Evaluating the Impact of the Vulvar Quality of Life Index for New Patient Dermatology Assessments.

Background: The prevalence of vulvar diseases has a significant impact on quality of life (QoL). Measurement may not be consistently collected during assessments. Incorporating a QoL measurement tool may help optimize patient-centred care.

Optimizing Intervention Sequences to Reduce Physician Blood Urea Nitrogen Test Overuse: A Multi-Hospital Analysis.

Background: Overuse of hospital laboratory testing has been identified as a priority for quality improvement (QI). A multifaceted initiative to reduce blood urea nitrogen (BUN) ordering was implemented in hospitals across one Canadian province, preceded by either a system-focused (SF) [electronic medical record (EMR)], person-focused (PF) [performance audit and education], or no intervention.

Objective: The purpose of this study was to demonstrate the impact of sequencing and combining interventions on Medicine physician BUN test ordering practice beyond a single hospital context.

Ending PJ paralysis for hospitalised patients: a quality improvement initiative.

Introduction: PJ paralysis refers to the negative effects experienced by hospitalised patients who remain inactive and dressed in hospital clothing, and is a serious problem, affecting one-third of hospitalised older adults. This study evaluated the impact of a multicomponent hospital-based intervention to get patients out of bed, dressed in non-hospital attire, and moving around/mobilised.

Methods: A 3-month quality improvement initiative was conducted at one hospital unit in Western Canada, which aimed for 50% of all patients to be dressed in their own clothing by midday, sitting up in a chair for all meals and mobilising to activities.

Using Human-Centred Design to Codesign Patient Engagement Tools With a Patient Advisory Council: Successes and Challenges.

Background: Co-build is one of the four pillars of the Patient Engagement Framework from the Canadian Institutes of Health Research Strategy for Patient Oriented Research. Collaborating with Patient Research Partners (PRPs) using co-build approaches can enhance the applicability of healthcare tools produced. Human Centred Design (HCD), a problem-solving methodology focused on creating functional solutions for users, offers a promising approach to co-building patient engagement tools.

What about physician wellness? Impact of a quality improvement intervention.

Background: Emergency department (ED) consultations with general internal medicine (GIM) are required when patients need admission, assistance with safe disposition or evaluation and management of complex or acute medical needs. GIM physicians often balance responsibilities between hospital wards and the ED, which can lead to delayed ED consultations, difficulty balancing workload and potential burn-out. To address this issue, a quality improvement (QI) initiative was trialled, establishing a dedicated GIM ED consultation service to manage these duties independently.

Advancing a virtual home hospital: a blueprint for development and expansion.

Background: The rising demand for hospitals has spurred increased interest in adopting virtual home hospital (VHH) care models. Development in this area often uses rigid research methods. This study describes a dynamic approach to constructing a VHH and outlines the progress over 5 years.

Elevating equity: advancing diversity and inclusivity through trialing bias reduction tools in the general internal medicine program resident application process.

Background: Decades of medical data show worse patient outcomes among racial and gender minorities due to implicit, explicit, and structural biases. Increasing representation of marginalized groups among care providers is imperative to help address this. Limited literature exists on bias awareness strategies for interviewers during the selection of applicants to General Internal Medicine (GIM) programs in Canada.

Stepped-Wedge Trial of Decision Support for Acute Kidney Injury on Surgical Units.

Introduction: Acute kidney injury (AKI) is common in the perioperative setting and associated with poor outcomes. Whether clinical decision support improves early management and outcomes of AKI on surgical units is uncertain.

Methods: In this cluster-randomized, stepped-wedge trial, 8 surgical units in Alberta, Canada were randomized to various start dates to receive an education and clinical decision support intervention for recognition and early management of AKI.

Optimising the indications for biliary stent placement during endoscopic retrograde cholangiopancreatography: a quality improvement initiative to enhance patient care and reduce healthcare resource utilisation.

Background: A retrospective chart audit was performed to review biliary stent utilisation from January 2020 to January 2021. Non-guideline-based stent insertion was identified in 16% of patients with common bile duct (CBD) stones presenting for endoscopic retrograde cholangiopancreatography (ERCP). To improve this knowledge-practice gap, a quality improvement (QI) intervention was devised and trialled.

Social determinants of health as barriers to care for vasculitis: perspectives of patients and healthcare providers.

Objective: This study examined patient and healthcare provider (HCP) perspectives on the impact of unmet social needs on healthcare barriers for patients with vasculitis.

Methods: Two surveys were developed to gather perspectives from patients with vasculitis, and HCPs specializing in vasculitis care. The patient survey also included a 20-question social needs assessment.

Advancing language concordant care: a multimodal medical interpretation intervention.

Background: Ensuring language concordant care through medical interpretation services (MIS) allows for accurate information sharing and positive healthcare experiences. The COVID-19 pandemic led to a regional halt of in-person interpreters, leaving only digital MIS options, such as phone and video. Due to longstanding institutional practices, and lack of accessibility and awareness of these options, digital MIS remained underused.

Patient perceptions of in-hospital laboratory blood testing: A patient-oriented and patient co-designed qualitative study.

Background: Indiscriminate use of laboratory blood testing in hospitals contributes to patient discomfort and healthcare waste. Patient engagement in low-value healthcare can help reduce overuse. Understanding patient experience is necessary to identify opportunities to improve patient engagement with in-hospital laboratory testing.

Teaching quality improvement concepts to pharmacy students using the Evidence-based Practice for Improving Quality (EPIQ) workshop.

Background And Purpose: Despite the benefits of quality improvement (QI) training, there is a scarcity of information on QI teaching formats for undergraduate pharmacy education. The Evidence-based Practice for Improving Quality (EPIQ) workshop was evaluated as a teaching format for a group of multi-year undergraduate pharmacy students, assessing knowledge acquisition and learner reactions.

Educational Activity And Setting: Using a convergent mixed-method analysis, 10-item pre- and post-workshop multiple-choice questionnaires measured students' knowledge acquisition of foundational QI concepts.

Factors of a physician quality improvement leadership coalition that influence physician behaviour: a mixed methods study.

Background: A coalition (Strategic Clinical Improvement Committee), with a mandate to promote physician quality improvement (QI) involvement, identified hospital laboratory test overuse as a priority. The coalition developed and supported the spread of a multicomponent initiative about reducing repetitive laboratory testing and blood urea nitrogen (BUN) ordering across one Canadian province. This study's purpose was to identify coalition factors enabling medicine and emergency department (ED) physicians to lead, participate and influence appropriate BUN test ordering.

Implementing a Diabetic Algorithm for Ophthalmology Surgery Patients: A Quality Improvement Initiative.

Introduction: The objective of this quality improvement, interventional study regarding patients with diabetes undergoing diabetic ophthalmology outpatient surgery aimed to develop, implement, and evaluate a new diabetic algorithm to improve safety, operating room efficiency, and decrease supply cost.

Methods: A multidisciplinary study team was assembled, including ophthalmologists, endocrinologists, anesthesiologists, management, and nurses to review the current diabetic protocol. From August 2016 to July 2017, 13 patient safety concerns or incident reports were reviewed that identified two serious cases of hypoglycemia.

Beyond Skin Deep: case-based online modules to teach multidisciplinary care in dermatology among clerkship students.

Background: Canadian medical schools offer limited clinical dermatology training. In addition, there is a lack of educational resources that are designed specifically for clerkship students that focus on the multidisciplinary nature of dermatology.

Objectives: After developing case-based educational resources to address the lack of clinical exposure and learning of multidisciplinary care in dermatology, this study aimed to evaluate the educational intervention and gather feedback for future module development.

Characteristics promoting behaviour change: physician experience with a coalition-led quality improvement initiative to reduce excessive laboratory test ordering.

Background: Attempts have been made to reduce excessive laboratory test ordering; however, the problem persists and barriers to physician involvement in quality improvement (QI) remain. We sought to understand physician participation experience following a laboratory test overuse initiative supported by a QI coalition.

Methods: As part of a larger mixed-methods study, structured virtual interviews were conducted with 12 physicians.

Stopping routine urine screening studies for stroke rehabilitation inpatient admissions.

Urine testing on asymptomatic patients is not aligned with guidelines; however, stroke survivors have trouble communicating symptoms, and urinary tract infections (UTIs) are a recognised poststroke complication. All stroke inpatients at a tertiary rehabilitation hospital underwent urine testing on admission. We led a quality improvement (QI) project on one stroke rehabilitation unit aimed to reduce admission urine testing from 100% to 0%.

Through the eyes of hospital-based healthcare professionals: exploring their lived experience during the COVID-19 pandemic.

Objective: The spread of the COVID-19 virus has caused an unforeseen strain on the healthcare system and particularly on healthcare workers (HCW). In this study, 1 year after the COVID-19 pandemic began, we used photovoice, a visual photographic approach, to understand HCW needs, concerns and resilience and to determine improvement strategies aligned with the HCW-described challenges.

Methods: Using a qualitative design, HCW were recruited from a single Western Canadian hospital, voluntarily submitting a photographic image and narrative that depicts their experiences.

Reduction of urea test ordering in the emergency department: multicomponent intervention including education, electronic ordering, and data feedback.

Introduction: In the emergency department (ED), laboratory testing accounts for a significant portion of the medical assessment. Although excess laboratory test ordering has been proven to be prevalent, different types of interventions have been used to encourage a behavioural change in how physicians order tests. In one western Canadian hospital medicine program, a quality improvement project aimed to reduce the total monthly blood urea nitrogen (BUN) test ordered by physicians was found to be successful.