Respiratory physiotherapy: Process mapping to target quality improvement and scope areas for future research

Children’s experiences in early education programs can have a profound influence on their cognitive, social, and emotional development. In these settings, interactions with educators serve as catalysts for children’s healthy development. Yet too few children today are in the types of high-quality early learning environments marked by warm, cognitively stimulating exchanges. This review summarizes research on the features of settings that promote growth in children’s skills across a range of developmental domains, then describes research documenting these features across today’s early education and care landscape. Turning to strategies for cultivating these features across the diverse early education and care system, the discussion focuses on the central role of the educator. The conclusion draws implications for ongoing public preK expansion and quality improvement efforts, as well as highlights opportunities for future research to further these efforts.

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149 Virtual Care: A Quality Improvement Project on the Experience of Paediatricians during the COVID-19 Pandemic

Paediatrics & Child Health ◽

10.1093/pch/pxab061.117 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e102-e104

Author(s):

Emma McCrady ◽

Julie Strychowsky ◽

Jessica Woolfson

Keyword(s):

Quality Improvement ◽

Online Survey ◽

Local Level ◽

Standard Of Care ◽

Subject Area ◽

Future Research ◽

Improvement Project ◽

Diagnostic Uncertainty ◽

Virtual Care ◽

Practice Efficiency

Abstract Primary Subject area Practice/Office Management Background Prior to the COVID-19 pandemic, in-person visits were the standard of care for paediatricians at our centre. With the pandemic onset, virtual care (VC) was adopted at an unprecedented scale and pace. Studies have reported positive patient VC experience; however, few have explored physician experience. This quality improvement (QI) initiative sought to qualify the VC experience of local paediatricians during the pandemic, with the intention of implementing VC clinical practice changes at the department level. Objectives To determine key factors that have supported and challenged the adoption of, and that will support integration of, VC in the future. Design/Methods The Donabedian model for healthcare QI was used to evaluate VC experience through an online survey with a focus on structure, process, and outcome measures. All physicians affiliated with the Department of Paediatrics (generalists and subspecialists in medicine and surgery) were invited to participate via email. Three reminder emails were sent at 2-week intervals. Descriptive statistics were reported. Results The response rate was 32.3% (63 of 195 physicians). The majority of respondents were subspecialists (84.1%), and at academic centres (87.5%) (Table 1). Pre-pandemic, only 30.1% used VC and saw <10% of patients virtually. During March-May 2020, 93.8% transitioned to VC, with > 50% seeing over 75% of patients virtually. By summer 2020, VC use declined, but remained higher than pre-pandemic (53.6% seeing < 25% of patients). OTN and telephone were platforms most used (32.8% and 28.6%, respectively). Most conducted visits from their work location (55.2%) versus home (44.8%). VC experience was considered positive by most physicians (73.6%), and only 18.8% found VC difficult to use despite technical difficulties reported by 41.5% (Figure 1). Physicians with ≤ 5 years in practice were most likely to find VC convenient (93.8%). Challenges with VC included lack of physical exam, diagnostic uncertainty, lower patient volumes, and poor patient VC etiquette. Regardless of practice location, specialty, years in practice, and prior experience, 96% would continue VC to 25% of patients, ideally for patients who live far away (26.4%) and for follow-ups of patients with established diagnoses (21.4%). Conclusion A rapid transition to VC during the COVID-19 pandemic was associated with challenges but also positive experiences. Willingness to continue VC was high. VC experience could be improved with greater patient education and focus on select patient populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for VC at a local level.

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Standardising Care in the ICU: A Protocol for a Scoping Review of Tools used to Improve Care Delivery

10.21203/rs.2.18217/v3 ◽

2020 ◽

Author(s):

laura Allum ◽

Chloe Apps ◽

Nicholas Hart ◽

Natalie Pattison ◽

Bronwen Connolly ◽

...

Keyword(s):

Quality Improvement ◽

Clinical Practice ◽

Care Delivery ◽

Cochrane Library ◽

Future Research ◽

Care Plans ◽

Icu Stay ◽

Structured Care ◽

High Dependency ◽

Prolonged Icu Stay

Abstract Background: Increasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families, and cost to health systems. Quality improvement tools such as checklists concisely articulate best practices with the aim of improving quality and safety, however these tools have not been designed for the specific needs of patients with prolonged ICU stay. The primary objective of this review will be to determine the characteristics including format and content of multicomponent tools designed to standardise or improve ICU care. Secondary objectives are to describe the outcomes reported in these tools, the type of patients and settings studied, and to understand how these tools were developed and implemented in clinical practice. Methods: We will search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO, Web of Science, OpenGrey, NHS evidence and Trial Registries from January 2000 onwards. We will include primary research studies (e.g. experimental, quasi-experimental, observational, and qualitative studies) recruiting more than 10 adult participants admitted to ICUs, high dependency units and weaning centres regardless of length of stay, describing quality improvement tools such as structured care plans or checklists designed to standardize more than one aspect of care delivery. We will extract data on study and patient characteristics, tool design and implementation strategies and measured outcomes. Two reviewers will independently screen citations for eligible studies and perform data extraction. Data will be synthesised with descriptive statistics; we will use a narrative synthesis to describe review findings. Discussion: The findings will be used to guide development of tools for use with prolonged ICU stay patients. Our group will use experience-based co-design methods to identify the most important actionable processes of care to include in quality improvement tools these patients. Such tools are needed to standardise practice and thereby improve quality of care. Illustrating the development and implementation methods used for such tools will help to guide translation of similar tools into ICU clinical practice and future research.Systematic Review Registration: This protocol is registered on the Open Science Framework, https://osf.io/, DOI 10.17605/OSF.IO/Z8MRE

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Conclusion

Ecotourism and Community Intervention - Advances in Hospitality, Tourism, and the Services Industry ◽

10.4018/978-1-7998-1635-5.ch005 ◽

2020 ◽

pp. 222-244

Keyword(s):

Quality Improvement ◽

Causal Relationship ◽

Community Intervention ◽

Intervention Strategies ◽

Future Research ◽

Study Analysis ◽

Research Opportunities ◽

Case Study Analysis

The concluding remarks of the case study analysis of community intervention strategies and resultant changes are presented in this chapter. The causal relationship between various variables under study and destination quality improvement and stakeholder opinions on community intervention strategies are included subsequently. The study contributions to theory, practice, and society, and the contemporary significance of the study is discussed. The significance and implications both theoretical as well as managerial are also explored and presented along with future research opportunities. The chapter ends with a few constructive suggestions and recommendations to strengthen institutional community intervention in ecotourism destinations.

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Enabling continuous learning and quality improvement in health care

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-10-2017-0198 ◽

2018 ◽

Vol 31 (6) ◽

pp. 587-599 ◽

Cited By ~ 2

Author(s):

Robert William Smith ◽

Elaina Orlando ◽

Whitney Berta

Keyword(s):

Quality Improvement ◽

Organizational Learning ◽

Performance Management ◽

Future Research ◽

Performance Management System ◽

Continuous Learning ◽

Learning Models ◽

Content Type ◽

Organizational Learning Theory ◽

And Performance

Purpose The purpose of this paper is to examine how the design and implementation of learning models for performance management can foster continuous learning and quality improvement within a publicly funded, multi-site community hospital organization. Design/methodology/approach Niagara Health’s patient flow performance management system, a learning model, was studied over a 20-month period. A descriptive case study design guided the analysis of qualitative observational data and its synthesis with organizational learning theory literature. Emerging from this analysis were four propositions to inform the implementation of learning models and future research. Findings This performance management system was observed to enable: ongoing performance-related knowledge exchange by creating opportunities for routine social interaction; collective recognition and understanding of practice and performance patterns; relationship building, learning for improvement, and “higher order” learning through dialogue facilitated using humble inquiry; and, alignment of quality improvement efforts to organizational strategic objectives through a multi-level feedback/feed-forward communication structure. Research limitations/implications The single organization and descriptive study design may limit the generalizability of the findings and introduce confirmation bias. Future research should more comprehensively evaluate the impact of learning models on organizational learning processes and performance outcomes. Practical implications This study offers novel insight which may inform the design and implementation of learning models for performance management within and beyond the study site. Originality/value Few studies have examined the mechanics of performance management systems in relation to organizational learning theory and research. Broader adoption of learning models may be key to the development of continuously learning and improving health systems.

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Current developments and future directions in respiratory physiotherapy

European Respiratory Review ◽

10.1183/16000617.0264-2020 ◽

2020 ◽

Vol 29 (158) ◽

pp. 200264

Author(s):

Antenor Rodrigues ◽

Gerard Muñoz Castro ◽

Cristina Jácome ◽

Daniel Langer ◽

Selina M. Parry ◽

...

Keyword(s):

Clinical Practice ◽

Integrated Care ◽

Respiratory Diseases ◽

Respiratory Therapy ◽

Current Evidence ◽

Future Research ◽

Future Directions ◽

Research Directions ◽

Future Research Directions ◽

Respiratory Physiotherapy

Respiratory physiotherapists have a key role within the integrated care continuum of patients with respiratory diseases. The current narrative review highlights the profession's diversity, summarises the current evidence and practice, and addresses future research directions in respiratory physiotherapy. Herein, we describe an overview of the areas that respiratory physiotherapists can act in the integrated care of patients with respiratory diseases based on the Harmonised Education in Respiratory Medicine for European Specialists syllabus. In addition, we highlight areas in which further evidence needs to be gathered to confirm the effectiveness of respiratory therapy techniques. Where appropriate, we made recommendations for clinical practice based on current international guidelines.

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Converting a clinical indicator on patient missed treatments into a functional quality improvement metric.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.101 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 101-101 ◽

Cited By ~ 1

Author(s):

Amy S. Harrison ◽

Laura A. Doyle ◽

Mark Hurwitz ◽

Lilya Babinski ◽

Jamie Williamson ◽

...

Keyword(s):

Quality Improvement ◽

Social Services ◽

Negative Impact ◽

Patient Characteristics ◽

Local Tumor Control ◽

Future Research ◽

Tumor Control ◽

Treatment Rate ◽

Clinical Indicator ◽

Functional Quality

101 Background: Extended time to complete a course of radiation can be detrimental to a patient’s overall local tumor control and survival. The American College of Radiology (ACR) Radiation Oncology Practice Guideline requires review of any unplanned interruptions during treatment. However, factors that impact missed treatments are neither required to be reviewed nor well characterized within the literature. We sought to understand the variables contributing to missed treatments by generating a functional metric for quality improvement. Methods: The departmental electronic medical record (EMR) was modified to create sub-sets of classifications for missed treatments. These categories were divided into intended and unintended breaks, with intended classification of physician prescribed break and eight subcategories of unintended breaks: patient preference, physician mandated, patient feels ill, transportation/social services, cancelled, no-show, weather, and machine downtime. Missed treatments were documented real-time by the treating radiation therapists using one of these eight categories. A custom report was generated to extract and separate missed treatments by category. Results: Over three years of ACR tracking, our department missed treatment rate ranged from 5-10%, out of 64,000 patient treatments. The new subcategory metric has been in place for the past six months. Overall compliance with documentation by therapists was 100%. The new metric yielded a six month total rate of missed treatments of 8% with detailed analysis showing the main reasons as: patient preferences (14%), inclement weather (14%), and machine down time (9%). Transportation was only a minor issue for the patient population. Conclusions: This stratification of a simple clinical indicator has identified the major factors influencing the total time to complete a course of treatment. Based on this analysis, our departmental quality committee is focusing on engaging and educating patients about the negative impact of missed treatments on their overall cancer care. Future research will attempt to identify patient characteristics that may predict individuals more likely to miss treatments.

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Process mapping: A cornerstone of quality improvement

Cancer Cytopathology ◽

10.1002/cncy.21946 ◽

2017 ◽

Vol 125 (12) ◽

pp. 887-890 ◽

Cited By ~ 4

Author(s):

Yael K. Heher ◽

Yigu Chen

Keyword(s):

Quality Improvement ◽

Process Mapping

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Development, characteristics and impact of quality improvement casebooks: a scoping review

Health Research Policy and Systems ◽

10.1186/s12961-021-00777-z ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Natalie N. Anderson ◽

Anna R. Gagliardi

Keyword(s):

Quality Improvement ◽

Scoping Review ◽

Clinical Care ◽

Evaluation Research ◽

Intervention Development ◽

Future Research ◽

Cancer Management ◽

Care Specialist ◽

Study Characteristics ◽

The Many

Abstract Background Quality improvement (QI) casebooks, compilations of QI experiences, are one way to share experiential knowledge that healthcare policy-makers, managers and professionals can adapt to their own contexts. However, QI casebook use, characteristics and impact are unknown. We aimed to synthesize published research on QI prevalence, development, characteristics and impact. Methods We conducted a scoping review by searching MEDLINE, EMBASE, CINAHL and SCOPUS from inception to 4 February 2021. We extracted data on study characteristics and casebook definitions, development, characteristics (based on the WIDER [Workgroup for Intervention Development and Evaluation Research] framework) and impact. We reported findings using summary statistics, text and tables. Results We screened 2999 unique items and included five articles published in Canada from 2011 to 2020 describing three studies. Casebooks focused on promoting positive weight-related conversations with children and parents, coordinating primary care-specialist cancer management, and showcasing QI strategies for cancer management. All defined casebooks similarly described real-world experiences of developing and implementing QI strategies that others could learn from, emulate or adapt. In all studies, casebook development was a multistep, iterative, interdisciplinary process that engages stakeholders in identifying, creating and reviewing content. While casebooks differed in QI topic, level of application and scope, cases featured common elements: setting or context, QI strategy details, impacts achieved, and additional tips for implementing strategies. Cases were described with a blend of text, graphics and tools. One study evaluated casebook impact, and found that it enhanced self-efficacy and use of techniques to improve clinical care. Although details about casebook development and characteristics were sparse, we created a template of casebook characteristics, which others can use as the basis for developing or evaluating casebooks. Conclusion Future research is needed to optimize methods for developing casebooks and to evaluate their impact. One approach is to assess how the many QI casebooks available online were developed. Casebooks should be evaluated alone or in combination with other interventions that support QI on a range of outcomes.

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The Continuity of Care: From Admission to the Recovery at Home

Canadian Journal of Emergency Nursing ◽

10.29173/cjen41 ◽

2020 ◽

Vol 43 (1) ◽

pp. 28-37

Author(s):

Kara Payne ◽

Sandra Reilly

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Continuity Of Care ◽

Systems Approach ◽

Patient Experiences ◽

Process Mapping ◽

Patient Surveys ◽

Clinical Consequences ◽

Ed Crowding ◽

Improve Patient

The treatment and support patients receive in their transition from the Emergency Department (ED) to the patient care unit (PCU), and eventually, the community, have clinical consequences, psycho-social outcomes, and financial ramifications. This quality improvement report provides recommendations intended to improve patient experiences and outcomes, in the context of ED crowding. The recommendations provided are informed by the findings of a master's project that examined the transfer of patients from admission in a crowded ED, to a select PCU, and then to the community using process mapping and patient surveys. The purpose of this project was to examine the sequence of care beyond the walls of the ED and include the PCU (McHugh et al., 2011) using a systems approach (Villa, Prenestini, & Giusepi. 2014). We believe that by understanding process successes and failures, between EDs and PCUs, we can make improvements to ensure efficient, effective, and streamlined transitions to promote continuity of care.

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