Assessing data quality issues in the Emergency Department through data and process mapping

Data and information quality is a well-established research topic and gradually appears on the decision-makers' top concern lists. Many studies have been conducted on how to investigate the generic data/information quality issues and factors by providing a high-level abstract framework or model. Based on these previous studies, this study tries to discuss the actual data quality issues with the operation-level and middle-level managers emerged during the emergency department data collection and reporting processes. By conduct data quality issues and business processes mapping, possible data quality issues are summarised under the well-known TOP model and the recommendations of data quality improvement are suggested.)

Development of an evidence-based scoring system (HF-IS) to assess the quality of heart failure programmes for patients postdischarge from hospital

Aim.  The aim of this study was to develop a potential scoring algorithm for interventions in a chronic heart failure management programme – the Heart Failure Intervention Score – to facilitate quality improvement and programme auditing.

Background.  The overall efficacy of chronic heart failure management programmes has been demonstrated in several meta-analyses. However, meta-analyses did not determine individual interventions in a programme that resulted in beneficial patient outcomes.

Design.  A prospective cross-sectional survey design.

Method.  All chronic heart failure management programmes in Australia (n = 62), identified by a national register, were surveyed to determine programme characteristics and interventions.

Results.  Of the 62 national chronic heart failure management programmes, 48 (77%) completed the survey and 27 individual interventions were identified. Variability in the use of the key interventions was common among the programmes. Each intervention was given an arbitrary weighted score according to the level of supportive evidence available and a total score calculated. Programmes were then categorised into low or high complexity based on several interventions implemented and their weighted score. A total score of ≥190 (median = 178, interquartile range 176–195) was used to divide programmes into two groups. Nine programmes were categorised into high Heart Failure Intervention Score group and majority of these were based in the acute hospital setting (78%). In the low Heart Failure Intervention Score group, there were 39 programmes of which there were a higher proportion of community-based programmes (38%) and programmes in small community hospitals (10%).

Conclusion.  The Heart Failure Intervention Score provides a potential evidence-based quality improvement tool through which a set of minimum standards can be developed. Implementation of the Heart Failure Intervention Score provides guidance to programme coordinators to enable monitoring of standards of heart failure programmes, which may potentially result in better patient outcomes.

Interprofessional interactions influence nurses' adoption of handover improvement

Aim: The purpose of this study was to explore clinician experiences of adopting quality improvement tools to standardise interprofessional (anaesthetist-to-nurse) handover communication when patients arrive in the post-anaesthetic care unit (PACU). Method: In this study, factors that impacted PACU nurses' adoption of the quality improvement tools were explored using pre- and postimplementation, semi-structured focus group interviews. Interview data was analysed using the PARiHS¹ (context, evidence and facilitation) framework as a deductive analysis tool. Results: PACU nurses recognised that PACU handover from anaesthetists to PACU nurses was suboptimal and described the tools as useful for their practice. However, PACU nurses frequently cited fear of anaesthetists' reactions as reasons not to insist on the use of the handover improvement tools. PACU nurses at Hospital 2 identified lacking "authority" (Hospital 2 FG 2) in the OR as hindering their willingness to use the tools against these behaviours. In comparison, visible support from leadership at Hospital 1 was described as encouraging nurses to be "assertive" (Hospital 1 FG 2) and take charge of their patients' care. Conclusion: PACU nurses perceived the handover tools were useful and helped them identify gaps in handover practice; however, PACU nurses described difficult relationships as hindering communication effectiveness and discouraging their adoption of the tools. However, strong leadership and organisational support of change emerged as essential to mitigate the effects of these difficult relationships.

Systematic review and quality appraisal of economic evaluation publications in dentistry

Economic evaluation (EE) studies have been undertaken in dentistry since the late 20th century because economic data provide additional information to policy makers to develop guidelines and set future direction for oral health services. The objectives of this study were to assess the methodological quality of EEs in oral health. Electronic searching of Ovid MEDLINE, the Cochrane Library, and the NHS Economic Evaluation Database from 1975 to 2013 were undertaken to identify publications that include costs and outcomes in dentistry. Relevant reference lists were also searched for additional studies. Studies were retrieved and reviewed independently for inclusion by 3 authors. Furthermore, to appraise the EE methods, 1 author applied the Drummond 10-item (13-criteria) checklist tool to each study. Of the 114 publications identified, 79 studies were considered full EE and 35 partial. Twenty-eight studies (30%) were published between the years 2011 and 2013. Sixty-four (53%) studies focused on dental caries prevention or treatment. Median appraisal scores calculated for full and partial EE studies were 11 and 9 out of 13, respectively. Quality assessment scores showed that the quality of partial EE studies published after 2000 significantly improved (P = 0.02) compared to those published before 2000. Significant quality improvement was not found in full EE studies. Common methodological limitations were identified: absence of sensitivity analysis, discounting, and insufficient information on how costs and outcomes were measured and valued. EE studies in dentistry increased over the last 40 y in both quantity and quality, but a number of publications failed to satisfy some components of standard EE research methods, such as sensitivity analysis and discounting.

Building equitable staff-parent communication in early childhood settings : an Australian case study

International research has consistently found that good staff-parent relationships in early childhood centers benefit children, staff, and parents. Given these findings, the Australian federal government's Quality Improvement and Accreditation Scheme (QIAS) requires centers to involve parents in their programs. However, international research has also found that early childhood staff are anxious about their relationships with parents. This article describes a study in which early childhood staff in Australia were asked about their experiences with parent involvement. It draws on those interviews to consider communication strategies to create equitable relationships between staff and parents.

Degradation of VOCs by phototcatalytic oxidation reactor using TiO2 pellets

Volatile Organic Compounds (VOCs) are air pollutants that come from burning fossil fuels and industrial emissions. They have potentially adverse health effects being carcinogenic and highly persistent in the environment. The use of photocatalytic oxidation to remove VOCs has the potential to be applied in indoor air quality improvement and industrial emission control. A fixed bed photocatalytic reactor was designed and built. UV black light lamps were installed in the reactor to provide a source of UV radiation. A non-film titania media as pellets were placed on the three fixed beds within the reactor. Toluene and acetone were used as indicators of VOCs during the experiment. With a flow rate of 12.75l/min, the oxidation efficiencies were obtained at four different concentrations of acetone laden gas streams ranging from 40ppm to 250ppm. It was found that the lower the acetone concentration of the untreated inlet gas, the higher the oxidation efficiency. The oxidation efficiency was in the range of 40–70% for various concentrations of untreated gases. Two concentrations of toluene laden gas stream were also tested using the same reactor. The oxidation efficiencies were found as 50% for 120ppm toluene gas and 45% for 300ppm toluene gas. It was found that the times required for toluene to reach oxidization equilibrium have been halved than for acetone gas stream. Other parameters such as flow rate and UV intensity were also altered to see their effects on the oxidation efficiency. A full spectrum scan was carried out using a Bio-rad Infrared spectrometer. It was found that the main components of the treated gas stream from the outlet of the reactor were CO2 and water along with small amount of untreated acetone. The suspected intermediates of aliphatic hydrocarbons and CO were found in very minimal amounts or undetectable. The research experiments supported that the TiO2 pellets can work effectively in a fixed bed photocatalytic reactor and achieve significant oxidation efficiencies for degradation of toluene and acetone as indicators of VOCs.

20 years on - have student evaluations made a difference?

This paper poses the question, what impact have student evaluations (SE’s) of teaching had on the improvement in teaching in Australian tertiary education. The paper proposes to assess the effectiveness of SE’s through an investigations of the ways in which have been used in Australian tertiary education over the last 20 years or so. Three approaches are discussed: a) quality assurance - student evaluations used to ensure the quality of the learning environment in which learning takes place; b) quality improvement - student evaluations used as a diagnostic tool for individual teaching staff; and c) student feedback – student evaluations used to provide prospective and current students with information to help inform their choices and expectations. The discussions reviews some of the research and known practise in Australian universities. It concludes that SE’s have had a profound impact on pedagological understandings of tertiary education by placing the student at centre stage of teaching and learning. However it suggests that we do not know how SE’s have impacted on teaching effectiveness and improvement. The paper concludes by recommending further research to define critical success factors, a better understanding of how to make the student feedback and evaluation tools and mechanisms more approachable and meaningful for students, and an assessment of the ‘survey industry’ as a sustainable enterprise.

A role for workforce competencies in evidence-based health promotion education

Education programs should be based on research about the knowledge and skills required for practice, rather than on intuition or tradition, but there is limited published curriculum research on health promotion education. This paper describes a case study of how workforce competencies have been used to assist evidence-based health promotion education in the areas of curriculum design, selection of assessment tasks and continuous quality assurance processes in an undergraduate program at an Australian university. A curriculum-competency mapping process successfully identified gaps and areas of overlap in an existing program. Previously published health promotion workforce competencies were effectively used in the process of selecting assessment items, providing clear guidelines for curriculum revision and a useful method to objectively assess competency content in an evidence informed framework. These health promotion workforce competencies constituted an additional tool to assess course quality. We recommend other tertiary institutions consider curriculum-competency mapping and curriculum based assessment selection as quality and evidence based curriculum review strategies.

Development of a collaborative model to improve school health promotion in the Netherlands

In recent decades, school health promotion programs have been developing into whole-school health approaches. This has been accompanied by a greater understanding among health promoters of the core-business of schools, namely education, and how health promotion objectives can be integrated into this task. Evidence of the positive impact of school health promotion on health risk behavior of students is increasing. This article focuses on the processes and initial results of developing a collaborative model tailored for whole-school health in the Netherlands, named schoolBeat. The Dutch situation is characterized by fragmentation, a variety of health and welfare groups supporting schools, and a lack of sound integrated youth policies. A literature review, observations, and stakeholder consultation provided a clear picture of the current situation in school health promotion, and factors limiting a comprehensive and needs-based approach to school health. This revealed that a health promotion team within a school is fundamental to an effective approach to tailored school health promotion. A respected member of school staff should chair this team. To strengthen the link with the school care team, the school care coordinator should be a member of both teams. To provide coordinated support to all schools in a region, participating organizations decided to share advisory tasks. These tasks are included in the regular health promotion work of their staff. This means working with one advisor representing all school-health organizations per school, and using a comprehensive overview of possible support and projects promoting health. Empowering schools in needs assessments and comprehensive school health promotion is an important element of the developed approach. This article concludes with an examination of emerging issues in evaluating collaborative school health support during the first 18 months of development, and implementation and future perspectives regarding sustainable collaboration and quality improvement.

Variable definitions: implications for the prediction of pulmonary complications after adult cardiac surgery

Aim: The aim of this paper was to review the implications that variable definitions have for the prediction of post-operative pulmonary complications after cardiac surgery.

Method: A review of the literature from 1980 to 2002. Selected studies demonstrated an original attempt to examine multivariate associations between pre, intra or post-operative antecedents and pulmonary outcomes in patients undergoing coronary artery bypass grafting (CABG). Reports that described the validation of established clinical prediction rules, testing interventions or research conducted in non-human cohorts were excluded from this review.

Results: Consistently, variable factor and outcome definitions are combined for the development of multivariate prediction models that subsequently have limited clinical value. Despite being prevalent there are very few attempts to examine post-operative pulmonary complications (PPC) as endpoints in isolation. The trajectory of pulmonary dysfunction that precedes complications in the post-operative context is not clear. As such there is little knowledge of post-operative antecedents to PPC that are invariably excluded from model development.

Conclusion: Multivariate clinical prediction rules that incorporate antecedent patient and process factors from the continuum of cardiovascular care for specific pulmonary outcomes are recommended. Models such as these would be useful for practice, policy and quality improvement.

So what do customer value propositions and strategic planning have to do with teaching and learning?

Within most universities there are central areas that assist with teaching and learning and, in the case of universities offering programs through distance education or flexible learning, there are also units that develop and or manufacture course material. As budget constraints squeeze universities and, with a plethora of choices in online and integrated learning, the usefulness of centralised learning resource units can be called into question. To ensure these units remain vital and can justify their budgets to their parent organisations they need to demonstrate delivery of customer value. What do faculty staff value from a central unit? What irritates students about their course materials? What are the most important services from the point of view of a head of school? This paper outlines the process followed by Learning Services at Deakin University to discover its customers’ value model. Customer value propositions and the removal of what irritates the customer are then used to drive strategic planning, service offerings and continuous process improvement.

Challenges in health services and health systems research

The relationship between emerging trends in healthcare systems and the consequent research priorities will be explored.

Governments and policy makers in developed countries are increasingly focused on the management of chronic disease, reflecting demographic changes and shifts in the burden of disease. Systems of quality improvement and reward are increasingly based on performance in chronic disease management. There is some evidence that countries with well-developed systems of primary care, such as Australia, achieve better health outcomes at less cost. In the past 15 years, almost all developed countries have undergone some type of health care reform. There has been a major focus on reducing costs; often involving shifting services from secondary to primary care. While there are few international comparisons, most suggest a complex relationship between the strength of primary care within the overall health services system and good performance, particularly with regard to lower costs of care and particularly relevant measures of health.

Aims for 21st century health systems
What, then, are the issues which are shaping contemporary general practice in developed countries? There are several imperatives: Safety, effectiveness, patient-centredness, timeliness, efficiency and equity. A study by the Nuffield Trust (Dargie, 1999) projected the shape of healthcare for the first fifteen years of this century. The study identified six issues that need to be addressed in the process of formulating health systems policies:

• Peoples’ expectations and financial sustainability
• Demography and ageing
• Information and knowledge management
• Scientific advance and new technology
• Workforce education and training
• Systems performance and quality (efficiency, effectiveness, economy
and equity)

Each of these six issues requires innovative thinking and priority setting on the part of the health sector, such as the delivery of health services in new and creative ways. Furthermore, there is a clear need for a finely tuned research, development and evaluation strategies to match these goals.

Power and passion:remoulded teamwork in a plastics factory

Purpose: – The purpose of this paper is to document the progress made in a specified period and the experience of managers and staff in sustaining the high performance team approach in a plastics factory.

Design/methodology/approach: – Single-case analysis was conducted on data collected through semi-structured interviews and site observations made with two managers and one team of six in a multinational plastics manufacturer (Visy) headquartered in Australia.

Findings: – Based on the authors' experiences and literature review a successful high performance team requires clear targets and efficiency standards, communication, rules of behaviour, continual input of facts and feedback, and last but not least – recognition of successes.

Research limitations/implications: – The findings are based on observations and interviews conducted in one part of a multinational organization in Australia. No follow-up interviews could be undertaken to track the progress.

Originality/value: – No other similar study had been undertaken in this organisation documenting the experiences of a quality improvement team and its interactions with managers. The findings have practical implications for industrial and other kinds of organisations engaged in implementing quality improvements through enhanced teamwork.

Mapping the information resources available to patients with colorectal cancer

The objectives of this study were to identify gaps in information provision along the colorectal cancer (CRC) treatment pathway as provided by health services within the North Eastern Metropolitan Integrated Cancer Service in Victoria Australia; to evaluate the information and recommend consistent, high quality health information resources; and to recommend strategies to improve delivery of patient information. A random sample of health professionals (n= 47) from various disciplines at eight health service sites participated in semi-structured interviews regarding the types of information they provided to CRC patients. Information items were mapped against a published CRC patient management framework and evaluated. A total of 193 information items were collected with 24 items specific to CRC. Gaps in information provision were evident in the community, at diagnosis, in clinics, when treatment was determined and when completed. The quality of information delivery to CRC patients across the public health sites was variable. Resources were often unavailable, out of date and inaccessible in other languages. Results indicate a need to improve health information availability and resource delivery to all CRC patients across different health services particularly at diagnosis and after treatment. Further research is required to determine patient preferences for information about CRC.

Implementing a journal club in a palliative care setting : a link in the chain of evidence-based practice

This paper describes the implementation and evaluation of a journal club in a privately funded palliative care unit. Journal club meetings were initiated as part of a quality improvement process to foster the uptake of evidence-based practice. Nurses were presented with research articles each month and discussions were conducted focussing on methodological considerations of the research and implications of the research for patient care. The maximum number of attendees at any one meeting was nine and the minimum number was four. Overall, evaluations were positive about all aspects of the meetings. Attendees found that the selected articles were relevant, providing new information, stimulated discussion and reflection on clinical practice and encouraged further reading. One of the positive aspects of the meetings identified by participants was the facilitation style that enabled discussion in a safe and supportive environment. An important outcome of the meetings is the potential to explore evidence-based practices relevant to palliative care and to implement new practices or revise existing ones. As part of this process practice changes and clinical guidelines have been implemented. A dedicated facilitator with university links and a supportive organisational culture promoted club meetings as a practical way to provide clinical nurses with the opportunity to explore evidence-based research in the area of palliative care.