Background: We had experienced an increase in admission hypothermia rates during implementation of deferred cord clamping (DCC) in our unit. Our objective was to reduce the number of babies with a gestation below 32 weeks who are hypothermic on admission, whilst practising DCC and providing delivery room cuddles (DRC). Method: A 12 month quality improvement project set, in a large Neonatal Intensive Care Unit, from January 2020 to December 2020. Monthly rates of admission hypothermia (<36.5 °C) for all eligible babies, were tracked prospectively. Each hypothermic baby was reviewed as part of a series of Plan, Do, Study Act (PDSA) cycles, to understand potential reasons and to develop solutions. Implementation of these solutions included the dissemination of the learning through a variety of methods. The main outcome measure was the proportion of babies who were hypothermic (<36.5 °C) on admission compared to the previous 12 months. Results: 130 babies with a gestation below 32 weeks were admitted during the study period. 90 babies (69.2%) had DCC and 79 babies (60%) received DRC. Compared to the preceding 12 months, the rate of hypothermia decreased from 25/109 (22.3%) to 13/130 (10%) (p = 0.017). Only 1 baby (0.8%) was admitted with a temperature below 36 °C and 12 babies (9.2%) were admitted with a temperature between 36 °C and 36.4 °C. Continued monitoring during the 3 months after the end of the project showed that the improvements were sustained with 0 cases of hypothermia in 33 consecutive admissions. Conclusions: It is possible to achieve low rates of admission hypothermia in preterm babies whilst providing DCC and DRC. Using a quality improvement approach with PDSA cycles is an effective method of changing clinical practice to improve outcomes.
3. Outstanding NIPEs (Neonatal/Infant Physical Examination), causing delay at discharge were highlighted 4. Exception Reporting discussion at a junior/senior meeting 5. Bleep-free Handover trialled again 6. Improve co-ordination on postnatal wards by encouraging joint doctor-midwife 'huddles' 7. Reduce interruptions on postnatal wards 8. Start handover earlier on postnatal wards Results An initial run chart showed doctors stayed back a mean of 52 minutes per doctor (Range 0-180 minutes) after their shift was due to end.Over this project, the mean time doctors stayed back at the end of a shift was reduced from 52 minutes to 28 minutes per doctor per shift.The most successful PDSAs were improving co-ordination on postnatal ward, and starting handover earlier.Exception reporting, the main tool for safeguarding working practices is rarely used, despite there being no barriers to do so.A narrative of doctor's viewpoints showed diverse attitudes including:'I don't want to handover rubbish!' 'It's just a job.' 'I'm lucky to have the job on my terms, I don't mind staying late.' (part time trainee). Conclusions There was exemplary engagement of seniors during the course of the project. Furthermore, the actual scheduled working hours were within European Working time directives.Staying on beyond the shift pattern produces tired, burntout doctors. who are more likely to make mistakes or even leave the profession. Safeguarding work-life balance is an important aspect of doctors' and ultimately patients' wellbeing. The project demonstrated that multiple small adjustments can improve the efficiency of the working day, enabling doctors to leave work on time.Changes can be considered in three areas.
The increase in the ageing of the population calls for advanced monitoring and actuation systems for the smart control and management of elderly households that should manage to optimise multi‐objective control problems. This study proposes a state‐of‐art approach, based on Approximate Dynamic Programming, that tackles multiple challenges, aiming to maximise the energy efficiency, the electricity cost reduction, the user comfort, and the load monitoring of a typical Greek residency (simulated in EnergyPlus), including both controllable and uncontrollable loads, an energy storage system, and power generation units. The article presents the various simulated loads, pricing schemes under Greek regulations and variety of control strategies that are co‐ordinately used to minimise the defined objective functions in contrast to the current state‐of‐the‐art approaches. The latter either focus on single objective problems or use simpler iterative and often limited to specific variables, approaches for multi‐objective control. Finally, the presented results provide insights for the optimal and safe residential management and validate the performance of the proposed control strategy in comparison with alternative demand response strategies, offering improved performance by 20% in terms of energy efficiency, cost reduction, and thermal comfort.
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