Quality and Safety in Healthcare

Evaluating the adherence to guidelines for management of acute heart failure in the Gaza Strip hospitals: A medical chart–based review study Mohamedraed Elshami, Reem Dabbour, Mohammed Alkhatib, Tamer Abdalghafoor, Enas Alaloul, Mohamed Habib, Montaser Ismail, Bettina Bottcher Global Journal on Quality and Safety in Healthcare 2019 2(2):21-29 Objective: To evaluate adherence of clinicians to the European guidelines for management of acute heart failure (AHF). Materials and Methods: This was a medical chart–based review study conducted from January to December 2016, including 200 medical records of patients admitted to two major hospitals in the Gaza Strip, Palestine. The AHF management was compared to the European Society of Cardiology (ESC) Guidelines, 2016. Results: The patients’ mean age was 66.0±13.0 years. A total of 100 patients (50.0%) were women and 192 (96.0%) had comorbidities including hypertension, diabetes, and heart disease. The most notable finding was that of a very poor standard of documentation, especially for vital signs. Patient management showed mostly moderate to good adherence to guidelines with 189 (94.5%) patients undergoing electrocardiogram, 90 (45.0%) echocardiography, 97 (48.5%) chest X-ray, and 79 patients of 167 (47.3%) receiving vasodilators appropriately. Good adherence was found in checking glucose levels, 176 (88.0%), and application of oxygen (100% with SpO2 < 90%). Some aspects of care showed poor adherence, such as overuse of digoxin in 57 patients (28.5%), of which only 30 (53.4%) had atrial fibrillation and inappropriate use of beta-blockers in two patients who were hypotensive. Furthermore, brain natriuretic peptide was not used at all. Conclusion: The results of this study show suboptimal adherence to the ESC guidelines in management of AHF, reflecting the need to improve awareness of evidence-based medicine among clinicians.

Radiographs reject analysis in a large tertiary care hospital in Riyadh Khalid A Alyousef, Shatha Alkahtani, Raghad Alessa, Hajar Alruweili Global Journal on Quality and Safety in Healthcare 2019 2(2):30-33 Background: Analysis of rejected radiographs is an important quality indicator of any radiology department. At King Abdulaziz Medical City (KAMC), about 185,000 radiographs are performed annually. Methods: The rejected radiographs over a period of 5 years were analyzed using a dedicated electronic rejection system. The rejection is performed by a certified radiologist and communicated electronically to the concerned technologist. Results: A total of 455 rejected radiographs were reviewed and analyzed. Of the reviewed rejected radiographs, 247 were adults (60%) whereas 166 were pediatrics (40%). In terms of sex, 231 (56%) of the rejected radiographs were for men and 182 (44%) were for women. The most common reason for rejection was labeling (22%), followed by procedure protocol (20%). Other reasons included positioning (14%), processing (14%), artifacts (13%), wrong documentation (9%), and exposure error (6%). The rejection due to exposure error was very low (6%) owing to the utilization of digital systems that offer a wide exposure latitude. Reported data at hospitals that use analog systems show up to 67% of rejections were due to exposure error. In terms of body parts, the highest rejection was for extremities (43%) followed by chest (31%). The remaining rejected radiographs includes abdomen (9%), spine (8%), pelvis (5%), and head and neck (4%).Conclusion: The outcome of this study can be used to set up training programs to improve radiological services and reduce the unnecessary radiation exposure to the patients.

Rare event control charts in drug recall monitoring and trend analysis of data record: A multidimensional study Mostafa E Eissa Global Journal on Quality and Safety in Healthcare 2019 2(2):34-39 Background: Control of the quality of pharmaceutical and healthcare products in the market is mandatory to ensure the safety and efficacy of the delivered product to the final consumers. The United States Food and Drug Administration (FDA) is providing a continuous and comprehensive updated list for various healthcare issues including drug recalls. Methods: This study provides a multidimensional analysis using statistical process control (SPC) tools to evaluate the risk associated over a 3-year period (2016–2018). Results: The study showed a simple implementation of the combination of SPC tools, which demonstrated that the major contributors to recalls are microbiological quality issues, problems with product compositions, and packaging defects. Months that contributed by more than 60% of the total recalls were from May to August, November, and December. Conclusion: The general trend of drug recall rates is increasing yearly, which should be a warning signal for the regulatory agencies to take preventive measures to control and prevent excessive cases of recalls.

Safe patient handling: How many people do you need to safely lateral transfer patients? Austin J Smith, Michele Loder Global Journal on Quality and Safety in Healthcare 2019 2(2):40-45 Background: Although friction-reducing devices reduce the amount of force to complete a lateral transfer, the total force is significantly higher than the recommended pushing and pulling limits. Caregivers complete lateral transfers without knowing the amount of force required to laterally transfer patients, which subjects them to injury. Methods: This study was designed to identify the force to laterally transfer patients of any weight, in conditions similar to those found within the hospital of this study. There were 16 participants in this study. The participants were moved from a hospital bed to a hospital cart using two force gauges pulling two gait belts secured around the participant. Each participant was moved three times, resulting in 48 data points. A regression analysis was used to evaluate trends between two variables. A general linear model was applied and the coefficient of determination was calculated to show the percent fit to the trend line. Results: This study found a strong correlation between force of lateral transfer and the weight of the patient. Using this correlation, this study was able to predict the total force of a lateral transfer for any patient weight. The results from this study allowed for the creation of a guide to determine how many caregivers are required during a lateral transfer to maintain a safe amount of force per caregiver. Conclusion: Caregivers need to be given information regarding the forces required to complete physical movements so they can protect themselves from overexertion and injury. This study provides a guideline for caregivers to know how many people are needed to safely complete a lateral transfer.

The impact of post-discharge follow-up calls on 30-day hospital readmissions in neurosurgery Dorothy M Mwachiro, Jacqueline Baron-Lee, Frederick R Kates Global Journal on Quality and Safety in Healthcare 2019 2(2):46-52 Background: Hospital readmissions that occur within 30 days of the initial hospital stay are costly and potentially avoidable. Studies have shown that in addition to patients’ discharge instructions and education, follow-up calls post-discharge can significantly reduce readmission that occurs within 30 days of the initial hospital stay. Objective: To evaluate the effectiveness of nurse follow-up calls conducted in the neurosurgery service for discharged patients between October 2017 and February 2018 in reducing readmissions that occur within 30 days of initial hospital stay. Methods: An audit was initially conducted to assess compliance with conducting follow-up calls. Weekly discharge reports were used to check if patients received a follow-up call within 24–48h post-discharge. To capture the nurses’ feedback on follow-up calls, an anonymous survey was administered. Medical insurance claims data, also known as claims-based data in the American health care system, were reviewed and analyzed to assess whether there was any difference in number of days from initial discharge to readmission between patients who received a follow-up call and those who did not. Results: Results based on a multivariable regression model indicated that patients who received a follow-up call after they were discharged from initial admission stayed out of hospital longer (incidence-rate ratio = 1.54, 95% CI = [1.13, 2.10], p = 0.006) compared to those that did not receive a follow-up call. Conclusion: Readmitted patients who received post-discharge follow-up calls had significant improvements in the length of time out of the hospital. Future development could include developing additional call strategies.