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Science of quality improvement – from vision to reality: Experience from a leading academic healthcare center in Qatar
Quality improvement and patient safety are cornerstones to the delivery of effective patient care. The introduction of a quality improvement curriculum for medical students and trainee physicians can have a significant effect on their understanding of the science of improvement and its role in improving the quality of healthcare delivery and patient safety. The article describes the development and implementation of a quality improvement curriculum for trainee physicians in the department of internal medicine at a tertiary care center in Qatar through online training courses workshops didactic activities and trainee-led quality improvement projects.
Management of patients with suspected meningitis or meningoencephalitis. Are we compliant with guidelines?
Background: Central Nervous system infections are associated with high morbidity and mortality. Initial presentation can be very non-specific the classic triad of: fever headache and altered mental status only found in 44% of patients with acute bacterial meningitis. In a recent study a delay in antimicrobial treatment of more than three hours after hospital admission was a strong and independent risk factor for mortality.
Methods: We reviewed case notes of patients presented with suspected meningitis or meningoencephalitis. We designed a Performa to collect information on presentation clinical findings investigation and management of these patients.
Results: 30 case notes were reviewed. 16 out of 30 patients had at-least 2 out of 3 classic features. Skin rash was not looked for in 53% patients. 83% patients had no documentation regarding presence or absence of papilledema. 75% of patients appropriately had CT Brain done before LP. 56% of patients had appropriate antibiotics in less than 3 hours. Mean time to perform LP was 10.38 hours. No patients had steroids before or along with antibiotics. One patient had CSF opening pressure checked on lumber puncture. In 10 patients paired serum sample was sent for glucose.
Conclusion: Major deficiencies are noted in documentation of key symptoms signs investigations and management for CNS infection. We have planned three major interventions: 1) Senior physician review of all patients suspected of CNS infection within one hour. 2) All patients suspected of CNS infection have appropriate antibiotics administered within three hours of presentation. Steroids should be given along with first dose of antibiotic where indicated. 3) Implement LP sticker to improve documentation We will run few PDSA cycles of suggested interventions and study the results. Recommendations will be made based on PDSA results.
Demographics, clinical characteristics, and recurrence rate of patients with primary spontaneous pneumothorax at a tertiary care center in Qatar
Introduction: Primary spontaneous pneumothorax (PSP) is a common medical emergency. Its treatment includes simple observation needle thoracentesis pleural catheter video-assisted thoracoscopy (VATS) and open surgery. We aimed to establish the demographic clinical characteristics and 12-month recurrence rate of patients with PSP in four hospitals of the Hamad Medical Corporation Qatar.
Materials and methods: We conducted a retrospective analysis of patients >14 years old who were admitted with PSP from January 1 2017 to December 31 2019. The patients were followed up for 12 months for the recurrence of PSP.
Results: Out of 246 patients enrolled in this study 223 (90.7%) were males and 23 (9.3%) were females. Their mean age was 29.1 ± 9.59 years and their mean body mass index (BMI) was 21.7 ± 4.22 kg/m2. Of these 123 (51.2%) patients were smokers. Chest pain was the most common presenting complaint (82.5%). A total of 59 (23.98%) patients had a small pneumothorax whereas 187 (76.01%) patients had a large pneumothorax.
Among the patients with small pneumothorax 16 (28.33%) were managed through observation alone 2 (3.33%) required needle aspiration 15 (25%) required pleural catheter insertion and 26 (44.06%) underwent surgical intervention for management. Out of 187 patients with large pneumothorax 16 (8.6%) were managed through observation 7 (3.76%) required needle aspiration 73 (38.1%) required pleural catheter insertion and 91 (48.6%) underwent surgery.
During the 12-month follow-up 58 patients were lost to follow-up and 5 patients (5/188; 2.66%) presented with a recurrence of PSP. Out of 108 patients who underwent VATS 2 (1.85%) had a recurrence of PSP.
Conclusion: PSP is more common in males than in females with a tendency for younger age onset. The recurrence rate of PSP in our study was 2.66%. Furthermore the recurrence rate in our patients who underwent VATS was 1.85%. Prospective studies are warranted to compare the success rates of different treatment interventions.