BMJ open quality
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Elective caesarean sections (ELCS) vary widely in surgical complexity and are routinely performed between 39 and 40 weeks of pregnancy. Unselected ELCS lists may create clinical risk due to inappropriately complex case mixes and over-running theatre time, impacting on emergency care. Despite evidence that ELCS list over-run is a widespread concern for many units, there is a paucity of literature regarding effective ELCS booking systems. ⋯ The requirement for extra ELCS lists to accommodate capacity reduced by 66%. ELECTIVIST is a novel system that improves ELCS booking using existing capacity and reduces theatre list over-run. It is transferable, cost neutral and could be widely applied in obstetric units.
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National Health Service England published the National Safety Standards for Invasive Procedures (NatSSIP) in 2015. They mandated that individual trusts produce Local Safety Standards for Invasive Procedures (LocSSIPs), a set of safety standards drawn from the NatSSIP that apply to a particular clinical situation in a given department, for all invasive procedures. The project goal was to design and implement the LocSSIP within the endoscopy department. ⋯ The composite score for compliance in 2016 was 57% increasing to 90% in 2017. In conclusion, stronger departmental leadership, broadening education and integration of the checklist into routine documentation to reduce duplication led to significant improvements in compliance with use of the checklist. Ongoing education and assessment is imperative to ensure that compliance is maintained to ensure patient safety.
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The British Thoracic Society recommends oxygen delivery to achieve target oxygen saturation range between 94% and 98% for medically unwell adult patients, and 88% to 92% in patients at risk of hypercapnic respiratory failure. Interviews with our medical and nursing staff suggested that oxygen was sometimes being given to patients without a valid order and there was a failure to titrate oxygen to the stated oxygen saturation range. Our aim was to improve appropriate oxygen delivery to 90% of our patients on a 30-bedded respiratory ward within 3 months. ⋯ Our quality improvement programme has shown simple interventions can improve oxygen prescribing and appropriate delivery of oxygen to the patient. The most effective PDSA interventions were sharing our measurements via email and displaying target oxygen saturation ranges by the patient bedside. We aim to provide future oxygen educational sessions at induction to our staff and scale our quality improvement programme to other wards including our acute medical unit.
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Maintaining quality of care and meeting patient expectations in the face of rising demand within emergency departments (ED) is a significant challenge for clinicians. This study tested the Always Events (AE) approach as a means to identify AE's relevance to patient care in the ED and act on this to address patient concerns. The project team looked to identify aspects of care patients would like to see improved within the minor injuries stream (MIS). ⋯ Implementing the AE approach in the MIS has improved patient experience. Our poster intervention had the greatest benefit regarding patient understanding of the ED and information provision. This project has also indicated that the AE method can be successfully combined with a QI tool and applied in the ED to address patient needs.