Quality and Safety in Health Care最新文献

{"title":"238 Stimulating access to words in patients with Alzheimer's disease","authors":"C. Marion, Kuhn Véronique, M. Franck","doi":"10.1136/QSHC.2010.041624.75","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.75","url":null,"abstract":"Background and objectives Lack of words is the second most common disorder after episodic memory loss in patients with Alzheimer's disease. Our objective was develop a speech therapy protocol for patients with Alzheimer's disease with a Mini-Mental State (MMS) score greater than or equal to 15 and suffering from a lack of words, in order to improve access to words. The relationship between cognitive deterioration as assessed by the MMS score and lack of words in Alzheimer's patients seems to be coincidental; no causal relationship has been established (Medina and al. (JEV08)). Programme We developed a computerised rehabilitation protocol for patients with Alzheimer's disease in order to stimulate the three stages in the mental lexicon described in Levelt's theoretical model of neuropsycholinguistics (1999): lexical selection, morphological encoding, and phonological encoding. Stimulation of lexical selection involved working on the multiple meanings of a word (finding its different meanings by facilitating naming through an indication of context), a search for the relevant and specific features of a word in order to make a guess, and evoking a target word from specific features. Stimulation of morphological encoding involved extracting the meaning of a morpheme by comparing two words, one of which is derived from the other, and then identifying the meaning of an affix by slipping it into a sentence. Phonological encoding was stimulated by the isolation of the initial two-syllable words and merging them to form a third word. A speech therapist assessed lexical naming and MMS score before and after administration of the rehabilitation protocol to patients who had been diagnosed with Alzheimer's disease at Béziers hospital. Results Thirteen of 14 included patients completed the 20 training sessions of 30 min each, held once or twice a week with their speech therapist. Holding sessions in the same environment helped patients feel more secure and master the exercises better. After the rehabilitation protocol, 12 of the 14 patients were better at naming words after visual confrontation (pictures) and reproducing words after auditory confrontation. A decline was noted in every cognitive aspect in nine patients. Eight of these nine patients maintained or improved their lexical access. Discussion and conclusion Although there was a decline in cognitive abilities in our study population, systematic activation of the lexicon helped maintain or improve linguistic aspects of language. These aspects are essential to oral communication from an ecological and psychosocial standpoint. A limitation of our study is the small number of participants. We plan to include a wider range of patients and collaborate with more speech therapists. Cette étude porte sur un essai de formalisation d'une rééducation orthophonique du manque du mot chez des patients atteints de la maladie d'Alzheimer (avec un MMS supérieur ou égal à 15). En effet, après l'atteinte de la mé","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74849489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"053 The Provence Diabetes network: management of patients undergoing insulin infusion therapy in South of France","authors":"O. Ronsin-Pradel, M. Jannot-Lamotte, C. Atlan, C. Mattei, V. Dicostanzo, F. Plat, B. Delenne, J. Cohen, D. Raccah","doi":"10.1136/QSHC.2010.041632.6","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041632.6","url":null,"abstract":"Background and Objectives Continuous subcutaneous insulin infusion therapy has been in use for more than 20 years. The device was included on the list of reimbursable products and services in France in 2000. At the time, 246 patients were being treated in the Provence-Côte d'Azur region. The Provence Diabetes network was created in order to meet regional organisational needs during device deployment, to establish deployment rules, and to ensure the safety, quality and consistency of practices. Our objective was to assess the results obtained for the year 2008. Programme The Provence Diabetes network currently includes nine pioneer centres (including two paediatric centres), over 100 endocrinologists in independent practice in charge of treatment follow-up, 13 providers, four device manufacturers, state-registered nurses, dieticians, nonhospital podologists and health care institutions. Results In 2008, 275 patients started insulin infusion therapy within the network and 1193 patients were undergoing regular monitoring. Overall, 89% of scheduled patients had undergone yearly evaluation. Their average age was 46 years, 84.3% had type 1 diabetes (average duration 19.5 years). They had been on insulin infusion for a mean of 5 years. When insulin infusion therapy was initiated, their glycated haemoglobin (HbA1c) was 8.3%. By the time of the yearly evaluation, their metabolic status had markedly improved; HbAIc had fallen to 7.5% (p<10–9). There were 0.02% episodes of ketoacidosis/patient/year, and 0.1 episodes of severe hypoglycaemia/patient/year. Compliance was good in 85.5% of patients (quarterly follow-up visits, regular dose adjustments, blood glucose levels recorded several times a day). Most patients mastered device use (only 6% needed further training), 85.5% were aware of the insulin substitution protocol in case of pump failure, and 68% knew how to react in an emergency. Discussion and Conclusions Analysis of metabolic results and patient education in patients evaluated in 2008 within the Provence diabetes network has established the efficiency and safety of continuous subcutaneous insulin infusion therapy at a regional level (better metabolic balance and few acute accidents). This was despite more widespread diffusion of the device after national health insurance coverage was granted. In addition, the network has provided added value as regards application of regulations by ensuring consistency of practices across health care centres and by professionals (common protocols and procedures), organising training, centralising medical device vigilance and making sure that everyone applies the necessary safety criteria. Contexte et objectifs Le traitement par pompe à infusion sous cutanée existe depuis plus de 20 ans. En 2000, date d'inscription au TIPS, 246 patients sont traités par pompe à insuline dans la région PACA (hors Alpes –Maritimes)- Corse. Pour répondre aux besoins d'organisation régional lors du déploiement de ce traitement, ","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79502019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"244 Implementation of point-of-care blood glucose testing in a surgical and cardiac ICU: a successful collaboration between clinicians, biologists and information department","authors":"B. Catargi, P. Derache, Janvier Gérard, P. Coste, X. Roques","doi":"10.1136/qshc.2010.041624.63","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.63","url":null,"abstract":"Objectives Blood glucose and variability in glucose concentrations has recently emerged as playing a key role in critical care. Hyper- and hypoglycemia are associated with increased mortality of critically ill patients. Because blood glucose (BG) levels can drive treatment decisions, accurate and reliable testing is critical in this setting. To meet this challenge a point-of-care (POC) glucose monitoring system (PXP Abbott Diabetes Care) was implemented in the cardiac surgical and cardiac intensive care unit (ICU) of our hospital in order to increase BG testing, distance advising and quality control. We analysed automatically collected capillary BG obtained in everyday life with our intravenous insulin protocol no only in terms of mean blood glucose concentrations but also of variability (SD). The program The PXP/QCM3 system is intended for professional use in POC testing and has additional features such as built in security options, patient and quality control data management and data networking capabilities. One hundred and eighty meters were installed since October 2006, beginning with ICUs. Results During the last 3 years a total of 52 823 BG results from 4861 inpatients in the surgical ICU and 63 900 BG from 3843 from inpatients in cardiac ICU were automatically collected by the system during the last 3 years. Intensive intravenous insulin therapy based on frequently measured BG: 9.7 tests/patient/day during the first year,10.8 the second year and 11.8 the third year increased with % of BG at target while % of hypoglycemia decreased together with SD. Thus, this system gives a precise and exhaustive idea not only of BG concentration but also of variability of blood glucose obtained with our intensive insulin algorithms in ICUs. Conclusions The strengths of this POC PXP system include delivery of accurate results while providing precious collected data about management of blood glucose in the intensive care setting. The clinical impact in terms of quality, safety, gain of time by medical team and cost savings with hospital distance hyperglycemia management has now to be assessed by a medico-economic multicenter study. Objectifs, contexte L'hyperglycémie est un état très fréquent au moment d'un évènement cardiovasculaire. Une glycémie élevée et variable dès l'admission et durant le séjour en unité de soins intensifs (USI) est facteur de morbi-mortalité reconnu. Peu de données sont disponibles concernant la mesure et le suivi des résultats glycémiques capillaires (GC) en USI. Un système de biologie délocalisée (PXP Abbott) de mesure des GC a été utilisé pour augmenter le nombre de patients bénéficiant du conseil spécialisé à distance, la sécurité (contrôle qualité, traçabilité) des GC, le suivi et l'archivage des résultats. Programme Ce travail concerne les patients hospitalisés au décours d'un événement aigu (pontage coronarien, infarctus) ayant des troubles glycémiques. Un programme utilisant le système ","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78264495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"286 Clinical impact and use of a registry of practices: experience of the RICO registry of the Côte d'Or (France)","authors":"A. Gudjoncik, L. Lorgis, L. Mock, P. Buffet, Richard Carole, L. Janin-Manificat, J. Beer, L. Rochette, A. Desplanques-Leperre, Y. Cottin, M. Zeller","doi":"10.1136/QSHC.2010.041624.61","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.61","url":null,"abstract":"The RICO registry of the Côte d'Or (France), created in 2001, now counts almost 8000 patients hospitalised for ACS in six cardiology centres. It covers a region of 500 000 inhabitants. Can the use of a registry lead to a reduction in morbi-mortality due to myocardial infarction? Two examples to illustrate two effective uses that can improve patient management: Example 1: The analysis of 1002 patients with MI followed by the RICO registry made it possible: to show that « Only 50% of patients with MI had normal blood glucose levels, and that for one diabetic patient in three the cardiologist was unaware of the patient's diabetes. In these patients, it was found that beta-blockers and thrombolysis were underused. At 1 year after discharge from hospital, almost half of the diabetic patients were not receiving treatment for control of their glycaemia, and that treatments for their cardiovascular condition were underused. As a result, in diabetic patients, cardiovascular mortality and the incidence of heart failure were significantly higher » to implement approaches to improve management: in particular informing emergency care teams, interventional cardiologists and cardiologists in charge of Intensive Care Units about screening and treatments for abnormal glycaemia in the acute phase and orienting screened patients towards organised care systems. to measure the impact in terms of morbi-mortality: significant increase in the proportion of patients presenting with hyperglycemia in the acute phase who received insulin therapy during the acute phase (more than 60% in 2008–2009 compared with less than 20% in 2006–2007). The impact of this approach on cardiovascular mortality will be available at the symposium. Example 2: The themes of clinical research associated with the registry have also led to improved management of patients with myocardial infarction. In a large cohort of 3291 consecutive MI patients included between the 1st January 2001 and the 31st December 2006, our data underline the impact and interest of measuring levels of NT-proBNP. Indeed: (1) NT-pro-BNP is an independent predictor of death at 1 year whatever the age group (2) NT-proBNP can therefore be used in clinical practice to stratify risk in elderly post-infarction patients. However, the relevance of NT-pro-BNP in elderly and very elderly patients with heart failure remains controversial. (3) The clinical impact of the marker lies in the fact that it can lead to improved pharmacological management, in particular by optimisation of titration for beta-blockers and angiotensin-converting enzyme inhibitors, therefore reducing mortality at 30 days and at 1 year (4). These results will be available at the symposium. Discussion/Conclusions The creation of a continuous registry of clinical practices has resulted in: an immediate benefit for patients managed in the speciality whose practises are recorded, followed and analysed by the registry team. a benefit in the medium term with the develop","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75047819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"247 Improving comprehensive care of patients with cardiovascular risk factors","authors":"A. Charles, B. Marc, V. Sabine","doi":"10.1136/qshc.2010.041624.66","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.66","url":null,"abstract":"Objective (s), context Cardiovascular mortality is very high in the Nord-Pas-de-Calais region of France. In 2004, a study of risk levels carried out in the Berlaimont district reported (1) a high level of cardiovascular risk in the population, (2) and confirmed the need for specific training inciting to comprehensive care. This prompted the setting up of an experimental regional project evaluating the impact of a comprehensive care program for patients with high cardiovascular risk. Program The program included four phases: designing and dissemination of tools, training in the identification of risk levels and in the implementation of comprehensive care for high-risk patients, follow-up care in patients aged over 40, including an evaluation of their risk level 1 year later, and analysis of results. Method Over a 1-month period between November, 2005 and December, 2007, patients aged over 40 and presenting previous history of cardiovascular disease or diabetes, or a minimum of three risk factors (RF), or a SCORE≥5% were recruited from four districts—Berlaimont, Cambrai, Montreuil and Maubeuge (max 100 patients/doctor). The tools developed for the intervention included a decision-making support kit, a questionnaire and eight follow-up indicators. Seven of these indicators were elaborated based on current recommendations validated by the AFSSAPS, ESC, ANAES and HAS. The steering group chose one impact indicator of comprehensive care based on an objective considered attainable within 1 year of appropriate follow-up care. The results are expressed as average mean differences for patients between baseline and year 1 (T1yr - T initial). The frequency of variables was compared using the one-sided χ2 test p=5%. Results Thirty doctors attended four training courses (estimated satisfaction: 9.02/10), 14 went on to participate to the comprehensive management study, and eight reported 1-year follow-up in their patients. Eight hundred and forty-nine patients were initially recruited (65 patients/doctor), 44% were lost to follow-up (256 with >3 RF and 139 with >5 RF) and 66% were still being followed up at 1 year (559 patients, 70 patients/doctor, 83% > 3 RF, 28% > 5 RF). After 1 year: (1) Consumption of portions of fruits and vegetables per day increased by +46.2%; (2) Blood sugar level < 1.26 g/l: +42.9%; (3) Decrease in BMI (−1 category): +35.6%, (4) Physical activity (30 min 3 times/week): +17.4%; 5) Consumption of fish (twice/week): +16.9%; 6) Decreased smoking prevalence: +5.7%; 7) Cholesterol control: +5%; 8) Reduction of at least one risk factor in 1 year: 32.1%. p<0.05 for all the indicators. Development, perspectives, limitations After 1 year, the study shows significant improvement in comprehensive care (8/8 modifiable criteria were significantly improved). Study limitations relate to the number of follow-up criteria, absence of a principal outcome measure and of a control group, participation of voluntary doctors, and proportion of patients lost to ","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75424465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"267 The prevention of hemiplegic shoulder in a neurovascular unit","authors":"Amandine Cook, E. Timmermans, D. Dathy, J. Caire, I. Sibon, R. Vergnes, P. Dehail, F. Rouanet","doi":"10.1136/QSHC.2010.041624.55","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.55","url":null,"abstract":"Background and objectives About 70% of hemiplegic patients suffer from hemiplegic shoulder pain after stroke (Roy et al, 1994). This common occurrence is a cause for concern in the rehabilitation setting (Salle JY, 1998) as it leads to (i) impairment of functional outcomes induced by discomfort and delays in rehabilitation, (ii) important psycho-emotional repercussions as there is a correlation between upper arm pain and depression, (iii) a longer hospital stay. Poor management of hemiplegic shoulder pain can ultimately give rise to type 1 ‘complex regional pain syndrome’ (CRPS I). There is no consensus on treatment, care pathways or useful devices for positioning acute stroke patients in the literature. Our objective is to compare the effectiveness of a new positioning procedure of the hemiplegic arm with conventional positioning (pillow and ‘shoulder-immobilisation’ sling) in acute stroke patients. Programme We are initiating a prospective study on new positioning devices providing optimal positioning of the hemiplegic shoulder according to the criteria given in the literature: elbow flexed at 40°, hand semi-prone, fingers abducted and in extension, and thumb in abduction. The medical devices under study are the SYSTAM’® positioning device for the upper-arm (spine position) and Ultrasling ER 15° DONJOY® (sitting or standing-up position). The study will include 30 acute stroke patients (ischaemic or haemorrhagic) with no alertness problems and with a shoulder motor function score between 0 and 2 on the Held-scale. A visual analogue scale (VAS) will be used, thus excluding patients with aphasia and dementia. The new positioning will be maintained for a maximum of 1 month or until the Held-scale score reaches 3. The primary end-point is pain (VAS) on Day 2, Day 7 and at 1 month. The secondary end-point is the National Institute of Health Stroke Score (NIHSS) at these times. Other variables are time (in hours) between patient arrival on the stroke ward and positioning, protocol compliance by staff and patients, and the percentage of patients with a diastasis on arrival and on discharge. Discussion This study of the impact of a specific positioning procedure compared to conventional treatment will enable the design of a randomised double-blind study with calculation of the number of patients to treat. Only such a study will be able to tell whether the new positioning procedure for early rehabilitation of acute stroke patients is effective in preventing the shoulder-hand syndrome. Introduction L’épaule hémiplégique douloureuse affecte 70% de la population des patients hémiplégiques ayant subi un accident vasculo-cérébral (AVC) (Roy et al, 1994) et constitue une préoccupation quotidienne des rééducateurs (Salle JY 1998). Elle engendre: une aggravation du pronostic fonctionnel, par la gêne et le retard à la rééducation sensori-motrice et à la récupération de la préhension1–3 un retentissement psychoaffectif important, des douleurs du ","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77288392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"107 Development of quality indicators for lung cancer surgery from the national database EPITHOR","authors":"Bernard Alain, Dahan Marcel, Falcoz Pierre Emmanuel, R. Caroline","doi":"10.1136/QSHC.2010.041624.12","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.12","url":null,"abstract":"Background and objectives Contrary to press reports, there are no relevant indicators in France to measure the quality of care in cancer surgery. The objectives of our programme were: (i) to estimate in-hospital mortality, which is the first quality indicator that can be derived from the national database, (ii) to develop a predictive model. Thoracic surgery teams will be able to use the model to estimate their adjusted mortality for lung resection. Programme The database of the French Society of Thoracic and Cardiovascular Surgery—EPITHOR—was set up in 2003. Participation is voluntary. Currently, the thoracic surgery teams of 70 private and public institutions send their data to this national database via internet. Patients are anonymous. Each surgeon can regularly check the quality of his/her data in a comparison with national data using a quality score ranging from 0 to 100%. Between January 2003 and December 2008, 18 049 lung resections for cancer were performed (limited resection, lobectomy, or pneumonectomy). Among database input variables were patient age, gender, American Society of Anaesthesia (ASA) score, performance status, body mass index (BMI), Forced Expiratory Volume (FEV), comorbidities, and tumour TNM classification. In-hospital mortality was calculated on the basis of all patients who died either within 30 days of surgery or during their hospital stay. A logistic regression model was constructed and internally validated by bootstrapping techniques. Results The overall in-hospital mortality rate for the period January 03 to December 08 was 3.8% (95% CI 3.5% to 4.1%). Mortality rate by type of lung resection was 2.4% for limited resection, 3% for lobectomy, and 7.7% for pneumonectomy. The independent predictors of in-hospital mortality used in the logistic model were age, gender, ASA score, performance status, FEV, BMI, side of resection, lobectomy, pneumonectomy, extended resection, stage III, stage IV, and the number of comorbidities per patient. The model was valid as the calibration slope was 0.96, that is, close to 1.The area under the ROC curve for the model was 0.78 (95% CI 0.76 to 0.797). Besides the predictive model, we are making available a ‘funnel plot’ which is a visual comparison of the deviation from the national average. It involves the construction of 99% CI limits of the national death rate for each type of procedure. A team's adjusted mortality rate is significantly different from the national average if it is outside the 99% confidence limits. Discussion and conclusion Currently, about 70% of thoracic surgery units in France are participating actively in the national database. Each team can compare the number of observed deaths to the number of expected deaths as given by applying the predictive model to each patient. The funnel plot method will enable them to engage in a quality improvement process relating to their surgical practice. To improve database quality, in particular with regard to missing data, an o","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77300785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"200 Programme donor action/cristal action: program to prevent the loss of chance for patients awaiting transplants","authors":"P. Jambou, Demont Frédérique, Jocelyne Henseler, J. Quaranta, C. Ichai, M. Kaidomar, Anne-Marie Vezies, E. Couadau, A. Freche, Jammes Didier","doi":"10.1136/QSHC.2010.041624.23","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.23","url":null,"abstract":"Context, objectives Intensive care staff plays a leading role in organ donation by identifying a potential donor, insuring his medical care and calling local transplant coordinator, to approach the close relations and engage a possible process of retrieval. However various enquiries have put in evidence the weak knowledge of the intensive care teams, concerning the imperatives of care of a brain death subject, and of his close relations. Furthermore, this activity is mostly not joined into the daily practice of the units. The result is a lack of assessment of professional practices relating to the donation and procurement. In front of this report, the Biomedecine Agency took a number of initiatives to train and mobilise all the professionals of critical care units. However, remained to set up a program of evaluation of the professional practices concerning this activity, in order to avoid a loss of chance to many patients in wait of transplant. That is what allows the Donor Action® program. Program It's an European program of insurance - quality, centred on the process of care of a brain death subject, with the aim of an organ retrieval process (Clinical Pathway). Its aim is to: reduce the unjustified variability of the care of a potential donor implement protocols of care, validated collectively by the Société Française d'Anesthésie Réanimation, the Société de Réanimation de Langue Française and the Biomedecine Agency improve the coordination and the communication between the actors of this care. It allows to know ‘where, when and why’ an organ retrieval was not successful. Its implementation leans on the support of the director of the establishment and the president of the CME, and on a steering committee. This project comes true generally on 6 to 9 months and contains three phases: an assessment of the existing, the propositions of corrective measures and a new performance appraisal. The cycle continues then indefinitely, bringing the retrieval activity in a continuous quality improvement approach. In practice this program is intended for the Emergencies and Critical Care units. It includes: a survey of opinion, identifying the perceptions and attitudes of staff, and highlighting their training needs. A retrospective survey of each deaths over time in the care unit concerned, measuring the difference between the number of potential donors presumed and actually identified during the period. After analysis, the results are communicated to the teams, during morbi-mortality reviews, allowing them to elaborate corrective measures. An assessment of the impact of these new measures is then performed by a prospective study of any new file of subject died in the unit. Results This program, implemented in eight critical care units of PACA - East/High Corsica region between 2006 and 2008, allowed an increase in 2 years of 52.5% of the number of potential donors referred, of 95.8% of the number of retrieved donors (13.0–27.4 pmp) and of 132% of t","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77494197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"139 Medical and organisational impact of identity errors: risk management and prevention by the use of the software tool ELUCID","authors":"P. Mayer, Y. Gendreike, P. Staccini, M. Delannoy, D. Delerue","doi":"10.1136/QSHC.2010.041632.22","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041632.22","url":null,"abstract":"Context The University Hospital of Nice (France) has decided a few years ago to achieve accurate patient identification. Main objectives were to improve quality and continuity of care, but also to ensure better reimbursements. The deployment of a brand new information system in 2007 was the opportunity to redefine all the processes dealing with patient identity. The independent French National Authority for Health (HAS) manages the accreditation of healthcare organisations. This agency in particular has published a set of criteria, to assess quality of identity management. The University Hospital of Nice sees in this national mandatory campaign for hospital assessment an opportunity to improve its organisation, and its information system. Project Following traditional ‘plan/do/check/act’ cycles, the University Hospital of Nice has achieved three steps. First aim was to improve the initial data provisioning of the new information system, using advanced record linkage techniques provided by a French innovative software company, Alicante. The IT department of the Hospital has then worked on the quality of the propagation of the patient identity between heterogeneous systems, inside its global information system. Weaknesses of standards, or improper use of these standards, have sometimes led to errors. The actual phase deals with continuous improvement of the patient identity management, on a day-to-day basis. There are numerous actors managing patient identity: administrative crews, secretaries, sometimes nurses and physicians. Each type of actor must have, within a short delay, relevant information about what is detected as the suspicion of an error. Results The quality of the initial patient data provisioning has been significantly improved. Technical messages between applications, within the global hospital information system, have all been assessed. Nonquality propagation is now limited. A global campaign to raise awareness of the importance of quality in patient identity management has been launched, based on the regular dashboards automatically produced by Alicante's tool, named ELUCID. Conclusion This project has proven that patient identity management is a keystone in hospital information systems. The diversity of actors involved in patient identity management has also been enlightened. Dashboards and automatic alerts must be deployed at the same time as training campaigns. Contexte, objectifs Le CHU de Nice a inscrit dans son projet d'établissement une démarche ambitieuse d'optimisation des processus transversaux de prise en charge du patient, en s'appuyant sur le système d'information. Dans ces processus, ceux gérant l'identité du patient font l'objet d'une attention particulière depuis début 2007. Le contexte du déploiement massif du nouveau système d'information a permis de mettre à plat les pratiques en la matière. L'avènement de la certification v2010 renforce la nécessité de cette démarche, avec notamment le critère 15","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74143200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"227 Developing quality indicators for lung cancer surgery from a national database (EPITHOR)","authors":"Bernard Alain, Dahan Marcel, Falcoz Pierre Emmanuel, R. Caroline","doi":"10.1136/QSHC.2010.041616.7","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041616.7","url":null,"abstract":"Background and objectives There are no relevant indicators in France for measuring the quality of care in cancer surgery. The objectives of our programme were to develop quality indicators for lung cancer surgery from the national database EPITHOR and to assess the impact of their use on the quality of care. Programme The database of the French Society of Thoracic and Cardiovascular Surgery—EPITHOR—was set up in 2003. Currently, the thoracic surgery teams of 70 private and public institutions enter their data into this national database via internet. Patients are anonymous. Each surgeon can regularly check the quality of his/her data in a comparison with national data using a quality score going from 0 to 100%. Between January 2003 and December 2008, 18 049 lung resections for cancer were performed. Results Examples of the implementation of quality indicators derived from the EPITHOR database by three thoracic surgery teams are: The estimated national rate of postoperative atelectasis requiring bronchoscopy after lung resection is 7.8%. However, in 2008, a team recorded a 20% risk-adjusted atelectasis rate (ratio of observed over expected number of events multiplied by the national rate of 0.078). This 20% rate was beyond the upper limit (17%) of the 99% confidence interval (CI) of the funnel plot and prompted the implementation of improvement measures. The estimated risk-adjusted atelectasis rate in June 2009 was 13% and below the upper limit of the 99% CI of the funnel plot. The measures implemented were clearly effective in reducing atelectasis after lung resection. The in-hospital mortality rate is 2.4% after limited resection, 3% after lobectomy, and 7.7% after pneumonectomy. A team recorded a risk-adjusted mortality rate of 3.4% for limited resections, 5.8% for lobectomy and 4.6% for pneumonectomy over the period January 2008–October 2009. The upper limit of the 99% CI of the funnel plots was 18%, 9.7%, and 29%, respectively. The team's mortality rates are thus consistent with the national average. Because they had recorded a rate of recurrent paralysis after left-side lymphadenectomy that was above the national average, a team implemented intra-operative changes to the procedure to prevent recurrent nerve injury. Several months later, the rate of recurrent paralysis had fallen down to the national average rate. Discussion and conclusion The EPITHOR database is a useful tool for improving practice in that it enables the development of quality indicators and the measurement of the impact of the implementation of improvement measures on quality of care. To improve database quality, in particular with regard to missing data, an on-site audit will be conducted. The database will be used to develop other quality indicators (completeness of surgery, quality of lymphadenectomy, occurrence of bronchopleural fistula, and postoperative pneumonia). Contexte et objectif En France, l'absence d'indicateurs pertinents contrairement à ce qui est rapporté","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74366131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}