Making data more accessible and understandable in quality improvement requires a diversity of approaches beyond formal teaching in technical skills of measurement. Improvement practitioners might co‐opt the wider skillset of analyst, designer, and storyteller in tailoring the team strategy needed to make best use of the data used to inform decision‐making at the point of care. Data literacy levels, negative prior experiences, or limited access to technology might influence the ability of teams to engage in measurement. Co‐designing the experience ensures that the data are meaningful, that it is framed in inclusive language, and that the process is manageable. Being mindful about intrinsic motivators when designing measurement strategies can improve the collective approach to data analysis and the sustainability of the project. Thoughtful data visualization takes account of the inherent perceptual challenges of comprehending data and complex images. Establishing a routine of simplification—removing redundant elements and distractions—and amplifying aspects that aid understanding can bring clarity to the important concepts within a chart. Story‐telling techniques can help wider audiences engage with data by carefully shaping analytical and emotional content around a central narrative—always mindful of the limitations of working memory, and the emotional momentum needed to inspire change.
1 . A case of haemangioma arising in the tendons of the extensor pollicis longus and extensor pollicis brevis muscles of a twenty-seven-year-old woman is described. 2. The etiology of the lesion is discussed, together with a brief review of the literature.
Introduction
The pandemic has shown how vital patient-centred treatment escalation planning (TEP) is for older people. Locally we have seen inappropriate transfer of dying patients to acute hospitals from rehabilitation units. Mortality review found a lack of useful TEPs in these cases. Baseline data in our rehabilitation hospital showed 54% of patients had a TEP and 16% a decision made about repatriation during acute illness. We aimed to increase the proportion of patients in this setting with a TEP to 80% over six months.
Methods
A multidisciplinary team of doctors, ANPs and senior nurses worked together. We conducted stakeholder engagement to understand the factors that result in transfer of patients and found that completion of TEPs was felt to be an effective way to improve communication out of hours. Our first test of change involved an ANP raising the CPR status and TEP for all new patients at the weekly MDT. We measured the process of what decisions were made once a fortnight. Outcome data on the overall completion of TEPs and repatriation decisions was collected each month.
Results
New decisions were made at each MDT – for example, on one date two new DNACPRs and six new TEPs were completed. Overall TEP completion rate varies however since our first intervention we have seen a sustained increase in the number of TEPs which include consideration of repatriation – from 16% to 60%. Ongoing conversation with doctors in training reveals challenges with ward staff awareness of TEP content and their ability to guide unexpected events out of hours.
Conclusion
Involvement of motivated permanent staff across disciplines has allowed us to ensure escalation plans are being made each week and see a sustained increase.
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