Improving the performance of nutrition screening through a series of quality improvement initiatives

Background Nutrition screening identifies patients at risk of malnutrition to facilitate early nutritional intervention. Studies have reported incompletion and error rates of 30-90% for a range of commonly used screening tools. This study aims to investigate the incompletion and error rates of 3-Minute Nutrition Screening (3-MinNS) and the effect of quality improvement initiatives in improving the overall performance of the screening tool and the referral process for at risk patients. Methods Annual audits were carried out from 2008-2013 on 4467 patients. Value Stream Mapping, Plan-Do-Check-Act cycle and Root Cause Analysis were used in this study to identify gaps and determine the best intervention. The intervention included 1) implementing a nutrition screening protocol, 2) nutrition screening training, 3) nurse empowerment for online dietetics referral of at-risk cases, 4) closed-loop feedback system and 5) removing a component of 3-MinNS that caused the most error without compromising its sensitivity and specificity. Results Nutrition screening error rates were 33% and 31%, with 5% and 8% blank or missing forms, in 2008 and 2009 respectively. For patients at risk of malnutrition, referral to dietetics took up to 7.5 days, with 10% not referred at all. After intervention, the latter decreased to 7% (2010), 4% (2011) and 3% (2012 and 2013), and the mean turnaround time from screening to referral was reduced significantly from 4.3 ± 1.8 days to 0.3 ± 0.4 days (p < 0.001). Error rates were reduced to 25% (2010), 15% (2011), 7% (2012) and 5% (2013) and percentage of blank or missing forms reduced to and remained at 1%. Conclusion Quality improvement initiatives are effective in reducing the incompletion and error rates of nutrition screening, and led to sustainable improvements in the referral process of patients at nutritional risk.

Strategies for improving safety performance of repair, maintenance, minor alteration and addition (RMAA) works

Purpose Managing and maintaining infrastructure assets are one of the indispensible tasks for many government agencies to preserve the nations' economic viability and social welfare. To reduce the expenditures over the life-cycle of an infrastructure asset and extend the period for which the asset performs effectively, proper repair and maintenance are essential. While repair, maintenance, minor alteration and addition (RMAA) sector is expanding in many developed cities, occurrences of fatalities and injuries in this sector are also soaring. The purposes of this paper are to identify and then evaluate the various strategies for improving the safety performance of RMAA works. Design/methodology/approach Semi-structured interviews and two rounds of Delphi survey were conducted for data collection. Findings Raising safety awareness of RMAA workers and selecting contractors with a good record of safety performance are the two most important strategies to improve the safety performance in this sector. Technology innovations and a pay-for-safety scheme are regarded as the two least important strategies. Originality/value The paper highlights possible ways to enhance safety of the rather under-explored RMAA sector in the construction industry.

Improving megasite management performance through incentives : lessons learned from the Shanghai Expo construction

As the biggest expo site in history, construction of the Shanghai Expo site faced a lot of challenges, including involvement of lots of investors, megaconstruction scale, concurrent construction mode, involvement of more than 40,000 migrant workers, and extremely tight completion deadlines, among others. Consequently, these challenges imposed great obstacles on accomplishing the safety, quality, and environmental goals. Through a case study of the Shanghai Expo construction, this paper paper presents the design and implementation of multicriteria incentives in megaprojects to accomplish the safety, quality, and environmental goals. Both quantitative and qualitative findings were triangulated to demonstrate the outcome of the incentives. Six critical success factors (CSFs) for the incentives, rule design, process orientation, top management support, training and promotion, communication in process, and process learning and improvement are identified and validated through case study data and content analysis. It is believed that the findings of this paper can enhance understanding of multicriteria incentive schemes in general and provide insights in implementing these incentive schemes in future megaprojects, particularly in the People’s Republic of China (PRC).

Mentoring : improving transition to practice

Nurse graduates indicate the transition from student of nursing to registered nurse (RN) is a difficult conversion. This impending change of role and accompanying higher expectations placed upon newly graduating RNs causes concern for students as their Bachelor of Nursing program nears completion. A career mentor scheme is suggested as a way to better prepare final year students for this transition. Evaluations indicate the positive impact the scheme has made on both mentors and mentees as it has enhanced their career development.

The Performance Nexus - A framework for improving energy efficiency in existing commercial buildings by considering a whole-of-building approach

Efforts to reduce carbon emissions in the buildings sector have been focused on encouraging green design, construction and building operation; however, the business case is not very compelling if considering the energy cost savings alone. In recent years green building has been driven by a sense that it will improve the productivity of occupants,i something with much greater economic returns than energy savings. Reducing energy demand in green commercial buildings in a way that encourages greater productivity is not yet well understood as it involves a set of complex and interdependent factors. This paper outlines an investigation into these factors and focuses on better understanding the performance of and interaction between: design elements, internal environmental quality, occupant experience, tenant/leasing agreements, and building regulation and management. In doing so the paper presents a framework for improving energy efficiency in existing commercial buildings by considering a range of interconnected and synergistic elements.

Airports of the future : improving operation, security and experience

The final report for the ARC project "Airports of the Future". It contains the findings and recommendations provided by the various teams to the industry partners.

Improving business through people and process

Recent information systems development using agile project management has yielded a 50% reduction in effort, together with significant improvements in organisational skills, productivity, quality and business satisfaction.

Improving construction management : an investigation into the influences of effective stakeholder involvement on project quality outcomes

This research has developed a framework to improve the effectiveness and efficiency of stakeholder involvement during the early planning stages of residential construction projects, in order to improve many of the quality issues that occur during the construction phases of such projects. A mixed methods approach (survey, interviews and case studies) was employed to collect the required data. It is expected that with development, this framework can bring some significant benefits to future construction projects in terms of reducing rework and wastage, improving timely delivery and avoiding disputes. The research is also anticipated to produce three high impact journal articles.

Improving safety for driverless city vehicles : real-time communication and decision making

This paper elaborates on the Cybercars-2 Wireless Communication Framework for driverless city vehicles, which is used for Vehicle-to-Vehicle and Vehicle-to-Infrastructure communication. The developed framework improves the safety and efficiency of driverless city vehicles. Furthermore, this paper also elaborates on the vehicle control software architecture. On-road tests of both the communication framework and its application for real-time decision making show that the communication framework is reliable and useful for improving the safe operation of driverless city vehicles.

Improving US airport taxicab services through governance arrangements

Most airports internationally have implemented customer satisfaction programs into their operations to increase non-aeronautical revenues. In the US, taxicabs are an essential airport transport mode given the limited public transport options available. Effective airport taxicab planning can increase airport customer satisfaction levels, as well as facilitate handling increased airport passenger volumes. However, little is known on how US airports have adapted their governance practices from a traditional hierarchical to a network approach in their efforts to undertake airport taxicab planning initiatives since the deregulation of the transportation industry. Data acquired from 51 US hub airports is used to examine their existing taxicab planning practices. The findings offer how US airports can modify governance processes in their airport taxicab planning processes to better support increases in the customer satisfaction levels of airport taxicab patrons.

Improving combustion stability in sugar factory boilers

Reliable operation of a sugar factory boiler station is essential for efficient and timely processing of the cane supply. Sugar factory boilers have to contend with changes in fuel quality caused by variations in performance of the extraction station, different cane varieties and associated agronomic factors along with fluctuations in factory steam demand. These variations can affect the stability of combustion in boiler furnaces leading to reductions in boiler steam output and large furnace pressure fluctuations that can cause serious damage. This paper investigates the causes of unstable combustion, discusses aspects of boiler design that make a boiler more susceptible to unstable combustion and uses modelling to evaluate different options for improving combustion stability.

Improving the detection of donations within the RHD negative blood donor panel which weakly express the RHD antigen

This project improved the detection and classification of very weakly expressed RhD variants in the Australian blood donor panel and contributed to the knowledge of anti-D reactivity patterns of RHD alleles that are undescribed. As such, the management of donations possessing these RHD alleles can be improved upon and the overall safety of transfusion medicine pertaining to the Rh blood group system will be increased. Future projects at ARCBS will be able to utilise the procedures developed in this project, thereby decreasing throughput time. The specificity of current testing will be improved and the need for outsourced RHD testing diminished.

Cyclone Tracy and the road to improving wind-resistant design

Early on Christmas morning 1974, tropical cyclone Tracy devastated the city of Darwin leaving only 6 per cent of the city’s housing habitable and instigating the evacuation of 75 per cent of its population. The systematic failure of so much of Darwin’s building stock led to a humanitarian disaster that proved the impetus for an upheaval of building regulatory and construction practices throughout Australia. Indeed, some of the most enduring legacies of Tracy have been the engineering and regulatory steps taken to ensure the extent of damage would not be repeated. This chapter explores these steps and highlights lessons that have led to a national building framework and practice at the fore of wind-resistant design internationally.

Improving the railway’s understanding of accident causation through an integrated approach to human factors analysis and technical safety data recording

This paper describes a safety data recording and analysis system that has been developed to capture safety occurrences including precursors using high-definition forward-facing video from train cabs and data from other train-borne systems. The paper describes the data processing model and how events detected through data analysis are related to an underlying socio-technical model of accident causation. The integrated approach to safety data recording and analysis insures systemic factors that condition, influence or potentially contribute to an occurrence are captured both for safety occurrences and precursor events, providing a rich tapestry of antecedent causal factors that can significantly improve learning around accident causation. This can ultimately provide benefit to railways through the development of targeted and more effective countermeasures, better risk models and more effective use and prioritization of safety funds. Level crossing occurrences are a key focus in this paper with data analysis scenarios describing causal factors around near-miss occurrences. The paper concludes with a discussion on how the system can also be applied to other types of railway safety occurrences.

Improving boiler performance with modified boiler control systems

For timely processing of the crop, sugar factories need boiler stations that can reliably produce steam when fired with fuel of variable quality. The control systems installed on most sugar factory boilers have changed little in the last thirty years and in some cases the default control system response to changes in fuel and/or fuel quality is not correct and operator intervention is required to prevent factory stoppages or reductions in crushing rate caused by poor combustion. Some factories have recently modified their boiler control systems for improved combustion performance and reduced maintenance costs. This paper describes testing carried out to evaluate some of these control system modifications and identifies boiler control system changes that can be applied more widely in the sugar industry.