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Mesay Milkias Wonte, Zemedu Aweke, Hailemariam Getachew, Siraj Ahmed Ali, Muhiddin Tadesse Department of Anesthesiology, Dilla University College of Health Science and Medicine, Dilla, EthiopiaCorrespondence: Mesay Milkias Wonte, Department of Anesthesia, Dilla University College of Health Sciences and Medicine, PO. BOX: 419/13, Dilla, Ethiopia, Tel +251949180127, Email milikiasssi@gmail.comIntroduction: Medications require suitable storage conditions to ensure the potency and efficacy of medicines. Appropriate putting-away conditions are required to ensure the potency of medications. Medication that is not maintained at the required temperature may further increase the unnecessary burden on the general population’s economy due to their lack of potency and efficacy. It is crucial to reduce any wastage, including that of drugs, to increase the efficient use of these scarce resources because there are significant health implications of drug waste.Methodology: A descriptive study was done at Dilla University Teaching Hospital beginning November 02, 2022, to December 02, 2022. Twenty indicators were used to assess the practice of drug storage, utilization, and checking expiration dates were designed and variables requiring a definition for the fullness of the checklist were predefined. For each measure, the expected achievement rate was 100%. A less than 50% completion rate was seen as a critical area in need of development, while indicators with a greater than 90% attainment rate were rated as acceptable. To analyze the data, SPSS version 26 was used.Results: The study found that none of the indications for the use, storage, and checking of drug expiration dates had a 100% completion rate. Among the indicators found to be below average (50%) were medical gas storage, medication storage, critical medication arrangement, storage of medications in refrigerators without using refrigerators for other purposes, storage facilities below 25°C, presence of lockable cupboards

Mustafa Sabir Abakar Awad,1 Mohamed FA Mohamednour,2 Fakher Aldeen Rafat,3 Mohaned Altijani,4 Abdelrahman Elfatih,3 Faris Jamalaldeen Mohammed Hamed,4 Abubakr Muhammed,5 Ibrahim Awad,6 Mohammed Alsiddig Alkheder,7 Mohammed Almubarak Omer Elhado,1 Aymen Yahya8 1Department of Community Medicine, Al-Neelain University Faculty of Medicine, Khartoum, Sudan; 2Department of Physiology, Al-Neelain University Faculty of Medicine, Khartoum, Sudan; 3Department of Internal Medicine, Al-Neelain University Faculty of Medicine, Khartoum, Sudan; 4Department of Surgery, Al-Neelain University Faculty of Medicine, Khartoum, Sudan; 5Department of Anatomy, Gezira University Faculty of Medicine, Gezira, Sudan; 6Department of Microbiology, Al-Neelain University Faculty of Medicine, Khartoum, Sudan; 7Department of Anatomy, Al-Neelain University Faculty of Medicine, Khartoum, Sudan; 8Managil Teaching Hospital, Managil, Gezira, SudanCorrespondence: Mustafa Sabir Abakar Awad, Email safsaf.sabir7@gmail.comBackground: Effective documentation is essential for ensuring high-quality clinical practice. Medical notes serve as a crucial form of communication among all those who are involved in a patient’s care. Therefore, it is important to have a quality assurance mechanism in place to ensure that medical records comply with established standards.Objective: To evaluate the quality of medical notes writing in different departments of Mangail Teaching Hospital, and to implement some possible solutions to improve the quality of existing medical records and overcome the deficiencies.Methodology: A retrospective, prospective observational audit carried out in Managil Teaching Hospital, we included 108 files in both audit cycles, 54 in each. Sampling was done through a systematic simple random sampling method over a period of one week for every cycle. Data were collected and each file was compared to the Royal College of Physician standards, the collected data were entered into an Excel sheet, cleaned t

Balew Arega,1 Abraham Minda,2 Andualem Admasu,2 Ayele Teshome,3 Elias Tewabe,1 Alemu Kibret,4 Dawit Mamo,1 Asnake Agunie2 1Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; 2Department of Health Care Quality, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; 3Department of Health System Capacity Building, Ministry of Health, Addis Ababa, Ethiopia; 4Deparment of Public Health, Yekatit 12 Hospital Medical College, Addis Ababa, EthiopiaCorrespondence: Balew Arega, Yekatit 12 Hospital Medical College, Sidst Kilo Square, P.O.Box: 257, Addis Ababa, Ethiopia, Email balewmlt@gmail.comBackground: Complete medical documentation is an integral part of health system quality and safe patient care. However, this is compromised during duty hours while the physician is tired, high patient-to-physician ratio, and a lack of senior physician guidance from junior doctors. This quality improvement project aimed to improve medical documentation duty hours for admitted patients through the senior physician’s audit feedback strategies.Methods: This quality improvement project was undertaken to improve the medical documentation of junior physicians for patients admitted during duty hours. We did it through the senior physician-led audit feedback system and by integrating the project tasks into senior physicians’ workflow. A collective group of project members teams, duty-assigned senior physicians, internal medicine residents, medical interns, nursing team, internal medicine, quality personnel, internal medicine department heads, and clinical vice provost. Quality improvement methods were used to test the role of the senior physician in improving the medical records documentation and maintaining the improvements obtained.Results: The medical record documentation improved from 73% to 96.4% before and after implementing the improvement interventions, respectively. It was effectively maintained for six months (97.2%). The senior physicia

Dagmawi Anteneh Teferi,1 Dawit Kebede Dadi,1 Ishmael Shemsedin Hassen,2 Berhanetsehay Teklewold Teklemariam,3 Abdu Adem Yesufe1 1Quality Improvement and Clinical Governance Directorate, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 2Critical Care Medicine Unit, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 3Endocrine and Breast Surgery Unit, Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Dagmawi Anteneh Teferi, Quality Improvement and Clinical Governance Directorate, St. Paul’s Hospital Millennium Medical College, P.O. Box 1271, Addis Ababa, Ethiopia, Email dagmawianteneh16@gmail.comBackground: Three-quarters of maternal deaths can be prevented by proper emergency referral procedures, early recognition of obstetric complications, and timely and adequate care. Nonetheless, lots of women still experience difficulties getting the life-saving emergency obstetric interventions they need promptly.Aim: Aim to improve maternal service delivery at the highest referring catchment health center to a tertiary teaching hospital through establishing a comprehensive obstetric care from December 2020 to April 2022.Methods: A pre and post-intervention follow-up study design was employed to evaluate the impact of a quality improvement project at a health center on the access and quality of maternal service. After identifying a highly referring catchment health center, we established a multidisciplinary team responsible for preparing a readiness plan, facilitating staff training on obstetric care, resource mobilization, and continuous supportive supervision.Results: Caesarian section delivery, holistic obstetric ultrasound service, and comprehensive abortion care were started at the catchment health center. The total monthly delivery at the health center almost quadrupled from 94 to an average of 334, referral out decreased from 156 mothers to a median of 12, and mate

Swaleh Kitabu Pazi,1 Ally Hamisi Mwanga,2 Tuzo A Lyuu,1 Masolwa Ng’wanasayi,3 John Rwegasha,1 Ewaldo Vitus Komba,4 Igembe Nkandala5 1Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania; 2Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 3Department of Internal Medicine, Aga Khan Hospital, Dar es Salaam, Tanzania; 4Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 5Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, TanzaniaCorrespondence: Igembe Nkandala, Department of Internal Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania, Tel +255 717 301956, Email igembe2002@yahoo.comBackground: Portal hypertension – a major complication of chronic liver disease – is associated with multiple complications that include ascites, varices, and hepatic encephalopathy; these complications can lead to substantial morbidity and mortality. Randomized control trials have demonstrated the efficacy of nonselective beta blockers (NSBB) for preventing primary and secondary gastroesophageal variceal bleeding. These drugs should be titrated to target the resting heart rate of 55– 60 beats per minute and the systolic blood pressure should not decrease < 90 mm Hg. The objective of this study was to perform an audit of the titration of nonselective beta blockers in patients with portal hypertension at the national referral hospital.Methods: The audit involved all adults aged 18 years and above with portal hypertension and evidence of esophageal varices who were regularly attending gastroenterology and hepatology clinics of Muhimbili National Hospital between January 2019 and December 2019. The patients’ clinical data were extracted from the electronic medical records. Permission to conduct the study was obtained from the hospital management.Results: Over the a

Introduction: The aim of our work has been to describe the results of the clinical audit carried out in 2021 and to compare the results with 2015 EPOCONSUL audit. Methods: EPOCONSUL 2021 is a cross-sectional audit that evaluated the outpatient care provided to patients with a diagnosis of chronic obstructive pulmonary disease (COPD) in respiratory clinics in Spain with prospective recruitment between April 15, 2021, and January 31, 2022. Results: A total of 45 hospitals participated in the 2021 audit and 4.225 clinical records of patients were evaluated. Clinical phenotype according to the Spanish National Guidelines for COPD care (GesEPOC) was reported in 63.1% of the audited patients, and the COPD type assessment for the Global initiative for chronic Obstructive Lung Disease (GOLD) was present in 38.3%. There was an improved compliance with clinical practice guideline (CPG) recommendations in the 2021 audit with respect to the 2015 audit. There was an increase in the proportion of cases with alfa-1-antitrypsin serum level testing available (audit 1: 18.9%; audit 2: 38.7%, p<0.001) and 6-min walk test carried out (audit 1: 24%; audit 2: 45.2%, p<0.001). However, these significant variations adherence to CPG recommendations were not reached for the clinical evaluation and therapeutic intervention category when adjusting for patient and resource variables. Conclusions: The 2021 EPOCONSUL audit showed increased adherence to recommendations although they seem to be related to the availability of resources for care. These results should be taken into account in order to establish improvements in resources to achieve a better quality of care., Depto. de Medicina, Fac. de Medicina, TRUE, pub

Background: Clinical audits have reported considerable variability in COPD medical care and frequent inconsistencies with recommendations. The objectives of this study were to identify factors associated with a better adherence to clinical practice guidelines and to explore determinants of this variability at the the hospital level. Methods: EPOCONSUL is a Spanish nationwide clinical audit that evaluates the outpatient management of COPD. Multilevel logistic regression with two levels was performed to assess the relationships between individual and disease-related factors, as well as hospital characteristics. Results: A total of 4508 clinical records of COPD patients from 59 Spanish hospitals were evaluated. High variability was observed among hospitals in terms of medical care. Some of the patient's characteristics (airflow obstruction, degree of dyspnea, exacerbation risk, presence of comorbidities), the hospital factors (size and respiratory nurses available) and treatment at a specialized COPD outpatient clinic were identified as factors associated with a better adherence to recommendations, although this only explains a small proportion of the total variance. Conclusion: To be treated at a specialized COPD outpatient clinic and some intrinsic patient characteristics were factors associated with a better adherence to guideline recommendations, although these variables were only explaining part of the high variability observed among hospitals in terms of COPD medical care., Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Depto. de Medicina, Fac. de Medicina, TRUE, pub

Objective: The aim of this analysis was to describe the patterns of inhaled maintenance therapy according to risk level and to explore the determinants associated with the decision to prescribe inhaled corticosteroids (ICS) in addition to bronchodilator therapy according to risk level as strategy in the follow-up of COPD in daily clinical practice. Methods: EPOCONSUL 2021 is a cross-sectional audit that evaluated the outpatient care provided to patients with a diagnosis of chronic obstructive pulmonary disease (COPD) in respiratory clinics in Spain with prospective recruitment between April 15, 2021 and January 31, 2022. Results: 4225 patients from 45 hospitals in Spain were audited. Risk levels were analyzed in 2678 patients. 74.5% of patients were classified as high risk and 25.5% as low risk according to GesEPOC criteria. Factors associated with the prescription of ICS in low-risk COPD were symptoms suggestive of asthma [OR: 6.70 (3.14-14.29), p<0.001], peripheral blood eosinophilia>300mm3 [OR: 2.16 (1.10-4.24), p=0.025], and having a predicted FEV1%<80% [OR: 2.17 (1.15-4.08), p=0.016]. In high-risk COPD, factors associated with triple therapy versus dual bronchodilator therapy were a mMRC dyspnea score of ≥2 [OR: 1.97 (1.41-2.75), p<0.001], symptoms suggestive of asthma [OR: 6.70 (3.14-14.29), p<0.001], and a predicted FEV1%<50% [OR: 3.09 (1.29-7.41), p<0.011]. Conclusions: Inhaled therapy in the follow-up of COPD does not always conform to the current guidelines. Few changes in inhaled therapy are made at follow-up visits. The use of ICS is common in COPD patients who meet low-risk criteria in their follow-up and triple therapy in high-risk COPD patients is used as an escalation strategy in patients with high clinical impact. However, a history of exacerbations and eosinophil count in peripheral blood were not factors predicting triple therapy., Depto. de Medicina, Fac. de Medicina, TRUE, pub

Purpose: Current COPD management recommendations indicate that pharmacological treatment can be stepped up or down, but there are no recommendations on how to make this adjustment. We aimed to describe pharmacological prescriptions during a routine clinical visit for COPD and study the determinants of changing therapy. Methods: EPOCONSUL is a Spanish nationwide observational cross-sectional clinical audit with prospective case recruitment including 4,508 COPD patients from outpatient respiratory clinics for a period of 12 months (May 2014–May 2015). Prescription patterns were examined in 4,448 cases and changes analyzed in stepwise backward, binomial, multivariate, logistic regression models. Results: Patterns of prescription of inhaled therapy groups were no treatment prescribed, 124 (2.8%) cases; one or two long-acting bronchodilators (LABDs) alone, 1,502 (34.6%) cases; LABD with inhaled corticosteroids (ICSs), 389 (8.6%) cases; and triple therapy cases, 2,428 (53.9%) cases. Incorrect prescriptions of inhaled therapies were observed in 261 (5.9%) cases. After the clinical visit was audited, 3,494 (77.5%) cases did not modify their therapeutic prescription, 307 (6.8%) cases had a step up, 238 (5.3%) cases had a change for a similar scheme, 182 (4.1%) cases had a step down, and 227 (5.1%) cases had other nonspecified change. Stepping-up strategies were associated with clinical presentation (chronic bronchitis, asthma-like symptoms, and exacerbations), a positive bronchodilator test, and specific inhaled medication groups. Stepping down was associated with lung function impairment, ICS containing regimens, and nonexacerbator phenotype. Conclusion: The EPOCONSUL study shows a comprehensive evaluation of pharmacological treatments in COPD care, highlighting strengths and weaknesses, to help us understand how physicians use available drugs., Sociedad Española de Neumología y Cirugía Torácica, Depto. de Medicina, Fac. de Medicina, TRUE, pub

Introduction: Neonatal deaths have decreased steadily in Sweden since the 1960s, but the stillbirth rate has been stable at around 4 per 1000 births, for the last 40 years. Risk factors of stillbirth are well studied; however, the cause of death is unclear in many cases. The purpose of this study was to examine causes of death in stillbirth using a classification system. In addition, we aimed to assess substandard care factors and identify areas for quality improvement. Materials and Methods: We performed a retrospective clinical audit of all stillbirths delivered between January 2006 and December 2019. We performed a detailed investigation of medical records and classified the causes of death according to ‘The Stockholm classification of stillbirth’. Unclear cases were discussed in a multidisciplinary local audit group. Substandard care factors were identified and classified as probable, possible, or unlikely, with respect to the cause of death. Results: In total, there were 64 cases of stillbirth. It was possible to determine a cause of death in 91% (95% confidence interval [CI]: 81.02–95.63) of the cases. The leading cause of death was intrauterine growth restriction (IUGR)/placental insufficiency (45%) (95% CI: 33.73–57.43), followed by infection (13%) (95% CI: 6.47–22.8) and placental abruption (9%) (95% CI: 4.37–18.98). Factors of substandard care were identified in 49% (95% CI: 37.06–61.4) of the cases, but in only 10% the substandard care factor had a probable association with the cause of death. Conclusion: Introducing a local audit group and using a validated classification system made it possible to find a cause of death in about 90% of the cases of stillbirth. Since IUGR/placental insufficiency is the leading cause of death, it is important to improve current strategies to identify pregnancies at risk for IUGR, antenatally. Our results suggest that there is a possibility to improve the quality of care in many areas, particularly regarding symphysis-fundu

Objectives We aim to explore undertriage and overtriage in a high-risk patient population and explore patient characteristics and call characteristics associated with undertriage and overtriage in both randomly selected and in high-risk telephone calls to out-of-hours primary care (OOH-PC). Design Natural quasi-experimental cross-sectional study. Setting Two Danish OOH-PC services using different telephone triage models: a general practitioner cooperative with GP-led triage and the medical helpline 1813 with computerised decision support system-guided nurse-led triage. Participants We included audio-recorded telephone triage calls from 2016: 806 random calls and 405 high-risk calls (defined as patients ≥30 years calling with abdominal pain). Main outcome measures Twenty-four experienced physicians used a validated assessment tool to assess the accuracy of triage. We calculated the relative risk (RR) for clinically relevant undertriage and overtriage for a range of patient characteristics and call characteristics. Results We included 806 randomly selected calls (44 clinically relevant undertriaged and 54 clinically relevant overtriaged) and 405 high-risk calls (32 undertriaged and 24 overtriaged). In high-risk calls, nurse-led triage was associated with significantly less undertriage (RR: 0.47, 95% CI 0.23 to 0.97) and more overtriage (RR: 3.93, 95% CI 1.50 to 10.33) compared with GP-led triage. In high-risk calls, the risk of undertriage was significantly higher for calls during nighttime (RR: 2.1, 95% CI 1.05 to 4.07). Undertriage tended to be more likely for calls concerning patients ≥60 years compared with 30-59 years (11.3% vs 6.3%) in high-risk calls. However, this result was not significant. Conclusion Nurse-led triage was associated with less undertriage and more overtriage compared with GP-led triage in high-risk calls. This study may suggest that to minimise undertriage, the triage professionals should pay extra attention when a call occurs during nightt

[Introduction] The aim of our work has been to describe the results of the clinical audit carried out in 2021 and to compare the results with 2015 EPOCONSUL audit., [Methods] EPOCONSUL 2021 is a cross-sectional audit that evaluated the outpatient care provided to patients with a diagnosis of chronic obstructive pulmonary disease (COPD) in respiratory clinics in Spain with prospective recruitment between April 15, 2021, and January 31, 2022., [Results] A total of 45 hospitals participated in the 2021 audit and 4.225 clinical records of patients were evaluated. Clinical phenotype according to the Spanish National Guidelines for COPD care (GesEPOC) was reported in 63.1% of the audited patients, and the COPD type assessment for the Global initiative for chronic Obstructive Lung Disease (GOLD) was present in 38.3%. There was an improved compliance with clinical practice guideline (CPG) recommendations in the 2021 audit with respect to the 2015 audit. There was an increase in the proportion of cases with alfa-1-antitrypsin serum level testing available (audit 1: 18.9%; audit 2: 38.7%, p < 0.001) and 6-min walk test carried out (audit 1: 24%; audit 2: 45.2%, p < 0.001). However, these significant variations adherence to CPG recommendations were not reached for the clinical evaluation and therapeutic intervention category when adjusting for patient and resource variables., [Conclusions] The 2021 EPOCONSUL audit showed increased adherence to recommendations although they seem to be related to the availability of resources for care. These results should be taken into account in order to establish improvements in resources to achieve a better quality of care.

Mohammed Ahmed,1 Sabeen Malik,2 Anthony Yong Kheng Ng,3 Syed Mohammad Tariq2 1Department of Respiratory Medicine, Southampton General Hospital, Southampton, Hampshire, UK; 2Department of Respiratory Medicine, Luton and Dunstable University Hospital, Luton, Bedfordshire, UK; 3Department of Respiratory Medicine, Addenbrooke’s University Hospital, Cambridge, Cambridgeshire, UKCorrespondence: Syed Mohammad Tariq, Luton & Dunstable University Hospital, Lewsey Road, Luton, Bedfordshire, LU4 0DZ, United Kingdom, Tel +44 7886025415, Fax +44 1582497237, Email doc_smt@hotmail.comAim: Chest drains are indicated for pleural effusions and pneumothoraces. Documentation of chest drain insertion in patients’ notes can vary and may be sub-standard. We did a retrospective audit of documentation of chest drain insertions and repeated it after the introduction of a chest drain pro forma.Patients and Methods: All chest drain insertions over a two-year period (2017– 2019) in our hospital were audited. Indwelling pleural catheter insertions were excluded. We re-audited chest drains inserted in the respiratory ward for 3 months (January–March 2020) after the introduction of a chest drain pro forma to assess improvements in documentation.Results: In the first audit, 134 patients had chest drains [85(63%) male; age 18– 91 years]; 16 of these were emergency procedures. Documentation of chest drain insertion procedures was poor. In 12(9%), the procedure was not recorded at all. One or more pre-procedural safety checks (indication, review of radiology, coagulation parameters) were documented in 23(17.2%) procedures. In 11(8.2%) the department/unit where the procedure was performed was not documented. In 30(22.4%) the time of the procedure was not entered. The grade and speciality of doctor performing the procedure was missing in 18(13.4%) and 13(9.7%) entries, respectively. Patient consent was available for 90(67.2%) procedures (61 verbal, 29 written). Adherence to aseptic techniq

[Objective] The aim of this analysis was to describe the patterns of inhaled maintenance therapy according to risk level and to explore the determinants associated with the decision to prescribe inhaled corticosteroids (ICS) in addition to bronchodilator therapy according to risk level as strategy in the follow-up of COPD in daily clinical practice., [Methods] EPOCONSUL 2021 is a cross-sectional audit that evaluated the outpatient care provided to patients with a diagnosis of chronic obstructive pulmonary disease (COPD) in respiratory clinics in Spain with prospective recruitment between April 15, 2021 and January 31, 2022., [Results] 4225 patients from 45 hospitals in Spain were audited. Risk levels were analyzed in 2678 patients. 74.5% of patients were classified as high risk and 25.5% as low risk according to GesEPOC criteria. Factors associated with the prescription of ICS in low-risk COPD were symptoms suggestive of asthma [OR: 6.70 (3.14–14.29), p < 0.001], peripheral blood eosinophilia > 300 mm3 [OR: 2.16 (1.10–4.24), p = 0.025], and having a predicted FEV1% < 80% [OR: 2.17 (1.15–4.08), p = 0.016]. In high-risk COPD, factors associated with triple therapy versus dual bronchodilator therapy were a mMRC dyspnea score of ≥2 [OR: 1.97 (1.41–2.75), p < 0.001], symptoms suggestive of asthma [OR: 6.70 (3.14–14.29), p < 0.001], and a predicted FEV1% < 50% [OR: 3.09 (1.29–7.41), p < 0.011]., [Conclusions] Inhaled therapy in the follow-up of COPD does not always conform to the current guidelines. Few changes in inhaled therapy are made at follow-up visits. The use of ICS is common in COPD patients who meet low-risk criteria in their follow-up and triple therapy in high-risk COPD patients is used as an escalation strategy in patients with high clinical impact. However, a history of exacerbations and eosinophil count in peripheral blood were not factors predicting triple therapy.

Tajera Tageza Ilala,1 Mengistu Yinges Kebede,1 Gudeta Teku Ayano,1 Megersa Kelbesa Olika2 1Department of Anesthesia, Faculty of Medicine, Hawassa University, Hawassa, Ethiopia; 2Department of Anesthesia, Institute of Health, Jimma University, Jimma, EthiopiaCorrespondence: Tajera Tageza Ilala, Department of Anesthesia, Faculty of medicine, Hawassa University, Hawassa, Ethiopia, Email tajeratageza@gmail.comBackground: PACU discharge score criteria facilitate a risk safe and timely discharge of surgical patients under satisfactory safety conditions, thereby improving post-operative patient outcomes and requiring minimum resources. The aim of this best practice study was to provide best evidence-based practice on post-anesthesia discharge score criteria among nurses at the post-anesthesia care unit in the Jimma Medical Center.Methods: An audit and re-audit inter-professional study was employed. Twenty-four post-anesthesia care unit nurses were interviewed for baseline audit and 118 post-anesthesia care unit discharge scoring opportunities were observed for follow-up audit using three audit criteria.Results: First stage of the audit showed a performance of 37.5% for successful pain assessment, level of consciousness, nausea, vomiting, and blood pressure prior to patient discharge from the post-anesthesia care unit, and 62.5% for routine use of discharge criteria score to determine discharge readiness of patients from the post-anesthesia care unit. Re-audit results revealed an average of 40% improvement of the audit criteria practice toward post-anesthesia care unit discharge score.Conclusion: This study revealed that the use of various strategies such as role modeling, posting reminders about PACU discharge criteria, and presenting guidelines to the recovery teams resulted in improved practice toward best available evidence for post-anesthesia care unit discharge score practice. Including the stakeholders in determining the strategies to upgrade practice is crucial in t

William Hutch,1 Brendan Payne,2 Mark Henderson,2 Breda Looney-Herlihy,2 Sheila Tarrant,2 Catherine Gillman2 1The Department of General Practice, University College Cork, Cork, Ireland; 2Woodbrook Family Practice, Newmarket, Co, Cork, IrelandCorrespondence: William Hutch, The Department of General Practice, University College Cork, Cork, Ireland, Tel +353 21 4632288, Email w.hutch@ucc.ieBackground: Rural general practitioners are typically located far from secondary care. As a result, they have to be able to manage many clinical presentations. One pivotal component is the doctor’s bag and emergency bag.Aim: To audit the doctor’s bag and emergency bag contents of suitable documentation, equipment and medications against standardised checklists. To create an online resource to monitor these contents.Methods: A list of medications, documentation and equipment in the practice doctors’ bag and emergency bag was undertaken. This was compared to a standardised checklist. An online intervention tool, the “Ampoule App”, allowed users to identify contents and expired items for each bag. The reaudit cycle allowed for replacement of outdated items based on the apps expiration dates.Results: The exact equipment, medications and documentation for our practice doctors’ bag and emergency bag were identified. The quantity and expiration dates of items were recorded. Fifty-eight out of 315 items had expired. These were replaced and this information was uploaded to the Ampoule App. Education and engagement with the app alerted users as to when a medication is due to expire in the future, therefore allowing adequate time to replace items.Conclusion: There was a desirable improvement in the contents of the doctor’s bag and emergency bag post intervention using the Ampoule App and re-education. This audit has led to an increased awareness of what we as GPs carry in our bags daily and how we prepare to deal with multiple

YG Alvin Tan,1,2 Ian A Scott1,2 1Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; 2Greater Brisbane School of Clinical Medicine, University of Queensland, Brisbane, Queensland, AustraliaCorrespondence: YG Alvin Tan, Tel +61 7 3176 2111, Email alvin.tan@health.qld.gov.auObjective: To assess contemporary concordance of inpatient management of community-acquired pneumonia (CAP) with guideline recommendations relating to use of severity assessment tools (SAT), antimicrobials and microbiological investigations.Methods: A single-centre, retrospective audit involving patients admitted with CAP to medical inpatient units of a tertiary hospital between September 2019 and March 2020 using electronic medical record review. SAT scores were retrospectively calculated for all patients, and the appropriateness of interventions determined with reference to local guidelines.Results: Of 200 patients of mean age 64 years, 58% were admitted to general medicine units and the remainder to other specialties. Treating clinicians recorded a SAT in 9% (18/200) of the patients, with calculated scores rating 58% of all cases as being mild. Antibiotic prescribing on admission was guideline-concordant in 16.0% of the patients, but significantly higher among patients with moderate-to-severe vs mild CAP (24% vs 10%; p=0.01). Step-down oral antibiotic prescribing was guideline-concordant in 39% of the patients, and significantly higher among younger (< 65 years) vs older patients (51% vs 31%; p=0.006) and those with longer (> 7 days) vs shorter length of stay (57% vs 34%; p=0.007). No significant differences in concordance were seen between different specialties. Among patients for whom blood cultures and sputum cultures were requested, only 2% (2/110) and 17% (15/86) respectively yielded a positive result.Conclusion: This study suggests infrequent use of SATs, low guideline concordance for antibiotic prescribing, and the

Simon Peter Katongole,1 Patricia Akweongo,2 Robert Anguyo,3 Daniel Evans Kasozi,4 Augustine Adomah-Afari2 1Simon Peter Katongole, School of Public Health, Gudie University Project, Kampala, Uganda; 2Department of Health Policy, Planning and Management, University of Ghana, Accra, Ghana; 3Monitoring, Evaluation, Technical Assistance and Research (METRe) Group; Department of International Public Health, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK; 4The United States Agency for International Development, US Embassy Kampala, Kampala, UgandaCorrespondence: Simon Peter Katongole, Gudie University Project, P.O. Box 27450, Kampala, Uganda, Tel +256 702 830 019, Email spkatongole@gmail.comPurpose: This study sought to determine the magnitude of patients’ misdiagnosis, classify the extent to which patients were misdiagnosed, determine the major diagnostic groupings and the topmost misdiagnosed diseases 11th version of the International Classification of Diseases (ICD-11).Methods: We conducted a retrospective review of 2431 patients’ records. A patient was adjudged to have been misdiagnosed if there was a difference between the initial diagnosis and the final diagnoses which had been collectively and collaboratively agreed upon review on admission. Misdiagnosis was classified as Class I, Class II, Class III and Class IV. The Pareto analysis was used to determine the topmost misdiagnosed diseases and ICD-11 major diagnostic groupings. We established the three leading misdiagnosed diseases for each of the topmost ICD-11 major diagnostic groupings.Results: The results indicate that 9.2% (223/2341) of the inpatients were initially misdiagnosed. There were 303 conditions involved in the misdiagnosis. The majority, 70.9% (158/223) of the misdiagnosed patients were classified as Class I. The ICD-11 major diagnostic groupings accounted for at least 80% of the misdiagnosis were certain infectious or parasitic diseases (32%), diseases of the digestive system (12%), d

Mahsa Tantiongco,1,2 Pascale Dettwiller,1,3,4 Stefan Kowalski2 1SA Pharmacy, SA Health, Adelaide, South Australia, Australia; 2Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia; 3University of Adelaide, Adelaide, South Australia, Australia; 4Adelaide Rural Clinical School, Adelaide, South Australia, AustraliaCorrespondence: Mahsa Tantiongco, Tel +61 433222216, Fax +61 8 8204 6245, Email mahsa.tantiongco@sa.gov.auPurpose: Antimicrobial stewardship programs are critical for promoting and monitoring judicious use of antimicrobials; however, there are many well-established barriers to their effective implementation in the rural setting. Pharmacist involvement in such programs is recommended as part of a multidisciplinary approach to improve appropriate antimicrobial prescribing. The aim of this study was to describe the impact of implementing a clinical pharmacy service on antimicrobial prescribing in a rural GP-led hospital; explore areas of suboptimal antimicrobial prescribing; and review the change in total antimicrobial cost per patient day.Patients and Methods: A retrospective case series audit of pre- and post-implementation of a new clinical pharmacy service was undertaken. All adult patients who had presented with sepsis, cellulitis, urinary tract infections and pneumonia between May and August 2015 and repeated for the same months in 2018 were included. Appropriateness of therapy was assessed using the National Antimicrobial Prescribing Survey guidelines.Results: A total of 115 antibiotic orders from 2015 and 158 orders from 2018 were included. During admission, 86% of the patients (55/64) in the post-intervention group were reviewed by a clinical pharmacist. Appropriate prescribing increased from 57% (66/115) in 2015 to 82% (129/158) in 2018 (P=0.001). Ceftriaxone was the most inappropriately prescribed antimicrobial. The cost of antimicrobial therapy was halved from $10.00 to $5.33 per patient day, pre- and post

Mark Daniel Salter,1– 4 Pramod Chandru,1– 4 Kit Rowe,1,2,4 Phillip Smith,1,4 Naren Gunja1,2,4 1Western Sydney Toxicology Service, Westmead and Blacktown Hospitals, Westmead, NSW, Australia; 2Faculty of Medicine, University of Sydney, Sydney, NSW, Australia; 3Department of Emergency Medicine, Nepean Hospital, Kingswood, NSW, Australia; 4Department of Emergency Medicine, Westmead Hospital, Westmead, NSW, AustraliaCorrespondence: Mark Daniel Salter, Tel +61 2 47342763, Email mark.salter@health.nsw.gov.auIntroduction: Poisoning in pregnant women creates challenges to healthcare providers due to the potential for dual harm to the mother and fetus from the exposure. The unknown safety profile of antidotes in pregnancy and nature of supportive care for pregnant women further complicate this presentation. Within the ED, the prevalence of unexpected pregnancy is shown to be between 0.2 and 6.3% for all presentations, whilst studies specific to poisonings demonstrate a prevalence of 0.07– 0.6%.Materials and Methods: The Western Sydney Toxicology Service (WSTS) works in the Western Sydney Local Health District to provide specialist poisons care to patients. We conducted a retrospective cohort study of all women who presented to the ED in Western Sydney hospitals requiring specialist toxicology advice or admission between ages 14 and 50 years. Primary outcome was the rate of pregnancy, especially unexpected pregnancy, between Jan 2013 and Nov 2019. Secondary outcomes included determining compliance with department policy of blood β-HCG testing for all female patients in reproductive years, rates of polypharmacy ingestions, types of exposures and drug classes commonly associated with poisoning.Results: Overall: The pregnancy rate was 1.6% (n = 39), while the unexpected pregnancy rate was 0.78% (n = 19). About 99.3% (n = 2421) had a blood test taken in ED or day one of admission, with 65.8% (n = 1605) having a blood β-HCG level measured. There was a higher proportion of d

Yang Jian Ong,1– 3 Nisha Sikotra,1,4 Janelle Prunster,1,2 Nicola Bailey,2 Jane Hadfield,2 Rosemary Smith,2 Rohen Skiba,2 Astrid Arellano,5 Eli Gabbay,1– 3,6 Timothy D Clay1,7,8 1Bendat Respiratory Research and Development Group, St John of God Healthcare, Subiaco, Western Australia, Australia; 2Department of Medical Teaching, St John of God Healthcare, Subiaco, Western Australia, Australia; 3The University of Notre Dame, Fremantle, Western Australia, Australia; 4Research Department, St John of God Healthcare, Subiaco, Western Australia, Australia; 5Department of Infectious Diseases, St John of God Healthcare, Subiaco, Western Australia, Australia; 6Department of Respiratory Medicine, St John of God Healthcare, Subiaco, Western Australia, Australia; 7Department of Medical Oncology, St John of God Healthcare, Subiaco, Western Australia, Australia; 8School of Medical and Health Sciences, Edith Cowan University Joondalup, Joondalup, Western Australia, AustraliaCorrespondence: Nisha Sikotra Tel +61 08 9382 9172Email Nisha.sikotra@sjog.org.auBackground: Febrile neutropenia (FN) is a medical emergency that requires prompt empirical antibiotic treatment. Logistical factors can hamper the timely delivery of antibiotics for patients with suspected FN.Aim: To determine our institution’s adherence to timeliness of antibiotic administration after the implementation of strategies following a previous audit.Methods: Two retrospective audits were performed. Patients were identified through hospital coding and data were extracted from medical records. Interventions following the first audit included targeted staff education; development of a “Febrile Neutropenia Box” and the establishment of an acute medical unit (AMU). Adherence to guidelines and the effect of interventions were compared.Results: Audit one: 72 admissions (January 2017–December 2017); audit two: 55 admissions (October 2018–October 2019). Median time to antibiotics and adherence to 60-minute administrat

Habtamu Wondmagegn,1 Abinet Gebremickael,1 Mala George,2 Teshale Fikadu,3 Tadiwos Hailu Zewdie,4 Tsegazeab Ayele,1 Mahteme Bekele Muleta5 1Department of Anatomy, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; 2Department of Biomedical Sciences, Arba Minch University, Arba Minch, Ethiopia; 3School of Public Health, Epidemiology and Biostatistics Unit, Arba Minch University, Arba Minch, Ethiopia; 4Department of Internal Medicine, Arba Minch University, Arba Minch, Ethiopia; 5Department of Surgery, Saint Paul Hospital Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Abinet GebremickaelDepartment of Anatomy, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia, Email abinetgebremickael@gmail.com; abinet.gebremickael@amu.edu.etPurpose: Renal vascular anatomy is known for presenting a wide range of variations. Kidneys with variant renal vascular anatomy, when used as a graft, appear to have a potential risk that could impair the outcome of kidney transplantation. Information on renal vascular variation and its implication in the surgical outcome of renal transplantation has not been well studied. The present study was aimed at evaluating the outcome of transplantation of renal allografts with variant renal vasculature as compared to allografts without renal vascular variation in the national kidney transplantation center of Ethiopia.Patients and Methods: A health institution-based retrospective cohort study was conducted. A retrospective review of the medical records of kidney recipients was performed. A total of 120 renal transplant recipients’ medical records were evaluated. A chi-square test and independent t-test were used to compare the surgical outcomes of renal transplantation. Graft survival was expressed using Kaplan–Meier curves and was compared using the log rank test. P-values less than 0.05 were considered statistically significant.Results: Evaluation of the renal trans

Background: Over the past few decades, public opinion and involvement in modern health care has been increasing continuously due to which the negligence cases in the health care were being accounted. Although these cases represent a very small proportion, a quality improvement process is required to improve patient care. This can be achieved through clinical audit.Aim: The aim of the present study is to conduct clinical audit on infection control among dental students in a teaching hospital, Telangana, according to the institution prescribed infection control guidelines.Materials and Methods: A cross-sectional study was conducted among 318 dental students in a teaching hospital, Khammam, Telangana, using a knowledge, attitude and practice questionnaire. Descriptive statistics and Chi-square test were applied. The statistical significance was considered at p<0.05.Results: Out of 318 students who filled up the questionnaire, 82.4% participants were females and 17.6% participants were males. The post graduates were about 30.2%, interns were 36.5% and IV BDS Students were 33.3%. A statistically significant difference was found among the study participants regarding the knowledge, attitudes and practices of infection control.Conclusion: The present clinical audit showed an overall good adherence with the “institution recommended infection control guidelines,” among the clinical dental students.

Objective: To assess the procedural and clinical outcomes associated with the introduction of minimally invasive surfactant therapy (MIST) into standard care at 2 tertiary Australian neonatal intensive care units. Study design: A prospective audit was designed before the introduction of MIST in 2018, with data collected over a period of 18 months. Procedural data were completed by the clinical team performing MIST, including clinical observations, medication use, and adverse events. The audit team collected demographic data and subsequent clinical outcomes from medical records. Result(s): There were 135 MIST procedures recorded in 122 infants. For the included infants, the median gestation was 302/7 weeks (IQR, 276/7 to 322/7 weeks) and birth weight was 1439 g (IQR, 982-1958 g). During the MIST procedure, desaturation to a peripheral oxygen saturation of <80% was common, occurring in 75.2% of procedures. Other adverse events included need for positive pressure ventilation (10.6%) and bradycardia <100 beats per minute (13.3%). The use of atropine premedication was associated with a significantly lower incidence of bradycardia: 8.6% vs 52.9% (P < .01). Senior clinicians demonstrated higher rates of procedural success. The majority of infants (63.9%) treated with MIST did not require subsequent intubation and mechanical ventilation. Conclusion(s): MIST can be successfully introduced in neonatal units with limited experience of this technique. The use of atropine premedication decreases the incidence of bradycardia during the procedure. Success rates can be optimized by limiting MIST to clinicians with greater competence in endotracheal intubation.Copyright © 2020 Elsevier Inc.

Aim: To determine predictors and outcomes of extubation failure in extremely preterm (EP) infants born <28 weeks' gestational age (GA). Method(s): Retrospective clinical audit across two tertiary-level neonatal intensive care units in Melbourne, Australia. Two-hundred and four EP infants who survived to their first extubation from mechanical ventilation. Extubation failure (re-intubation) within 7 days after the first extubation. Result(s): Lower GA (odds ratio [OR] 0.71, 95% confidence interval (CI), 0.61-0.89, P < 0.001) and higher pre-extubation measured mean airway pressure (MAP) on the mechanical ventilator (OR 1.9 [95% CI 1.41-2.51], P < 0.001) predicted extubation failure. The area under a receiver operating characteristic curve for GA and MAP was 0.77 (95% CI 0.70-0.82). After adjustment for GA, infants who experienced extubation failure had higher rates of bronchopulmonary dysplasia (P < 0.001), post-natal systemic corticosteroid treatment (P < 0.001), airway trauma (P < 0.003), longer durations of treatment with mechanical ventilation (P < 0.001), non-invasive respiratory support (P < 0.001), supplemental oxygen therapy (P = 0.05) and longer hospitalisation (P = 0.025). Conclusion(s): Lower GA and higher pre-extubation measured MAP were predictive of extubation failure within 7 days in extremely preterm infants. Extubation failure was associated with increased morbidity and extended periods of respiratory support and hospitalisation.Copyright © 2021 Paediatrics and Child Health Division (The Royal Australasian College of Physicians)

Objective: To investigate administration of pro re nata (PRN) medications and nurse-initiated medications (NIMs) in Australian aged care services over a 12-month period. Design(s): Twelve-month longitudinal audit of medication administrations. Setting and participants: Three hundred ninety-two residents of 10 aged care services in regional Victoria, Australia. Method(s): Records of PRN and NIM administration were extracted from electronic and hard copy medication charts. Descriptive statistics were used to calculate medication administration per person-month. Poisson regression was used to estimate predictors of PRN administration. Result(s): Over a median follow-up of 12 months (interquartile range 10-12 months), 93% of residents were administered a PRN medication and 41% of residents an NIM on 21,147 and 552 occasions, respectively. The mean number of any PRN administration was 5.85 per person-month. The most frequently administered PRN medications per person-month were opioids 1.54, laxatives 0.96, benzodiazepines 0.72, antipsychotics 0.48, paracetamol 0.46, and topical preparations 0.42. Three-quarters of residents prescribed a PRN opioid or PRN benzodiazepine and two-thirds of residents prescribed a PRN antipsychotic had the medication administered on 1 or more occasions over the follow-up. Conclusions and Implications: Most residents were administered PRN medications. Administration was in line with Australian regulations and institutional protocols. However, the high frequency of PRN analgesic, laxative, and psychotropic medication administration highlights the need for regular clinical review to ensure ongoing safe and appropriate use.Copyright © 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine

BACKGROUND: The clinical audit is an important evaluation tool to ensure quality assurance. A clinical audit requirement for interns during their emergency department (ED) term may be a valuable educational activity.METHODS: The Emergency Audit Initiative (EAI) Program was initiated at Redcliffe Hospital in January 2018. Interns, who were paired with a staff specialist audit mentor, chose a topic of interest and carried out a clinical audit during their 10-week ED term. At the end of term, interns formally presented audit findings in a grand round setting. Interns and staff specialists were surveyed at the end of the intern year regarding aspects of the program. Surveys aimed to assess: (1) value of the program as an educational activity, (2) availability of time and resources to conduct the audit, and (3) perceived impact on practice.RESULTS: During the first year of the program, 27 clinical audits were carried out. 16 interns (59%) and 8 staff specialists (57%) responded to the surveys. Interns and staff specialists reported that the audit was a valuable educational experience (88% and 100%). Interns also reported that they had adequate time (94%) and resources (81%) to conduct the audit. Interns and staff specialists however reported only a modest impact on clinical practice because of the audit program.CONCLUSIONS: Our experience with the EAI program suggests that incorporating a clinical audit requirement into the ED term is possible. Interns and staff specialists reported it to be a beneficial educational and professional development activity.

Age-related macular degeneration (AMD) is a leading cause of vision impairment worldwide. Currently, there are no approved therapies for earlier stages of AMD. Furthermore, treatments available for later stages of the disease may not reverse vision loss. Of key importance for reducing patients’ risk of progression to sight-threatening late-stage AMD, is the early identification and management of modifiable risk factors. Optometrists in Australia have a key role in providing primary eye care to people who are at risk of developing, or who have earlier stages of, AMD. They are therefore ideally placed to ask and counsel their patients about lifestyle modifications that can reduce the risk of disease progression. Our research team has recently developed the Macular Degeneration Clinical Care Audit Tool (MaD-CCAT), which is designed to audit the optometric care provided to people with AMD, relative to current best-practice standards. The first research project described in this thesis used self-audit data, collected by optometrists using the MaD-CCAT, to both characterise current optometric AMD practice patterns, and evaluate whether the process of clinical self-audit and receiving analytical feedback could improve AMD care. The second project involved a randomised, placebo-controlled trial to evaluate the efficacy of a novel AMD point-of-care clinical tool, delivered either in hardcopy (paper) or online format, for improving optometrists’ AMD knowledge and documented clinical care. In the first project it was found that there are several areas for improvement relating to optometrists’ documentation patterns for key areas relating to AMD care. In addition, self-audit with feedback significantly improved optometrists’ clinical record documentation, including: AMD risk factors, clinical examination techniques, AMD severity classification, and management, post-audit. The optometric practice patterns observed in this study were used to inform the development of two new AMD

Background: National hip fracture registries have been established in several countries and recent publications show that the care process has been audited inspecting the representativeness according to quality standards. The aim of this study was to analyse if the Spanish National Hip Fracture Registry (RNFC) represents the Spanish population aged 75 and older admitted for hip fractures, and to compare its results regarding the care process with the national average, according to the National Inpatient register (Minimum Basic Dataset, CMBD). Methods: The 2017-2018 National Minimum Basic Dataset (Conjunto Mínimo Básico de Datos, CMBD) was used as reference. For analysis, we included 83,110 cases from the CMBD and 21,130 from the RNFC. Eight common variables of both registries were selected for comparison. Results: No significant differences were observed in the patient-related common variables (age, sex, type of fracture and fracture side), but statistically significant differences were found in the variables describing the care process (proportion of patients operated, deceased, surgical procedures and postoperative length of stay). Conclusions: The RNFC, designed as a convenience sample, is also representative of the population of patients aged 75 and older treated for hip fractures in Spain. However, there is a participation bias related to the professionals and the hospitals interested in voluntarily participating in a quality improvement program, which would explain the better results observed in the care process, compared to the national average as collected by the CMBD., Fundamentos: Los registros nacionales de fracturas de cadera se han establecido en varios países y publicaciones recientes muestran que el proceso de atención ha sido auditado para explorar su representatividad de acuerdo a estándares de calidad. El objetivo de este trabajo fue analizar si el Registro Nacional de Fracturas de Cadera (RNFC) es representativo de la población española de 75 o más años de edad ingresada por fractura de cadera, y comparar los resultados acerca del proceso asistencial con la media nacional según el Conjunto Mínimo Básico de Datos (CMBD). Métodos: Se empleó el CMBD de los años 2017-2018 como referencia. Para el análisis se incluyeron 83.110 casos del CMBD y 21.130 del RNFC. Se seleccionaron ocho variables comunes a ambos registros para ser comparadas. Resultados: No se observaron diferencias significativas en las variables comunes paciente-dependientes (edad, sexo, tipo y lado de fractura), pero se hallaron diferencias significativas en las variables que describían el proceso asistencial (proporción de pacientes intervenidos, fallecidos, tipos de procedimiento quirúrgico y estancia postoperatoria). Conclusiones: El RNFC, diseñado como muestra de conveniencia, es también representativa de la población de pacientes de 75 y más años, atendida por fractura de cadera en España. Sin embargo, existe un sesgo de participación relacionado con los profesionales y los hospitales interesados en participar voluntariamente en un programa voluntario de mejora de calidad que podría explicar los mejores resultados observados en el proceso asistencial, comparado con la media nacional según se recoge por el CMBD.

OBIETTIVI: descrivere la metodologia di un sistema pilota di sorveglianza della mortalità perinatale (SPItOSS) volto a migliorare la qualità delle cure e a prevenire la grave morbosità e la mortalità perinatale evitabili in tre regioni italiane (Lombardia, Toscana e Sicilia). DISEGNO: un progetto di sorveglianza di popolazione per monitorare i casi di natimortalità dopo 28 settimane di gestazione e di mortalità neonatale entro 7 giorni dalla nascita. Per ogni decesso è stato organizzato un audit multidisciplinare per valutare la causa di morte presso la struttura dove si è verificato il caso. Una selezione dei decessi è stata analizzata da esperti attraverso indagini confidenziali regionali e nazionali per valutarne le cause e l’evitabilità. Per identificare le morti perinatali e codificarne le cause, sono stati adottati la definizione di mortalità perinatale dell’OMS e il suo sistema di classificazione ICD-PM. SETTING E PARTECIPANTI: professionisti sanitari di ogni unità di ostetricia e/o neonatologia nelle tre regioni coinvolte, che in totale registrano il 32,3% delle nascite in Italia. La raccolta dei dati è iniziata il 01.07.2017 e si è conclusa il 30.06.2019. PRINCIPALI MISURE DI OUTCOME: tasso di partecipazione delle unità ostetriche e neonatali nelle regioni aderenti al progetto, descrizione dell’organizzazione strutturale dei punti nascita, partecipazione degli operatori sanitari ai corsi di formazione sulle procedure della sorveglianza, stima dei tassi di mortalità perinatale nel periodo di studio, tasso degli audit clinici e delle indagini confidenziali eseguiti. RISULTATI: tutti i professionisti sanitari provenienti da tutte le unità di ostetricia e/o neonatologia (n. 138) hanno aderito al progetto pilota. Complessivamente, sono stati segnalati 830 decessi; 699 sono stati esaminati durante audit multiprofessionali presso le strutture dove si erano verificate le morti; 94 casi selezionati sono stati sottoposti a indagini confidenziali sia, OBJECTIVES: to describe the methodology of a pilot perinatal mortality surveillance system (SPItOSS) aimed to improve quality of care and prevent avoidable perinatal severe morbidity and mortality in three Italian regions. DESIGN: population-based surveillance project monitoring incident cases of stillbirths, born dead ≥ 28 weeks of gestation and live births dying within 7 days. Local multidisciplinary audits in obstetric and neonatal units were conducted to assess causes of each death. A selection of deaths was also discussed by experts in regional and national Confidential Enquiries to assess causes and avoidability. The WHO perinatal mortality definition and the ICD-PM classification were adopted to codify perinatal deaths. SETTING AND PARTICIPANTS: health professionals working in any obstetric and neonatal unit in Lombardy (Northern Italy), Tuscany (Central Italy), and Sicily (Southern Italy), ac-counting for 32.3% of births in Italy. Data collection started on 01.07.2017 and ended on 30.06.2019. MAIN OUTCOME MEASURES: obstetric and neonatal units’ participation rate in the participating regions, facility struc-tural organisation description, health professionals’ training course participation, estimate of perinatal death rates, clinical audits and Confidential Enquiries rates. RESULTS: health professionals from all obstetric and/or neonatal units (N. 138) joined the pilot project. Overall, 830 incident perinatal deaths were reported; 699 underwent a faci-lity-based clinical audit, and 94 selected cases were analysed in detail through regional and national Confidential Enquiri-es. Among the latter, 16.0% were assessed as avoidable de-aths. Interregional differences related to the facility structu-ral organisation were identified. CONCLUSIONS: SPItOSS was efficient in identifying and analysing incident cases of perinatal deaths and detecting improvable aspects of care and avoidable perinatal deaths. The next objective is to extend the surveillance at the national

Mahteme Bekele Muleta,1 Etsehiwot Haileselassie Yisak,1 Hana Abebe Gebreselassie,1 Tsega Tefera,1 Eden Berhanu,1 Adugna Lissanewerk Mekonnen,2 Woineshet Alaye,3 Gizachew Taddesse Akalu,4 Engida Abebe Gelan,1 Delayehu Bekele5 1Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 2Department of Ophthalmology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 3St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 4Department of Microbiology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 5Department of Obstetrics and Gynecology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Mahteme Bekele Muleta Email mahtemebekele@gmail.comPurpose: This study aimed at looking into the demand and utilization of blood and blood components at a tertiary teaching hospital in Ethiopia.Methods: A cross-sectional study was conducted from June 1, 2018 to August 31, 2018 at St Paul’s Hospital Millennium Medical College. Data on the types of blood products requested, indication for transfusion, availability of blood products and the utilization of different blood components, were collected by a structured questionnaire. Data were entered into SPSS version 20.1 and presented as frequency and percentage.Results: Blood and blood components were requested for 819 patients during the study period. Blood group O RhD positive was the commonest blood group (BG) accounting for 292 (35.7%) of the study participants followed by blood group A RhD positive 259 (31.7%). Physicians requested 3290 units of blood and blood components for transfusion; however, only 1840 (55.9%) were available and transfused. Of the 1840 transfused blood and blood components, 771 (42%) were packed RBC, 460 (25%) platelet, 352 (19%) fresh frozen plasma, and 257 (14%) whole blood. Postpartum hemorrhage was the commonest indication of blood transfusion in obstetrics, while severe a

Samuel Debas Bayable, Melaku Bantie Fetene, Molla Amsalu Tadesse College of Medicine and Health Science, Debre Berhan University, Debre Berhan, EthiopiaCorrespondence: Samuel Debas Bayable Tel +251 9-11-43-75-07Email samueldebas88@yahoo.comBackground: Assessing the quality assurance of providing work-ready anesthesia equipment in operating rooms is so vital. Most of the anesthesia-related adverse events are preventable by the identification and correction of anesthesia machine errors and equipment preparation in the pre-induction period. This paper aimed to keep a high-quality environment for workers and patients in the surgical operating theater.Materials and Methods: Data were collected after ethical clearance obtained from the institutional ethical review board, and daily observations of pre-induction anesthesia preparation were done in all surgical rooms at the start of each day and continuously before the next cases with a prepared anesthesia machine checklist. Descriptive statistical analysis and cross-tabulation of each checklist with the type of anesthesia and urgency of surgery were done to determine the degree of staff compliance with daily preparations using SPSS version 22, and finally, results were presented by texts and graphs.Results: In this study, a total of 61 checking events with 19 items were involved during the study period. There were 893 (77.1%) fully met checking events, 205 (17.7%) not-met checking events(sodalime) 61 (5.3%) not available in anesthesia machine check and equipment preparation before use. Among 19 checklists, only three (power source plugged in, power source switched on, and functionality of monitoring) were perfectly completed; however, the rest sixteen checklists are in bad practice among them seven checklists (presence of functional self-inflating bag, automatic machine check, power source backup battery, anti-hypoxic device, ventilator, difficult airway equipment and scavenging systems) were checked below 90%.Conclusions a

Said Alyacoubi,1 Loai Albaraqouni,2 Khamis Elessi,1 Bettina Bottcher1 1Evidence-Based Medicine Unit, Faculty of Medicine, Islamic University of Gaza, Gaza, Gaza Strip, Palestine; 2Centre for Research in Evidence-Based Practice, Bond University, Robina, Queensland, AustraliaCorrespondence: Said AlyacoubiSouthampton General Hospital, Southampton, SO16 6YD, UKEmail said-alyacoubi@hotmail.comBackground: Clinical audit plays a fundamental role in improving the quality of patient care and hence, is considered a cornerstone of clinical governance. This study evaluates clinical audit as a newly introduced quality improvement tool in the healthcare system of the Gaza Strip.Methods: Medical students and healthcare professionals who conducted audits between 2015 and 2018 were invited to fill in an online survey from October 12 to November 2, 2018. Data were collected on different aspects of the audit process.Results: A total of 62 audits were collected. Training in clinical governance was received by 55 authors (88.7%) while senior supervision was available in 56 audits (90.3%). Audits were performed across different hospitals and specialties with 18 audits (29%) in obstetrics, 16 audits (25.8%) in medicine and 11 audits (17.7%) in each of surgery and paediatrics. A clear trend of increasing numbers of audits was observed with 4 audits (6.4%) conducted in 2015, 12 audits (19.3%) in 2016, 22 audits (35.4%) in 2017, and 24 audits (38.7%) in 2018. Only 32 audits (51.6%) were presented to the local staff. The audit cycle was completed in 13 projects (20.9%) with only seven of them reporting subsequent improvements in practice.Conclusion: The rise in the number of audits reflects a growing awareness of its key role in healthcare and patient safety. However, the closure of loops and the actual implementation of recommendations are still lagging behind. Therefore, more focused efforts are needed to implement changes and ensure continuous evaluation of their effectiveness.Keywords: qu

Mariea A Brady,1 Holly Carrington,1 Tim Theologis1,2 1Medical Sciences Division, Oxford University Hospital, Oxford, UK; 2Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Oxford, UKCorrespondence: Tim TheologisNDORMS, Nuffield Orthopaedic Centre, Windmill Road Headington, Oxford OX3 7HE, UKTel +44 300 304 7777Email tim.theologis@ouh.nhs.ukPurpose: In 2019, the results of the first James Lind Alliance (JLA) research priorities setting partnership (PSP) in paediatric orthopaedics were published in the form of 10 top questions. One of which was, “What is the clinical and cost effectiveness of pre-operative rehabilitation in children presenting with lower limb orthopaedic conditions?” The purpose of this study was to assess the clinical and cost effectiveness of simple pre-operative rehabilitation (prehabilitation) strategies, as measured by hospital Length of Stay (LoS).Patients and Methods: Clinical records were reviewed retrospectively to determine the average LoS for patients who underwent lower limb paediatric orthopaedic surgery before any prehabilitation intervention. Prehabilitation intervention strategies were introduced, including patient education, provision of crutches and goal setting and subsequent data was collected. LoS before and after intervention were compared. In addition, extra bed days, defined as the difference between actual and expected LoS (determined by the treating clinician with reference to national data), were compared.Results: Before intervention, the average LoS after paediatric orthopaedic surgery in our hospital was 2.95 days (range 12 days; standard deviation (SD) 2.20 days) and after intervention, the average LoS was reduced to 2.70 days (range 7 days; SD 1.84 days). These data showed an 8% reduction in hospital LoS after the introduction of prehabilitation. Further, there was a significant (p=0.024) reduction in extra bed days (per patient) from 1.12 days (range 14 days; SD

Mark Mohan Kaggwa,1 Sarah Maria Najjuka,2 Sheila Harms,1,3 Scholastic Ashaba1 1Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 2Makerere University, College of Health Sciences, Kampala, Uganda; 3Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, CanadaCorrespondence: Mark Mohan Kaggwa Email kmarkmohan@gmail.comBackground: There is higher global mortality among persons living with mental illness than the general population, attributed to the risky behaviours associated with mental illness, medical comorbidities, or side effects of psychiatric medications that result in premature death among psychiatric in patients.Objective: This audit aimed to describe the characteristics of patients with mental illness who died during admission at a tertiary psychiatric ward in Uganda.Methods: This was a retrospective chart review of patients who died while admitted to a psychiatry ward between January 1995 to July 2020.Results: We reviewed 30 charts, of which 18 (60%) patients were women. The majority of patients died during 2002 (13.3%). Many were diagnosed with a brief psychotic disorder, 7 (23.3%), followed by bipolar disorder 6 (20.0%). HIV and epilepsy were the most common comorbidities. The majority of the death causes of death were unknown, 20 (66.7), but heart attack (n=2) was the most identified cause.Conclusion: The majority of the causes of mortality were unknown. The most common cause of mortality was heart attack, a common effect of metabolic disease and chronic antipsychotic use. Mortality audits are warranted to identify possible causes and to develop strategic interventions for mortality prevention.Keywords: mortality, audit, psychiatric inpatients, suicide, antipsychotic medications, medical comorbidities, HIV/AIDS, hospitalization, mental health, epilepsy, continued care

Objectives To study evidence for construct validity, the aim was to describe the outcome from the recently developed Diabetes Questionnaire, assess the associations of that outcome with clinical variables and generic health-related quality of life, and study the sensitivity to differences between clinically relevant groups of glycaemic control in adults with type 1 and type 2 diabetes in a nation-wide setting. Design Cross-sectional survey. Setting Swedish diabetes care clinics connected to the National Diabetes Register (NDR). Participants Among 2479 adults with type 1 diabetes and 2469 with type 2 diabetes selected at random from the NDR, 1373 (55.4%) with type 1 and 1353 (54.8%) with type 2 diabetes chose to participate. Outcome measures The Diabetes Questionnaire, the generic 36-item Short Form version 2 (SF-36v2) health survey and clinical variables. Results Related to the prespecified assumptions, supporting evidence for construct validity for the Diabetes Questionnaire was found. Supporting divergent validity, the statistically significant correlations with the clinical variables were few and weak. In relation to the SF-36v2 and in support of convergent validity, the strongest correlations were seen in the Diabetes Questionnaire scales General Well-being and Mood and Energy. In those scales, machine learning analyses showed that about 40%–45% of the variance was explained by the SF-36v2 results and clinical variables. In multiple regression analyses among three groups with differing levels of glycated haemoglobin adjusted for demographics, other risk factors, and diabetes complications, the high-risk group had, in support of sensitivity to clinically relevant groups, statistically significant lower scores than the well-controlled group in most Diabetes Questionnaire scales. Conclusions This nation-wide study shows that the Diabetes Questionnaire captures some generic health-related quality-of-life dimensions, in addition to adding diabetes-specific informatio

Cutaneous melanoma is a common type of cancer in Adolescents and Young Adults (AYAs, 15–39 years of age). However, AYAs are underrepresented in clinical trials investigating new therapies and the outcomes from these therapies for AYAs are therefore unclear. Using prospectively collected nation-wide data from the Dutch Melanoma Treatment Registry (DMTR), we compared baseline characteristics, mutational profiles, treatment strategies, grade 3–4 adverse events (AEs), responses and outcomes in AYAs (n = 210) and older adults (n = 3775) who were diagnosed with advanced melanoma between July 2013 and July 2018. Compared to older adults, AYAs were more frequently female (51% versus 40%, p = 0.001), and had a better Eastern Cooperative Oncology Group performance status (ECOG 0 in 54% versus 45%, p = 0.004). BRAF and NRAS mutations were age dependent, with more BRAF V600 mutations in AYAs (68% versus 46%) and more NRAS mutations in older adults (13% versus 21%), p < 0.001. This finding translated in distinct first-line treatment patterns, where AYAs received more initial targeted therapy. Overall, grade 3–4 AE percentages following first-line systemic treatment were similar for AYAs and older adults; anti-PD-1 (7% versus 14%, p = 0.25), anti-CTLA-4 (16% versus 33%, p = 0.12), anti-PD-1 + anti-CTLA-4 (67% versus 56%, p = 0.34) and BRAF/MEK-inhibition (14% versus 23%, p = 0.06). Following anti-CTLA-4 treatment, no AYAs experienced a grade 3–4 colitis, while 17% of the older adults did (p = 0.046). There was no difference in response to treatment between AYAs and older adults. The longer overall survival observed in AYAs (hazard ratio (HR) 0.7; 95% CI 0.6–0.8) was explained by the increased cumulative incidence of non-melanoma related deaths in older adults (sub-distribution HR 2.8; 95% CI 1.5–4.9), calculated by competing risk analysis. The results of our national cohort study show that baseline characteristics and mutational profiles differ between AYAs and older adults with

There is an increasing number of specialties performing office-based procedures, with many different providers practising in this field. Office Based Anaesthesia Solutions is a private enterprise designed to be a high-quality general anaesthesia and sedation service delivering care across 18 dental practices in Victoria. We undertook a criterion-based audit of our practice standards and outcomes. Following ethics approval, we retrospectively reviewed consecutive patients managed by our service between March 2014 and July 2017. We collected demographic data, information about anaesthesia technique, and surgical features. We assessed our findings against the Australian and New Zealand College of Anaesthetists (ANZCA) day surgery policy documents. During the specified period, we provided anaesthesia or sedation for 1,323 patients. Their ages ranged from two to 93 years (mean [standard deviation] 33.3 [18.6] years). Ninety-three percent of patients were American Society of Anesthesiologists (ASA) physical status classification 1 or 2. Patient demographics were in line with ANZCA day surgical policy documents. Total intravenous anaesthesia was used in 1,054 of the 1,096 documented general anaesthesia cases. There were three unplanned hospital transfers (annual incidence 0.07%). As this was the first Australian criteria-based audit of office-based anaesthesia (OBA) for dental procedures, we cannot compare our findings directly to previous studies. However, we feel that our patient demographics fell within acceptable ANZCA day procedure standards and our adverse event rate was both very low and similar to other published international adverse event rates. Our audit indicates that with careful screening processes, patient selection and medical governance, OBA is a viable model of care for patients undergoing dental procedures.Copyright © 2018 Australian Society of Anaesthetists.

Introduction: Elective in-patient admission for "stabilisation" of glycaemic control in type 1 diabetes mellitus is an intervention used in an effort to identify and address barriers to optimal metabolic control which have been unsuccessfully managed on an outpatient basis. The Endocrinology team at the Royal Children's Hospital Melbourne typically arrange 1-2 elective admissions per month for this purpose where intensive input from the diabetes medical and allied health teams is provided to individuals with HbA1c >=10% (86 mmol/mol). Objective(s): This retrospective clinical audit aimed to assess the efficacy of elective admissions for stabilisation of T1DM to the Royal Children's Hospital and to identify personal or clinical factors which may contribute to a more successful outcome in terms of short and medium-term metabolic improvement. We hypothesised that there is a sustained clinical benefit of elective admissions for stabilisation overall. Method(s): Data pertaining to all T1DM elective admissions to the Royal Children's Hospital between January 2016 and May 2018 was analysed. The outcome measures assessed were the change ('delta') in HbA1c 3, 6 and 12 months post-elective admission from baseline preadmission HbA1c. Result(s): The average length of stay was 3 days (range 2-6). Mean (SD) age at the time of admission was 15 (2.5) years, at a mean of 7.0 +/-3.6 years post diagnosis with T1DM. The median [IQR] HbA1c at time of admission was 10.7% [9.9, 11.5] (93mmol/mol [85, 102]). The median [IQR] delta HbA1c at 3, 6 and 12 months post-admission was -1.35% [-1.9,-0.5], -1.4% [-2.2,-0.8 ] and -1.1% [-1.95,-0.6] respectively. Conclusion(s): Our review suggests an overall improvement in HbA1c following elective admissions that is sustained at 12 months postadmission to hospital. It is unclear whether this improvement can be achieved in other patients with comparable diabetes control with alternative interventions such as intensive allied health input on an outpatie

Objectives: To analyse all mortalities related to surgery for urinary tract calculi in Australia from 1 January 2009 to 31 December 2018, and identify common causes, clinical management issues (CMIs), and areas for improvement. Patients and Methods: All urological-related deaths reported to the Australian and New Zealand Audit of Surgical Mortality (ANZASM) from 2009 to 2017 were analysed. The Bi-National Audit of Surgical Mortality (BAS) database was interrogated for any involvement with renal, ureteric or bladder stones and all relevant associated data analysed. Any CMIs documented by the peer reviewers were recorded and compared to those in urology and all of surgery ANZASM data. Result(s): Of 1034 total urological deaths, 100 (9.7%) were related to stones. The mean (range) age of patients was 74.4 (21-97) years; 95% of the patients underwent at least one procedure, with 45 (47.4%) of these being elective. Urinary sepsis was responsible for 49.5% of the deaths, with 20% dying of cardiac events. In all, 39% (37/95) of deaths were associated with CMIs, the most common considerations being delays in diagnosis or treatment, perioperative management and inadequate preoperative evaluation. This is a considerably higher percentage than the 26% recorded for the general urology and all surgery national data. Ureterorenoscopy at 54% (12/22) had the highest rate of CMIs. Conclusion(s): Death related to stone surgery represents only a small proportion of all urological surgical deaths, but generates more CMIs amongst ANZASM peer assessors. Results could be improved with more rapid diagnosis and treatment. Careful case selection and access to all treatment options are recommended.Copyright © 2020 The Authors BJU International © 2020 BJU International Published by John Wiley & Sons Ltd.

Background: Detection of small for gestational age (SGA) foetuses with risk factor screening and selective growth ultrasonography is the standard of care in Australia, but evidence regarding diagnostic accuracy is limited. We sought to identify pregnancies at risk of poor foetal growth, quantify the use of foetal growth ultrasonography and assess compliance with local screening guidelines for SGA foetuses. Method(s): This was a retrospective clinical audit of all singleton deliveries after 20 weeks' gestation at a large metropolitan maternity care centre, over 18 months. Terminations of pregnancy were excluded. An SGA neonate was defined by birthweight below the 10th percentile according to local reference ranges. Suspected SGA was defined as sonographic estimated foetal weight or abdominal circumference below the 10th percentile at any gestational age after 24 weeks, or small or static symphysis-fundal height. Result(s): 13384 singleton pregnancies were included. 10266 pregnancies (77.0%) had at least one risk factor for an SGA infant. Of these, 6650 (64.8%) underwent at least one foetal growth ultrasound after 24 weeks' gestation. 1330 infants (10.0%) were SGA at birth. Antenatal detection rate of SGA at birth was 39.6%, with a false positive rate of 10.2%. Conclusion(s): Three-quarters of pregnancies had risk factors for delivering an SGA infant, but growth ultrasonography may be underutilised. Overall, antenatal recognition of poor foetal growth is suboptimal using current screening protocols.

Objective: Mycotic aneurysms of the abdominal aorta (MAAA) can be treated by open repair (OR) or endovascular aneurysm repair (EVAR). This nationwide study provides an overview of the situation of MAAA treatment in The Netherlands in 2016.Methods: A retrospective cohort study was conducted with all centers that registered aortic abdominal aneurysms in the Dutch Surgical Aneurysm Audit in 2016. Questionnaires on 1-year outcomes were sent to all centers that treated patients with MAAA. The primary aim was to determine 30-day and 1-year mortality and morbidity of OR- and EVAR-treated patients. Morbidity was determined by the need for reoperations and the number of readmissions to the hospital.Results: Twenty-six MAAA were detected in the Dutch Surgical Aneurysm Audit database of 2016, resulting in an incidence of 0.7% of all registered abdominal aortic aneurysms. The 30-day mortality for OR and EVAR treated patients was 1 in 13 and 0 in 13, respectively. Major and minor reinterventions within 30 days were needed for two (one OR and one EVAR) and two (one OR and one EVAR) patients, respectively. Two patients (15.4%) in the OR group and one patient (7.7%) in the EVAR group were readmitted to hospital within 30 days. In total, 1-year outcomes of 23 patients were available. In the OR group, one patient (9.1%) died in the first postoperative year. There was one major reintervention (removal of endoprosthesis and spiralvein reconstruction) in the EVAR group. Two patients (18.2%) treated with OR and two (16.7%) treated with EVAR required a minor reintervention. In both groups, four patients (OR, 36.4%; EVAR, 33.3%) were read-mitted to hospital within 1 year postoperatively.Conclusions: Both OR- and EVAR-treated patients show acceptable clinical outcomes after 30 days and at the 1-year follow-up. Depending on the clinical course of the patient, EVAR may be considered in the management of this disease.

Objective The aim of this study was to map end-of-life care in acute hospital settings against Elements 1-5 of the Australian Commission on Safety and Quality in Health Care's (ACSQHC) Essential Elements for Safe and High-Quality End-of-Life Care. Methods A retrospective medical record audit of deceased in-patients was conducted from 2016 at one public (n = 320) and one private (n = 132) hospital in Melbourne, Australia. Ten variables, key to end-of-life care according to the ACSQHC's Elements 1-5 were used to evaluate end-of-life care. Results Most patients (87.2%) had a limitation of medical treatment. In 91.97% (P < 0.0001) of cases, a written entry indicating poor prognosis preceded a documented decision to provide end-of-life care, with a documented decision noted in 81.1% of cases (P < 0.0001). Evidence of pastoral care involvement was found in 41.6% of cases (P < 0.0001), with only 33.1% of non-palliative care patients referred to specialist palliative care personnel (P = 0.059). An end-of-life care pathway was used in 51.1% of cases (P < 0.0001). Conclusion There is clear scope for improvement in end-of-life care provision. Health services need to mandate and operationalise Elements 1-5 of the ACSQHC's Essential Elements into care systems and processes, and ensure nationally consistent, high-quality end-of-life care. What is known about the topic? Acute care settings provide the majority of end-of-life care. Despite the ACSQHC's Ten Essential Elements, little is known about whether current end-of-life care practices align with recommendations. What does this paper add? There is room for improvement in providing patient-centred care, increasing family involvement and teamwork, describing and enacting goals of care and using triggers to prompt care. Differences between public and private hospitals may be the result of differences in standard practice or policy and differences in cultural diversity. What are the implications for practitioners? The Essential Ele

Objective: Patient-reported outcomes (PROs) provide self-reported patient assessments of their quality of life, daily functioning, and symptom severity after experiencing an illness and having contact with the health system. Feeding back summarised PROs data, aggregated at the health-service level, to healthcare professionals may inform clinical practice and quality improvement efforts. However, little is known about the best methods for providing these summarised data in a way that is meaningful for this audience. Therefore, the aim of this scoping review was to summarise the emerging approaches to PROs data for ‘service-level’ feedback to healthcare professionals. Setting: Healthcare professionals receiving PROs data feedback at the health-service level. Data sources: Databases selected for the search were Embase, Ovid Medline, Scopus, Web of Science and targeted web searching. The main search terms included: ‘patient-reported outcome measures’, ‘patient-reported outcomes’, ‘patient-centred care’, ‘value-based care’, ‘quality improvement’ and ‘feedback’. Studies included were those that were published in English between January 2009 and June 2019. Primary and secondary outcome measures: Data were extracted on the feedback methods of PROs to patients or healthcare providers. A standardised template was used to extract information from included documents and academic publications. Risk of bias was assessed using Joanna Briggs Institute Levels of Evidence for Effectiveness. Results: Overall, 3480 articles were identified after de-duplication. Of these, 19 academic publications and 22 documents f

PURPOSE/OBJECTIVE: A national incentive brought about the instauration of systematic clinical audits of all Belgian radiotherapy departments (n = 25) from 2011 to 2015 using the International Atomic Energy Agency QUATRO (Quality Improvement Quality Assurance Team for Radiation Oncology) methodology. The impact of these audits was evaluated and the emitted recommendations originating from the audit reports were analysed to identify areas of weakness on a national basis. METHOD: The QUATRO audits performed in each radiotherapy department gave rise to reports in which each department received a list of recommendations that it is free to implement. These audit reports were analyzed to identify common areas for which improvements were recommended. Moreover, questionnaires were sent to all departments in order to evaluate the overall usefulness of the recommendations as well as the relevancy and the actual impact of each individual recommendation. RESULTS: Of the 381 emitted recommendations, 34% concerned process optimization of which a quarter involved process improvement and protocol development. Twenty-seven percent of the recommendations concerned infrastructure of which one-third was related to the quality of the equipment or facility. Nineteen and 20% of recommendations addressed department organisational and staff issues respectively. When analysing the departments' feedback questionnaires, 54% of the departments evaluated the audits' recommendations as being very useful. Furthermore, 42.7% of the recommendations were found to be very relevant and 23.5% were deemed to have an important impact. CONCLUSION: This first round of audits in Belgium allowed for the identification of common areas for improvements of practice in radiation oncology departments, with a focus on process optimization and infrastructure elements. Similarly, the audits' emitted recommendations were globally deemed very relevant. Encouraged, by this analysis, a second cycle of audits has started i

Background: In dual antiplatelet therapy (DAPT), low-dose acetylsalicylic acid is combined with a P2Y12 inhibitor. However, combining antithrombotic agents increases the risk of bleeding. Guidelines on DAPT recommend using this combination for a limited period of between three weeks and 30 months. This implies the risk of DAPT being erroneously continued after the intended stop date. Objective: The primary objective of this study is to assess the proportion of hospitalized patients treated with DAPT whose treatment deviated erroneously and unintentionally from the guidelines. We also assessed risk factors and the effect of a pharmacist intervention. Methods: All patients admitted to the Spaarne Gasthuis (Haarlem/ Hoofddorp, the Netherlands) who used DAPT between March 25th, 2019, and June 14th, 2019, were, in addition to receiving regular care, reviewed to assess whether their therapy was in line with the guidelines’ recommendation and whether deviations were unintended and erroneous. In the event of an unintended deviation, the pharmacist intervened by contacting the prescriber by phone and giving advice to adjust the antithrombotic therapy in line with the guideline. Results: We included 411 patients, of whom 21 patients (5.1%) had a treatment that deviated from the guidelines. For 11 patients (2.7%), the deviation was unintended and erroneous. The major risk factor for erroneous deviation was the use of DAPT before hospital admission (OR 18.7; 95%CI 4.79–72.7). In patients who used DAPT before admission, 18 out of 58 (31.0%) had a deviation from the guidelines of whom 8 (13.8%) were erroneous. For these eight patients, the pharmacist contacted the prescriber, and in these cases the therapy was adjusted in line with the guidelines. Conclusions: Adherence to the guidelines recommending DAPT was high within the hospital. However, patients who used DAPT before hospital admission had a higher risk of erroneous prescription of DAPT. Intervention by a pharmacist increa

Muhammad Qasim Bhatti,1 Richard Mathew Francis,1 Firas Khaleefah Al Nidawi1,2 1School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Al Sayh, Bahrain; 2Department of Neurology, King Hamad University Hospital, Al Sayh, BahrainCorrespondence: Muhammad Qasim Bhatti Email qb2517@hotmail.comBackground and Objective: Acute ischemic stroke (AIS) is one of the leading causes for disability worldwide. Incidence has substantially been on the rise globally including Bahrain. The American Heart Association has proposed their latest recommendations with careful integration of the latest literature to optimize stroke care. The aim of this clinical audit is to determine adherence of King Hamad University Hospital to the latest recommendations provided by the AHA/ASA association in order to evaluate the quality of AIS care and highlight improvements to standard practice.Patients and Methods: A retrospective review of patient records was conducted on 75 eligible patients. Patient charts were analyzed for adherence to a select number of parameters pertinent to the AHA/ASA guidelines.Results: Results indicated high adherence rates ranging from 61.1% to 100% for parameters pertaining to stroke scales, imaging, door to needle times, blood glucose, electrocardiograms and anti-platelet agents. Standards were met in the in-patient setting for the relevant guidelines with the exception of dysphagia and dvt prophylaxis.Conclusion: Dysphagia screening and dvt prophylaxis adherence rates should be improved. Specific recommendations are proposed including checklist implementation, informing patient care staff for prompt dysphagia assessment and integrating latest guidelines into the existing dvt prophylaxis protocol.Keywords: ischemic, stroke, audit, alteplase, adherence