BACKGROUND AND AIMSInflammatory bowel diseases (IBDs) are chronic gastrointestinal conditions requiring long-term outpatient follow-up, ideally by a dedicated, multidisciplinary team. In this team, ...the IBD nurse is the key point of access for education, advice, and support. We investigated the effect of the introduction of an IBD nurse on the quality of care delivered.
METHODSIn September 2014, an IBD nurse position was instituted in our tertiary referral center. All contacts and outcomes were prospectively recorded over a 12-month period using a logbook kept by the nurse.
RESULTSBetween September 2014 and August 2015, 1313 patient contacts were recorded (42% men, median age38 years, 72% Crohn’s disease, 83% on immunosuppressive therapy). The contacts increased with timeQ1 (September–November 2014)144, Q2322, Q3477, and Q4370. Most of the contacts were assigned to scheduling of follow-up (316/1420), start of new therapy (173/1420), therapy follow-up (313/1420), and providing disease information (227/1420). In addition, 134 patients contacted the IBD nurse for flare management and a smaller number for administrative support, psychosocial support, and questions about side effects. During the study period, 30 emergency room and 133 unscheduled outpatient visits could be avoided through the intervention of the IBD nurse. A faster access to procedures and other departments could be provided for 136 patients.
CONCLUSIONThe role of IBD nurses as the first point of contact and counseling is evident from a high volume of nurse–patient interactions. Avoidance of emergency room and unscheduled clinic visits are associated with these contacts.
To examine trends in patient experiences in the period 2014-2019, describe improvement strategies implemented by hospitals in the same period, and study associations between patient experiences and ...implemented strategies.
Multi-center retrospective region-wide observational design.
Flanders, Belgium.
44 out of 46 Flemish acute-care hospitals publicly reporting patient experiences via the Flemish Patient Survey (FPS).
Primary outcomes were the two global FPS ratings: percentage of patients rating the hospital 9 or 10 and percentage of patients definitely recommending the hospital. Secondary outcomes were the average top-box score percentages for each of the 8 remaining dimensions of the FPS.
Between 2014 and 2019, there was a significant improvement in patients scoring the hospital 9 or 10 (56% to 61%) and patients definitely recommending (67% to 70%) the hospital. Significant increases in patient experiences over time were also observed in other dimensions, except for the dimension discharge. Hospital key informants reported various improvement strategies related to patient experiences with care and the FPS. Feedback to nursing wards (n = 44, 100%) and clinicians (n = 39, 89%) were most common. Overall, most improvement strategies were not or only weakly associated with patient experience ratings in 2019 and changes in ratings over time. Still, positive associations were discovered between the strategies 'nursing ward interventions' and 'hospital wide education' and recommendation of the hospital.
Patient experiences have improved modestly in Flemish acute-care hospitals. Hospitals report to have invested in patient experience improvement strategies but positive associations between such strategies and FPS scores are weak, although there is potential in further exploring nursing ward interventions and hospital wide education. Hospitals should continue their efforts to improve the patient's experience, but with a more targeted approach, taking the lessons learned on the efficacy of strategies into consideration.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose
Proximal humeral fractures are the third most common fractures affecting the elderly. Angular stable osteosynthesis has become indispensable in the operative treatment. However, surgical ...fixation remains challenging. The aim of this retrospective study was to analyse the failure rate after osteosynthesis of proximal humeral fractures over a year in a level-1 trauma centre. Furthermore, parameters that are presumed to be related to osteosynthesis failure will be investigated and discussed.
Methods
After meeting the exclusion criteria, 134 patients were operatively treated with angular stable osteosynthesis between January 2017 and January 2018 at the University Hospitals of Leuven.
Results
Circa 16% of the proximal humeral osteosyntheses failed. Our study showed that the most significant parameter for osteosynthesis failure was smoking. The odds of failure were significantly lower if treated by a shoulder surgeon compared to another trauma surgeon in the plate and nail group combined.
Conclusion
The management of proximal humeral fracture osteosynthesis remains a controversial subject. In this retrospective analysis, a failure rate of 15.7% was calculated. Smoking is a statistically significant parameter related to osteosynthesis failure. The subspecialty of the treating trauma surgeon affected the failure rate significantly. A lower failure rate was noted after osteosynthesis by a shoulder surgeon compared to another trauma surgeon.
In healthcare, improvement leaders have been inspired by the frameworks from industry which have been adapted into control systems and certifications to improve quality of care for people. To address ...the challenge to regain trust in healthcare design and delivery, we propose a conceptual framework, i.e. the "House of Trust". This House brings together the Juran Trilogy, the emerging concept of co-production in quality management and the multidimensional definition of quality, which describes core values as an integral part of the system to deliver person- and kin-centered care.
In the "House of Trust" patients, their kin, healthcare providers, executives and managers feel at home, with a sense of belonging. If we want to build a care organization that inspires and radiates confidence to all stakeholders, highlighting the basic interactions between front- and back-office is required. An organization with both well-organized back- and front-offices can enable all to benefit from the trust each of them needs and deserves.
A quality system does not depend on government inspection and regulations nor on external accreditation to develop itself into a House of Trust. Success will only be achieved if all involved continuously question themselves about the technical dimensions of quality and their core values during the "moment of truth".
ObjectivesTo describe healthcare providers’ symptoms evoked by patient safety incidents (PSIs), the duration of these symptoms and the association with the degree of patient harm caused by the ...incident.DesignCross-sectional survey.Setting32 Dutch hospitals that participate in the ‘Peer Support Collaborative’.Participants4369 healthcare providers (1619 doctors and 2750 nurses) involved in a PSI at any time during their career.InterventionsAll doctors and nurses working in direct patient care in the 32 participating hospitals were invited via email to participate in an online survey.Primary and secondary outcome measuresPrevalence of symptoms, symptom duration and its relationship with the degree of patient harm.ResultsIn total 4369 respondents were involved in a PSI and completely filled in the questionnaire. Of these, 462 reported having been involved in a PSI with permanent harm or death during the last 6 months. This had a personal, professional impact as well as impact on effective teamwork requirements. The impact of a PSI increased when the degree of patient harm was more severe. The most common symptom was hypervigilance (53.0%). The three most common symptoms related to teamwork were having doubts about knowledge and skill (27.0%), feeling unable to provide quality care (15.6%) and feeling uncomfortable within the team (15.5%). PSI with permanent harm or death was related to eightfold higher likelihood of provider-related symptoms lasting for more than 1 month and ninefold lasting longer than 6 months compared with symptoms reported when the PSI caused no harm.ConclusionThe impact of PSI remains an underestimated problem. The higher the degree of harm, the longer the symptoms last. Future studies should evaluate how these data can be integrated in evidence-based support systems.
Objectives
This study aimed to describe the differences and similarities in the reaction of the healthcare worker involved in a patient safety incident or during the COVID-19 pandemic. We also ...compared the differences in support they need.
Methods
A secondary data analysis was performed based on 2 cross-sectional survey studies. One study evaluated the impact of patient safety incidents on healthcare professionals, and the other evaluated the impact of COVID-19. Measurements on mental health reactions and an evaluation of the experienced support system were compared between 883 doctors and 1970 nurses working in different hospitals.
Results
Anxiety, difficulties concentrating, doubting knowledge and skills, feeling on their own, feeling unhappy and dejected, feeling uncertain in team, flashbacks, hypervigilance, sleep deprivation, stress and wanting to quit profession were statistically higher in the COVID-19–related groups. Second victims tend to speak about it with their own/close colleagues, whereas healthcare workers working during the COVID-19 pandemic talk more often to their partner and friends. Only a small number talked to a psychologist, but the number who needed to talk to a psychologist but did not is higher than the number who did talk to a psychologist or used professional support in all 5 groups.
Conclusions
The impact of the COVID-19 pandemic on the mental health of healthcare workers is larger than after being involved in a patient safety incident. There is the need for an adequate support system, and the mental health of all healthcare workers needs to be considered. Partners and friend play a more important role in the support experienced during the COVID-19 pandemic, and there is an important need for professional help.
Background
For amoxicillin-clavulanic acid and meropenem to be effective, concentrations must exceed the minimum inhibitory concentration of infecting pathogens.
Objective
To retrospectively evaluate ...time windows between both scheduled prescription and administration and reconstitution-preparation and end of administration of intravenous amoxicillin-clavulanic acid and meropenem prescriptions.
Setting
37 hospital wards at a tertiary hospital, Belgium.
Method
All adult hospital stays with at least one amoxicillin-clavulanic acid or meropenem administration in 2018 were reviewed. Time windows were deemed acceptable if < 30 min between prescription and administration and < 90 or < 150 min between reconstitution-preparation and end of administration for amoxicillin-clavulanic acid and meropenem, respectively.
Main outcome measure
Time windows between prescription and administration and between reconstitution-preparation and administration.
Results
For 50 273 administered prescriptions, both time windows were acceptable in 53.7% of first dose and 56.4% of follow-up dose administrations. 43.7% of first doses did not respect the time window between reconstitution-preparation and administration (2.8%) or between prescription and administration (40.9%). These discrepancies equalled 11.1% and 26.3% for follow-up doses, respectively. Large variation across hospital wards was observed. After the first five consecutive administrations, 93.1% of patients had not received their antibiotics within the time windows allowed. The most striking predictor of timely administration with respect to both prescription and reconstitution-preparation time was prescription synchronisation with nursing administration rounds.
Conclusion
For amoxicillin-clavulanic acid and meropenem, timeliness of reconstitution-preparation and administration was appropriate in approximately half of administrations. Evaluating and safeguarding the timeliness of antibiotic administration should be considered an important aspect of antibiotic stewardship.
Measuring quality is essential to drive improvement initiatives in hospitals. An instrument that measures healthcare quality multidimensionally and integrates patients', kin's and professionals' ...perspectives is lacking. We aimed to develop and validate an instrument to measure healthcare quality multidimensionally from a multistakeholder perspective.
A multi-method approach started by establishing content and face validity, followed by a multi-centre study in 17 Flemish (Belgian) hospitals to assess construct validity through confirmatory factor analysis, criterion validity through determining Pearson's correlations and reliability through Cronbach's alpha measurement. The instrument FlaQuM-Quickscan measures 'Healthcare quality for patients and kin' (part 1) and 'Healthcare quality for professionals' (part 2). This bipartite instrument mirrors 15 quality items and 3 general items (the overall quality score, recommendation score and intention-to-stay score). A process evaluation was organised to identify effective strategies in instrument distribution by conducting semi-structured interviews with quality managers.
By involving experts in the development of quality items and through pilot testing by a multi-stakeholder group, the content and face validity of instrument items was ensured. In total, 13,615 respondents (5,891 Patients/kin and 7,724 Professionals) completed the FlaQuM-Quickscan. Confirmatory factor analyses showed good to very good fit and correlations supported the associations between the quality items and general items for both instrument parts. Cronbach's alphas supported the internal consistency. The process evaluation revealed that supportive technical structures and approaching respondents individually were effective strategies to distribute the instrument.
The FlaQuM-Quickscan is a valid instrument to measure healthcare quality experiences multidimensionally from an integrated multistakeholder perspective. This new instrument offers unique and detailed data to design sustainable quality management systems in hospitals. Based on these data, hospital management and policymakers can set quality priorities for patients', kin's and professionals' care. Future research should investigate the transferability to other healthcare systems and examine between-stakeholders and between-hospitals variation.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A substantial degree of variability in practices exists amongst donor hospitals regarding the donor detection, determination of brain death, application of donor management techniques or achievement ...of donor management goals. A possible strategy to standardize the donation process and to optimize outcomes could lie in the implementation of a care pathway. The aim of the study was to identify and select a set of relevant key interventions and quality indicators in order to develop a specific care pathway for donation after brain death and to rigorously evaluate its impact.
A RAND modified three-round Delphi approach was used to build consensus within a single country about potential key interventions and quality indicators identified in existing guidelines, review articles, process flow diagrams and the results of the Organ Donation European Quality System (ODEQUS) project. Comments and additional key interventions and quality indicators, identified in the first round, were evaluated in the following rounds and a subsequent physical meeting. The study was conducted over a 4-month time period in 2016.
A multidisciplinary panel of 18 Belgian experts with different relevant backgrounds completed the three Delphi rounds. Out of a total of 80 key interventions assessed throughout the Delphi process, 65 were considered to contribute to the quality of care for the management of a potential donor after brain death; 11 out of 12 quality indicators were validated for relevance and feasibility. Detection of all potential donors after brain death in the intensive care unit and documentation of cause of no donation were rated as the most important quality indicators.
Using a RAND modified Delphi approach, consensus was reached for a set of 65 key interventions and 11 quality indicators for the management of a potential donor after brain death. This set is considered to be applicable in quality improvement programs for the care of potential donors after brain death, while taking into account each country's legislation and regulations regarding organ donation and transplantation.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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