Reducing potentially avoidable tasks in a hyperacute stroke unit

Abstract

The workflow in a stroke unit can be very high, and this is especially noticeable during evening and night shifts, where staffing is reduced but the patient’s need for frequent and intensive care is not. The specialised and standardised settings in a stroke regime are constant and demanding for healthcare providers who, therefore, must work efficiently. Patient admissions, acute situations and routine tasks are major contributors to the burden of work during evening and night shifts for junior doctors on call. Thus, it is important to reduce the number of potentially avoidable tasks done by these junior doctors during night shifts so they have more time to perform tasks of high priority. The aim of this project was to reduce the potentially avoidable tasks occurring at night for the on-call junior doctor to only one per shift. We investigated the types of tasks that frequently occur for the on-call junior doctor during the night shift and improved our daily morning and evening rounds to reduce the number of tasks during the night shift. Using the plan–do–study–act method, we made improvements through education, knowledge sharing, checklists and feedback, and we reduced the number of potentially avoidable tasks for on-call junior doctors from a median of 11 to a median of 3 per week, demonstrating that the workload for the on-call junior doctor during the night shift can be reduced through a systematic approach to improving the work routines of doctors and nurses.

Advances in Stroke: Quality Improvement

“…In a tertiary care hospital in Japan, the development and implementation of a stroke code protocol and educational workshops resulted in decreased time from stroke recognition to neurologist assessment (91-35 minutes; P=0.002) and to neuroimaging (123-74 minutes; P=0.013), but no changes in thrombolysis or endovascular therapy were observed. 13 Acute Hospital Care QI Several studies described in-hospital care QI initiatives including in Nova Scotia (Canada), 14 Australia, 15 and in single institutions in Denmark, 16 and East Kent (United Kingdom). 17 The studies varied in terms of the QI intervention; some were multifaceted, 14 whereas others focused on a single QI strategy (eg, PDSA cycles, 16,17 external facilitation 15 ).…”

“…13 Acute Hospital Care QI Several studies described in-hospital care QI initiatives including in Nova Scotia (Canada), 14 Australia, 15 and in single institutions in Denmark, 16 and East Kent (United Kingdom). 17 The studies varied in terms of the QI intervention; some were multifaceted, 14 whereas others focused on a single QI strategy (eg, PDSA cycles, 16,17 external facilitation 15 ).…”

“…17 PDSA cycles were also used successfully to reduce the number of potentially avoidable night-time tasks in a Danish stroke unit. 16 The project included education, knowledge sharing, checklists, and feedback over a period of 17 weeks and 5 PDSA cycles. The number of avoidable tasks for on-call junior doctors reduced from a median of 11 to a median of 3 per week.…”

Improving patient satisfaction for patients with acute neurological symptoms by increased flow from the front door of hospital and more specific documentation in medical record notes: a quality improvement project

“… 6 7 A QI project demonstrated that it is possible to improve clinical practices and reduce potential avoidable tasks in a busy emergency environment of healthcare professionals by implementing low-cost changes such as education, knowledge sharing, checklists and feedback. 8 Systematic verbal transfer of information is essential to improve efficiency and both patient safety and experience. 9 One QI demonstrated improvement of the written documentation by introducing a ‘handover sticker’.…”

“…A substantial number of QI projects exists on interventions that aim to improve patient flow in the emergency setting 6 7. A QI project demonstrated that it is possible to improve clinical practices and reduce potential avoidable tasks in a busy emergency environment of healthcare professionals by implementing low-cost changes such as education, knowledge sharing, checklists and feedback 8. Systematic verbal transfer of information is essential to improve efficiency and both patient safety and experience 9.…”