Risky Business: Creating A Process To Review Accuracy Of American Society Of Anesthesia (Asa) Classification And To Improve Overall Quality Risk Adjustment Of Surgical Patients, Jane Kinney, Sonja Orff, Robyn Begin, Nicholas Flavin, Eira Hyrkas, Christopher Adams, Ian Neilson

Costas T. Lambrew Research Retreat 2024

Through interdisciplinary education and the creation of an audit process, we have observed a 30.6% reduction in the number of ASA assignment misclassifications.

Operationalizing The Datagauge Framework In A Health Information Exchange Utilizing Hepatitis C Data, Edward Yao

Translational Projects (Open Access)

This project aims to implement the DataGauge framework in a health information exchange (HIE) setting as a proof of concept. The modified DataGauge framework, described by Diaz-Garelli et al. (2019), is utilized to test its functionality and applicability with any dataset. The specific objective of the project is to determine the number of hepatitis C-positive tests within the HIE. The implementation involved multiple iterations following the DataGauge framework's steps for data extraction and analysis. Five iterations were conducted, resulting in both successful and failed queries based on the validity of the data standards. The findings revealed that the HIE, in …

Audit Tumor Reports In Pathology For Completeness And Compliance By An Artificial Intelligence Tool, Chatgpt, Ashbita Pokharel, Keran Zhao, Reenal Patel, Jack W. Qu, Zhenhong Qu

Conference Presentation Abstracts

Context: A tumor synoptic report (TSR) audit is an important quality control tool for compliance with reporting requirements; however, no simple audit tool is readily available to most pathologists. ChatGPT (https://chat.openai.com/chat) is an emerging artificial intelligence tool with wide applications. Its ability to extract data from text content has been widely reported but lacks evidence-based validation for its application in medicine. We assess the effectiveness of ChatGPT to identify and extract key data elements of TSRs and detect missing elements.

Design: Forty synoptic reports of malignant tumors of the lung, kidney, colon, and uterus were collected randomly. Key data elements …

Lived Experience-Centred Word Clouds May Improve Research Uncertainty Gathering In Priority Setting Partnerships, Oliver D. Mowforth, Lance Burn, Danyal Z. Khan, Xiaoyu Yang, Sybil R.L. Stacpoole, Toto Gronlund, Lindsay Tetreault, Sukhvinder Kalsi-Ryan, Michelle L. Starkey, Iwan Sadler, Ellen Sarewitz, Delphine Houlton, Julia Carter, Paige Howard, Vafa Rahimi-Movaghar, James D. Guest, Bizhan Aarabi, Brian K. Kwon, Shekar N. Kurpad, James Harrop, Jefferson R. Wilson, Robert Grossman, Emma K. Smith, Angus Mcnair, Michael G. Fehlings, Mark R.N. Kotter, Benjamin M. Davies

Department of Neurosurgery Faculty Papers

INTRODUCTION: AO Spine RECODE-DCM was a multi-stakeholder priority setting partnership (PSP) to define the top ten research priorities for degenerative cervical myelopathy (DCM). Priorities were generated and iteratively refined using a series of surveys administered to surgeons, other healthcare professionals (oHCP) and people with DCM (PwDCM). The aim of this work was to utilise word clouds to enable the perspectives of people with the condition to be heard earlier in the PSP process than is traditionally the case. The objective was to evaluate the added value of word clouds in the process of defining research uncertainties in National Institute for …

Implementing An Educational Intervention Aimed At Nursing Staff To Improve Patient Hand Hygiene, Bonita Moore

DNP Projects

Abstract

Background/Purpose: Healthcare organizations are responsible for ensuring that healthcare workers adhere to effective hand hygiene (HH) protocols, and ample research exists on the best methods for monitoring and encouraging compliance. Despite the importance of HH for infection prevention, there has been little focus on patient hand hygiene (PHH). The purpose of this pilot project was to focus on improving nursing staff’s knowledge and attitudes about PHH with the expectation of showing a correlation between these factors and an increase in the performance PHH.

Methods: The project used a quasi-experimental study that took place on one hospital unit at …

Creating The Stroke Compliance Report For System Wide Use, Staci Howard Bsn, Rn, Samantha Baker Bsn, Rn

Nursing Publications

Poster presented at Nursing Research Symposium 2022.

Purpose/Aim: The aim of this project was to create an all encompassing stroke core measure report in one easy to access location which would decrease time spent completing audits.

Problems: • Feedback regarding audit tool determined it to be cumbersome and tedious • Each audit required nurse leader to enter each patient record to search for the information • Completion of the audit took a considerable amount of time which removed the nurse leader from the bedside and patient care.

Administrative Data Improves Quality Of Cervical Pre-Cancer Surveillance In Davidson County, Tennessee, United States, Sheelah Blankenship, Manideepthi Pemmaraju, Edward Mitchel, Tiffanie M. Markus, Marie R. Griffin, Jessica L. Castilho

Journal of Health Research

Background: Accurate data are critical for public health surveillance yet can be challenging to ensure. The Tennessee (TN) HPV Vaccine IMPACT Project aims to assess the effectiveness of the human papillomavirus (HPV) vaccine in prevention of cervical cancer and high-grade dysplasia through laboratory reporting of pathology results among Davidson County women. This project assessed feasibility and value of use of administrative sources for improved data quality and completeness of high-grade cervical events in TN HPV-IMPACT between 2013-2017.

Method: We queried three administrative data systems (Hospital Discharge Data System, Ambulatory Surgical Treatment Center, and Tennessee Medicaid [TennCare]) for eligible women with …

Critical Analysis Of Laboratory Requisition Forms Received In A Cytopathology Laboratory Of A Tertiary Care Centre: An Audit And Review Of Literature, Shivali Sehgal, Sujata Jetley, Zeeba S Jairajpuri, Sabina Khan

Journal Articles

BACKGROUND: A laboratory requisition form (LRF) is the main communication link between the laboratories and the clinicians. In a cytopathology laboratory, incomplete forms with inadequate information significantly impact the quality of the results and waste precious time of the lab.

AIMS: The aim of this study was to audit the LRFs for adequacy of demographic and clinical data and to analyze the reasons for the same.

SETTINGS AND DESIGN: A retrospective study was conducted in the cytopathology laboratory of a tertiary care center.

MATERIALS AND METHODS: All the original LRFs received for Pap smears and FNACs of 1-month duration were …

Applying A Mixed-Method Approach To Improve On-The-Job Learning And Job Satisfaction In A Cohort Of Interns At A University Hospital, Amna Subhan Butt, Muhammad Shahzad Shamim, M Asghar Ali, Farah Naz Qamar, Irum Qamar Khan, Swaleha Tariq, Syeda Amrah Hashmi, Quratulain Hafeez, Muhammed Tariq

Section of Gastroenterology

Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern's work-based learning and satisfaction in a university hospital setting.
Methods: Using Kern's six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome …

Quality Assurance Audit In Adult Cardiac Anaesthesia, Syed Shabbir Ahmed, Mohammad Hamid, Faisal Junejo

Department of Anaesthesia

Objective: To assess different anaesthesia-related quality indicators during adult cardiac surgery.
Methods: The prospective clinical audit was conducted at the Aga Khan University Hospital, Karachi, from October 2016 to March 2017, and comprised all adult patients scheduled for cardiac surgery. Different anaesthesia-related quality indicators were observed during the pre-induction phase, before the cardiopulmonary bypass, during the procedure, and post-surgery till the transfer from the operating room to the cardiac intensive care unit. Data was analysed using SPSS 19.
Results: Of the 264 patients, 217(82.2%) had complete record; 160(73.7%) males and 57(26.3%) females. The overall mean age was 56.56±12.46 years. In …

Impact Of Audit And Feedback On Timing Variation In The Point Of Care Glucose Collection-Insulin Administration Workflow: A Quality Improvement Study, Paula S. Hudon

DNP Scholarly Projects

BACKGROUND: Multiple roles contribute to the point of care glucose collection and insulin administration workflow. Diabetes care associations and safety advocates provide recommendations since the time-action profile of prandial insulin requires knowledge and performance to deliver insulin safely.

PROBLEM: Variation of practice in relation to the time that point of care glucose was collected and meal and insulin administration assessments were completed failed to meet parameters.

PURPOSE: A quality improvement project aimed to test the effect audit and feedback has on rapid acting insulin administration and point of care glucose collection practice at meals.

METHOD: Audit and feedback, a knowledge …

Behavioral Health Audit Tool Implementation And Health Care Documentation, Stephanie Lou Weatherly

Walden Dissertations and Doctoral Studies

Quality documentation is a foundational element in healthcare. This QI project was conducted to examine the extent to which the implementation of a standardized behavioral health audit tool influenced compliance with required documentation elements. The context, input, process, product evaluation model was used to support the need for documentation compliance in behavioral health. A new audit tool was developed and implemented. Retrospective audit data were gathered from 86 locations over a period of 3 years, reflecting quarterly corporate audits and monthly program self-audit results. The first five quarters exhibited the widest variation in scoring; 28 locations required action plans for …

Ppe Compliance And Knowledge Among Healthcare Staff, Beatrice Hagert, Nicole Krummel

Nursing DNP Projects

Abstract

Problem: One of the most important steps in infection prevention is the use of personal protective equipment (PPE) to protect patients and staff from infectious agents; yet, research indicates that PPE compliance remains suboptimal in many healthcare institutions.

Purpose: To identify the effect of a multidisciplinary education campaign on PPE compliance and knowledge among healthcare workers (HCWs) on a rehabilitation unit of a large, midwestern teaching hospital.

Methods: This project utilized pre-intervention observational audits and a survey to determine baseline PPE compliance and knowledge on the piloted units. A post-intervention survey was sent to HCW to assess for a …

Standardisation Of Systemic Anti-Cancer Therapy (Sact) Prescription Forms: A Pre–Post Audit Evaluation, Felicity Sim, Gail Ross-Adjie, Leanne Monterosso

Nursing Papers and Journal Articles

Introduction Clinical practice guidelines based on best available evidence and national safety and quality standards promote high quality and safe care.

Aim To review and standardise systemic anti-cancer therapy (SACT) forms in a 20-chair cancer centre to reflect Australian and international clinical practice guidelines.

Method A pre–post audit design based on Clinical Oncological Society of Australia (COSA) guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy underpinned the project. The pre-audit (47 forms) provided a benchmark for SACT form improvements: 177 new forms were then developed over 18 months and implemented.

Results Pre-audit: 9/19 criteria were >70% …

Comparison Of A Self-Audit Tool To Accrediting Health Care Agencies’ Standards Of Care In A Corrections Setting, Matthew C. Widerman

Doctoral Projects

Millions of individuals enter correctional facilities each year and require health services. Inmates are bound to a set of rules, wherein they are thought of as objects of surveillance, punishment, or rehabilitation, rather than as patients. In addition to standards of care defined by national accrediting bodies and state boards of practice, correctional facilities also have state laws that define expected health services for incarcerated persons. All health care providers have a responsibility to provide the highest quality care, but in prisons, patients are still inmates bound to correctional rules. Policies and procedures guide health care practices in correctional facilities, …

Re-Code Dcm (Research Objectives And Common Data Elements For Degenerative Cervical Myelopathy): A Consensus Process To Improve Research Efficiency In Dcm, Through Establishment Of A Standardized Dataset For Clinical Research And The Definition Of The Research Priorities, Benjamin M. Davies, Danyal Z. Khan, Oliver D. Mowforth, Angus G.K. Mcnair, Toto Gronlund, Angelos G. Kolias, Lindsay Tetreault, Michelle L. Starkey, Iwan Sadler, Ellen Sarewitz, Delphine Houlton, Julia Carter, Sukhvinder Kalsi-Ryan, Bizhan Aarabi, Brian K. Kwon, Shekar N. Kurpad, James Harrop, Jefferson R. Wilson, Robert Grossman, Armin Curt, Michael G. Fehlings, Mark R.N. Kotter

Department of Neurosurgery Faculty Papers

Study Design: Mixed-method consensus process.

Objectives: Degenerative cervical myelopathy (DCM) is a common and disabling condition that arises when mechanical stress damages the spinal cord as a result of degenerative changes in the surrounding spinal structures. RECODE-DCM (REsearch Objectives and Common Data Elements for Degenerative Cervical Myelopathy) aims to improve efficient use of health care resources within the field of DCM by using a multi-stakeholder partnership to define the DCM research priorities, to develop a minimum dataset for DCM clinical studies, and confirm a definition of DCM.

Methods: This requires a multi-stakeholder partnership and multiple parallel consensus development processes. It …

Clinical Audit To Assess Delays In Chemotherapy Administration At Daycare Oncology Center At A Tertiary Care Hospital In Karachi, Pakistan, Arifa Arifa Aziz, Zarka Samoon, Afsheen Feroz, Nadia Ayoub, Safia Awan, Madhia Beg

Department of Radiation Oncology

Aim: There were delays reported by patients in chemotherapy administration in daycare oncology. Therefore, we decided to audit all processes which are involved in chemotherapy administration. The objective was to improve our service by decreasing the time between admission and initiation of chemotherapy and identify the reasons for delays. Materials and Methods: The audit was conducted in three parts. In Review I, audit tool was developed and information documented of 109 patients receiving chemotherapy at daycare center from April 14 to May 13, 2015. Five processes were assessed out of which delay in initial assessment by the nurse was the …

Clinical Audit To Assess Delays In Chemotherapy Administration At Daycare Oncology Center At A Tertiary Care Hospital In Karachi, Pakistan, Arifa Aziz, Zarka Samoon, Mohammad Khurshid, Afsheen Feroz, Nadia Ayoub, Safia Awan, Madhia Beg

Section of Haematology/Oncology

Aim: There were delays reported by patients in chemotherapy administration in daycare oncology. Therefore, we decided to audit all processes which are involved in chemotherapy administration. The objective was to improve our service by decreasing the time between admission and initiation of chemotherapy and identify the reasons for delays.

Materials and Methods: The audit was conducted in three parts. In Review I, audit tool was developed and information documented of 109 patients receiving chemotherapy at daycare center from April 14 to May 13, 2015. Five processes were assessed out of which delay in initial assessment by the nurse was the …

Meeting Joint Commission Compliance By Improving The Chart Audit Process, Nicole Hiroi

Master's Projects and Capstones

A hospice and home health care agency with an estimated 300 current patients looking to gain Joint Commission accreditation tasked its quality improvement department with identifying and improving deficiencies in the nursing documentation of patients’ charts. In order to do so, a redesign of their current chart auditing system needed to occur to take the process from pen and paper to an electronic database where the data gathered from the audit could be disseminated. The quality improvement team focused on ensuring that the new electronic process was user-friendly, encompassed all the quality areas needed, and allowed charts to be reviewed …

Developing And Implementing A Quality Assurance Strategy For Electroconvulsive Therapy, Jessa Hollingsworth

Theses and Dissertations

The literature provides scant guidance in effective quality assurance strategies concerning the use of electroconvulsive therapy (ECT) for the treatment of psychiatric conditions. Numerous guidelines are published that provide guidance in the delivery of care, however, little has been done to determine how a program or facility might ensure compliance to best practice for safety, tolerability, and efficacy in performing ECT. The objective of this project was to create a quality assurance strategy specific to ECT. Determining standards for quality care and clarifying facility policy were key outcomes in establishing an effective quality assurance strategy. An audit tool was developed …

The Effect Of A Multifaceted Reminder Intervention On Nursing Documentation Completeness, Meredith A. White

Evidence-Based Practice Project Reports

Nationwide, nurses must withstand growing patient assignments and increased workloads. The consistency between nursing documentation and technical nursing interventions performed indicates that registered nurses provide much more care than they record. This incongruence has the potential to impact patient safety, but also has significant financial implications, since reimbursement is linked to documented services. The purpose of this EBP project was to implement a multifaceted reminder intervention (including a 10-minute PowerPoint and visual reminder) in an IMCU setting to assist the nursing staff (n = 38) in completing the HAPU documentation components. John Kotter’s Eight-Stage Process and the Iowa Model of …

Audit Of Endoscopic Third Ventriculostomy In The Treatment Of Obstructive Hydrocephalus, Hayat Mohammad Khan, Naeemul Haq, Muhammad Usman, Ramzan Hussain

Pakistan Journal of Neurological Sciences (PJNS)

To analyze various aspects of endoscopic third ventriculostomy in the treatment of obstructive hydrocephalus. Material and Methods: This descriptive study was conducted in the Department of Neurosurgery Lady Reading Hospital Peshawar from September 2010 to April 2011. All patients who underwent endoscopic third ventriculostomy were included in the study. Data was analyzed on SPSS version sixteen. Results: Total of 59 patients were included in the study. Thirty two patients were male and 27 were female. Most of the patients presented with headache, vomiting and loss of consciousness. The procedure was successful in 69 percent of cases. Common operative complication was …

Electronic Documentation Systems: The Impact On Pain Documentation, Stephanie Gilbertson-White, S. Shapiro

Stephanie Gilbertson-White

No abstract provided.

An Audit Of Vending Machines In Public Places In Regional Nsw, Australia, V Flood, A Carrad, A Alshukri, J Louie, B Kelly, H Yeatman, L Tapsell

Illawarra Health and Medical Research Institute

Abstract of paper that presented at 20th International Congress of Nutrition, Granada, September 2013.

Improvement In The Management Of Acutely Poisoned Patients Using An Electronic Database, Prospective Audit And Targeted Educational Intervention, S Greene, David Wood, I Gawarammana, C Warren-Gash, Nick Drake, Alison Jones, Paul Dargan

Alison L Jones

Problem: The need to improve the clinical assessment and management of acutely poisoned patients presenting to an NHS hospital emergency department (ED). Design: Creation of an electronic clinical toxicology database to prospectively collect all aspects of clinical information on poisoned-patient presentations. Systematic analysis of collated information to identify shortfalls in patient assessment and management. Bimonthly audit meetings, and design and implementation of educational interventions to address identified shortfalls. Ongoing audit to demonstrate continued improvement in patient care. Background and setting: ED in tertiary-level inner-city London teaching hospital. Study conducted by staff from the ED and clinical toxicology service. Key measures …

The Use Of Provider Audit And Feedback On Improving Hypertension Control In The Type 2 Diabetic Population, Kara Painton

Evidence-Based Practice Project Reports

As the seventh leading cause of death, diabetes affects more than 25 million Americans and contributes to major cardiovascular diseases and complications (CDC, 2011). The cost of care for these Americans is astounding: $174 billion dollars was spent on diabetes care in 2007 (ADA, 2011). Furthermore, an estimated 75% of patients with type 2 diabetes have concomitant hypertension, and nearly one-half of these patients have uncontrolled hypertension (Thomas & Kodack, 2011; USDHHS, 2011). An initial chart audit at an outpatient, rural clinic in east central Illinois revealed that 90% of the type 2 diabetic population had concomitant hypertension, and only …

An Audit Of Alcohol Brand Websites, Ross Gordon

Faculty of Health and Behavioural Sciences - Papers (Archive)

Introduction and Aims.The study investigated the nature and content of alcohol brand websites in the UK. Design and Methods.The research involved an audit of the websites of the 10 leading alcohol brands by sales in the UK across four categories: lager, spirits, Flavoured Alcoholic Beverages and cider/perry. Each site was visited twice over a 1-month period with site features and content recorded using a pro-forma. The content of websites was then reviewed against the regulatory codes governing broadcast advertising of alcohol. Results.It was found that 27 of 40 leading alcohol brands had a dedicated website. Sites featured sophisticated content, including …

Cancellation Of Surgery In Patients Attending The Preoperative Anaesthesia Assessment Clinic: A Prospective Audit, Tauseef Ahmed, Mueenullah Khan, Fauzia Khan

Department of Anaesthesia

OBJECTIVE: To find the causes of operating room cancellation in patients attending preoperative anaesthesia clinic and scheduled for surgery at our institution.

METHODS: This audit included all those patients who presented to the pre anaesthesia clinic with their surgeries planned in the main operating rooms of our hospital. The duration of this audit was two months. Cancelled cases were identified from the operating room lists and the reasons for cancellations were categorized into above mentioned four factors.

RESULTS: Fifty five (55) cancellations were identified; patient related factors (58%) were the most frequent cause followed by anaesthetic (22%), surgical (18.2%) and …

Success And Failure Of Fast Track Extubation In Cardiac Surgery Patients Of Tertiary Care Hospital: One Year Audit, Mohammad Irfan Akhtar, Mohammad Hamid

Section of Cardiothoracic Surgery

OBJECTIVE: To identify the causes of delayed extubation in patients planned for fast tract extubation during cardiac surgery.

METHODS: A prospective observational study was conducted at cardiothoracic unit of Aga Khan University Hospital for the period of one year. All elective coronary artery bypass graft (CABG) surgery patients, between the ages of 35-75 years with LVEF > or = 40 percent were included. Patients with Intra aortic balloon pump, chronic renal failure, respiratory compromise and requiring high ionotropic support were excluded from this audit. A performa was designed and later filled by the primary investigator. Patient demographics and various reasons for …

Audit Vs. Qualitatssicherung - Versuch Einer Vergleichenden Beurteilung, Hans D. Dahl

Graduate School of Medicine - Papers (Archive)

The term audit occurs regularly in the vocabulary of Anglo-Saxon corrugated surgeons and used with great reverence. The surgical associations have published guidelines for the implementation of audit. The theoretical approaches are similar to the German quality assurance considerations. In this work will investigate to what extent the published audit requirements be implemented in everyday life.