯ Specific measures to improve the use of CIRS in primary care should focus on network management and practice owners. Practices need basic training on safety culture and error management. Continuing, practices should implement an offline CIRS, before they can profit from the exchange of reports via web-based CIRS. It is crucial that practices receive feedback on incidents, and trained network management personnel can provide such support.
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The theatre sterile surgical unit (TSSU) is an essential core to support the operating theatres in National University Hospital. Surgical instruments and supplies are processed, packaged and sterilised safe for surgical procedures. A rapid improvement event adopting lean methodology was conducted with the TSSU team to streamline the workflows in this area. ⋯ Long-term initiatives such as the use of disposables and an improved theatre instrument management system were planned for as well. Initiatives derived from this project can be spread to other sterile supply units within the hospital, further optimising the use of resources at a hospital level. The concept of role redesign was found to be applicable to healthcare, highlighting its potential in other areas of the hospital.
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Paediatric resuscitation is highly stressful, technically challenging and infrequently performed by paramedics. Length-based equipment selection, weight-based medication dosing and less familiar paediatric clinical scenarios create high cognitive load. Our project aimed to decrease cognitive load and increase paramedic comfort by providing standardised paediatric resuscitation cards across an entire Emergency Medical Services (EMS) system. ⋯ MOPed cards were well adopted across a large EMS system, with improvement in paramedic comfort in managing some paediatric resuscitation scenarios.