QAI Journal for Healthcare Quality and Patient Safety

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Background: Lean Six Sigma (LSS) is the latest generation of improvement approaches. The amount of waiting time directly impacts in patient experiences in physical therapy outpatient care. Patient waiting time data supports, patients referred to the physical therapy department for an appointment waited a minimum of 3 weeks. The physical therapy staff found this frustrating as patient's conditions often became more chronic during the wait and they often needed to take prolonged periods of sick leave. Physical therapists felt that to provide a better quality service they should reduce the waiting time of the patients. Aim: The aim of this study was to reduce the patient waiting time and improve the patient flow with optimized patient experience to using LSS methodology in an Outpatient Physical therapy Department (OPD). Subjects and Methods: LSS define–measure–analyze–improve–control methodology was adopted with using different quality tools. Results: A number of nonvalue added activities were identified within the process, and actions were initiated to systematically eliminate different forms of waste using the principles of lean thinking. The Non value added activities of Rework, Rejections, delayed approval Process leads to revenue loss were identified and eliminated from the process. Cause-and-effect analysis was carried out to identify the potential causes for unacceptable waiting times, and data were collected to validate these causes by the GEMBA investigation. As a result of this project, the average waiting time was reduced from 13.5 days (2 weeks) to 4 days to execute the first physical therapy session from the insurance approval. The Action plans were implemented on different levels of the process and specifically allocated to team members of Physicians, Physiotherapists, Patient's Administrators & Insurance Coordinator. Conclusion: There was a significant reduction in waiting time and improving the patient flow was achieved in the outpatient services of the physical therapy department using the LSS approach.

Background: The quality of blood centers and transfusion services is judged by the timely availability of blood components and their effective utilization by those in need. Proper utilization of the needed blood components can also prevent the wastage of blood products. Stock management of blood and blood components will increase their maximum availability and utilization. Many studies have shown that a lack of blood and its components increases the risk of severe complications in patients who require blood transfusions on an emergency basis, such as during intraoperative or postpartum hemorrhage, in trauma patients with severe anemia, and so on. All the health-care sectors need supportive facilities to provide on-time services to their customers. Hospital image and the quality of health-care services will be influenced by customer and patient satisfaction. The blood center plays a vital role in that by providing lifesaving blood and its components on an emergency basis as well as to the needy population. Objective: The goals of this research are to examine the stock availability of blood and blood components, to determine the utilization of blood units based on consumer needs, and to discover and analyze blood and blood component waste before use. Methodology: A retrospective study was conducted in a teaching hospital blood center on stock verification and the issuing of blood components. The retrospective record analysis was performed for 18 months. Sampling Method: The availability of stock and the utilization of blood and blood components data were collected from January 2021 to June 2022 from registers maintained and documented in the blood center. Conclusion: Our study provided a clear picture of how to maintain the stock level of blood units and blood components by explicitly stating the percentage of collection, stock level maintained for emergency needs, and percentage of utilized blood and blood components. We were able to determine the number of blood and blood component discards throughout the study and the causes of these discards so that we could implement the best inventory control for blood units in accordance with our analysis of GroupWise blood units' stock level maintenance to satisfy customer needs.

Background and Objectives: Catheter-associated urinary tract infection (CAUTI) is one of the most common health care-associated infections worldwide. Determination of the clinical and financial burden of CAUTI is of critical importance for all stakeholders for rational and fair allocation of resources. Materials and Methods: This study was a prospective observational study. The microbiological profile, antimicrobial usage, length of hospitalization (LOH), and cost of antimicrobial therapy of the patients diagnosed to have CAUTI were assessed. Data were expressed as mean ± standard deviation and range. Simple regression was used to find an association between the duration of catheterization and the development of CAUTI, one-way ANOVA was used to analyze the organism-specific differences in the above parameters. Results and Interpretation: One hundred and seventy-two patients with CAUTI were identified during the study period. The mean number of days from the insertion of the catheter to the development of the first symptom of CAUTI was 5.19 ± 2.08 days with a range of 2–14 days. Escherichia coli spp. was the most common isolate in 62% of patients. 81.39% of isolates were multidrug resistant. There was no significant difference observed in the days of therapy or length of therapy or LOH in different patients of CAUTI based on the causative organism; however, the cost of acquisition of antimicrobial therapy was found to be significantly different among the different microorganisms. Conclusion: Increasing prevalence of multidrug-resistant organisms has made the management of CAUTIs considerably more challenging. Implementation of optimum preventive measures and antimicrobial stewardship practices is essential.

Background: Patient safety is significant to improve the quality care in health-care organisations; hence, assessment of patient safety culture is the paramount need of the h. However, in middle- and low-income countries, the burden of patient safety is vital as the healthcare-related injuries and deaths are increasing, this is global health concern. The awareness of measuring patient safety culture needs to be improved in low- and middle-income countries and this can help in evaluating the culture and formulating interventions and also achieving the accreditation standards. National Accreditation Board for Hospitals (NABH) with a focus of patient safety has contributed largely in the quality of health care in Indian hospitals and witnessed progress and improvement. However, the challenges in a country like India are large and complex and need to be addressed systematically beyond the meeting accreditation standards. Aim: The aim of this study was to assess the level of perception among the healthcare providers at a tertiary care hospital. Methods: Cross-sectional study was conducted using The Hospital Survey on Patient Safety culture (HSOPSC v⁻¹) tool to assess the level of perception of patient safety culture among healthcare providers. The survey was conducted among 400 respondents of tertiary care hospital, Bangalore, Karnataka (India) through a structured, open- and close-ended questionnaire. Participants were selected through nonprobability random sampling. Collected data were analyzed through composite scores, Chi-square, and Man–Whitney U-test for test. Results: The present study showed a highest positive response in teamwork within the units and the least in nonpunitive response to error. The domain hands off and transitions which requires cooperation from other departments also showed low positive responses in many studies including the present study (41.13%). For the data analyzed above regarding the perception of patient safety culture dimensions among the healthcare professionals, it was seen that there was a statistically significant association (0.0026) between the two variables that perception and safety culture existing in the hospital. Conclusion: After comparing between experience and level of perception among healthcare providers, it was concluded that the Chi-square value is 0.04 which is statistically significant and there is a significant association between positions and level of perception. Therefore, our study indicates that there is a high need to develop strategies related to certain safety domains that urgently need improvement in this hospital.

Online since 20^th August 2018