2024 Abstract Book

Short Orals & Lightning Talks

1
Day 1 – Wednesday 25th September .............................................................................. 20
Morning ................................................................................................................... 20
Short Orals ........................................................................................................... 20
Integrating traditional care for Indigenous women seeking antenatal care in rural
Guatemala: Results from an ethnographic study : (3544) Arja Huestis Garcia ... 20
Supporting Quality Mental Health Services for Adolescent Depression in Primary
Care: A Learning System Approach: (1536) Diana Sarakbi ............................. 21
"It can be a lonely job": Role experiences of paediatric care
coordinators working in rural Australia: (2787) Yvonne Zurynski ..................... 23
The need for early intervention to meet the unmet biopsychosocial needs
of children with common chronic illness: (1978) Raghu Lingam ..................... 25
Re-thinking integrated care for the most vulnerable people using Community
Paramedics: (1845) Peter Hibbert ................................................................. 26
Patient engagement for patient safety: results of a Belgian survey: (1861) Quentin
Schoonvaere ............................................................................................... 28
Effect of pressure injury reduction project utilizing three types of continuity
of care on pressure injury incidence rates in a general hospital: (3502) Suryang
Seo ............................................................................................................. 30
Patient as Observer Intervention to Increase Hand Hygiene Adherence among
Healthcare Workers in the Ambulatory Setting: (2873) Vickly LoPachin........... 32
Mutual Healing Program©: Helping patients, their families and healthcare
workers heal together after unexpected medical harm: (1638) Wendy Nicklin . 33
Improving the quality of antenatal care (ANC) and postnatal care (PNC) services
by strengthening supportive supervision of service providers at private
health facilities in urban slums of Bangladesh: (2986) Anjuman Begum .......... 35
Promoting Factual, Affirming, Informative and Respectful (FAIR) Documentation
in the EHR to Reduce Bias and Improve Patient Care: (3240) Carol R. Horowitz37
What matters the most for the quality of inpatient treatment and care
experience?: (3061) Gang Chen .................................................................... 39
Interweaving quality and circular economy in healthcare: A synergistic
framework : (3236) İbrahim Halil Kayral ......................................................... 40
Implementation of Key Result-based Digital-Performance Management System
for Quality Manpower, Leadership Excellence and Safe Patient care in a
Multispecialty Hospital: (2100) Amitha Prashanth Marla ................................. 42
Care Under Pressure 2: causes and solutions to workplace psychological ill-
health for nurses, midwives and paramedics- a realist review: (2744) Jill Mabe 45

2
 Sustaining Community-Based Family Planning Service Delivery in the Philippines
through Community Health Worker Capacitation: A Systematic Task Shifting
Strategy: (2864) Jaime Dela Roca Bonifacio, Jr. ............................................... 47
Comparative Analysis of Perioperative Patient Safety Policies in Five European
Countries: Findings from the SAFEST Project : (1760) Kaja Kristensen .............. 48
How Organisational Research Culture and Translational Research Pathways Are
Affecting Research Translation: A Mixed-Methods Study in an Australian
Healthcare Organisation: (1980) Carolynn L Smith ......................................... 50
Strengthening Quality Assurance System for Malaria Microscopy to Improve the
Quality of Parasitological Confirmation in Benue, Nasarawa, Plateau, and
Zamfara states in Nigeria: (2545) Methodius Okouzi....................................... 51
Culture of quality ‘traps’ for quality improvement for mothers and children in the
Kyrgyz Republic: (3289) Nurshaim Tilenbaeva ................................................ 53
Lightning Talks ..................................................................................................... 54
In-vitro fertilization (IVF) patient perspective and experiences with digital
innovation during treatment in Vietnam: (2344) Anh Dang ............................... 54
Co-designing a hospitality program to improve supportive care in oncology:
(3461) Chantal Arditi .................................................................................... 57
Reducing Obstetric Fistula Surgical Backlog Through a Comprehensive Routine
Service Delivery Model in Makueni County, Kenya: A promising approach: (3465)
Christine Kalondu Muia .............................................................................. 58
Enhancing cervical Cancer screening Pathway in a Health network -Saudi Arabia:
(2995) Duaa Al Abbas ................................................................................... 59
The Patient-centred Care Team: Effect on Patient reported Health-related Quality
of Life: (3228) Gro Karine Rosvold Berntsen ................................................... 61
A Framework for Improving Clinical Quality In Ensuring Good Clinical Outcomes
and Enhanced Patient Experience In Surgery Care Through A Digital Approach:
(2786) Ilaveyini Selvaraj .............................................................................. 63
Implementation of Person Centered Care in Turkiye: Challenges and Success
Points Learned from a Unique Culture: (3413) Ilkay Baylam ............................ 64
Ethics are relational: A Critical Systems Thinking approach to implementing
ethics in medical AI: (1567) Magali Goirand ................................................... 65
Supporting women middle managers in the Health and Social Service System by
fostering their psychological well-being : A qualitative inquiry into lived
experiences: (2354) Eric Walling ................................................................... 66

3
 Quality Improvement Capacity Building Program for the Nigerian National
Clinical Mentors Program - Lessons Learnt from Implementation: (1337) Isa
Salihu Daniel ............................................................................................... 68
Implementing Genomics in Primary Care: (2974) Janet C Long ........................ 69
Changes in health Insurance coverage and the utilization of Cone Beam CT;
Health insurance claims data from 2013 to 2022: (2716) Jeonghye Kim ............ 70
Patient safety culture in general population: an unmet need: (2350) Micaela La
Regina ........................................................................................................ 72
Feasibility and Preliminary Evaluation of Cognitive Stimulation Therapy (CST) in
Elderly Patients with Mild to Moderate Dementia in KPJ Damansara Specialist
Hospital: (2370) Parwathi Alagirisamy ........................................................... 73
Human-centered Design Approach for Group Antenatal-Postnatal (ANC-PNC)
improves accessibility of ANC-PNC services: (2993) Shafia Rashid ................. 75
Eliminating Delays in Pharmaceuticals Re-ordering Process through Automation:
(1141) Zarfan Ali .......................................................................................... 77
Lunchtime ............................................................................................................... 81
Lightning Talks ..................................................................................................... 81
Surveyor Training in China, moving from a National to an Internationally
accredited programme Introduction: (2695) A. LEE ........................................ 81
Assessing the quality of facilities in all healthcare sectors: harmonization
underway in France: (2029) Amélie LANSIAUX .............................................. 83
The Impact of the Co-Production Model on the Health Accreditation Process in
Brazil: (3030) Ana Carla Restituti ................................................................... 84
Enhancing Pediatric Healthcare Quality and Safety: A Case Study of International
Accreditation Implementation in Iashvili Children’s Central Hospital, Tbilisi,
Georgia: (2335) Lela Tsakadze....................................................................... 85
Exploring Quality of HA standards: An Observational Study of HA Scoring
Guidelines and Standards Compliance Evaluation in Thailand: (2793) Piyawan
Limpanyalert ............................................................................................... 87
ACE (awareness compliance & excellence) for CSSD at a tertiary care facility:
(2966) Shweta Prabhakar.............................................................................. 90
Impact of the OECI Designation and Accreditation Program on the Arturo Lopez
Perez Foundation (FALP), Chile: (2220) Silvia Basso ........................................ 92
Pros and Cons of Survey Report Verification and Strategy for Improving The
Effectiveness of It: (3029) Yael Esthi Nurfitri Kuncoro ...................................... 94

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 The advantages and weaknesses of providing 13 Accreditation Organizing
Institutions for Community Health Centres: Indonesia experience: (3233) Yanti
Herman ...................................................................................................... 95
Accreditation Surveyors According to the 5-Factor Theory of Personality: (3231)
Zuhal Cayirtepe ........................................................................................... 97
Ethics and Health Accreditation Standards in the Era of Artificial Intelligence:
(3204) Zuhal Cayirtepe ................................................................................. 98
Co-production and implementation of a handbook for the primary healthcare
centers quality documentation: (3001) Wafa Allouche .................................. 100
ARTIFICIAL INTELLIGENCE IN HEALTHCARE: ADVANCING PATIENT EXPERIENCE
AND OPERATIONAL EFFICIENCY: (1182) Ahmed G. Newera .......................... 103
Communication during telemedicine consultations in general practice:
Perspectives from general practitioners and their patients: (1722) Amy Nguyen
................................................................................................................ 105
Comparison of Treatment Discontinuation Risk Between Oral Medication and
Long-Acting Injectable in Schizophrenia : Using PSM and IPW: (2672) Kyungmi
Kim ........................................................................................................... 106
Patient Perspective of the Clinical Learning Environment: (1877) Nancy Koh .. 109
THE USE OF THE UNIMETRICS PLATFORM – MANAGEMENT INFORMATION
CLASSIFICATION MODULE (CIG) FOR COSTS, RESULTS AND QUALITY
MANAGEMENT IN HEALTH INSURANCE COMPANIES IN BRAZIL, 2019 TO 2023:
(1921) Fabio Leite Gastal ............................................................................ 110
Lessons of the NuRS study. Reflections and approaches from a multi-centre big
data study in the NHS: (2928) Sarahjane Jones ............................................. 111
Patient-Centric Efficiency: Accelerating Discharge Processes for Enhanced
Healthcare Satisfaction: (3069) Shoaib Hassan ........................................... 112
The Effect of Education Given With The Teach Back Method on Chemotherapy
Symptom Management and Quality of Life: A Randomized Controlled Trial:
(3107) Belkıs Güllü Gücüyener .................................................................... 115
Enhancing Clinical Outcomes in Diabetic Kidney Disease (DKD) through Risk
Prediction and Case Management in Patients with Diabetes: (2143) Mao Cheng-
Hsien ........................................................................................................ 116
Afternoon .............................................................................................................. 118
Short Orals ......................................................................................................... 118
Quality practices in mental health: An example from Turkey: (3305) Hülya Şahin
................................................................................................................ 118

5
 Safety Culture - challenges and the perspective under the lens of equity: (1635)
Aline Cristina Pedroso ................................................................................ 119
TRESNO KOE (Indonnesian acronym for Problem-solving Respons Point for JKN
Mobile Online Registration): (3301) Tri Wahyuningsih.................................... 121
Health Justice in fragile and shock-prone settings: from theory to practice
towards building resilient health systems: (3441) Wesam Mansour ............... 123
Benefits of external accreditation in primary care services: (3330) Ana Maria Saut
................................................................................................................ 125
Advantage use of External Evaluation on Clinical Performance during Hospital
Mentoring: (3192) Dwirani Amelia ............................................................... 127
An exploratory study into the perceived impact of the accreditation on health
care quality and its associated cost among accredited healthcare organizations
(HCOS) in India: (2940) Prashanth Nag ........................................................ 128
Factors Affecting the Sustainability of Hospital Accreditation Program
Establishment and Implementation in Low- and Middle-Income Countries
(LMICs): (1619) Reece Hinchcliff ................................................................. 131
JCI Enterprise Accreditation – Quality Improvement for Complex Health Systems:
(3311) Joel Andrew Roos ............................................................................ 134
'Healthcare in my happy place': co-designing digital health to support access to
care in First Nations remote communities: (3014) Tim J Shaw ....................... 135
Efficiency of AI Models in Complication Detection after Surgery: (2311) Julia
Vetter........................................................................................................ 136
Optimizing Hospital Readmission Reduction with Predictive Machine Learning
and Bundle Care Models: (2057) Mao Cheng-Hsien...................................... 138
Leveraging advanced analytics and electronic health data to monitor trajectories
of medicine use in residential aged care: insights from the MED-TRAC studies:
(2991) Nasir Wabe ..................................................................................... 139
Digital Medical Devices for Professional Use: A new framework initiated by the
French National Authority for Health (HAS): (2033) Simon Renner ................. 141
Global Impact through a Local Lens: Introducing a Localized Accreditation
Framework for Georgia: (1254) Katerina Tarasova ......................................... 142
Through the eyes of the health care providers: Exploring the state of patient
safety culture in a selected hospital in North West Province, South Africa: (2601)
Sabelile Tenza ........................................................................................... 143

6
 Analysis of enablers and barriers to After Action Review of patient safety events
in an Irish hospital and identification of behaviour change techniques to support
implementation: (2998) Siobhan E McCarthy ............................................... 144
What’s in a Learning Health System? A rapid review of emerging definitions,
models, and frameworks: (3002) Georgia Fisher ........................................... 145
Mortality 30 days after acute myocardial infarction: Results of a French national
indicator based on medico-administrative data: (3283) Linda Banaei-Bouchareb
................................................................................................................ 146
Lightning Talks ................................................................................................... 148
Perception of stakeholders’ readiness and recommendations for health system
policy and implementation in scaling up Hospital-at-Home care model: A
descriptive qualitative study: (1859) Crystal Min Siu Chua ............................ 148
AI tracking Multidisciplinary Decision Making: Enabling a regional support tool:
(3392) Dominic Van Loggerenberg ............................................................... 149
A Comprehensive Survey of the Clinical Trial Landscape on Digital Therapeutics:
(2275) Han Yao .......................................................................................... 150
Use process control and digital transformation to improve operating room
efficiency: (1807) Hsing-Hao Su .................................................................. 152
The digital direct-to-consumer telemedicine revolution: Consumer perspectives
of benefits and pitfalls: (2466) Louise Ellis ................................................... 153
Prioritising electronic health record optimisation to reduce technology-
related prescribing errors and improve patient safety: results from two tertiary
paediatric hospitals: (2387) Magda Z Raban................................................. 154
How well do electronic health records support medication administration in
paediatric hospitals?: (2422) Magda Z Raban ............................................... 156
Community engagement to build a bridge: an empirical examination of the
strategic large-scale redesign of future health services: (2252) David Greenfield
................................................................................................................ 157
From Bits to Brilliance: Enhancing the Efficiency of Cancer Registry Coding
Quality Review by Human-factors engineering digitalization at a Medical Center
in Taiwan: (1784) Mau-Shin Chi ................................................................... 158
Digital Health Transformation: “What and How to Achieve Success?”: (2667) Rr
Tutik Sri Hariyati......................................................................................... 160
A Sustainable Health Technologies Innovation Model To Improve LRS Clinical
Outcomes: (3327) Stefano Bergamasco ...................................................... 162

7
 Development of AI-based fall prevention models from the perspective of artificial
intelligence in healthcare: (2804) Ya-Ting Ke ................................................ 164
Use of Artificial Intelligence to Improve Radiology Service Efficiency: (1939)
Yung-Cheng Wang ..................................................................................... 165
Good healthcare simulation practices: recent works in France: (1910) Zineb
Messarat-Haddouche ................................................................................ 167
Case Report: Assisted Village Project By Rizki Amalia Medika Hospital Support
National Program Against Stunting Wasting: (2710) Anggrieni Wisni .............. 168
They Save Your Life, We Give it Back: A Quicker, Safer Track to Specialty Beds:
(3401) Allison Philpot ................................................................................. 170
Increasing the Capacity for Cervical Cancer Screening for Women on Anti-
Retroviral Therapy at ALERT Comprehensive Specialized Hospital: A Quality
Improvement Project: (1094) Abeba Aleka Kebede ....................................... 171
Day 2 – Thursday 26th September ................................................................................ 174
Morning ................................................................................................................. 174
Short Orals ......................................................................................................... 174
Can ‘living’ guidelines be made, and if so, will they be used? An evaluation of the
Australian Living Stroke Guidelines: (2390) Peter D Hibbert ........................... 174
Development of a national mapping tool for quality and patient safety assurance
in the hospital settings: the MaQPS instrument, structure- criteria- rating
methodology and verification method: (2225) Angeliki Katsapi ...................... 176
Accreditation of Healthcare Facilities in France: A Lever for Developing Good
Digital Practices and Preventing Cyber Risks: (2920) Anne Chevrier ............... 177
The best results for Virtual Surveys: (1930) Fabio Leite Gastal ....................... 179
Beyond Standards: Exploring the Impact of Hospital Accreditation on Patients’
Experience: (1368) Mahi Mahmoud Al-Tehewy ............................................. 180
Quality improvement (QI) as an essential tool for disaster preparedness: How
New Orleans (NOLA) assures safety for persons living with HIV (PLWH) in its
healthcare system as hurricanes surge: (3414) Bruce D Agins ....................... 181
Pioneering accreditation standards for low-carbon, sustainable and resilient
hospitals: (1637) Sylvia Basterrechea .......................................................... 182
Desflurane-Sparing Anesthesia Practice: Tackling Climate Change from the
Operating Theatre: (1733) Annemarie Chrysantia Melati ............................... 184
An evaluation on the effect of climate change on health: The case study of
quality employees: (3217) Elif Özyurt........................................................... 185

8
 Exploring the Implementation of Sustainable Operational Strategies in
Healthcare Institutions: (2531) Syuan-Fang Jian ........................................... 188
Digital Health Stakeholders’ Views: Using Electronic Medical Records in
Improving Communication between Hospitalised Patients and Health
Professionals across Transitions of Care: (2038) Guncag Ozavci ................... 190
Using the cohort effect to boost improvement projects in ovarian cancer: (2213)
Helen Crisp ............................................................................................... 191
Learning from Soft Intelligence for Patient Safety: Development and Piloting of a
Tool for Continuous Data Capture and Sensemaking: (2899) Jonathan Benn .. 193
An online-based patient safety culture survey at 20 healthcare facilities in six
districts in Indonesia: a benchmarking study: (3080) Poppy Elvira Deviany ..... 194
Analysis of barriers and facilitators of patient safety culture assessments in
Brazil using the consolidated framework for implementation research: (3492)
Zenewton André da Silva Gama .................................................................. 196
Incorporating safety into patient experience daily huddles: its association with
patient safety culture in ambulatory centers: (2349) Alejandro Arrieta ........... 197
First national survey to measure patient safety culture within healthcare facilities
in France: (2840) Amélie Lansiaux ............................................................... 199
Enhancing Maternal Health Care through Patient Feedback: The Role of
Women's Education in Quality Improvement: (2955) Elisabeth Ezekiel ........... 201
Safety Culture Redefined: A Leadership Perspective in Healthcare
Transformation: (1354) Gaurav Loria ........................................................... 203
Correlation between patient safety culture and the safety-relevant attitude of
supervisors in Austrian hospitals: Potential for improvement: (2846) Guido
Offermanns ............................................................................................... 204
Findings from Ireland’s first National End of Life Survey; a survey of bereaved
people on care provided to relatives and friends in the last three months of life:
(3184) Donnacha O' Ceallaigh .................................................................... 205
Lightning Talks ................................................................................................... 206
Integrating Cervical Cancer Screening Program as Modle of Care in Eastern
Health Cluster: (2753) Dalia Al-OUF ............................................................ 206
Improving Performance for Private Practice Midwife through online Client
Satisfaction Survey: (2260) Damaryanti Suryaningsih ................................... 209
Enhancing Diversity in Health Research through Research Engagement Network
(REN): A Hyperlocal Community- Based Approach in Northwest London (NWL):
(2622) Ganesh Sathyamoorthy .................................................................. 211

9
 Interdisciplinary collaboration and computer-assisted home healthcare referral
in the emergency department: An innovative model in Taiwan: (3245) Hung-Jung
Lin ............................................................................................................ 213
Hub and Spoke Model: To Nurture Quality Improvement of Neonatal Services
across four Nahdatul Ulama Hospital Network in East Java Province, Indonesia:
(3072) Istiyani Purbaabsari ........................................................................ 214
Establish a Diversified Palliative Care Network in Long-term Care Institutions:
(2397) Jheng-Ling Li ................................................................................... 215
Municipality rehabilitation after hospital admission: (1847) Lars Morsø ......... 217
Tumor markers changed among hepatitis C adults after antiviral therapy:
Implication for primary healthcare: (1815) Mei-Yen Chen .............................. 218
My Voice Our Stories: using storytelling data to inform public policy and address
unmet needs: (3357) Michael T Hager ......................................................... 220
Association between PM2.5 exposure and incident Metabolic Dysfunction-
Associated Steatotic Liver Disease (MASLD): a Cohort Study: (3390) Wei-Chun
Cheng ....................................................................................................... 221
Massive Closure of Pediatric Clinics and Exodus of Pediatricians in Korea: (1692)
Jin Yong Lee ............................................................................................... 223
Price determinants of medical procedures, devices, and medicine: A
comparative analysis of national health insurance in five countries: (1746)
Jiyoung Keum ............................................................................................ 224
Patient Safety Leadership WalkRounds™ and Patient Focused Methodology
collaborate to create a culture of safety: (2375) Ke-Yung Zhuang ................... 225
“Working with babies brings me a lot of joy – also brings me routine, money and
stability” Keeping paediatric nurses in nursing: (1322) Laurel Mimmo ............ 227
Changing ‘the way we do things around here’: Improving organisational culture
for staff and residents in residential aged care: (2270) Maree Saba ................ 228
Resilience in Australian Healthcare: Analysing Team Factors for Adaptive
Capacity: (2159) Maree Saba ...................................................................... 230
Implementation experiences of providing care coordination for children with
medical complexity in rural Australia: (2619) Raghu Lingam .......................... 231
Psychosocial complexity and limited preparation for transition to adult services
for young people living with type-1 diabetes results in care fragmentation: A
multi-method study: (2270) Yvonne Zurynski ............................................... 232
Lunchtime ............................................................................................................. 234
Lightning Talks ................................................................................................... 234

10
 Turning data into safety: A data-driven approach to mitigating risks for aging
adults with type 2 diabetes: (2954) Amy Nguyen........................................... 234
Privacy as a Ruse? Reframing legal and ethical challenges to improve
engagement with quality improvement using health data: (3278) Kavisha Shah
................................................................................................................ 235
Advancing Patient Safety and Quality Education for a Sustainable Future: (2494)
Mabel Sim ................................................................................................. 236
Root Cause Analysis and strategies to implementing actions based on lessons
learned from sentinel events: (3388) Mayara Santos ..................................... 238
The impact of nurse outcomes on nurse-perceived patient outcomes in South
African hospitals: (3189) Alwiena J. Blignaut ................................................ 242
Relation Between The Implementation Of International Patient Safety Goals
(IPSG) And Patient Satisfaction At The Persahabatan Centre General Hospital:
(2760) Endah Nurohmah ............................................................................ 243
Validating rates of nursing-sensitive adverse events in administrative healthcare
data in Ireland: A retrospective chart review study: (2557) Anna Connolly ...... 244
Reducing Vascular Complications via Femoral Artery Approach for Post Elective
Procedure in Improving Patient Safety: (1943) Arni Azura Abd Karim .............. 246
Improving malaria case management quality by reducing irrational use of
antimalarials - A systems thinking approach in four southern states (Akwa Ibom,
Cross River, Ebonyi, and Oyo) in Nigeria: (2540) Augustine Firima .................. 247
Evaluation of Nurses' Attitudes and Knowledge Levels Regarding Safe Medication
Use Process: (2806) Birkan Tapan ............................................................... 248
Improve the correctness of patient self-care after joint replacement surgery:
(3277) Chen Chan Kuo ............................................................................... 249
Enhancing Taiwan Patient-safety Reporting Volume through Patient Safety
WalkRounds: (2645) Chien-Kai Lo ............................................................... 250
Implementation of patient blood management program in transfusion practice of
orthotopic liver transplantation: (2126) Chueng-He Lu ................................. 251
Language Services for Limited English Proficient Patient Quality and Safety -
Dashboard and Data Driven Process Improvement (3477) Samuel Verkhovsky253
The ADR journey – improving adverse drug reaction management to decrease the
risk of patient harm: (1307) Linda Velta Graudins ......................................... 254
A Bibliometric Analysis of Studies on Sustainability and Quality in Healthcare
Services: (2749) Ahmet Yesildag ................................................................. 255

11
 Assessment of sustainable healthcare practices in Indonesian hospitals: A focus
in water, sanitation, and care waste management interventions: (2761) Hanny
Rono Sulistyo ............................................................................................ 257
ELECTRONIC WITNESS SYSTEM IN FERTILITY CENTER: STAFF AND PATIENTS
PERSPECTIVES: (2050) Quyen Dang ............................................................ 258
Implementation of Patients Safety Checklist (PASC) in Surgery, a Stepped Wedge
Cluster RCT - Effects on Patient and Implementation Outcomes: (3561) Arvid
Steinar Haugen.......................................................................................... 260
Short Orals ......................................................................................................... 261
Advancing Co-design Research Tools for Evidence-Based Quality and Patient
Safety Improvements: Insights from the Development of the Irish National
Quality and Patient Safety Competency Framework: (1426) Dimuthu Wasana
Rathnayake ............................................................................................... 261
Optimizing Effective Access to Sexual and Reproductive Services in Primary
Healthcare Settings through joint optimization of technical, human and care
culture values in selected facilities in Ethiopia: (2815) Berhanetsehay Teklewold
................................................................................................................ 262
Patient-Centric Progress: Unveiling the Landscape of Shared Decision Making at
Shin Kong Medical Center: (1880) Jui-Ting Chang ......................................... 264
DISCO with Patients, Patient Advocates and Healthcare Teams – A Healthcare
Improvement Collaboration Platform: (1302) Keith Heng .............................. 266
Embedding evidence-based professional development tools and quality
improvement resources for General Practitioners to improve patient experience
in healthcare: (3581) Tina Janamian ............................................................ 268
Utilizing Information Technology in Community Large-Scale Events: Establishing
Real-Time Care Models to Enhance Medical Efficiency: (2093) Chia Hui Chu . 269
Empowering Women's Access to Quality Healthcare Through AI-Enabled Virtual
Coaching Support: (3387) Elisabeth Ezekiel ................................................. 270
Evaluations of the surveyor and the assessed organization related to the remote
survey using the eye tracking and augmented reality technologies: (3137)
Keziban AVCI ............................................................................................. 273
The SEE-IT Trial: Emergency Medical Services Streaming Enabled Evaluation in
Trauma. A feasibility randomised controlled trial: (3174) Lucie Ollis .............. 274
Telehealth utilization trends for respiratory conditions in Australian General
Practice: A means to reduce infection risk during the pandemic and beyond:
(2829) Mirela Prgomet ................................................................................ 276

12
 Strengthening Patient Safety and Driving Quality Improvement: Healthcare
Accreditation and Information Technology in the Era of Digital Transformation in
Thailand: (3370) Piyawan Limpanyalert ....................................................... 278
Facilitating a Positive Patient Safety Culture by Learning: (2868) John Fitzsimons
................................................................................................................ 281
Advancing healthcare quality: The Nambian experience in implementing
international quality standards in public hospitals: (1787) Apollo Basenero ... 282
Catalyzing 'Herd Quality in healthcare’: NABH motivating accredited hospitals to
mentor smaller healthcare facilities in rural and urban settings in India - A pilot
project: (3079) Atul Mohan Kochhar ............................................................ 284
A Learning Health System initiative to improve MS outcomes: The Multiple
Sclerosis Continuous Quality Improvement Collaborative (MS-CQI) multicenter
step-wedge randomized controlled study: (3519) Brant Oliver ....................... 285
The Learning Organization: A New Concept in Lebanese Hospitals: (1366) Jamal
Ahmad Yasmine......................................................................................... 287
Patient Safety in Community-based Surgical Centers in Alberta, Canada: a
descriptive study of post-surgical adverse events in accredited non-hospital
facilities from 2018 to 2023: (3491) Fizza Israr Gilani .................................... 289
Experiences of early-career health professionals in the WiSDOM cohort study of
their clinical practice environments in South Africa: (2010) Laetitia Charmaine
Rispel ....................................................................................................... 291
Building an authorising environment to enable large-scale change programs:
learning from an Australian statewide initiative: (2188) Janet C Long.............. 292
Polypharmacy measurement in aged care settings: discrepancies between
prescribed and administered polypharmacy rates have implications for quality
indicator reporting guidelines: (1745) Nasir Wabe ....................................... 293
Implementing the National Policy for Quality in Healthcare for Malaysia: Tracking
the First-year Progress: (2051) Samsiah Awang ............................................ 294
Lightning Talks ................................................................................................... 295
Multiple strategies to improve sarcopenia for nursing home residents: (1209)
Chia-Ming Chi ........................................................................................... 295
Towards a digital age: Project Lakshya: (1344) Gaurav Loria .......................... 297
Patient Discharge Journey - An Enigma Decoded!: (1270) Gaurav Loria .......... 299
Towards patient-centred communication in the management of older patients'
medications across transitions of care: A focused ethnographic study: (3004)
Guncag Ozavci .......................................................................................... 301

13
 The Risks of Patient Safety caused by Information Technology-preliminary results
in Taiwan: (1447) Han-Chi Chung ............................................................... 303
To Determine Nurses' Attitudes Towards Convicted Patients: (2691) Hanife Cakir
................................................................................................................ 305
How we can learn from mistakes - health and social care safety investigation as a
fostering patient and client safety: (3130) Hanna Tiirinki ............................... 305
Registration of indicators across ten patient safety themes – The status a decade
after the implementation of the Dutch National Patient Safety program: (2874)
Hanneke Merten ........................................................................................ 307
Adverse events and screening on frailty indicators for older patients in Dutch
hospitals: results of a retrospective record review study: (3347) Hanneke Merten
................................................................................................................ 308
Using Quality Control Circle to Optimise Hospital Pharmacy Inventory
Management Processes-A Case Study of a Medical Center in Taiwan: (1207) Jing-
Ying Huang ................................................................................................ 310
Point of Care Quality Improvement (POCQI) Model Implementation in Jordan:
(3466) Heba Mezeyd .................................................................................. 312
Using ultrasound guidance to reduce the rate of venous catheter repositioning:
(2730) Hsieh Shih Wei ................................................................................ 314
Improving Medication Safety for New Healthcare Staff with HFACS Human
Factors Analysis and Experiential Activity Teaching: (1998) HsiuHsia Weng .... 316
Measuring Health system performance; a new approach to accountability and
quality improvement in Jordan: A qualitative study: (2797) Ibrahim Aqel......... 317
Care Behavior Impact and Acceptability of Scope-Based Structured Point of care
obstetric ultrasound (SPOUS) provided at Point of practice in Selected Rural
Primary care setups in Ethiopia: (2816) Ishmael Shemsedin ......................... 321
NON-CLINICAL SPECIFIC INTERVENTIONS TO IMPROVE PATIENT SAFETY IN
PERIOPERATIVE CARE PROCESS: AN UMBRELLA REVIEW: (2007) Janne
Kommusaar .............................................................................................. 323
Determinants of Inpatient Satisfaction in a Post-Acute Care Rehabilitation
Hospital in the US: (1988) Jing Xu ................................................................ 324
Facilitators and barriers of critical care nurses’ alarm customization on the
physiologic monitor: An interpretive descriptive study: (3300) Liqing Yue ....... 326
Day 3 – Friday 27th September ................................................................................... 327
Morning ................................................................................................................. 327
Short Orals ......................................................................................................... 327

14
 What are the key patient experiences driving overall rating of cancer care?
Insights from the Swiss Cancer Patient Experiences (SCAPE-2) study: (3417)
Chantal Arditi ............................................................................................ 327
Improving patient participation in value improvement teams: An action research
study: (1392) Jet Jeltje Westerink................................................................. 328
Patient/Family Advisors Co-designing Healthcare Quality & Safety Improvement -
From Planting Seeds to Driving Transformation: (1412) Dr. Katharina Kovacs
Burns ........................................................................................................ 330
Understanding the influence of co-design on distress, clinical decision making
and disease self-management of cancer patients-as-partners: a quasi-
experimental study: (2015) Zahraa Al Raychouni .......................................... 331
Building bridges between people, systems and organisations: transformative
system and practice improvement through in Touch Residential Aged Care
Facility Pathway: (2157) David Greenfield .................................................... 333
Medication Review in Patients on Polypharmacy: Insights from Integrated Care
Data: (3371) Derryn Lovett .......................................................................... 334
Improving Systems of Care for ST Elevation Myocardial Infarction patients
through Public-Private integration for Pre-Hospital Care activation of Primary
Percutaneous Coronary Intervention: (1944) Farina Mohd Salleh................... 336
Comprehensive and integrated Geriatric Care Program in a model regional
teaching hospital in Taiwan: (1493) Meng-Chih Lee ...................................... 337
Enhancing Early Discharge after Elective Caesarean Section: Implementing a
Fast-Track Approach (ERAS) for Improved Patient Outcomes: (2923) Afnan
Tawfiq Ahanfish ......................................................................................... 339
Variations in diagnostic guideline compliance for COPD: Observational study of
primary care in England: (2895) Alex Bottle .................................................. 340
An European Consensus on Core Measures Set for Patient Safety in Perioperative
Care (SAFEST project): (1926) Carola Orrego .............................................. 342
Navigating the information source landscape: a mixed methods study to assess
the use of information sources by Dutch medical specialists: (2206) Floris Weller
................................................................................................................ 343
Importance of Effective Hospital Stock Analysis for Healthcare Quality: ABC and
VED Analysis Pharmaceutical Stock Analysis with AHP Method: A Private
Hospital Example: (2958) İbrahim Halil Kayral ............................................ 346
Engaging Stakeholders to Enhance patient safety by Ensuring standards in
instrument Sterilisation: A National level Quality Improvement Journey in India:
(3047) Jayalakshmi Jayarajan ...................................................................... 347

15
 Postgraduate Education in Patient Safety/Quality Improvement: Setting
Expectations to Optimize Clinical Learning Environments: (2595) Robin Wagner
................................................................................................................ 349
Systematic Review on the Frequency and Quality of Reporting Patient and Public
Involvement in Patient Safety: (1496) Sahar Hammoud ................................. 350
Using resilience in healthcare (RiH) theory to generate reflective learning from
safe care delivered to deteriorating patients: a mixed methods study : (1965)
Shalini Ganasan-Ryan ................................................................................ 351
Development of key principles for stakeholder involvement in resilient
healthcare: a multi-phase, multi-method empirical study: (3281) Veslemøy
Guise ........................................................................................................ 353
Integration of Team Resource Management with Simulation Training to Promote
Obstetric and Neonatal Safety: (2469) Wei-Ting Hsu ..................................... 354
Lightning Talks ................................................................................................... 356
Patient Electronic Health Record Accessibility Optimization with root-cause
analysis in a Medical Center of Taiwan--A Digital ECGs Uploading study: (2546)
Chung Chieh Wen ...................................................................................... 356
EVALUATION OF HOSPITAL MANAGEMENT STRATEGIES RELATED TO PANDEMIC:
(3212) Keziban AVCI ................................................................................... 359
Identifying the prevalence and distribution of adverse drug events in children
within community settings: A scoping review: (1832) Kim Sears .................... 360
The impact of a consensus process on implementation of interventions into
healthcare settings: A qualitative study: (1997) Lisa Pagano .......................... 361
Health for People and Planet: Building Bridges to a Sustainable Future: (2421)
Lisa Pagano ............................................................................................... 363
Student Nurse Retention – identifying risks and best practices for retention via
retrospective data analysis: (2921) Robert M. Cook ...................................... 364
Promoting & Encouraging Exception Reporting (PEER) Quality Improvement
Project: (1709) Schnell D'sa ........................................................................ 366
Distilling implementation and policy strategies for sustainable healthcare
innovation using policy labs: A Hospital at Home case study: (1852) Yi Feng Lai
................................................................................................................ 369
Setting Standards in Long Term Care: Identifying Achievable Benchmarks of
Care for Long Term Care Facilities: (1505) Maria Carolina Inacio ................... 370
Measures or mitigating the negative effects of patient participation in patient
safety: a qualitative study: (1444) Michael Van Der Voorden .......................... 371

16
 Longitudinal relationship between Vitamin D supplementation and falls
incidents in residential aged care: Implications for Falls Prevention Programs:
(3010) Nasir Nasir ...................................................................................... 373
Impact of Early detection and Management of colorectal cancer to improve
patient outcomes and Reducing the healthcare cost in AL-HADA Armed Forces
Hospital -TAIF Region - KSA: (1738) Neda MAZEED Althkafai.......................... 374
Analysis of Factors Causing Low Doctor Verification Compliance based on
Hospital Accreditation Standard: (3459) Nungky Nurkasih Kendrastuti .......... 375
Improving the quality of hospital care for mothers and children in Kyrgyzstan:
(2884) Nurshaim Tilenbaeva ....................................................................... 376
Addressing patient flow issues reducing risks to patient safety and improving the
quality of care: (1879) Pieter Jan Van Dam ................................................... 378
The burden of potential drug-drug interactions in a large tertiary care teaching
hospital in rural India and suggested interventions: (2417) Pratheesh Ravindran
................................................................................................................ 379
Lunchtime ............................................................................................................. 381
Lightning Talks ................................................................................................... 381
The effect of Joint Commission International accreditation on patient safety
culture and outcomes: (2154) SIDIKA KAYA .................................................. 381
Prevention of Lower Limb Deep Venous Thromboembolism and Pulmonary
Embolism: Early Ambulation 24 Hours Post-Cesarean Section: (2063) Wei An
Chen ........................................................................................................ 382
Assessment of Antimicrobial Stewardship Program Implementation in Hermina
Hospital Group, Indonesia: A Survey-Based Study: (3199) Wenny Retno
SarieLestari ............................................................................................... 384
The role of KARS surveyors in accelerating the reduction of maternal mortalityin
Indonesia: (2888) Yessy Rachmawati .......................................................... 385
An attempt to make 5S-KAIZEN a managerial foundationforpatient safety at
government hospitals in Uganda; Needs ofparallel application ofIHI-GTT and
Tracer Method to accelerate the improvement: (1118) Yujiro Handa .............. 386
Effectiveness of PRIDE program in the restraint Patient care: (1676) YUMEI LEE
................................................................................................................ 388
Optimizing Inpatient Care: Implementing an Evidence-Based Hospitalist
Program: (2692) Zainab Abdullah Alzaki ....................................................... 390
Patient and family engagement in patient safety in the Eastern Mediterranean
Region: A scoping review: (3255) Zhaleh Abdi............................................... 391

17
 AN EVALUATION OF ACCREDITATION STANDARDS IN HEALTH SERVICES FROM
THE PERSPECTIVE OF INTERNATIONAL ACCREDITATION ORGANIZATIONS:
(3534) Ayşe Sibel GÜLTÜRK ........................................................................ 392
Assessing The Implementation of The World Health Organization (WHO) Building
Blocks in The Maternal Health System in Indonesia: (1251) Prita Muliarini ...... 394
Gastro-Intestinal Anaesthesia Safety Checklist Audit in improving patient care at
a tertiary care cancer centre (CARE): (1323) Reshma Ambulkar ..................... 396
Reduction and Control of Surgical Site Infections: A multidisciplinary approach
to enhance patient safety: (3036) Saadia Pervaiz .......................................... 398
Engaging and encouraging staff for incident reporting: Leading towards improved
patient and workplace safety: (3033) Saadia Pervaiz..................................... 400
Language Services for Limited English Proficient Patient Quality and Safety -
Dashboard and Data Driven Process Improvement: (3477) Samuel Verkhovsky
................................................................................................................ 402
Evaluation of the Use of Quality Improvement Tools by Quality Managers of
Hospitals in Turkey: (2973) Şenol DEMİRCİ .................................................. 403
What role does compassion have on quality care ratings? A regression analysis
and validation of the Sinclair Compassion Questionnaire: (1066) Shane Sinclair
................................................................................................................ 404
Comparative Analysis of Patient Safety Incidents: Identifying Disparities between
Units with Frequent and Sporadic Recurrence in Hospital: (2347) Shih-Chiang
Hung......................................................................................................... 406
HOW CAN WE ENSURE PATIENT SAFETY ON NOVEL AND RISKY SURGERY?-6-
YEAR EXPERIENCE OF STATUTORY INTERNAL REVIEW SYSTEM: (1802) Shin
Ushiro ....................................................................................................... 407
Afternoon .............................................................................................................. 410
Short Orals ......................................................................................................... 410
Health justice and equity of access to digital mental health services for
Indigenous and ethnic minority youth – The Human Rights Framework and
Obligations: (3259) Solveig Hodne Riska...................................................... 410
Health Worker Safety Indicators during Pandemics, lessons from the COVID-19
Pandemic: (2513) Alaa A. Sayed.................................................................. 412
Mobilising staff, data, and AI to improve equity in a large UK hospital to improve
quality and patient outcomes: (2778) Esther Kwong ..................................... 414
Towards Improving the sexual reproductive health (SRH) and gender equity of
Women Survivors of Intimate Partner in a Sample of Syrian Refugees in Jordan, a
cross-sectional Study: (1788) Sarah Ahmad Aitan ........................................ 416

18
 Hospital Transition from Paper Towels to Hand Dryers: A Smart Solution: (3042)
Mr. Uzair Ali Shaikh .................................................................................... 418
Evaluation of Measures That Can Be Taken for Public Health within Framework of
Climate Change Adaptation and Action Plan: Türkiye 2010-2023 Climate Change
Adaptation and Action Plan Example: (1914) Didem Incegil........................... 420
Reduce Paper Usage in Hospitals– A Step Towards Environmental Sustainability
and Digitalization: (3444) Huma Naz ........................................................... 423
Environmental Impact of extensive use of Personal Protective Equipment in
health care during COVID-19: (3536) Tilotma Jamwal ................................... 425
The healthcare provider views on the implementation of the national guidelines
of patient safety incident reporting in a selected hospital in North West province,
South Africa: (2599) Sabelile Tenza ............................................................. 427
Improving care for respiratory conditions, including Covid 19 in the public
primary care system in Mendoza, Argentina: (2801) Ezequiel Garcia Elorrio.... 428
Prescribing error patterns among junior medical officers in paediatrics: (1256)
Johanna Westbrook ................................................................................... 429
Identifying actual harm from prescribing errors in acute paediatric care: (2373)
Magdalena Z Raban ................................................................................... 431
Electronic Health Record Transition: Clinician Perspective and Patient Safety:
(3565) Ozlem Eskil Cicek ............................................................................ 433
Implementation of patient flow-based electronic clinical pathways (ECP) for
patients presenting with HIP fractures in emergency departments: (2809)
Ricardo Sampaio Paco ............................................................................... 435
Ambulatory Medication Reconciliation: A tool to improve patient safety and
minimize medication errors: (2027) Salma Al Khani ...................................... 437
Insights from Adjudicated Complaints: Identifying Hot Spots and Blind Spots
with HCAT: (2731) Søren Fryd Birkeland ....................................................... 439

19
Day 1 – Wednesday 25th September

Morning

Short Orals

Integrating traditional care for Indigenous women seeking antenatal care in rural Guatemala:
Results from an ethnographic study : (3544) Arja Huestis Garcia

ISQUA2024-ABS-3544

Huestis Garcia 1, M. Berger Gonzalez 2, M. Murdock 3,*, F. Lopez 4, S. Weinstein 5, C. Maldonado Martinez
4

1
Strategic Information, MSH, Washington DC, United States, 2Medical Anthropology, UVG, Guatemala
City, Guatemala, 3MSH, New York, United States, 4MSH, Quetzaltenango, Guatemala, 5MSH,
Washington DC, United States

Introduction: In the Guatemalan highlands, pregnant Indigenous women in rural areas continue to
suffer the highest rates of maternal morbidity and mortality. The Utz’ Na’n project aims to improve
their health and wellbeing by increasing the acceptability, accessibility, and quality of facility-based
antenatal care (ANC) through integration of comadronas (traditional birth companions) into the public
health care system and to improve Indigenous women’s experience of high quality, culturally-sensitive
care. The objective of this study is to identify women’s definition of quality ANC and opportunities for
improving ANC attendance in a medically pluralistic context, including through self-care.

Methods: A mixed-methods ethnographic research was conducted, including semi-structured key

informant interviews and focus group discussions to identify barriers and facilitators and health care
seeking pathways to ANC related to women’s experience of care, health decision making autonomy,
gender-based violence, and food insecurity. In addition, surveys covering the socioeconomic
characteristics of households and the knowledge, attitudes and practice of healthcare staff, were
administered online to primary healthcare workers (HCWs) and in-person with comadronas and
pregnant Indigenous women. The data collection protocols and tools utilized (REDcap and Kobo) were

20
piloted, revised and approved by the IRB of the Centro de Estudios en Salud of the Universidad del
Valle de Guatemala. STATA and Excel were used for univariate analysis, Dedoose for coding qualitative
data, and process maps were drafted to describe healthcare seeking pathways.

Results: The study surveyed and interviewed 317 pregnant Indigenous women (over age 18), 104
comadronas, and 906 HCWs. Fifty percent of women visited both a comadrona and a public HCW
throughout their pregnancy, attending on average 8 ANC sessions between both types of
providers. Sixteen percent of women initially confirmed their pregnancy and had their first ANC visit
with their comadrona. Not realizing they were pregnant, previous pregnancy experiences, fear of
vaccinations, and financial and geographic constraints were key reasons for delayed use of facility-
based ANC. Indigenous women expressed high trust in public healthcare ANC staff (95%) and
comadronas (98%). Public health services met the women’s expectations for provision of nutritional
supplements, clinical tests, vaccines, and attention to high risk-cases. Women felt that
comadronas provide more holistic and culturally-sensitive counseling and guidance for self-care. At the
same time, the survey of HCWs found that found that over two-thirds of them did not receive training
in culturally pertinent, respectful care, indicating therefore a gap in providing culturally responsive care
at public health facilities.

Conclusion: This study provides critical insight on ANC seeking pathways of Indigenous women in rural
areas, the essential role of traditional birth companions, and entry points to facilitate access to
respectful, culturally sensitive pregnancy care. Integrating comadronas into a collaborative,
community-engaged model represents a sustainable approach to improved person-centered maternal
health care and equitable access to services. The results suggest that a transformative shift towards a
more blended, plurimedical model of ANC that meets the needs of Indigenous women has the
potential to improve the experience of care and help reduce poor maternal health outcomes.

Disclosure of Interest: None Declared

Supporting Quality Mental Health Services for Adolescent Depression in Primary Care: A Learning
System Approach: (1536) Diana Sarakbi

ISQUA2024-ABS-1536

D. Sarakbi 1,*, D. Groll 2, J. Tranmer 3, R. Kessler 4, K. Sears 5

1
Health Quality Programs, 2Department of Psychiatry and Psychology, 3School of Nursing and
Department of Public Health Sciences, Queen's University, Kingston, Canada, 4Department of Family
Medicine, University of Colorado, Colorado, United States, 5School of Nursing and Health Quality
Programs, Queen's University, Kingston, Canada

Introduction: The World Health Organization suggests that depression is one of the leading causes of
illness and disability for adolescents [1]. While primary care providers play a key role in the early
detection of adolescent depression, the literature highlights gaps in the quality of care for this
population, including missed diagnosis, inadequate treatment, and lack of follow-up care [2]. Providing

21
quality mental health services in primary care, referred to as integrated care, requires a common
framework. The Practice Integration Profile (PIP), a valid and reliable survey, measures the level of
integration of mental health services in primary care with six domains: case identification, workflow,
clinical services, workspace, shared care, and patient engagement and retention [3]. Given the health
reform in Ontario Canada, there was a policy window to research the governmental strategies needed
to support quality integrated care, represented by the PIP domains, within a learning system
framework. This framework can be used by primary care practices in regional networks, such as
Ontario Health Teams (OHTs), to continuously identify systemic barriers and strategies to support
quality integrated for adolescent depression based on real-world data. Therefore, the aim of this study
was to answer the following research question: How can OHTs help identify the governmental
strategies needed to support quality integrated care for adolescent depression, represented by the PIP
domains, using real-world data?

Methods: We employed a descriptive, multi-case study design. This study was approved by the
Queen’s University Health Sciences and Affiliated Hospitals Research Ethics Board. Two OHTs, regional
networks designed to support integrated care, participated in this study. Data collection consisted of
(1) the administration of the PIP (V1.0) to the team-based primary care services within each OHT to
obtain a baseline measure on the PIP domains, and (2) focus groups to inform the strategies needed
to support the PIP domains for adolescent depression within a learning system framework. Focus
group participants included administrators, primary care and mental health clinicians, and a patient
partner. The survey and focus group results were analyzed together to respond to the research
question. The PIP median total scores were compared to the number of statements by PIP domain.
The PIP mean scores at the item-level were also compared to relevant quotes from the focus groups
to determine whether they confirmed, complemented, or conflicted with the findings.

Results: The team-based primary care practices in the OHTs had a median PIP score of 69 out of 100.
Among the PIP domains, the lowest median score out of 100 was case identification (50), and the
highest one was workspace (100). These results were compared to the scores obtained in the PIP
validation study conducted in the United States [3]. The mean scores out of 100 of the practices in the
OHTs (69) were slightly higher than the ones in the PIP validation study (60). However, the ranking of
the mean domain scores from lowest to highest was about the same between the two groups,
suggesting there could be similar systemic barriers in applying the PIP domains which were further
explored for OHTs during the focus groups. The focus groups generated 180 statements mapped to the
PIP domains where workflow had the highest number of coded statements (n=59, 32.8%) followed by
case identification (n=37, 20.6%). While all the primary care practices in the OHTs had mental health
clinicians on-site, the findings highlighted systemic barriers with adhering to the integrated care
pathway for adolescent depression. These include limited access to mental health expertise for
assessment and diagnosis, long wait times for treatment, and shortages of clinicians trained in
evidence-based behavioral therapies. These challenges contributed to the reliance on antidepressants
as the first line of treatment due to their accessibility rather than evidence-based guidelines. Potential
strategies were offered to help address these systemic barriers with support from targeted indicators.

Conclusion: This study adapted a learning system framework to continuously identify the systemic
barriers and the governmental strategies needed to support quality integrated care for adolescent
depression based on the experiences of two OHTs. Primary care practices, within regional networks
such as OHTs, can build upon these results by forming a learning system adapted to their local context.

22
References:

1. World Health Organization, Health for the world’s adolescents. A second chance in the second
decade. 2014.
2. Sarakbi, D., et al., Achieving Quality Integrated Care for Adolescent Depression: A Scoping Review.
Journal of Primary Care & Community Health, 2022. 13.
3. Kessler, R.S., et al., Development and validation of a measure of primary care behavioral health
integration. Fam Syst Health, 2016. 34(4): p. 342-356.

Disclosure of Interest: None Declared

"It can be a lonely job": Role experiences of paediatric care coordinators working in rural
Australia: (2787) Yvonne Zurynski

ISQUA2024-ABS-2787

Y. Zurynski 1,*, K. Hutchinson 1, A. De Groot 1, R. Lingam 2 and Rural Kids Guided Personalised Service
(Rural KidsGPS) Investigators Group

Australian Institute of Health Innovation, Macquarie University, 2Population Child Health Research
1

Group, School of Women's and Children's Health, University of New South Wales, Sydney, Australia

Introduction: Implementation of integrated care for children living with medical complexity (CMC) and
their families requires the establishment and support of new roles in the health system. The Rural Kids
Guided Personalised Service (RuralKidsGPS) is a paediatric care coordination service implemented in
four Local Health Districts (LHDs) in New South Wales, Australia since 2022. RuralKidsGPS is reliant on
nurse Paediatric Care Coordinators (PCCs) who provide family-centred care, shared care plans, and link
multiple clinical teams looking after the CMC. At implementation, care coordination services were at
different levels of maturity - one LHD had an established service since 2017, another had a service
which had been discontinued and re-instated and two LHDs were starting anew. Understanding the
experiences of PCCs in these contexts is crucial to effective integrated care delivery and model
sustainability.

Methods: All PCCs were invited to participate in one-on-one qualitative semi-structured interviews at
6 and 12 months after beginning their roles. Ten interviews were conducted, audio-recorded and
transcribed verbatim. Transcripts were analysed by two experienced researchers who identified key
themes whilst undertaking an inductive thematic analysis with a focus on how PCCs experienced
providing care coordination for CMC and their families.

Results: PCCs felt very supported by their local line managers, however, not having direct access to
other PCC colleagues was described as “isolating” and “lonely”. It is not unusual for two PCCs working

23
in the same LHD to be located >200 kilometres apart with limited face to face contact. PCCs talked
about having less contact with families than they expected with the role centring on organising,
seeking, and connecting needed services. The roles also varied across regions and some PCCs also
provided clinical care as part of their role. Capacity was discussed by all PCCs most of whom held part-
time roles and worried about supporting families on non-work days. In five out of six interviews, PCCs
talked about being available on days off as “there is no one else to help these families”. PCCs had been
employed under standard nurse position descriptions which did not take the role complexity of PCCs
into consideration. Furthermore, PCCs raised the need for greater role clarity, a competency
framework and a more realistic allocation of time to the role.

Significant emotional and cognitive toll was described by PCCs during care provision for highly complex
medical needs, in the context of challenging psych-socio-economic family challenges. PCCs displayed
resilience and felt that they were making a real difference in the care of CMCs and their families: “The
role is very heavy at times, heavy on your heart and heavy in the workload, but it is also very
rewarding….”

The importance of professional networks or a “buddy-system” was a theme underlined by all PCCs.
They felt that resources were needed to support networks and PCC communities of practice to ensure
these new roles are supported and sustained.

Conclusion: The PCC role is complex, varied and nuanced to the local context and CMC needs. The role
is valued by PCCs and they make a real difference to the lives of families with CMC living in rural
Australia. Organisations implementing innovative models of care must consider adequate support for
the key workforce working in these new models of care. A community of practice involving all PCCs in
NSW has been established and is one way of supporting PCCs in their important and challenging roles
when providing integrated care.

References: Chao, S. M., Professor,A., Yen, M., Lin, H. S., Sung, J. M., & Hung, S. Y.(2022).

Effects of helping relationships on health-promoting lifestyles among patients with chronic kidney
disease: A randomized controlled [Link] Journal of Nursing Studies,126,1-10.

Clarke, A.L.,, Jhamb. M., & Bennett. P.N.,(2019) .Barriers and facilitators for engagement and
implementation of exercise in end-stage kidney disease: Future theory-based interventions using the
Behavior Change Wheel . Public Health, 32(4),308-319. doi: 10.1111/sdi.12787.

Lee, J. Y., Park, H. A., & Min, Y. H. (2015). Transtheoretical model-based nursing intervention on lifestyle
change: A review focused on intervention delivery methods. Asian Nursing Research, 9 (2), 158-167.
doi:10.1016/[Link].2014.03.01

Wembenyui,C., Douglas,C., & Bonner, A.(2020). Validation of the Australian version of the Chronic
[Link] Journal of Nursing Practice ,27(2),[Link].1111/IJN.12857

, School of Women's and Children's Health, University of New South Wales, Sydney, Australia

Disclosure of Interest: None Declared

24
The need for early intervention to meet the unmet biopsychosocial needs of children with
common chronic illness: (1978) Raghu Lingam

ISQUA2024-ABS-1978

R. Lingam 1,* on behalf of CYPHP, E. Cecil 2, N. Hu 1, I. Wolfe 2 and CYPHP clinical research group

Paediatrics, University of New South Wales, Sydney, Australia, 2Child Health, Kings College London,
London , United Kingdom

Introduction: Approximately 20% of childhood deaths across England, the USA, Australia, and New
Zealand are thought to be preventable through better clinical care and self-management.(1) The
marked decrease in child mortality over the last century, through improvements in public health and
paediatrics, has been mirrored by an increase in childhood chronic illness and disability.(2, 3) Chronic
conditions affect at least 1 in 5 children and account for 79% of all disability-adjusted life years lost
among children aged 1–14 years across Europe.(2, 4, 5). We assessed the biopsychosocial needs and
key health drivers among children living with a common chronic illness, and outline a novel model of
care the Children and Young People’s Health Partnership (CYPHP) to address these needs.

Methods: Cross-sectional data were analysed from a large population sample of children from South
London with asthma, eczema, or constipation, as exemplar tracer conditions of a new integrated care
service, CYPHP. Descriptive and regression analyses, accounting for socio-demographic factors,
investigated social needs, psychosocial outcomes, and quality of life associated with poor symptom
control.

Results: Among 7779 children, 4371 children (56%) had at least 1 uncontrolled physical health
condition. Across the three domains of physical health, mental health, and social needs, 77.5% of
children (n=4304/5554) aged 4-15 years had at least one unmet need, while 16.3% of children had
three unmet needs. Children from the most socio-economically disadvantaged quintile had a 20%
increased risk of at least one poorly controlled physical condition (RR=1.20, 95% CI: 1.11 to 1.31,
p<0.001) compared with those from the least disadvantaged quintile. There was an 85% increased risk
of clinically important mental health needs among children with uncontrolled asthma (RR=1.85,
95%CI: 1.65 to 2.07, p<.001); 57% for active constipation (RR=1.57, 95% CI: 1.12 to 2.20, p<.01); and
39% for uncontrolled eczema (RR=1.39, 95%CI: 1.24 to 1.56, p<.001). Health-related quality of life was
associated with poor symptom control.

Conclusion: There is a large burden of unmet biopsychosocial needs among children with chronic
illness, signalling an urgent need for prevention, early intervention, and integrated biopsychosocial
care. The overlap between the physical, psychological, and social needs of children highlights the need
for a comprehensive health systems response to anticipate and meet needs, reduce health
inequalities, and improve child health outcomes.(3, 6)The CYPHP Model consisting of early
intervention and integrated biopsychosocial care through primary care. nurse led and community-
based services has the potential to meet these increased needs.

References:

25
1. Fraser J, Sidebotham P, Frederick J, Covington T, Mitchell EA. Learning from child death review in
the USA, England, Australia, and New Zealand. The Lancet. 2014;384:894-903 doi: 10.1016/S0140-
6736(13)61089-2 [published Online.

2. Wolfe I, Thompson M, Gill P, et al. Health services for children in western Europe. The Lancet.
2013;381:1224-34 doi: 10.1016/S0140-6736(12)62085-6 [published Online.

3. Wolfe I, Mandeville K, Harrison K, Lingam R. Child survival in England: Strengthening governance for
health. Health Policy. 2017;121:1131-8 doi: [Link]
[published Online.

4. Suris JC, Michaud PA, Viner R. The adolescent with a chronic condition. Part I: developmental issues.
Archives of Disease in Childhood. 2004;89:938 doi: 10.1136/adc.2003.045369 [published Online.

5. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: A meta-analysis of
the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry.
2015;56:345-65 doi: 10.1111/jcpp.12381 [published Online First: 2015/02/05].

6. Wolfe I, Satherley RM, Scotney E, Newham J, Lingam R. Integrated Care Models and Child Health:
A Meta-analysis. Pediatrics. 2020;145 doi: 10.1542/peds.2018-3747 [published Online First:
2020/01/01].

Disclosure of Interest: None Declared

Re-thinking integrated care for the most vulnerable people using Community Paramedics: (1845)
Peter Hibbert

ISQUA2024-ABS-1845

P. Hibbert 1 2,*, C. Molloy 1 2, M. Basedow 1

1
Australian Institute of Health Innovation, Macquarie University, Sydney, 2IIMPACT in Health Allied
Health and Human Performance, University of South Australia, Adelaide, Australia

Introduction: Across the world, health systems are struggling to deliver high quality integrated
community care to vulnerable populations, such as aged persons and indigenous, particularly in rural
areas. The South Australian Ambulance Service (SAAS) is delivering a Community Paramedic (CP)
Program in two rural areas, >300 kms from a major city. The aim of the CP Program is to provide skilled
clinicians to regional communities who co-ordinate community care options that link vulnerable clients
with appropriate care teams, such as palliative care, mental health teams or complex care teams. The
CPs treat patients in their usual place of residence and provide preventative health screening and
referrals in the community to avoid medical conditions from developing into high acuity situations that
require urgent medical attention. The objective of this project was to undertake a qualitative
evaluation of the CP Program.

Methods: This evaluation interviewed a total of 54 people - 18 CP clients and 36 stakeholders. Other
data sources included the CP service databases and two audit sources. The study setting was the Outer

26
Limestone Coast Region and Ceduna of South Australia. Interview transcripts and notes from
observations were inductively and thematically analysed independently and iteratively. Ethics
approvals were obtained from SA Department for Health and Wellbeing Human Research Ethics
Committee (HREC/20/SAH/84) and the Aboriginal Health Council of South Australia’s Aboriginal Health
Research Ethics Committee (AHREC) (04-21-917).

Results: One of the goals of the CP Program was that it would impact on reduced health service
demand by reducing ED and GP presentations and hospital admissions. However, the impact of the
CPs was not a one-way effect, i.e., a reduction in health service demand. Their impact is more dynamic
and related to highly vulnerable patients receiving more appropriate health care. Their interventions
can result in more emergency department and pharmacy demand as they are frequently referring,
encouraging and brokering patients who require care to the health services, but who were unlikely to
seek this care without the CPs encouragement. For example, the regular health checks that the CPs
undertake are likely to result in considerably more medication being appropriately prescribed.

There were six inter-related success factors for the CP Program:

- The design is responsive to the local community’s needs

- Focus on the most vulnerable and the gaps in health care

- Forming informal partnerships with local health and social service providers

- Skill sets

- Outreach

- Trust

Image:

27
Conclusion: Programs delivering integrated care in the community may need to re-frame their aims
from reducing demand to delivering more appropriate care to vulnerable patients (Figure 1). The CPs
increase appropriate care (such as provision of medication and health checks, emergency care for
prisoners) to patients that for a variety of reasons may not seek care or have access to timely care.

Disclosure of Interest: None Declared

Patient engagement for patient safety: results of a Belgian survey: (1861) Quentin Schoonvaere

ISQUA2024-ABS-1861

Q. Schoonvaere 1,*, H. Avalosse 2, G. Vandeleene 2, V. Fabri 3, W. Kestens 4

PAQS, 2Mutualité chrétienne, 3Solidaris, 4Les Mutualités Libres, Brussels, Belgium

1

Introduction: The objective of this article is to assess the ability of Belgian French-speaking patients to
report adverse events using a PRIM questionnaire (Patient-Reported Incident Measures). The research
question is whether we can rely on patients' reports of adverse events?

To address this question, we contextualized our adverse event reporting rate with the findings of other
surveys. Secondly, we assessed the association between the reporting of adverse events and factors
that could influence patients. We identified determinants specific to healthcare institutions, including

28
the level of maturity in an institution's safety culture and the organization of care processes. Studies
suggest that various individual factors can impact the occurrence of adverse events. Older individuals,
an extended duration of stay, or poorer health are correlated with an increased risk of experiencing
adverse events [1-2]. Hence, it is anticipated that patients identifying deficiencies in organizational
factors, along with those possessing individual risk factors (such as age, health status, and length of
stay), will be more inclined to report adverse events.

Methods: The questionnaire used is the result of a collaborative effort involving experts from OECD
member countries and patient representatives. The French translation of the questionnaire was
conducted by PAQS in collaboration with professionals and a panel of patients. The process of
identifying and contacting patients was carried out in collaboration with 3 Belgian’s insurance
organizations. They identified, in their databases, patients hospitalized in the third month preceding
the extraction date. The survey was operationalized online. Three insurance organizations sent 21,902
emails to their members. The number of survey logins amounted to 2,037, with a login rate of 9.3%
and a response rate of 5% relative to the emails sent. To test whether individual and organizational
characteristics are associated with the reporting of an adverse event, we used a chi-square
independence test.

Results: This survey shows that 16.5% of patients residing in French-speaking Belgium reported at least
one adverse event. This result is the highest among OECD countries that have operationalized this
survey [3]

The study also indicates that individuals reporting poorer health or those with longer stays are more
likely to report an adverse event. Further investigations focus on identifying weaknesses within care
processes, particularly in communication among various stakeholders. A strong correlation is observed
between patients' perception of such weaknesses in communication and their reporting of adverse
events.

Image:

29
Conclusion: Our findings allow for a positive response to our research question. In light of other results,
it is evident that our adverse event reporting rate is high but may be overestimated. This is particularly
likely, considering that respondents who made the effort to participate likely experienced safety
concerns during their hospitalization. We also highlighted a significant correlation between adverse
event reporting and organizational and individual variables that may influence this reporting.

The results of this study highlight opportunities for improvement, not only in terms of patient safety
but also in the management of adverse events. Integrating a PRIM tool into the strategy is rightfully
positioned to enhance the quality and safety of care in the hospital, complementing other tools and
sources of information on adverse events.

References: Tsilimingras D, Rosen AK, Berlowitz DR. Patient safety in geriatrics: A call for action.
Journals of Gerontology, 2003; 58(9):813-9

Charles Vincent. L’essentiel sur la sécurité des patients.& Suisse : Wiley-Blackwell et Fondation pour la
Sécurité des Patients; 2012.

Kendir, C., et al. (2023), « Patient engagement for patient safety : The why, what, and how of patient
engagement for improving patient safety », Documents de travail de l'OCDE sur la santé, n° 159,
Éditions OCDE, Paris, [Link]

Disclosure of Interest: None Declared

Effect of pressure injury reduction project utilizing three types of continuity of care on pressure
injury incidence rates in a general hospital: (3502) Suryang Seo

ISQUA2024-ABS-3502

S. Seo 1,*, E. Lee 1

Nursing, SMG–SNU BORAMAE MEDICAL CENTER, Seoul, Korea, Republic Of

1

Introduction: Pressure injuries (PI) pose a significant threat to patient health, quality of life, and
healthcare costs. It serves as one of the key clinical indicators of patient safety and healthcare quality
in a hospital. To prevent and manage PIs, hospitals engage in activities focused on patient treatment,
educate staff and caregivers on the importance and methods of prevention and management, and
implement systems designed for effective PI management. The aim of this project was to reduce the

30
incidence of PIs utilizing three aspects of Continuity of Care in an internal medicine ward with 42-beds
in a general hospital with 765-beds in South Korea.

Methods: This uncontrolled before-and-after study investigated the impact of the PI reduction project
on PI incidence in an Internal Medicine Gastroenterology inpatient ward. PI incidence was calculated
as the number of patients admitted to the ward who developed a new pressure injury divided by 1,000
patient days. This study measured PI incidence density before (January 2020 to January 2022) and after
the project (February 2022 to December 2023), consisting of informational continuity, relational
continuity, and management continuity.

- First, relational continuity, which was considered the most important aspect of continuity, was
implemented by scheduling a daytime ‘hygiene-nurse’ responsible for basic nursing care of patients
wearing diapers or receiving tube feeding, etc. from one-time duty scheduling to at least 3 consecutive
duty scheduling per week by ‘hygiene-nurse’ who voluntarily applied for the month.

- Second, informational continuity was conducted by posting the information needed for each
patient’s PI care, such as how to perform PI site dressing, what postures to consider, and what
ointment to apply at designated times on the patient’s bedside.

- Third, management continuity was applied by adjusting the worklist of hygiene-nurses towards
consistency of care and flexibility of each patient.

As PI incidence density can be affected by the severity and factors of patients hospitalized at a specific
time, data were collected monthly on the number of patients who needed PI prevention and
management, including patients at PI risk and non-PI risk patients with PI(s). Data on PI incidence
density and the incidence density of PI higher than Grade 2, including Grade 3 PI, 4 PI, Unstageable PI,
and Deep Tissue PI, were collected every month and analyzed using Microsoft Excel and Python 3.10
for descriptive statistics and independent t-test.

Results: This study observed 32,961 patient days before and 29,843 patient days after the intervention.
The mean PI incidence density decreased significantly from 5.42 (standard deviation, SD 2.53) to 1.30
(SD 1.30) post-intervention (p<.001). And the mean incidence density in PI higher than grade 2 also
decreased from 2.06 (SD 1.32) to 0.35 (SD 0.65) after the intervention (p<.001). Figure 1 and 2 show
the monthly incidence density of PI cases per 1,000 patient days. The total number of PI incidences
and PI higher than grade 2 were significantly reduced after the project (Figure 3 and 4). In addition,
the number of patients who required PI prevention and management before and after the project was
statistically insignificant (p = .74).

Image:

31
Conclusion: The project effectively reduced the incidence of PIs, suggesting the value of integrating
continuity of care aspects in PI prevention and management strategies. Further research is needed to
apply continuity of care in PI prevention and management in various medical settings, considering the
severity and factors of patients.

References: 1. European Pressure Ulcer Advisory Panel| National Pressure Ulcer Advisory Panel| Pan
Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/injuries: Clinical Practice
Guideline: the International Guideline| Prevention and Treatment of Pressure Ulcers: Clinical Practice
Guideline. Cambridge Media, 2019.

2. MA, Rachael McKendry. "Defusing THE Confusion: Concepts AND Measures OF Continuity OF
Healthcare." (2002).

3. Stifter, Janet, et al. "Proposing a new conceptual model and an exemplar measure using health
information: Technology to examine the impact of relational nurse continuity on hospital-acquired
pressure ulcers." Advances in Nursing Science 38.3 (2015): 241-251.

Disclosure of Interest: None Declared

Patient as Observer Intervention to Increase Hand Hygiene Adherence among

Healthcare Workers in the Ambulatory Setting: (2873) Vickly LoPachin

ISQUA2024-ABS-2873

32
Rebecca M. Anderson1, Amanda Kirincic1, Jemilat Siju2, Bernard Camins3, Vicky LoPachin* 1
1
Office of the Chief Medical Officer, 2Nursing, 3Infection Prevention, Mount Sinai Health
System, New York , United States

Introduction: Hand hygiene is the most cost effective method to prevent transmission of
multi-drug resistant organisms (MDRO). However, monitoring of adherence to the World
Health Organization (WHO) Five Moments for hand hygiene by healthcare workers (HCW) is
challenging. We assessed the efficacy of the patient-as-observer hand hygiene program on
adherence to hand hygiene recommendations before and after patient interaction in the
ambulatory setting.

Methods: 204 ambulatory clinics affiliated with a large urban healthcare system in New York
City, NY, USA are included in this retrospective analysis of a quality improvement initiative
that took place from May 2019 until December 2023. Upon arrival to their appointment,
patients are asked to complete a hand hygiene survey, either via a paper form or through a
QR code with a link to the survey. The survey asks if their provider, nurse, or other
healthcare worker (HCW) performed hand hygiene before and after their
encounter. Patients completed the survey in real-time, with automatic data entry via the QR
code or by a paper form that was submitted at the end of each visit to front desk staff that
was then entered into the database. Data are aggregated on a monthly basis and are
available through a dashboard on the organization’s intranet. Differences in adherence rates
were analyzed using chi-square. A p-value <0.05 was considered statistically significant.

Results: A total of 303,589 observations were recorded over the study period, with 297,056
being paper surveys and 6,533 being electronic surveys via the QR code. In 2019, overall
hand hygiene compliance was 86%, with compliance before patient encounters at 89% and
after patient encounters at 83%. In 2020, overall compliance was statistically higher at 91%,
with a greater than 91% compliance rate sustained for the subsequent 3 years (p < 0.001).
At baseline, providers, nurses, and other HCWs were more likely to have been observed to
perform hand hygiene before an encounter than after the encounter (p < 0.001). Other
HCWs had a statistically higher adherence rate (87% vs. 86%; p <0.001) than providers at
baseline but all categories had similar adherence rates by 2020 which was maintained
through 2023.

Conclusion: In a large urban healthcare system, a patient-as-observer approach to hand

hygiene adherence has been shown to be efficacious and sustainable. This method engages
the patients to participate in their care. The ease of implementation and the use of both the
paper survey and QR code demonstrate that the operationalization of the program can be
done with or without technology, making it broadly applicable to all ambulatory
practices. Future work will include the encouragement of the use of the QR code to alleviate
the need for data entry.

Disclosure of Interest: None Declared

Mutual Healing Program©: Helping patients, their families and healthcare workers heal together
after unexpected medical harm: (1638) Wendy Nicklin

ISQUA2024-ABS-1638

33
D. L. Aubin 1, W. Nicklin 2,* on behalf of Patients for Patient Safety Canada Mutual Healing Working
Group

Patients for Patient Safety Canada, Edmonton, 2Patients for Patient Safety Canada, Ottawa, Canada
1

Introduction: Patients, their families and healthcare workers (HCWs) can experience psychological
trauma as an outcome of a medical error resulting in unexpected harm to the patient. For patients and
their families (‘patients’), medical errors can have tremendous physical, emotional and psychological
impacts.1,2 At the same time, unexpected patient harm is known to be devastating and distressful to
HCWs.3-5

There is growing recognition that there is insufficient emotional support for both patients and HCWs
after patient harm. Although there is some information in the form of case studies6, incidental findings
and testimonials that indicate there might be merit in bringing together patients and HCWs to heal
emotionally after unexpected harm, there have been no formal studies on this topic, nor evidence of
any existing programs that take this approach. Our study aimed to investigate whether purposeful
conversations between patients and HCWs might promote mutual healing and wellness after a medical
error. We explored with patients and HCWs the value, barriers and effectiveness of mutual healing. If
the results supported our theory, our final objective was to put the theory into practice and pilot a
Mutual Healing Program© in collaboration with Patients for Patient Safety Canada (PFPSC), which had
in the meantime also identified the potential for patients healing through conversations with
healthcare workers.

Methods: Phase I: We used a patient-oriented research approach with constructive grounded theory
methodology. We conducted 22 interviews with concurrent data collection and analysis. With our
findings, we created a framework of the communication process between patients and HCWs.

Phase II: Based on the results of Phase I and guided by implementation science, we created a step-by-
step guide to implement a Mutual Healing Program© in collaboration with PFPSC and Healthcare
Excellence Canada (HEC).

Phase III: We are currently piloting the Mutual Healing Program© in collaboration with PFPSC at up to
three organizations in Canada over the next two years.

Results: Our Phase I findings7 suggest that, after a medical error causing harm, both patients and HCWs
have feelings of empathy and respect towards each other that often goes unrecognised. Barriers to
communication for patients were related to their perception that HCWs did not care about them,
showed no remorse nor admitted to the error. For HCWs, communication barriers were related to
feelings of blame or shame, and fear of conflict with the patient, or professional and legal
consequences. Early results from Phase II indicate that institutional and resource barriers play a
significant role in the implementation of a Mutual Healing Program©.

Our resulting framework suggests that an open and purposeful conversation after disclosure, when
both parties are ready, and before increased emotional suffering might provide an opportunity to
bridge the barriers to find common ground, to gain perspective of each other’s experience, and strive
to recognise each other’s humanity (see attached).

Image:

34
Conclusion: Our findings from Phase I indicate that further exploration of the value of mutual healing
conversations is warranted. The step-by-step guidelines developed in collaboration with PFPSC and
healthcare workers are ready to be tested. The pilot testing of the Mutual Healing Program© will
assess the effectiveness of the guidelines and the impact and feasibility of this approach to healing.

References: 1 Massó Guijarro P, Aranaz Andrés JM, Mira JJ, et al. Adverse events in hospitals: the
patient's point of view. Qual Saf Health Care2010;19:144–7.

2 Ottosen MJ, Sedlock EW, Aigbe AO, et al. Long-Term impacts faced by patients and families after
harmful healthcare events. J Patient Saf 2021;17:e1145–51.

3 Davies JM, Steinke C, Flemons WW. Fatal solution: how a healthcare system used tragedy to
transform itself and redefine just culture. New York, NY: Routledge, 2022.

4 Aubin D, King S. The healthcare environment: a perfect ecosystem for growing shame. HealthcQ
2018;20:31–6.

5 Robertson JJ, Long B. Suffering in silence: medical error and its impact on health care providers. J
Emerg Med 2018;54:402–9.

6 Dekker S, Oates A, Rafferty J. Restorative just culture in practice: implementation and evaluation.
New York, NY: Routledge Taylor and Francis Group, 2022.

7 Aubin DL, et al. Support for healthcare workers and patients after medical error through mutual
healing: another step towards patient safety. BMJ Open Quality 2022;11:e002004.
doi:10.1136/bmjoq-2022-002004

Disclosure of Interest: None Declared

Improving the quality of antenatal care (ANC) and postnatal care (PNC) services by strengthening
supportive supervision of service providers at private health facilities in urban slums of
Bangladesh: (2986) Anjuman Begum

ISQUA2024-ABS-2986

A. R. Karim 1,*, A. Begum 1, S. Rashid 2, F. Islam 1, N. Carbone 2

35
Management Sciences for Health, Dhaka, Bangladesh, 2Management Sciences for Health, Arlington,
1

United States

Introduction: In Bangladesh, pregnant women in urban slums have limited access to and knowledge
of quality health services. While the proportion of women receiving quality ANC increased from 18%
to 21% between 2017 and 2022[i], these numbers are low and faster progress is needed.

The Healthy Women, Healthy Families (HWHF) project, implemented by Management Sciences for
Health (MSH), BRAC, Population Council, and Scope, is testing group ANC-PNC, an innovative service
delivery model, at two private, non-profit primary health facilities, BRAC Maternity Centers (BMCs).
HWHF aims to improve access to quality maternal & newborn health and family planning (MNH/FP)
services for young first-time parents in the urban slums of Tongi. As clinical counseling skills are
essential in ensuring quality of care, the HWHF project aims to strengthen the capacity of service
providers. Providing service providers with continuous supportive supervision is a key strategy to
ensure the quality of MNH/FP services.

Methods: Supportive supervision helps staff continuously improve their work performance using
supervisory visits to grow the technical knowledge and skills competencies of health care providers.
Supervision encourages open communication and utilizes team building approaches that facilitate
problem-solving. The HWHF project team provides each facility with 24 visits in a two-month
timeframe to ensure that each service provider receives at least one supportive supervision visit.

The HWHF project adapted supportive supervision checklists from government tools to identify gaps
in MNCH/FP competencies on respectful maternal care, physical examination, prescribing and
documenting necessary supplements, and recording patient history, obstetrics information, and vital
signs. Service providers providing ANC and PNC check-ups and services are observed, and information
is collected using paper HWHF supervision checklists. Following the supervision visits, composite
supervision scores are calculated using an Excel template and areas for improvement and feedback are
provided to the service providers through demonstrations, group discussions, and on-the-job training.

Results: Data from the supportive supervision visits show improvements in the quality of ANC and PNC
services. At baseline in April 2022, composite scores indicated that 75% of providers correctly
performed key ANC practices (history taking, physical examination, lab-test and medicine distribution),
and 78% provided key PNC services (counseling for family planning). After 18 months of the
intervention (May 2022-October 2023), the average scores increased to 92% for ANC and 91% for PNC.
The data below shows continuous improvement of quality ANC/PNC services in the last 11 months due
to regular monitoring and supportive supervision. It was also observed that supportive supervision
increases the confidence of service providers.

Image:

36
Conclusion: Supportive supervision improved the quality of health services at two health facility sites
in the urban slums of Bangladesh. Engaging facility leadership and conducting continuous supportive
supervision helped private-sector providers to address gaps in providing quality ANC and PNC services
and establish a culture of continuous improvement. Supportive supervision also increased the
confidence of the service providers through targeted support, mentorship, and follow-through on
action items. The potential to improve care in other similar settings should be explored.

References: [i] Bangladesh Demographic & Health Survey (BDHS) 2022–23; Page 45.
([Link]

Disclosure of Interest: None Declared

Promoting Factual, Affirming, Informative and Respectful (FAIR) Documentation in the EHR to
Reduce Bias and Improve Patient Care: (3240) Carol R. Horowitz

ISQUA2024-ABS-3240

A. R. Glasser 1,*, C. R. Horowitz 2, L. D. Richardson 2, D. Apakama 2, S. Schlozman 2, D. Hyppolite 1,

V. LoPachin 1, R. Anderson 1

1Office of the CMO, 2Institute for Health Equity Research , Mount Sinai Health System, New York,
United States

Introduction: Reducing bias and health disparities in patient care and outcomes is a top priority for
Mount Sinai Health System (MSHS), an 8 hospital, 400+ ambulatory clinic health system located in
New York. A change in policy in the United States has increased patient access to medical records,
and notes are no longer just for members of a patient’s care team but are now available to patients.
Expanded access to patient notes can enhance the patient/provider relationships and care. However,
the use of biased language and negative descriptors can adversely impact patient care by reinforcing
harmful stereotypes, harming a patients’ mental health and well-being, and inappropriately biasing
other members of the care team.

37
Methods: As part of a MSHS commitment to advancing health equity, in June 2022, the FAIR (Factual,
Affirming, Informative and Respectful) Documentation Workgroup (WG) was formed. The WG is
multidisciplinary and co-led by the Office of the Chief Medical Officer and the Institute for Health
Equity Research (IHER) and includes clinicians, trainees, researchers, patients, advocates,
administrators and health systems leaders. Our intent is to reduce negative descriptors in patient
medical records and promote the use of positive and affirming language across MSHS.

The work started with a literature review on biased and stigmatizing language in the electronic
health record (EHR). We then used a modified Delphi technique, with input from clinical and non-
clinical WG members and patients, to identify an initial list of 19 Never Words (words we do not want
used nor documented in the EHR). For educational purposes, the words were then put into 1 of 4
categorizes: Discrediting, Judgmental, Stigmatizing/Labeling or Stereotyping. The EHRs for patients
seen in the Emergency Department (ED) between January 1, 2022 and March 31, 2023 were
reviewed to determine the frequency and characteristics associated with Never Words, and assessed
the feasibility of creating an algorithm to detect biased language in the EHR using natural language
processing. We employed a phased approach to build a language model that could reliably detect
biased language.

Results: Preliminary analyses showed a 100% match between the algorithm and independent
reviewers for 18 of the 19 Never Words, except for the word “Claimed” which had an 80% match. In
our review of 1,248,074 ED notes, prevalence of Never Words was low, occurring in less than 0.5% of
notes in the review period. Attending Physicians were more likely to document these Never Words
compared to Residents, Nurses or Advance Practice Providers. The word “Claims” was the most
commonly recorded Never Word, followed by drug seeking, toxic habits, belligerent and hostile.

Conclusion: Our study shows that an algorithm could be built and trained to detect biased language
in ED notes, and that the Never Words we identified are not commonly used in the ED charts
reviewed. Our next steps are to refine the algorithm to detect negative descriptors and stigmatizing
language that is not captured in a single word, and take the context of words into account. We will
also implement an awareness and educational campaign, to ensure that health care teams
understand the importance of always documenting in a factual, respectful, informative and affirming
manner. We also found that a diverse clinical and administrative team are committed to strive for
documentation that reduces bias and supports the delivery of safe, high-quality care.

Disclosure of Interest: None Declared

38
What matters the most for the quality of inpatient treatment and care experience?: (3061) Gang
Chen

ISQUA2024-ABS-3061

G. Chen 1,*, N. Brusco 1, M. Morris 2 3

1Monash University, 2La Trobe University, 3Victorian Rehabilitation Centre, Melbourne, Australia

Introduction: High-quality care is essential to the increasing demand and health services utilisation
as well as the improvement of health outcomes. It is increasingly important to gain patients’
perspectives on health care quality. The Australian Hospital Patient Experience Question Set
(AHPEQS) is a 12-item tool that has been developed to assess the quality of patients’ experiences.
This study aims to understand what matters the most for the inpatient treatment and care
experience perceived by the Australian population based on items included in the AHPEQS.

Methods: A discrete choice experiment (DCE) was designed and administrated online to elicit
consumers’ preferences on inpatient treatment and care experience. The DCE consists of 9 attributes
(items) from the AHPEQS (with the exclusion of two optional and one overall quality items) and each
item was described using 4 or 5 response levels. Respondents were recruited by an online panel
provider (Dynata) in Australia. The DCE data were analysed using a conditional logit model under the
random utility framework. The study has been approved by the Monash University Human Research
Ethics Committee, Monash University, Australia (Project ID: 31834).

Results: Data from a total of 1036 respondents were included in the analyses. They had a mean
(range) age of 47 (18-92) years old and 51% were females. Around half of the respondents had
inpatient experience in the past five years by the time of the survey; among them, 86% rated their
most recent hospital admission experience to be Good or Very Good. The DCE data analyses found
that all nine attributes statistically and significantly influence inpatient treatment and care
experience, albeit their relative importance varied. A scoring algorithm (value set) was developed
based on DCE estimates to create a preference-weighted aggregate score for the responses to the
nine AHPEQS items.

Conclusion: The AHPEQS adopts an equal weight to its items in understanding patients’ experiences.
This study provides important insights into the general public’s perceptions of the relative
importance of different treatment and care experiences. The preference-weighted value set
represents how society values different inpatient treatment and care experiences and could be used
to facilitate hospital performance evaluation.

Disclosure of Interest: None Declared

39
Interweaving quality and circular economy in healthcare: A synergistic framework : (3236) İbrahim
Halil Kayral

ISQUA2024-ABS-3236

I. H. Kayral 1,*, D. Incegil 1, A. Söyler 2, S. Taşır 3, F. Çizmeci Şenel 4

1International Programs, TÜSKA, Ankara, 2Bakırçay University, İzmir, 3Ankara Univercity, 4TÜSKA,
Ankara, Türkiye

Introduction: As the healthcare industry continually strives for excellence in service delivery, this
research aims to explain how the integration of circular economy practices can improve the overall
quality of healthcare. This research aims, firstly, to evaluate current quality standards and
improvement initiatives in healthcare, and secondly, to depict how circular economy principles can
be strategically incorporated to improve these quality measures. Achieving a harmonious balance
between quality and circularity not only ensures better patient outcomes but also promotes
environmentally responsible healthcare practices.

Methods: The research methodology covers a comprehensive review of existing literature on quality
improvement in healthcare and circular economy applications across various sectors.

Results: The current literature review on quality improvement in healthcare and circular economy
applications in various sectors is summarized in Table.1. Advancements in biotechnology and life
sciences offer new possibilities for integrating the principles of the circular economy into laboratory
studies, biosecurity applications, and, more broadly, the field of bioeconomy. This integration not
only extends beyond reducing environmental impacts but also provides cost savings and
sustainability advantages. Circular economy aims to optimize resource management in laboratories
and healthcare facilities. In this context, it encompasses elements such as Waste Management and
Quality Control, Reusable Laboratory Materials, Green Chemistry Practices, Quality Management
Systems and Continuous Improvement, as well as Material Tracking and the Analytics Cycle. The goal
is to maintain materials, components, and products at their highest value and utility, ensuring their
continuous and efficient use. A bio-based circular economy provides solutions to meet the demands
arising from a growing human population, opens up new opportunities in the field of healthcare, and
introduces novel concepts for ensuring the health of humans, animals, and plants in the future
(Liguori et al, 2016, Negi et al 2021. Sun, 2021).

40
Image:

Conclusion: Nowadays, there is a need to investigate the concepts of sustainability and circular
economy in healthcare quality research. Considering the addition of circularity to quality models in
Health Services from a quality perspective and the issue of what changes will occur in terms of
quality in health services with the implementation of the circular economy is becoming increasingly
important today. It also aims to provide a solid basis for collecting empirical data through case
studies and interviews with healthcare professionals and experts, triangulating qualitative and
quantitative data, formulating recommendations for the seamless integration of quality initiatives
and circular economy principles in healthcare.

References:

Allen-Duck, A., Robinson, J. C., & Stewart, M. W. (2017). Healthcare Quality: A Concept Analysis.
Nursing Forum, 52(4), 377–386. Https://[Link]/10.1111/Nuf.12207

Alshemari, A., Breen, L., Quinn, G., & Sivarajah, U. (2020). Can We Create A Circular Pharmaceutical
Supply Chain (Cpsc) To Reduce Medicines Waste? Pharmacy, 8(4), 221.
Https://[Link]/10.3390/Pharmacy8040221

Çaha, H. (2007). Service Quality In Private Hospitals In Turkey *. Journal Of Economic And Social
Research, 9(1), 55–69.

Donabedian, A. (1966). Evaluating The Quality Of Medical Care. The Milbank Memorial Fund
Quarterly, 44(3), 166–206.

41
Donabedian, A. (1988). The Quality Of Care: How Can It Be Assessed? Jama: The Journal Of The
American Medical Association, 261(8), 1151. Https://[Link]/10.1001/Jama.1989.03420080065026

Greenfield, D., & Braithwaite, J. (2008). Health Sector Accreditation Research: A Systematic Review.
International Journal For Quality In Health Care, 20(3), 172–183.
Https://[Link]/10.1093/Intqhc/Mzn005

Liguori, V. Faraco, Biological processes for advancing lignocellulosic waste biorefinery by advocating
circular economy, Bioresour. Technol. 215 (2016) 13–[Link], D., Vermeulen, W. J. V., & Witjes, S.
(2018). The Circular Economy: New Or Refurbished As Ce 3.0? — Exploring Controversies In The
Conceptualization Of The Circular Economy Through A Focus On History And Resource Value
Retention Options.

Kayral, I. H. (2014). Perceived Service Quality In Healthcare Organizations And A Research In Ankara
By Hospital Type. Ankara Araştirmalari Dergisi, 2(1), 22–34.

Disclosure of Interest: None Declared

Implementation of Key Result-based Digital-Performance Management System for Quality

Manpower, Leadership Excellence and Safe Patient care in a Multispecialty Hospital: (2100) Amitha
Prashanth Marla

ISQUA2024-ABS-2100

A. P. Marla 1,*, G. V. Prabhu 2, H. P. Miranda 2

Administration, 2A.J. Hospital & Research Centre, Mangalore, India

1

Introduction: A well-implemented Performance Management System (PMS) contributes to

organizational success by aligning individual and team efforts with strategic goals and fostering
employee development. Talent management and performance Management are highly interesting
and provocative topics, less touched on hospitals in India which mostly follow the traditional 360-
degree method.

Scientific Performance Management using KRA/KPI and Leadership attributes not only leads to talent
management but identifies skill management and training for improving the performance and morale
of staff. This concept aligns with the World Health Organization's Strategy to link commitment to
patient safety with appraisal systems for healthcare professionals in the Global Patient Safety Action
Plan 2021-2030.

Digital-PMS serves as strategic alignment to achieve quality manpower by accessing the leadership
practices of individual and their fulfillment of KRA/KPIs which plays a major role in data-driven
decision-making, addressing training needs, and enhancement of healthcare professionals' and teams'
performance.

Objectives

(1) To replace traditional 360-degree manual PMS with a scientific approach to digital ePA.

42
(2) To follow a Pathway measuring the Key result area (KRA), Key performance indicators (KPI), and
Leadership attributes.

(3) To identify the training needs and focus on Talent management and succession planning.

(4) Identify the role of e-PA for transformational leadership in shaping the performance of individuals.

Methods: The research methodology encompasses a committee's formation to establish Key Result
Areas (KRAs) and 16 Leadership Attributes under 3 success factors for assessment. Evaluation criteria
include both KRAs and Leadership Attributes, with a weighted distribution of 60% for KRAs and 40%
for Leadership Attributes for the Incharge, Supervisor and manager levels. The Subordinates are
exclusively assessed on 16 leadership attributes, accounting for 100% weightage. A custom-designed
software facilitates data collection, featuring a multi-level evaluation process encompassing self-
assessment, manager evaluation, and independent reviewer scoring. The unique scoring mechanism
employs various scales, with specialized training provided to the workflow approvers. To gain
comprehensive insights into the PMS, a Business Intelligence (BI) tool is used to analyze and visualize
key performance metrics.

Results: The task force identified KRAs and KPIs for all departments, establishing a range from a
minimum of 3 to a maximum of 6 KRAs. Within this framework, weights were assigned, particularly
focusing on areas with less than 6 KRAs. Total 1022 Appraisees participated in the PMS where the
overall result indicates that the average staff performance stood at 77% out of 100.

The findings underscore a distinctive performance distribution among staff members, with 44%
meeting the maximum 100% threshold, and 38% achieving a commendable 90% KRA fulfillment.
Notably, no staff members fall below 50% fulfillment, underscoring a predominantly positive
adherence to KRA targets within the organization. A portion of the staff, constituting 5%, has been
identified for developmental discussions, and 14 individuals show potential for higher levels of job
responsibility. 74.47% of the staff demonstrate the exhibition of leadership practices in People & Team
Leadership, Delivering Values and Business leadership. Additionally, 14.55% of the staff have identified
training needs for their development across the spectrum of 16 leadership practices. The Implemented
process of PMS and its overall sustainability can be adopted in various hospitals.

43
Image:

Conclusion: Employee performance management can vary depending on the business industry,
company size and strategic objectives of the organization. In the traditional appraisal system, the
manager is automatically cast as JUDGE, hence the subordinate’s natural reaction is to assume a
defensive role but not in the KRA, KRA-driven appraisal system which focuses on Employee
development and achieving the strategic goals & and objectives of the Department/organization.

The individual and collective performance, with a specific emphasis on KRAs fulfillment, and exhibition
of leadership attributes contribute to the development of targeted training programs and fostering a
culture of continuous improvement. Appreciable improvement is realized only when specified goals
and deadlines are mutually established and agreed on by the subordinate and his manager through
the Performance evaluation which we visibly see in our study. Thus, it appears likely that well planned

44
Performance management at the hospital is the key to quality manpower leadership excellence & and
patient care management.

Disclosure of Interest: None Declared

Care Under Pressure 2: causes and solutions to workplace psychological ill-health for nurses,
midwives and paramedics- a realist review: (2744) Jill Mabe

ISQUA2024-ABS-2744

J. Maben 1, C. Taylor 1,*, K. Mattick 2, D. Carrieri 3, J. Jagosh 4, S. Briscoe 3

1
School of Health Sciences, University of Surrey, Guildford, 2Department of Health & Community
Sciences, 3Medical school , University of Exeter, Exeter, 4Faculty of Health and Applied Sciences,
University of the West of England, Bristol , United Kingdom

Introduction: Providing high quality patient care requires healthy and motivated staff but there is a
high and increasing incidence of psychological ill-health. Yet, psychological ill-health in healthcare staff
has been a worldwide problem for decades, leading to presenteeism, absenteeism and attrition, with
an unavoidable impact on quality of care.

Nurses, midwives and paramedics collectively comprise over half of clinical staff in the UK National
Health Service (NHS) with some of the highest prevalence of psychological ill-health. Organisations
across the world are struggling with recruitment and retention, thus improving staff working lives is a
priority.

Building on our previous work with doctors (Carrieri et al. 2020), this study aimed to improve
understanding of how, why and in what contexts nurses, midwives and paramedics experience work-
related psychological ill-health; and determine which high-quality interventions can be implemented
to minimise psychological ill-health in these staff.

We further asked:

1. Why is psychological ill-health in healthcare professionals still a huge and growing problem?

2. Why despite having interventions (many with an ‘evidence-base’) does the problem persist?

Methods: We used a realist synthesis methodology consistent with RAMESES reporting guidelines
(Wong et al. 2014). First round database searching in MEDLINE ALL (via Ovid), CINAHL (via EBSCO) and
HMIC (via Ovid), was undertaken February-March 2021, followed by more specific supplementary
searching strategies (e.g., hand searching, expert solicitation). Subsequent database searches

45
(December 2021) targeted COVID-19- specific literature and literature reviews. We developed novel
approaches to characterise the state of psychological wellbeing for the three professions, understand
the context, manage the different-sized literatures, and co-produce the analysis (reverse chronological
quota screening and appraisal journaling).

We worked closely with a stakeholder group comprising nurses, midwives, paramedics,

representatives of patients and the public, managers and policy makers.

Results: Following initial theory development from 8 key reports, 159 sources were included. We
surfaced 14 key tensions in the literature (incompatible aspects of work that affect psychological ill-
health) and identified 26 Context Mechanism and Outcome configurations (CMOcs) supporting five
key findings: (i) interventions are fragmented, individual-focused and insufficiently recognise
cumulative chronic stressors; (ii) it is difficult to promote staff psychological wellness in a blame
culture; (iii) the needs of the system often override staff wellbeing at work (‘serve & sacrifice’); (iv)
there are unintended personal costs of upholding and implementing values at work; and (v) it is
challenging to design, identify and implement interventions to work optimally for diverse staff groups
with diverse and interacting stressors.

Overall, the service architecture (organisational features, context and working practices) increased risk
rather than the profession itself. Staff appear particularly at risk when newly qualified, exposed to
trauma, or under investigation. Individual characteristics including ethnicity, sexual orientation and/or
gender identify, and disability require greater attention.

Conclusion: Our final programme theory argues that healthcare organisations need to rebalance the
working environment to enable healthcare professionals to recover for the stress and trauma they
experience and thrive. Healthcare is a balancing act, with different considerations needing to be held
in productive tension, such as the needs of staff and the needs of patients. For the future, investment
in multi-level systems approaches to promoting staff psychological wellbeing is required.

References: - Carrieri D, Mattick K, Pearson M, et al. Optimising strategies to address mental ill-
health in doctors and medical students: ‘Care Under Pressure’ realist review and implementation
guidance. BMC Med. 2020;18:76.

- Wong G, Greenhalgh T, Westhorp G, Pawson R. Health Services and Delivery Research.

Development of methodological guidance, publication standards and training materials for realist and
meta-narrative reviews: the RAMESES (Realist And Meta-narrative Evidence Syntheses - Evolving
Standards) project. Southampton: NIHR Journals Library Copyright (c) Queen's Printer and Controller
of HMSO; 2014.

Disclosure of Interest: J. Maben Grant / Research support from: NIHR £263,759, C. Taylor Grant /
Research support from: NIHR £263,759, K. Mattick Grant / Research support from: NIHR £263,759, D.
Carrieri: None Declared, J. Jagosh Grant / Research support from: NIHR £263,759, S. Briscoe Grant /
Research support from: NIHR £263,759

46
Sustaining Community-Based Family Planning Service Delivery in the Philippines
through Community Health Worker Capacitation: A Systematic Task Shifting Strategy: (2864)
Jaime Dela Roca Bonifacio, Jr.

ISQUA2024-ABS-2864

J. D. R. Bonifacio, Jr. 1,*, R. M. Benabaye 1, R. Gavino 1, O. Mendoza 1, L. Tapere 1

RTI International, Pasig City, Philippines

1

Introduction: Community Health Workers (CHWs) are essential components of the Philippine
healthcare delivery system, responsible for disseminating health information and facilitating access to
services within communities. In response to disruptions in family planning (FP) services caused by
COVID-19 in 2020, the Philippine Department of Health (DOH) mobilized them to directly deliver pills
and condoms to clients' homes. While this strategy underscored their potential in addressing FP
barriers, it also uncovered challenges and deficiencies in their ability to carry out basic health tasks. To
tackle these issues, USAID ReachHealth conducted an implementation research (IR) project aimed at
identifying effective task-shifting mechanisms to sustain community-based FP service delivery through
CHWs.

Methods: The project spanned nine diverse localities across the Philippines. It involved focus group
discussions and in-depth interviews with 92 CHWs, 64 clients, and 35 program managers to obtain
diverse perspectives on FP service provision in the community. Triangulating qualitative data from
these activities with quantitative service delivery data from facility records enabled an analysis of FP
service utilization trends and identification of gaps in community-based FP service delivery.
Additionally, stakeholders were consulted to develop interventions targeting gaps identified during the
initial data collection, with a focus on capacitating CHWs and gradually shifting basic tasks from public
health midwives to them.

Results: The study revealed that CHWs, whom community members trust, may have a tendency to
disseminate incorrect health messages when inadequately trained and supervised. Significant gaps
were also identified in the support provided to them, particularly in training, supervision, and service
delivery, compromising the quality of their work and hindering their preparedness for task shifting. In
response, a capacity-building package was developed for basic FP service delivery, aimed at facilitating
systematic task shifting within the FP program. Initial training involved 219 CHWs, which proved
effective in enhancing their knowledge and understanding of CHW roles in FP, as well as in correcting
misinformation about health services. Records indicated that three months after training, these CHWs
reached 8,576 women, with 20% having an unmet need for FP; further assisting 38% of those with
unmet needs in contraceptive utilization.

In 2023, the DOH endorsed the training package and its accompanying supportive supervision strategy
for nationwide dissemination.

Conclusion: The project highlighted the effectiveness of a thoughtfully designed training program in
enhancing CHWs' capacity in basic FP service delivery. It emphasized the need for ongoing, high-quality
capacity-building efforts to ensure CHWs perform FP tasks correctly and feel confident in their
contributions. Furthermore, the intervention underscored that relying solely on government directives

47
and orientation activities is insufficient for CHWs to deliver FP services appropriately. Continuous
coaching, mentoring, and provision of job aids are essential. Moreover, the mobilization of CHWs for
FP services creates opportunities for expanded task shifting within the FP program. With proper
training and supervision, CHWs can assist in relieving midwives and nurses of basic FP activities,
allowing them to focus on other critical responsibilities.

References: Department of Health. (2012). Department Memorandum 2020-0222. Guidelines on the

Continuous Provision of Family Planning Services During Enhanced Community Quarantine Following
the COVID-19 Pandemic. Available at: [Link]

Department of Health. (2015). Barangay Health Workers’ Reference Manual.

Department of Interior and Local Government. (2019). Department Memorandum Circular 2019-100.
Designation of Local Population Officers and Mobilization of Community Officials, Volunteers, and
Workers to Intensify the Implementation of the National Program on Population and Family Planning.
Available at: [Link]
201978_241660dfb9.pdf

Family Planning High Impact Practices. (2021). Community Health Workers: Bringing Family Planning
Services to Where People Live and Work. Johns Hopkins University. Available at:
[Link] workers/

Disclosure of Interest: None Declared

Comparative Analysis of Perioperative Patient Safety Policies in Five European Countries: Findings
from the SAFEST Project : (1760) Kaja Kristensen

ISQUA2024-ABS-1760

K. Kristensen 1,*, S. Wang 2 3, O. Groene 1

1
OptiMedis AG, Hamburg, Germany, 2University of Toronto, Toronto, Canada, 3Organisation for
Economic Co-operation and Development (OECD), Paris, France

Introduction: The EU-funded SAFEST project aims to improve patient safety practices in perioperative
care across 10 hospitals in 5 European countries and scale up the learning to 100 hospitals in the EU
and abroad. A quality improvement collaborative and benchmarking platform have been established
to stimulate the adoption of the harmonized practices. The outputs produced by the SAFEST project
have a great potential to be scaled up from pilot sites to routine practice across the EU and beyond. To
strategically guide this scaling up, a nuanced understanding of regulatory environments surrounding
perioperative patient safety is needed.

Methods: Semi-structured interviews were conducted in the piloting countries (Spain, the
Netherlands, Portugal, Estonia, and the Czech Republic) with representatives from Ministries of Health,
regulatory or accreditation bodies, professional associations or scientific societies, as well as
managerial hospital staff and patient safety experts. A desktop search for relevant policy and
regulatory frameworks around perioperative patient safety informed the development of the semi-

48
structured interview guide. Generated data were coded using an a priori framework adapted from the
updated Consolidated Framework for Implementation Research (Damschroder et al. 2022) and a
framework for assessing health systems‘ quality improvement and patient safety initiatives (El-Jardali
2017), complemented by inductive coding. Subsequently, codes were thematically analysed to
delineate and compare the perioperative patient safety landscapes within the five countries. The
analysis was performed using the software MAXQDA.

Results: In 24 interview sessions, 28 informants were interviewed, including five representatives each
from Ministries of Health, professional associations or scientific societies, hospital staff, and patient
safety experts, and eight representatives from regulatory or accreditation bodies. The mean length of
interviews was 46 minutes (SD = 8.4). The analysis revealed variations in the existence of national
policies for quality improvement and patient safety across health systems, often characterized by
fragmented legislation and strategic plans. With regard to reporting and monitoring systems national
patient safety indicators vary in detail and purpose of use. Accountability mechanisms differ among
the target countries, with structured national audit programs, voluntary external accreditation, and
rarely contractual agreements in place. Across all countries patient safety is not consistently integrated
into the educational curriculum and professional training for healthcare professionals. Further, the
interviews revealed a gap between high-level policies and the implementation of patient safety
practices at local level.

Conclusion: The results of this study provide a roadmap for the SAFEST project to scale up harmonized
perioperative patient safety practices within the diverse landscapes of patient safety policies in the
target countries. Acknowledging variations in policies, legislation, monitoring, and accountability
mechanisms, the project can tailor country-specific strategies to address gaps and enhance patient
safety practices. Additionally, our findings stress the need to systematically incorporate standardized
patient safety education into existing healthcare professional curricula to heighten the awareness and
foster a cultural shift. This provides an opportunity for SAFEST to advocate and contribute to
standardized programs. The identified gap between high-level policies and the implementation of
patient safety practices at local levels highlights the need for targeted interventions. The SAFEST
project can play an important role in bridging this divide by providing tools and resources and fostering
collaborative learning.

References: Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated
Framework for Implementation Research based on user feedback. Implement Sci. 2022;17(1):75.

El-Jardali F, Fadlallah R. A review of national policies and strategies to improve quality of health care
and patient safety: a case study from Lebanon and Jordan. BMC Health Serv Res. 2017;17(1):568.

Disclosure of Interest: None Declared

49
How Organisational Research Culture and Translational Research Pathways Are Affecting Research
Translation: A Mixed-Methods Study in an Australian Healthcare Organisation: (1980) Carolynn L
Smith

ISQUA2024-ABS-1980

C. L. Smith 1,*, S. Wijekulasuriya 1, L. Clynes 2, Y. Zurynski 1

Macquarie University, Sydney, 2Research Australia, Darlinghurst, Australia

1

Introduction: Health care organisations that engage with research and have an active research culture
have been found to have improved patient outcomes compared to non-research-active organisations.
However, there can be many impediments to undertaking and implementing research. This study
aimed to identify the research translation pathways and research culture within a large healthcare
organisation with the goal of generating insights into methods to strengthen research translation and
improve research culture.

Methods: A sequential mixed-method study was conducted in 2022 in an Australian healthcare

organisation, involving several hospitals, community care, and aged care facilities. Data on experiences
and perceptions of research translation were collected via an online survey. Semi-structured interviews
and focus group discussions were then conducted to further understand managers’ and frontline
staff’s perspectives on improving research translation and to identify barriers and facilitators
embedded within organisational research culture.

Survey data were analysed using descriptive and multinomial logistic regression statistical analyses in
SPSS. Deductive thematic content analysis using the Knowledge-to-Action (KTA) framework and
inductive approaches were employed to analyse the interview data.

Ethics approval was provided by the Macquarie University Human Research Ethics Committee
(Approval number: 520221179540139).

Results: The survey received responses from 741 healthcare staff across the organisation. Most of
respondents indicated that they would like to be involved in research (n=484, 80.5%), but fewer had
been previously involved in research (n=107, 17.5%) or in implementing a change in practice (n=134,
31.6%). Staff working in private or public hospitals were significantly more likely to have been involved
in research or quality improvement than those at community or aged care facilities (Private Hospital:
P < 0.022, OR = 2.3, 95% CI: 1.13-4.73; Public Hospital: P < 0.001, OR = 5.5, 95% CI: 2.61-11.44). Barriers
to participation in research implementation included lack of institutional support, high workload, and
insufficient knowledge of research processes. Only half of the respondents were “completely” or
“fairly” confident in their ability to apply evidence from the research literature to patient care (n=210,
50.8%).

Twelve staff members participated in the interviews: seven executives and five frontline workers. The
main themes identified in the KTA framework were on identifying areas in which research is required
(Action), identifying published research outcomes to apply to practice (Knowledge), assessing barriers
to knowledge use (Action), and evaluating outcomes and sustaining changes in practice (Action). Key
themes included challenges with research governance (including lengthy ethics approval processes
and lack of knowledge of research pathways), high variation in organisational research culture

50
between facilities, and recommendations for additional support to facilitate research translation, such
as dedicated research staff, more research training, improved dissemination of research results.

Conclusion: The results reveal a strong desire among health professionals to be involved with research
translation but also systemic barriers to the identification, implementation, and evaluation of research
in practice. Increased training and education, additional funding, and more streamlined processes for
applying for, reporting, disseminating, and evaluating research translation were seen as key. The study
findings can inform future policies, plans and activities for healthcare organisations seeking to increase
research involvement and translation.

Disclosure of Interest: None Declared

Strengthening Quality Assurance System for Malaria Microscopy to Improve the Quality
of Parasitological Confirmation in Benue, Nasarawa, Plateau, and Zamfara states in Nigeria:
(2545) Methodius Okouzi

ISQUA2024-ABS-2545

M. Okouzi 1,* on behalf of RBM Case Management WG, I. Nglass 1 on behalf of RBM Case Management
WG and Comfort Kingsley-Randa1, Abiodun Ojo1, Abimbola Olayemi1, Uchenna Nwokenna1, Justice
Adaji¹, Munira Ismail1, Belabo Dooshima1, Victor Pam1, Thomas Hall², Thetard Rudi², Jean Bosco
Ndabarinze² Erkwagh Dagba3, Veronica Momoh3, Jules Mihigo3 John Danjuma4, M

PD, MSH, Abuja, Nigeria

1

Introduction: Malaria, with a national prevalence of 21% (Nigeria Malaria Indicator Survey, 2021), is a
public health scourge in Nigeria. Parasitological confirmation with either microscopy or rapid
diagnostic tests is critical for providing timely and appropriate treatment, and for accurate
measurement of the disease burden. Microscopy is used in tertiary and secondary health facilities
providing in-patient care with functional laboratories where malaria microscopy is supervised and
conducted by trained microscopists. The identification of species and parasite quantification is
accurate to improve parasitological confirmation of malaria and monitor response to treatment
determined by the parasite clearance rate. President’s Malaria Initiative for States (PMI-S) project
conducted baseline assessment in 2020 which revealed insufficient trained microscopist, inadequate
supply of laboratory equipment and consumables, lack of supervisory visits and very low use of
personal protective equipment. PMI-S supported the training of 55 certified medical laboratory
scientists in 2021 and 2022, two years’ supply of laboratory consumables including preparation and
distribution of quality-assured Giemsa stains, procurement and distribution of 30 binocular
microscopies (Cx-23 Olympus) and one optical teaching multi-head microscope to each of 31 health
facilities without functioning microscopes to fill gaps. Also, provision of logistics support for the
conduct of regular rounds of quarterly microscopy QA/QC supervisory visits followed by technical
review meetings to discuss challenges and identify corrective actions which commenced in 2023 were
supported.

51
Methods: Data from three quarterly QA/QC supervision rounds (March 2023 to December 2023)
hosted on kobo toolbox platform, which were conducted in 44 health facilities (6 tertiary and 38
secondary) in the four states, was analyzed to measure improvement in sensitivity, specificity,
detection agreement, use of personal protective equipment, and reported clinical diagnosis. Analysis
of trend in each parameter across the health facilities was conducted by comparing records of
retrieved slides from each health facility which were re-validated and reported by trained quality
assurance officers in March 2023 with similar performance in December 2023. Also, the number of
reported presumptive cases of malaria seen were compared across the same facilities within the same
period.

Results: Results showed a 39% increase in the number of readable archived malaria slides, from 564
to 787 and significant increases in sensitivity (V=22, p-value =1.42 x 10-5) from 53.4% to 94.2%,
specificity (V=75, p-value =1.86x 10-6) from 39.8% to 70.0%, and detection agreement (V=123.5, p-
value = 7.12 x 10-5) from 56.1% to 79.6%. Similarly, clinical diagnosis among these health facilities
dropped from 21% to 8.2%. For safety practices, improvement was observed in the number of health
facilities with running water from 30 to 35 (16%), use of lab coat/gowns by lab workers when at work
from 25 to 35 (40%) and use of hand gloves when at work from 28 to 36 (28%).

Conclusion: This study reinforces that strengthening the capacity of malaria microscopists through
regular supervision and increasing the supply and availability of critical laboratory equipment,
consumables, and PPE enhances the capacity of the health workers to produce accurate malaria test
results using microscopy. These efforts improve detection of malaria, and reduced risk of
misdiagnosis. Exploring the opportunities available in the states to support the current scope of
microscopy EQA activities which will sustain the gains made through the support provided by the PMI-
S project to national and sub-national malaria control efforts is advised.

References: Nigeria Malaria Indicator Survey, 2021

PMI-S Quarterly QA/QC reports from March 2023 to December 2023

Disclosure of Interest: None Declared

52
Culture of quality ‘traps’ for quality improvement for mothers and children in the Kyrgyz Republic:
(3289) Nurshaim Tilenbaeva

ISQUA2024-ABS-3289

Nurshaim Tilenbaeva* 1, Susanne Carai2, Sophie Jullien2, Alona Mazhnaia 3, Oleg Kuzmenko3, Martin
Weber2

World Health Organization, Bishkek, Kyrgyzstan, 2World Health Organization, Athens , Greece,
1

World Health Organization, Copengahen , Denmark

3

Introduction: Quality of care in health care is not just an ultimate goal for improving health status
and outcomes of population. It is a culture that drives continuous quality improvement. Over the
past decades the Kyrgyz Republic has achieved significant reductions in neonatal, child and maternal
mortality. Despite the progress, mortality rates are still unnecessarily high compared to the average
in the WHO European Region [1]. The Government of Kyrgyzstan considers maternal, newborn and
child health a priority and is committed to ending preventable mortality. Cases of maternal and child
deaths are investigated at different levels and using different approaches. Since 2006 the country has
started introduction of evidence-based approaches to near miss case review and death surveillance;
however, given quality improvement approaches are accompanied by ‘traditional’ investigations,
which focuses on errors of individuals and associated blame culture. The mandatory punishment in
cases of deaths makes it a forced choice to identify and sacrifice a culprit for supposed ‘mistakes’ [2].
Current quality of care culture in the country is driven by top-down command, external inspection
and mandatory committees at the facility level, rather than inherent in the work of clinical teams or
embedded in training and continuing professional development [3]. Often the demand for punishing
health care providers for ‘supposed’ mistakes rises from general public. Active social mobilization
using social media is one approach used.

Methods: Within the framework of the hospital improvement project for mother, newborn and child
health in 11 hospitals of the Kyrgyz Republic, the quality of care was assessed and re-assessed in
2021 and 2023 respectively. Assessments were conducted using adapted WHO tools on hospital care
for children (2015) and hospital care for mothers and newborn babies (2014). Furthermore, the
implementation research was conducted with three embedded components including the
experience of provision of care. Within the qualitative research 38 interviews were conducted with
doctors, nurses and midwives from the hospitals participating in quality improvement project.
Furthermore, a snapshot review of social media posts on maternal and child deaths cases for the last
13 months in the country was analyzed for a subject of language use and nature of both key
messages delivered and people’s feedback towards the posts.

Results: Results of the re-assessment of quality of care in 11 hospitals showed considerable

improvement in many case management indicators; however, the standard of care achieved after
two years of interventions was largely still not according to international standards in most cases.
Hospitals with greater involvement and support from their management have more advanced in
quality improvement. Qualitative study within the implementation research showed that healthcare
professionals feel unsupported and unprotected by the health system. Doctors may favor patients’
hospitalization and medication prescription demands to avoid complaints and exposure. Patients
frequently use social media platforms to live-stream or record their hospital experiences and express

53
dissatisfaction with aspects of their care. This further expose healthcare providers to potential
conflicts without support from the healthcare system to address such situations effectively. Lack of
support from the healthcare system exacerbates the negative impacts of excessive workload and
limited resources on healthcare professionals. Review of social media posts on cases of maternal and
child mortality for the last 13 months has also shown the use of excessive blaming language both by
post authors as well as negative comments users leave. General population often blame care
providers on incompetency and calls for immediate actions for ‘supposed’ mistakes including
imprisonment. As a response National health authorities form external commissions and
investigations which often lead to employment-initiated termination of culprits.

Conclusion: Blame culture being an integral part of the dysfunctional “vicious cycle” for
implementation of evidence-based quality improvement approaches. Blame culture and punitive
measures demoralize the health workforce. It is also ineffective in identifying and enabling learning
to prevent the recurrence of the same errors within a health system. It is also counterproductive as it
may cause further patient harm as healthcare providers involved in making such errors tend to hide
or mask then in anticipation of punitive actions brought against them. Building an enabling and
protective regulatory environment is a key step for building a ‘blame-free’ quality of care culture.

References: [1] The Global Health Observatory 2023 (Indicator Details ([Link])). Data assessed on
18.12.2023

[2] Reason J, Human error: models and management. BMJ 2000, 320-768-70

[3] World Health Organization. Quality of care review in Kyrgyzstan. 2018. Available at Quality of care
review in Kyrgyzstan (2018) | United Nations in Kyrgyz Republic

Disclosure of Interest: None Declared

Lightning Talks

In-vitro fertilization (IVF) patient perspective and experiences with digital innovation during
treatment in Vietnam: (2344) Anh Dang

ISQUA2024-ABS-2344

A. Dang 1 2,* and Bao G. Huynh1, 2, Hoan K. Nguyen1, Can D. Dang1, Tuong M. Ho1, 2

54
IVFMD - My Duc Hospital, 2HOPE Research Center - My Duc Hospital, Ho Chi Minh City, Viet Nam
1

Introduction: The IVF long protocol may make the couples have difficulty in making sense of their
fertility problems and make the psychological impacts which affected specifically not only the
associated treatment protocol but also the rate of success become important. On the other hand, the
internet has become a common source offertility treatment-related information, and social media is
viewed as a potentially effective avenue for dissemination of fertility-related news and education.
Although the evidence is still limited, considering the ease of access to low quality information like
social media could improve patients’ fertility-related knowledge, experiences and help decision-
making(Curchoe, 2020). Within the Vietnamese context, it is reasonable to hypothesize that
providing high-quality information and experiences via a smartphone application can be an
appealing strategy to help offset the damage incurred from vastly accessible low-quality information
and rapidly reduce the rate of drop-out treatment. However, to improve literacy on Vietnamese
fertility treatment and strategically renovate our IVFMD Mobile App, we must investigate the
perspectives and experiences of IVF patients in smartphone application.

Methods: The mixed method research was used to combine qualitative and quantitative experiments
in two stages of the study from September to December 2022 at IVFMD, My Duc Hospital, Ho Chi Minh
City, Vietnam. In the qualitative stage, nine patients who have used the IVFMD Mobile App during their
treatment at least once time and three customer care staffs were conducted for 45-60 minutes one-
on-one interview. In the quantitative stage, 150 patients who used the IVFMD Mobile App during their
treatment were conducted for 20 minutes face to face survey.

Results: The smartphone application, IVFMD, is the most unique IVF health care application in
Vietnam that has been widely downloaded by about a half million Vietnamese and as two of its
features, this application provides high-quality information and electrical fertility treatment record
developed under the supervision of a reproductive endocrinology specialist. It also has been reported
that 65% IVFMD patients are tech-savvy. 78% of the participants were introduced to the IVFMD Mobile
app by IVFMD employees, while 96% of the patients agreed that the doctor appointment scheduling
platform through the IVFMD Mobile app was the most useful feature for them. Some participants
suggested that the application interface should be improved, and more applications should be added
such as increasing the available slots for scheduling the doctor appointments, updating treatment
information and records for their following and being further smoothly and personally.

Image:

55
Conclusion: The result regarding the effects of the IVFMD mobile application on patient satisfaction
and experience during the infertility treatment process was positive. Mobile apps are increasingly used
in reproductive healthcare to promote wellness, treat, diagnose, aid clinical decision-making, manage
patient care, experiences and collect data for medical research. The challenge for the IVFMD Mobile
app is not only to prove that it meets the accuracy standards of tested, tried, and true methods in
treatment protocol and research but also the patient experiences that can shape their reproductive
lives and release their stress partially during the treatment.

References: Curchoe, C. L. (2020). Smartphone Applications for Reproduction: From Rigorously

Validated and Clinically Relevant to Potentially Harmful. EMJ Repro Health Reproductive Health 6.1
2020, 6(1), 85–91. [Link]

İnam, Ö., & Satılmış, İ. G. (2023). Development of a mindfulness-based mobile application specific to
the IVF process in infertility. Reproductive BioMedicine Online, 47, 103487.
[Link]

Silver, L. (2019, February 5). Smartphone Ownership Is Growing Rapidly Around the World, but Not
Always Equally. Pew Research Center’s Global Attitudes Project.
[Link]
around-the-world-but-not-always-equally/

Zegers-Hochschild, F., Adamson, G. D., Dyer, S., Racowsky, C., de Mouzon, J., Sokol, R., Rienzi, L., Sunde,
A., Schmidt, L., Cooke, I. D., Simpson, J. L., & van der Poel, S. (2017). The International Glossary on
Infertility and Fertility Care, 2017. Fertility and Sterility, 108(3), 393–406.
[Link]

Disclosure of Interest: None Declared

56
Co-designing a hospitality program to improve supportive care in oncology: (3461) Chantal Arditi

ISQUA2024-ABS-3461

K. Lê Van 1,*, C. Arditi 2, L. Terrier 3, F. Ninane 1, A. Savoie 1, S. Rochat 4, I. Peytremann-Bridevaux 2, M.

Eicher 2, B. Schaad 1
1
Lausanne University Hospital CHUV, 2Center for Primary Care and Public Health (Unisanté),
Department of Epidemiology and Health Systems, University of Lausanne, 3EHL Hospitality Business
School, HES-SO, University of Applied Sciences and Arts Western Switzerland, 4Patient representative,
Lausanne, Switzerland

Introduction: Supportive care in oncology aims to provide the necessary services for those living with
or affected by cancer to meet their physical, emotional, social, psychological, informational, spiritual
and practical needs across the care pathway, with the overall aim to enhance experiences of care. In
previous work, we developed the Lausanne Hospitality Model, where we integrated hospitality
services inspired by the hotel industry in this supportive care framework, as these services have an
impact on the patient experience. Building on this model, we aimed to develop an intervention
program to improve hospitality services in a hospital setting.

Methods: Qualitative data collected through focus groups and interviews with patients, health and
administrative professionals working, and experts in hospitality were analyzed to identify needs in a
hospital oncology department. Based on the “Lausanne Hospitality Model”, we co-designed a
hospitality intervention in cancer care to reinforce practical, emotional, and informational services
offered to patients with cancer.

Results: We identified nine unsatisfied needs related to hospitality services for people affected by
cancer (e.g., receive information in the event of delays or have easy access to reliable information
about their illness). We then co-designed with the patients, health and administrative professionals
and hospitality experts a hospitality-focused program with four components to address these needs:
a mobile application dedicated to patients; an information kit; hospitality training for oncology teams;
a revised integration process for new hospital staff based on the hotel model. The “Lausanne
Hospitality Model” offers new insights into the notions of cancer journey, patient experience, services,
and the practices that may be involved when facilitating hospitality.

Conclusion: Our study provides insights into unmet hospitality needs and how to address them with a
hospitality program co-designed with patients, hospital professionals and hospitality experts.
Improving the services offered to patients is an important lever for enhancing their experiences and,
by extension, optimizing communication between patients and professionals, supporting the work of
administrative teams, strengthening tools to facilitate patients’ care pathway and providing better
overall cancer care.

Disclosure of Interest: None Declared

57
Reducing Obstetric Fistula Surgical Backlog Through a Comprehensive Routine Service Delivery
Model in Makueni County, Kenya: A promising approach: (3465) Christine Kalondu Muia

ISQUA2024-ABS-3465

C. K. Muia 1,*, D. Ruto 1, M. Muthengi 1 and None

Program, Jhpiego, Nairobi, Kenya

1

Introduction: Obstetric fistula (OF) is a major burden for women in low- and middle-income countries.
OF is prevalent in 1% of women in Kenya which can be attributed to underreporting, stigma, and
limited access to healthcare. The World Health Organization has estimated that between 50,000 and
100,000 women are affected by OF each year. In developing countries including Kenya, many women
and girls are silently suffering from OF that occur due to early marriage, poor socioeconomic status,
lack of access to skilled birth attendants and limited awareness of obstetric fistula. The condition
remains ‘hidden’ in the community and it is highly associated with myths and misconceptions. There
is a global shortage of skilled fistula surgeons. Kenya currently only has 11 fistula surgeons, (with the
11th one recently trained from Makueni county) . In many instances, fistula surgery has been done
through repair camps which is a short-term mobilization of women with suspected fistula for
screening and repair of positively diagnosed women.

Methods: The routine model focuses on integrating Obstetric Fistula into routine health services,
rather than relying on intermittent surgical camps which are expensive and there is no continuity of
patient care. The OF Care team comprising of an obstetrician/Gynecologist, theatre and post-natal
ward nurses, anaesthetists, physiotherapist, counsellor and nutritionist underwent a 6-week period
training for the surgeon and 2-weeks training for the other team members. The trained surgical team
conducted a whole-site orientation to the other health care workers with a focus on screening,
preoperative preparation, surgical intervention, postoperative care, and psychological support. The
county leadership provided the required infrastructure, equipment and supplies. Client mobilization
and awareness creation was done through media engagements, trained community health volunteers
(CHPs), community engagement activities among others.

Results: A total of 45 surgeries have been done with over 120 screened for fistula since March
2023.15,000 community members reached through structured and unstructured avenues on OF
messaging. 406 CHPs trained on community screening tool for OF and referrals. 9 Journalists trained
on debunking of myths and misconceptions on OF

Conclusion: To successfully set up a fistula centre, the following key components are
necessary: training of the fistula care team, provision of the necessary infrastructure,equipment and
supplies and community involvement to help identify cases, improve access to treatment and support
successful reintegration and rehabilitation of clients

The comprehensive routine service delivery model presents a sustainable and scalable solution to
reduce the Obstetric Fistula surgical backlog in resource-limited settings. It underscores the
importance of local health system strengthening and community engagement in addressing global
health challenges. With success of this approach, advocacy can be done for scalability in regions
grappling with similar health issues

58
References: 1. Bellows B, Bach R, Baker Z, Warren C. Barriers to Obstetric Fistula Treatment in
Low-income Countries: A Systematic [Link]: Population Council; 2014. [PubMed] [Google
Scholar]

2. El Ayadi AM, Barageine JK, Miller S, et al. Women’s experiences of fistula-related stigma in
Uganda: a conceptual framework to inform stigma-reduction interventions. Culture, Health Sexuality
2020; 22: 352–67. [PMC free article][PubMed]

3. (2006). Ethical guidelines on obstetric fistula. International Journal of Gynaecology and

Obstetrics; 94:174-175.

4. Hezekiah, Greciano. (2013). Obstetric fistula in Africa.

5. Holtz, A. and Ahmed, S. (2007). Social and economic consequences of obstetric fistula: Life
changed forever? International Journal o f Gynaecology and Obstetrics;

Disclosure of Interest: None Declared

Enhancing cervical Cancer screening Pathway in a Health network -Saudi Arabia: (2995) Duaa Al
Abbas

ISQUA2024-ABS-2995

D. Al Abbas 1,*, D. Al Muallem 2, Z. Alsaffar 3

Obstetrics and Gynecology, 2Nursing Manager , 3Quality, Qatif Health Network, Qatif, Saudi Arabia
1

Introduction: Cervical cancer is a global public health [Link] proven effectiveness of

intervention measures, such as vaccination (1) and screening,makes cervical cancer a largely
preventable disease. (2) Among women globally, Cervical cancer is the fourth most common neoplasm
and the fourth leading cause of cancer death (3) The literature demonstrated that, unlike global trends,
cervical cancer incidence in Saudi Arabia is increasing. In addition to that, a high proportion of it is
discovered in advanced stages. This state of late discovery was attributed to the absence of efficient
preventive and screening programs.(4) By 2030, the yearly incidence of cervical cancer is expected to
jump to 700,000, and the number of deaths is predicted to increase if no further intervention is done
(5)

Methods: The study aim to evaluate the prevalence of abnormal Pap smear results among women
who were screened at Qatif Central Primary Health Care Centers, between November 2022 and
December 2023, with the aim of establishing a mandatory national screening program based on the
findings

The project has adopted a continuous approach by implementing a newly established cervical
screening program at Primary Health Centers (PHCs), which utilizes Pap smear tests for asymptomatic
women. This program is overseen by family physicians. Additionally, the project includes training for

59
family physicians to implement national guidelines, raising awareness, and developing key
performance indicators to monitor progress

Results: A sum of 626 Pap smears were conducted, aiming to reach 2% of married women annually,
equivalent to approximately 44 Pap smears per month. This endeavor resulted in the detection of
specific cases of ASCUS, LSIL, HSIL, and Adenocarcinoma, prompting the need for further examination
and referral for additional assessment.

Image:

Conclusion: The introduction of a compulsory cervical cancer screening program in the Qatif region
marks a significant stride towards enhancing women's health. This initiative prioritizes early detection
and prevention, aiming to mitigate the impact of cervical cancer through proactive measures

References: [Link] M, Xu L. Efficacy and safety of prophylactic HPV vaccines. A Cochrane review of
randomized trials. Expert Rev Vaccines. 2018;17:1085–1091

[Link] V, Wentzensen N, Mackie A, et al. The IARC perspective on cervical cancer screening. N Engl
J Med. 2021;385:1908–1918.

3 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018:
GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer
J Clin. 2018; 68: 394-424

[Link] and Predictive Factors of Cervical Cancer Screening in Saudi Arabia: A Nationwide Study:
Cureus. 2023 Nov; 15(11): e49331

60
Monitoring Editor: Alexander Muacevic and John R Adler

Fatimah H Alkhamis,1 Zainab Alabbas S Alabbas,1 Jwaher E Al Mulhim,1 Fadk F

Alabdulmohsin,1 Mariyyah H Alshaqaqiq,1 and Eithar A Alali1

5. A cervical cancer-free future: first-ever global commitment to eliminate a cancer. [ Nov; 2023 ].
2020. [Link]
commitment-to-eliminate-a-cancer

Disclosure of Interest: None Declared

The Patient-centred Care Team: Effect on Patient reported Health-related Quality of Life: (3228)
Gro Karine Rosvold Berntsen

ISQUA2024-ABS-3228

L. R. Marco 1, E. S. Norheim 1, M. Rumpsfeld 2, L. Spansvoll 3, M. M. Dalbakk 2, M. Tayefi 1, G. K. R.

Berntsen 1,* and The PAtient Centered Team (PACT) Study group
1
Norwegian Center for E-healthresearch, 2E-health, collaboration and innovation centre, University
hospital of North Norway Trust, Tromsø, 3E-health, collaboration and innovation centre, University
hospital of North Norway Trust, Harstad, Norway

Introduction:

There is a call for bold and innovative innovation in the face of the sharp increase in multi-morbid frail
elderly, with complex and long-term needs (CLNs). Frail multi-morbid patients are at documented risk
for sub-optimal care processes and outcomes which in turn drives costs. Due to low resilience in this
group, small insults may quickly spiral into a clinical crisis and hospitalization. While emergency
hospitalizations are undesired, they also represent an opportunity to review the patient’s conditions
and provide comprehensive person centred care (PCC) that aims to improve quality of life. Yet we, to
the best of our knowledge, we found no study of comprehensive PCC interventions effect on Health
related Quality of life (HR-QoL) in elderly multimorbid patients with CLNs in the context of an
emergency hospital admission.

We have previously showed in the context of emergency hospital admissions that the Patient Centered
Care Team (PACT) reduced risk of emergency care, increased use of planned care and reduced mortality
by 40% in a group of frail multimorbid patients [1]. Research question: Does the PACT intervention also
have an impact on patients’ quality of life?

Methods:

Patients were eligible for inclusion in treatment group if they were referred to their first PACT team
episode during an emergency hospitalization, > 60 years of age, had multimorbidity and complex care
needs, were accepted for treatment in the PACT team and provided informed consent. Consenting
PACT patients were matched using a propensity score (PS) algorithm from previous work [1] to
potential controls from a pool of patients > 60 years of age, admitted to emergency hospital care within

61
the last 3 weeks. Potential controls were included if a research assistant confirmed that they were
multimorbid and had CLNs, did not have prior PACT-epsiode, and provided informed consent.

Prognostic variables were collected from routine hospital electronic health record (EHR) data. The PS
covariates were demographic, morbidity and health care utilization measures. We collected the
following HR-QoL measures at baseline and 3 months: SF12-v1, physical score (primary outcome), EQ-
5D-3L and the patient generated index (PGI). We used inverse propensity score weighting (IPSW) to
correct for baseline imbalances between the groups and adjusted for remaining imbalance in
multivariate IPSW regression outcomes analysis.

Results:

We identified 275 PACT eligible patients and 680 eligible controls. Of these, 141 (PACT) and 184
(Controls) were included in analyses. Response rate: 33%. Main exclusion reasons were "Too ill to
provide consent" and "Non-consent". Included patients were healthier than non-recruited patients.

Crude analyses: The intervention group improved more than the control group in all measures. The
intervention group scored poorer than the control group at baseline in all measures except SF-12
mental health, but had caught up with the control group at follow-up.

Adjusted analyses: In adjusted IPSW outcomes analyses, both groups improved, but the intervention
group improved their HR-QoL more than the control group in all three main outcome measures. The
primary outcome, Change SF12 physical score, improved 3.9 points more (95% CI: 0,33-7,47) than the
control group. Similarly, change in EQ5D was + 0,53 points (95% CI: 0,33-7,47) and change PGI was
+0,79 points (95% CI: 0,12-1,45) more compared to control group. The average adjusted improvement
of SF-12 physical for the treatment group was 5,7 (95% CI: 3,06-8,44) and 1.8 (95% CI: -0,25-3,9) points
in the PACT and control group respectively. The PACT patients SF-12 change is 3-times the minimally
clinically important difference of 1,8 for SF-12 [2].

SF-Mental scores were the same in both groups at both baseline and follow-up, which reflects that
PACT was not primarily a mental health intervention. The change in EQ5D-Visual analogue scale of
overall health did not differ between the groups.

Conclusion:

A comprehensive care program, with a strong focus on person-centred care for multimorbid frail
elderly, improved HR-QoL in a clinically meaningful way compared to the control group.

References:

1. Berntsen G, Dalbakk M, Hurley JS, Bergmo T, Solbakken B, Spansvoll L, JG B, Skrøvseth SO,

Brattland T, Rumpsfeld M: Person-centred, integrated and pro-active care for multi-morbid elderly
with advanced care needs: a propensity score-matched controlled trial. BMC Health Serv Res
2019(19):682.

2. Clement ND, Weir D, Holland J, Gerrand C, Deehan DJ: Meaningful changes in the Short Form
12 physical and mental summary scores after total knee arthroplasty. Knee 2019, 26(4):861-868.

62
Disclosure of Interest: None Declared

A Framework for Improving Clinical Quality In Ensuring Good Clinical Outcomes and Enhanced
Patient Experience In Surgery Care Through A Digital Approach: (2786) Ilaveyini Selvaraj

ISQUA2024-ABS-2786

I. Selvaraj 1,*, A. Ashok 2, G. Kulkarni 3, A. Prabhakar 3

1
Surgery care, 2Research and Development, 3Doctor Relations, Medibuddy Digital Healthcare Services,
Bangalore, India

Introduction: Providing patient-centered care constitutes a crucial element of a high-quality

healthcare system where patient experience is emphasized as a critical measure of quality. Globally,
advancements in digital healthcare are enhancing every facet of the patient care continuum,
presenting substantial opportunities for optimizing clinical care, particularly in areas such as surgery
care, providing a hassle-free experience and convenience for patients throughout their surgical
[Link] care serves as a comprehensive solution, for patients to identify the right doctors &
hospitals for their surgeries and especially pre and post-operative needs, enhanced with insurance
support, and ensuring high quality care and optimal clinical outcomes through close
[Link] a framework for clinical effectiveness in surgery care, using a digital approach, is
crucial for advancing healthcare practices, optimizing patient outcomes, adapting to the digital
healthcare landscape, and establishing best practices in the field. It contributes to evidence-based
decision-making, continuous improvement, and addressing healthcare challenges while enhancing
patient-centered [Link] primary objective is to develop a comprehensive PDSA(Plan-Do-Study-Act )-
driven framework for Surgery Care, integrating digital healthcare services and assessing the
effectiveness. The focus is on clinical excellence through a process driven approach, stratifying risk
right at the beginning, with patient safety as a priority, aimed to achieve positive clinical outcomes and
enhanced patient satisfaction.

Methods: This study introduces a framework grounded in the Plan-Do-Study-Act (PDSA)

model,designed to optimize Surgery Care experience via digital healthcare [Link] study employs
a multi-stage approach to Surgery care right from initial patient screening, Doctor Consultation,
Hospital Admissions till Post-Surgery follow-ups. Each stage incorporates various clinical checks and
patient monitoring measured by patient satisfaction at each stage enabling us to get valuable insights
about patient [Link] strengthen the clinical quality in surgery care, we have designed a risk
stratification model at preoperative level, to enable risk categorization of each patient undergoing
surgery, so that effective clinical support and monitoring can be provided to ensure better clinical
outcomes.

Results: Out of the 15,000 elective surgeries performed between April 2022 and the present, this
framework has been implemented and evaluated in 9,000 elective surgeries. Results indicate a
consistent Customer Satisfaction (CSAT) rating of 4.8( (on a 5 pointer scale) , alongside good clinical
outcomes in terms of quality indicators such as elective surgery mortality and postoperative
complications rates with lesser incidents reported. Furthermore, feedback from patients highlights

63
high satisfaction levels, with 95% rating their experience with the surgeon and 93% rating their overall
support from the surgery care team with a CSAT rating greater than 4.

Conclusion: Through the implementation of the proposed framework, the study demonstrated
improved clinical care, streamlined processes, and heightened patient safety with enhanced patient
satisfaction. The study envisions a transformative impact on patient outcome and patient experience,
reinforcing the importance of continuous improvement in surgery care processes.

Disclosure of Interest: None Declared

Implementation of Person Centered Care in Turkiye: Challenges and Success Points Learned from a
Unique Culture: (3413) Ilkay Baylam

ISQUA2024-ABS-3413

Baylam 1,*1Partner Success, Planetree, Derby, United States

Introduction: Person Centerd Care framework and its implementation in three different healthcare
organizations in Turkey has been a learning experience. In this presentation author is finding the
answers to the questions below:

What are the unique challenges of Turkiye in the implementation of Person Centered Care program?

How did we overcome these challenges?

What are the outcomes of Person Centered Care implementation in three healthcare organizations?

Methods: Planetree's Excellence in Person Centered Care Certification program implementation

including developing person centered care structures, practices and measurement of both process and
outcome meaures such as patient experience scores and staff engagement scores are used in this study

Results: We were able to identify an increase with the patient satisfaction scores and staff engagement
scores of the three healthcare organizations which this study was implemented.

Conclusion: This study provided us information about different cultures' unique challenges in the
implementation of Person Centered Care program. However, once these challenges are addressed, we
were able to see an increase in both patient experience and staff engagement scores as a result of this
implementation

References: Harnessing Evidence and Experience to Change Culture: A Guiding Framework for Patient
and Family Engaged Care

Susan B. Frampton, PhD, Planetree; Sara Guastello, Planetree; Libby Hoy, PFCCpartners; Mary Naylor,
PhD, FAAN, RN, University of Pennsylvania School of Nursing; Sue Sheridan, MBA, MIM, DHL, Patient-
Centered Outcomes Research Institute; Michelle Johnston-Fleece, MPH, National Academy of
Medicine

Disclosure of Interest: None Declared

64
Ethics are relational: A Critical Systems Thinking approach to implementing ethics in medical AI:
(1567) Magali Goirand

ISQUA2024-ABS-1567

M. Goirand 1, E. Austin 1,*, R. Clay-Williams 1. 1Australian Institute of Health Innovation, Sydney, Australia

Introduction: Artificial Intelligence (AI) is increasingly integrated into healthcare, and implementing
ethics in medical AI is complex and contextual [1] for which a Critical Systems Thinking (CST) approach
is well suited [2]. A CST approach promotes co-producing with a group representative of stakeholders
in an inclusive, transparent, and egalitarian way. This study aimed to explore how to implement ethics
in medical AI following a CST approach.

Methods: A diverse group including physicians, patients and AI developers were engaged in a
participatory process about a fictitious COVID-19 AI app based on real AI apps. The process consisted
of individual interviews and group discussions. The 37 participants included diverse clinicians,
healthcare technology professionals, data scientists, AI developers, and professionals from diverse
sectors such as state and local government, academia, insurance, education, consulting, retail
spanning diverse cultural backgrounds. The age of the participants ranged from 23 to 83, gender, urban
and rural residents had a balanced representation. The app had three functionalities: personal health
self-monitoring, physician’s remote monitoring of COVID patients, and infection clusters monitoring by
public health agencies. The participatory process based on CST practices. It implies that participants
were asked to share their experience of the process, and the principal researcher kept a journal.

Results: Exchanges in the group discussions were respectful, robust, and formative. Mapping the flow
of knowledge between the different agents such as patients, AI, and clinicians and other stakeholders
was found to be an effective support for the group discussions. In the process, the patient-clinician-AI
model was enriched and ethical assumptions emerged rapidly. Another finding is that ethics are
embedded in the relationships between the agents which leads to the reflection about how intentional
the design of such relationships is when developing and implementing the AI systems. The CST
approach augmented by a set of questions derived from the current research would guide AI
developers and implementers in their reflection before undertaking a participatory process, and guide
the conversations during the participatory process.

Conclusion: Such participatory processes should start at the inception of the medical AI app and carry
on during the app lifecycle. The custodian of the data used by the AI app, as well as of the process of
implementing ethics should be neutral and independent of the organisations developing and
implementing the app. While this study was based on a fictitious app, the process and the outcomes
can be adopted for future AI apps.

65
References: [1] Goirand, M., Austin, E. & Clay-Williams, R. 2021, ‘Implementing ethics in healthcare AI-
based applications: a scoping review’, Science and Engineering Ethics, vol. 27, no. 5, p 61.

[2] Midgley, G. & Rajagopalan, R. 2021, ‘Critical systems thinking, systemic intervention and beyond’.
In: G. S. Metcalf, K. Kijima & Deguchi, H. (eds.) Handbook of Systems Sciences, Springer Publishing
Company, New York.

Disclosure of Interest: None Declared

Supporting women middle managers in the Health and Social Service System by fostering their
psychological well-being : A qualitative inquiry into lived experiences: (2354) Eric Walling

ISQUA2024-ABS-2354

E. Walling 1,*, H. Walling 1. 1Walling Consulting, Quebec, Canada

Introduction: Despite this prevalence of woman in healthcare (67% of global healthcare workers, 80%
for Europe and Asia [1]), research on the success and wellbeing of woman middle managers (WMM)
has primarily focused individual factors, such as the glass ceiling, pay equity, and organizational
policies. However, there is a significant gap in research on how WMM in healthcare systems navigate
the structural challenges arising from their middle-management positions, as they seek to juggle their
complex professional, family, and individual lives.

This research sought to understand the realities of WMM in Health and Social Service Systems (HSSSs)
and what impacts their psychological wellbeing, using Quebec’s HSSS as a case study. Research
questions were the following:

What organizational/personal factors contribute positively/negatively to the success of WMM in HSSS?

What organizational/personal factors contribute positively/negatively to the wellbeing of WMM in

HSSS?

How do WMM manage their multiple roles?

What recommendations do they have for the HSSS?

Methods: To answer the research questions, a qualitative inquiry approach was conducted, using semi-
structured interviews to hear about participants’ experiences, the collisions between work and family
responsibilities, the strategies they use to support themselves and manage their multiple roles, and
their recommendations for changes that would support them. The questions were designed to solicit
participants’ stories around societal, individual, and organizational factors, as determined by a
comprehensive review of the literature.

Interviews were transcribed, coded, and themed based on structures identified through the research,
using a lens of social constructivism and interpretivism. Findings were compared to the participant
transcripts to ensure that they were reflective of the data that emerged.

Experience in middle management of the participants ranged from 3 years to over 20. The sizes of the
teams managed by the participants varied from 12-15 to over 700 employees, with an average of 50-
75. Most participants were in relationships and had children.

66
Ethics approval was obtained from Concordia University and the Quebec HSSS. A requirement for
ethics approval by the HSSS was that participants reach out to the research team, following project
promotion by the HSSS internally.

Results: The findings of this study are far reaching and have broad implications at societal,
organization, and personal levels for health and social service systems. Many of the participants
described themselves as change agents, communication agents, human resource managers,
organizational strategists, and political strategist, demonstrating the complexity of their realities. This
contributed to significant psychological stress on the participants, with tearing emerging as a primary
contributor to stress and poor wellbeing in these WMM. This was particularly compounded by a clash
between the espoused organizational values of compassion, respect, collaboration, accountability, and
innovation, and the realities of the demands placed on them, following efficiency driven models of
austerity, productivity, and efficiency above all else. The values espoused by Quebec’s HSSS are like
those of many other healthcare systems, both private and public, around the world.

Factors that were found to contribute to their well-being and success were: positive relationships,
support at work and home, flexibility, control, recognition, and confidence. Factors that challenged
their well-being were: societal norms, clash of values, organizational culture, conflict, perfectionism,
emotional labor, recovery time, tearing. Individual and organizational strategies to improve success
and psychological well-being were proposed. Insights included the following: all participants accepted
societal norms regarding their caregiving roles, the 2nd and 3rd shift were very present and a leading
cause in exhaustion, the HSSS placed unrealistic expectations on all of them, which compounded their
superwomen syndrome, ultimately leading to systemic burnout. This contributes to understanding
recent research that has found burnout rates for WMM in healthcare varying between 40% and 60%
[2,3].

Conclusion: Persistent gender segregation in paid and unpaid work spheres leaves in a position that is
detrimental to wellbeing. This raises important implications for policies and practices that contribute
to work environments which are systematically maladapted to WMM. If true progress is to be made,
society must value caregiving and develop policies and practices which allow people to thrive in all
spheres of their lives: self, family, and work. Traits such as confidence and self-esteem are not enough
to overcome clash of values and organizational cultures that are simply inconsiderate of the realities
of women.

References: 1. WHO, 2019. Delivered by women, led by men: a gender and equity analysis of the global
health and social workforce.

2. Zhang et al., 2023. Association of job characteristics and burnout of healthcare workers in different
positions in Rural China: a cross-sectional study. Int J Pub Health, 68.

3. Dugani et al., 2018. Prevalence and Factors Associated With Burnout Among Frontline Primary
Health Care Providers in Low- and Middle-Income Countries: A Systematic Review. Gates Open Res
2:4.

Disclosure of Interest: None Declared

67
Quality Improvement Capacity Building Program for the Nigerian National Clinical Mentors
Program - Lessons Learnt from Implementation: (1337) Isa Salihu Daniel

ISQUA2024-ABS-1337

I. S. Daniel 1,*, O. Olatoregun 2, K. Balogun 1, O. Onimode 2, J. Osi - Samuels 3, A. Abutu 4, A. Bashorun 5

and Nil. 1Data Management and Analytics, 2Management, 3Principal Investigator, Public Health
Information Surveillance, Solutions and Systems, 4Government Engagement and Sustainability, US
Centre for Disease Control, 5NASCP, Federal Ministry of Health, FCT, Abuja, Nigeria

Introduction: The Federal Ministry of Health (FMOH) in partnership with the US Centers for Disease
Control and Prevention (US CDC) initiated a National Clinical Mentorship Program (NCMP) in December
2021 with Public Health Information, Surveillance, Solutions, and Systems (PHIS3) as technical
partners. Considering Quality Improvement (QI) methods are proven approaches to improve clients'
Quality of Care and Outcomes in healthcare settings, the FMOH identified and employed highly skilled
healthcare practitioners as mentors to provide continuous education and to enhance workforce
performance and engagement as such the need for QI capacity building of these individuals was vital.

Methods: The NCMS provide mentorship and leadership to healthcare workers (HCWs) in the HIV
program in Nigeria and will need an extensive set of CQI skills to enable them to mentor the HCWs.
We set out to implement a NCM QI Mentorship program to equip the NCMs with the necessary
knowledge and skills in QI methods to enable them to implement QI projects across facilities in the
country and provide them with the capacity for QI coaching. As a result, a Quality Improvement
capacity-building program was conceptualized to have these components – 5 days basic QI training,
didactic sessions, mentoring sessions, and a practicum built on the collaborative. Following the
engagement of an NCM across the 19 US CDC-supported states, the project began with the 19 NCMs
undertaking a five-day basic QI training in June 2022. The Model for Improvement (MFI) was chosen
as the QI methodology for the training. The MFI is a simple but effective Quality improvement method
which uses Plan-Do-Study-Act (PDSA) cycles and targets accelerating improvement in projects, it has
two critical parts. The first part provides answers to three fundamental questions and the second is
the PDSA cycle tests. Pre- and post-training assessments were done for the participants to assess
knowledge gain The areas assessed (8) were; QI knowledge, Performance management, Quality
management (QM) assessment, QM facilitation, QM capacity building, QM strategy, QM collaboration
and QM deployment. The NCMs were supported to implement QI projects in selected facilities in their
states. Monthly virtual mentoring group sessions were scheduled with the NCMs to build their capacity
in QI skills and facilitation and to support ongoing QI projects by providing mentoring on how to coach
QI teams and provide guidance on challenges identified during QI meetings. To ensure uniformity, a
standardized template was used to guide presentations on work done (collaborative update and issues
faced) within the review by the NCMs per session.

Results: The NCMs made presentations that contextualized their improving QI mentoring and
facilitation skills and revealed key change ideas that show improvement in the process measures
tracked by the facilities' QI project. Post-mentoring session polls demonstrated knowledge gain
especially in the QI knowledge section (from 60% to 100%). During each mentoring session, each NCM

68
demonstrated learning and practice acquired by presenting their QI projects to QI advisors who then
provided feedback on any areas that needed improvement. Lessons learned from the NCMP were
applied in the conceptualization of a similar mentorship program for over 170 SCMs in the 19 US CDC-
supported states. This also resulted in the provision of more basic training practical sessions, monthly
didactic sessions, and monthly mentoring meetings for SCMs. The NCMs co–facilitate most of the
ongoing capacity-building activities for SCMs.

Conclusion: The efforts to achieve sustainable HIV epidemic control require QI capacity at both
national and sub-national levels. By providing Quality Improvement (QI) mentoring and enhancing the
capabilities of NCMs, a cascading effect has been initiated for sustaining a QI culture in the country.

Disclosure of Interest: None Declared

Implementing Genomics in Primary Care: (2974) Janet C Long

ISQUA2024-ABS-2974

J. C. Long 1,*, S. Best 1 2 3, Z. Fehlberg 1 3, J. Braithwaite 1. 1Australian Institute of Health Innovation,

Macquarie University, Sydney, 2School of Health Sciences, University of Melbourne, 3Australian
Genomics, Murdoch Children's Research Institute, Melbourne, Australia

Introduction: Genomic testing is becoming more widely available across all health care settings in
Australia, including primary health. The evidence-base of clinical utility and cost effectiveness of many
genomic applications is now well established and growing, and consumer attitudes are becoming more
positive to testing. Recent additions of genomic tests onto the Australian universal insurance scheme,
Medicare, have made tests such as genetic carrier screening for couples planning a family, and testing
for actionable genetic diseases such as familial hypercholesterolaemia, more feasible in primary
practice. However, many general practitioners (GPs) [family physicians], have limited experience in
genetic testing. There are also concerns over the capacity of specialist genomic services to handle any
increases in referrals. The aim of this study is to define the challenges of implementing genomics into
primary care, and strategies and resources being used to address them. This has very important
consequences for the quality of care and the sustainability of health systems.

Methods: This study draws on findings from three studies conducted at different system levels. (1) At
the macro level of the system, we developed a holistic view of clinical genomics across Australia1. Data
came from synthesised grey and peer-reviewed literature, and interviews with nine key informants
from Australian Genomics. Key stakeholders were defined including clinicians across various settings,
patients, industry, research institutions, government, regulatory bodies, and consumer advocates.
Interactions between these stakeholders and the constraints and enablers influencing the system were
mapped. (2) At the meso level, grey and peer-reviewed literature reviews summarised genomic
workforce issues across Australia, including shifting demands and capacity for genomics services, and
education needs for non-genetically trained clinicians2. (3) At the micro level, interviews were
conducted with 23 GPs from across Australia who were involved in recruiting couples for reproductive

69
genetic carrier screening for the research project “Mackenzie’s Mission”3. The Theoretical Domains
Framework was used to deductively analyse data to define barriers the GPs faced in offering the
screening. Ethics approval was granted by Royal Childrens’ Hospital Melbourne Research Ethics
Committee (HREC/53433/RCHM-2019).

Results: Findings from the systems level view of genomics were the dynamic interplay of government,
professional bodies (e.g., Royal College of Pathologists Australasia) and patient advocacy groups that
provided the context in which GPs were working. Key challenges were around sustainable and
equitable funding of tests, and coordination of fragmented endeavours across separate sectors. At the
meso level, it was recognised that GPs along with the majority of the healthcare workforce were not
prepared for genomics. Classroom education was shown to be inadequate to develop the skills needed
for genomic practice, and uncoordinated resource development was confusing rather than assisting.
Innovative models using genetic specialists as “shepherds” of non-genetic trained clinicians are
showing promise, as are nation-wide projects developing resources such as a Directory of genomic
tests. At the micro level, individuals reported lack of time as a barrier to offering genomic testing, and
lack of skills rather than knowledge per se. Flexible, high quality education modules, “shepherding” by
genetic counsellors, and consumer facing resources (including in other languages) were seen as
mitigating these issues.

Conclusion: As genomic testing becomes mainstream, a systems approach to implementation allows

a holistic approach to be taken. It can also avoid unintended consequences of solutions developed in
isolation.

References: 1. Long JC, Gul H, McPherson E, et al. A dynamic systems view of clinical genomics: a
rich picture of the landscape in Australia using a complexity science lens. BMC Medical Genomics
2021;14(1):63. doi: 10.1186/s12920-021-00910-5

2. Long JC, Gaff C, Clay C. Transforming the genomics workforce to sustain high value care: Deeble
Institute for Health Policy Research 2022. doi: 10.25916/ba4a-nw69

3. Best S, Long JC, Fehlberg Z, et al. The more you do it, the easier it gets: using behaviour change
theory to support health care professionals offering reproductive genetic carrier screening. European
Journal of Human Genetics 2022 doi: 10.1038/s41431-022-01224-5

Disclosure of Interest: None Declared

Changes in health Insurance coverage and the utilization of Cone Beam CT; Health insurance claims
data from 2013 to 2022: (2716) Jeonghye Kim

ISQUA2024-ABS-2716

J. Kim 1,*, E. Choi 2, S. Kim 2, S. Kim 2, S.-K. Park 2, S. Choi 2. 1Health Insurance Review & Assessment
Service, 2Health Insurance Review & Assessment Service, Wonju, Korea, Republic Of

Introduction: The Cone Beam CT (CBCT) is useful for diagnosing bone changes in teeth and maxilla.
Since its coverage began in 2008, it expanded to cover the sinuses, and the upper and lower
extremities. As the procedure has been selected for intensive review since 2014, there have been
efforts to maintain a reasonable level of its utilization, however it has been continuously on the rise in

70
accordance with increased coverage for implants. As such, this study is aimed to analyze the increase
in health insurance coverage, the status of CBCT equipment over the past decade (from 2013 to 2022),
and their utilization in the medical field.

Methods: In order to conduct the analysis, 4,782,594 patients have been selected from a pool of
5,993,172 cases that were associated with the CBCT billing codes within the health insurance claims
data spanning from 2013 to 2022. The number of exams and fees were analyzed by year, age group,
type of medical facility, department, and age of the equipment. The program SAS Enterprise Guide 7.1
(SAS Institute Inc., Cary, NC, USA) was used to create and analyze the datasets.

Results: The number of CBCT equipment and their medical usage has sharply increased in the past ten
years due to increased coverage for their use. The number of CBCT scanners increased from 4,146 in
2013 to 16,603 in 2022, representing a yearly average increase of 16.7%. This growth rate is
significantly higher than that of regular CTs (2.2%). The number of scanners per 1 million inhabitants
in South Korea increased from 81.1 in 2013 to 322.8 in 2022, indicating a 3.9-fold increase. Dental
hospitals/clinics own 14,921 (as of 2022) which makes up 89.9% of all CBCT scanners. In 2022, the
majority of scanners in use had been operational for less than five years, accounting for 50.8% (8,442
units). However, the number of scanners aged from 10 to 15 years increased by 75.2% compared to
2013, suggesting a rise in the presence of older equipment.

CBCT exam fees rose from KRW10.9 billion in 2013 to KRW61.9 billion in 2022, reflecting a yearly
average increase of 21.3%. The number of exams conducted increased from 230.5 thousand in 2013
to 1.117 million in 2022, indicating a yearly average increase of 18.9%. The number of billing
institutions increased from 2,603 in 2013 to 11,501 in 2022, which is a 4.4-fold increase. Since coverage
was offered for the otolaryngology department in 2015, there has been a 29.0% increase compared to
the previous year; and coverage was offered for upper and lower extremities in 2016, which led to a
383.4% increase compared to the previous year. The number of implants and CBCT exams showed a
high correlation coefficient of 0.93 (p<0.001) since implants became billable in 2014.

Conclusion: In the unique Korean environment, where the people have easy access to dental facilities,
the number of CBCT exams carried out by dental clinics, which own the majority of the scanners,
increased with the rise in coverages offered. Furthermore, it is hypothesized that the increased cases
of non-billable procedures (such as implants) that guarantee high profits for dental clinics are
correlated with an increase in CBCT exams, though further in-depth analysis is needed to confirm this.
Repeat CBCT exams increase the patients’ exposure to radiation, and financial burden, therefore
reasonable levels of use must be maintained. In order to achieve this, we must firstly, establish the
optimal number of coverage for the exam, secondly, provide differentiated insurance fees depending
on the age of the scanner, and thirdly, put in place a monitoring system and management mechanism
for non-billable exams.

Disclosure of Interest: None Declared

71
Patient safety culture in general population: an unmet need: (2350) Micaela La Regina

ISQUA2024-ABS-2350

M. La Regina 1,*, C. Parretti 2, D. Bernardini 3, N. Oneto 3, L. Di Candido 4, M. Baroni 5, R. Tartaglia 2

1
Clinical Governance and Risk Management Unit, Azienda sociosanitaria ligure 5, La Spezia,
2
Department of engineering sciences, Marconi University, Rome, 3Patient Safety & Pharmacovigilance
GDD, Novartis Farma S.p.A, Milano, 4Asl Bat, Trani, 5Clinical Risk Management, Fondazione Monasterio,
Pisa, Italy

Introduction: Citizen involvement in improving quality and safety has proven to be crucial in the
healthcare. By becoming active members of the healthcare team, patients can contribute to the safety
of their own care but also that of the healthcare system as a whole. Therefore, patient and family
involvement has been incorporated into Resolution WHA72.6 – “Global Action on Patient Safety” and
the Global Patient Safety Action Plan 2021-2030 as key strategies to move towards eliminating of
avoidable harms in healthcare [1, 2]

However, to encourage full participation of citizens, it appears necessary to align knowledge and
language between citizens, patients and healthcare professionals.

Safety culture has been widely studied among healthcare workers [3, 4, 5], while among citizens the
research was limited to evaluate the perception about quality and safety of care. not knowledge.

The main objective of our study was to evaluate the level of knowledge about quality and safety of
care in a representative sample of Italian citizens, with and without chronic pathologies, to verify
whether direct experience can increase the level of knowledge

Methods: We used a semi-structured questionnaire containing 35 questions, developed using the

CAWI (Computer-Assisted Web Interviewing) methodology.

Four areas of investigation: 1. basic concepts of clinical risk management.; 2. Best practices for safety;
3. Sources of information about quality and patient safety; 4. Citizen participation
Study period: 1 month.

Sample: 400 subjects with at least one serious chronic condition (patients) and 800 without (citizens).
The statistical analysis was mainly descriptive. Comparisons were made between patients and citizens
and within each group between different age groups, sex, geographical area and level of education.

Results: The study revealed a low level of knowledge about fundamental principles of patient safety
(definition of adverse event and medical error, systemic theory of error, most common incidents in
hospitals and nursing homes, etc....), and distrust about clinical trials for innovativie drugs and
telemedicine;better the knowledge of good practices for patient safety. No statistically significant
differences about such issues have been found between citizens with and without chronic medical
conditions. Structured citizen engagement in healthcare improvement is not widespread in the
country, with only 11% of patients and a mere 4% of citizens having such experiences

Conclusion: To our knowledge this is the first study that explores patient safety culture among citizens.
Its main finding is to have highlighted that patient safety culture is low among healthcare users and
also among chronic patients. Co-producing is a scarcely diffused but interesting procedure.

72
It is imperative to make efforts to develop a culture of quality and safety among citizens, but also to
repeat the survey in other countries, as health literacy was found to be country-linked in previous
works. [6]

References: 1. World Health Organization. Resolution WHA72.6: Global action on patient safety
[Internet]. Geneva:World Health Organization; 2019 May 28.
2. Global patient safety action plan 2021–2030: towards eliminating avoidable harm in health care.
Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.
3. Tartaglia Claudia Reis, Sofia Guerra Paiva, Paulo Sousa. The patient safety culture: a systematic
review by characteristics of Hospital Survey on Patient Safety Culture dimensions. Int J Qual Health
Care 2018 Nov 1; 30(9): 660-677
4. Patrick Waterson, Eva-Maria Carman, Tanja Manser, and Antje Hammer. Hospital Survey on Patient
Safety Culture (HSPSC): a systematic review of the psychometric properties of 62 international studies.
BMJ Open. 2019; 9(9): e026896.
5. Tocco Tussardi, I., Moretti, F., Capasso, M., Niero, V., Visentin, D., Dalla Barba, L., & Tardivo, S. (2022).
Improving the culture of safety among healthcare workers: Integration of different instruments to gain
major insights and drive effective changes. The International Journal of Health Planning and
Management, 37(1), 429-451.
6. M-POHL - WHO Action Network on Measuring Population and Organizational Health Literacy.
[Link] 2023

Disclosure of Interest: None Declared

Feasibility and Preliminary Evaluation of Cognitive Stimulation Therapy (CST) in Elderly Patients
with Mild to Moderate Dementia in KPJ Damansara Specialist Hospital: (2370) Parwathi
Alagirisamy

ISQUA2024-ABS-2370

P. Alagirisamy 1,*, N. A. B. Rusdi 1, N. Nordin 2. 1Rehabilitation Services, 2Geriatric , KPJ Damansara

Specialist Hospital, Kuala Lumpur, Malaysia

Introduction: In Malaysia, prevalence of dementia is projected to increase from 261,000 in 2030 to

590,000 by 2050 (Alzheimer’s Disease International, 2015). Memory loss, cognitive decline,
comprehension problems, and behavioral abnormalities are among the effects of dementia that
negatively impact patients' quality of life (Ganapathy et al., 2020). Cognitive Stimulation Therapy (CST)
is a non-invasive psychological treatment recommended by the National Institute for Health and
Clinical Excellence of the United Kingdom (NICE 2006) for people with cognitive impairments. The
objective of this study is to assess the feasibility and preliminary effects of CST for patients living with
dementia in KPJ Damansara Hospital.

73
Methods: A single-group pretest–posttest design was conducted to evaluate the effects of the CST
programme. Participants were recruited from the out-patient geriatric clinic, KPJ Damansara Specialist
Hospital, aged 60 years and over with mild to moderate dementia. The exclusion criteria included
having a learning disability and diagnosed with severe depression. Informed consent was obtained
from all the participants and caregivers. A total of 14 older adults participated in a 7-weeks group CST
program in three cohorts from February to August 2023. Each cohort consists of 4-5 participants. CST
sessions took place twice a week for 7 weeks with each session lasting 45-60 minutes. Trained CST
facilitators including occupational therapist, physiotherapist and nurse delivered 14 sessions of group
CST themes activities (Figure1).

At baseline, demographic characteristics were recorded. The clinical effectiveness of CST were
assessed by cognitive functions (Mini Mental State Examination-MMSE), communication (Holden
communication scale-HCS) and quality of life (Quality of Life in Alzheimer’s Disease-QOL-AD) (Ward et
al, 2022; Yong et al 2017). Feasibility of the study included participant retention rate and program
satisfaction measured at post-treatment. Data were analysed using Statistical Package for the Social
Sciences (SPSS) Version 23. The paired t-test was used in accepting or rejecting the null hypothesis
with p-value set at 0.05.

Results: The mean age (±SD) of the participants was 79 (±5.95) years, and most of them were females
(71%) and 79% were Malays (Table 1). The Paired t-test revealed MMSE mean score (p<0.373)
increases of one point are considered clinically significant although not statistically significant. In
regards to QOL, the score change for both patient (p<0.066)and caregiver (p<0.076) groups showed
an improvement, but the difference was too small to be statistically and clinically significant. There
was a significant improvement for communication (p<0.006) and across all communication
subcategories: conversation (p<0.001), awareness(p<0.001) and communication(p<0.001). The study
achieved acceptable feasibility with high satisfaction (98-100%) and retention rates (100%) (Table 2).

Image:

74
Conclusion: CST appeared to benefit persons living with dementia. The findings of this study provide
evidence to support the use of CST as a routine program to complement those with mild to moderate
dementia on pharmacological treatment in KPJ Damansara Specialist Hospital.

References: [Link]’s Disease International. World Alzheimer Report 2015: Attitudes to dementia.
London: Alzheimer’s Disease International; 2015.

[Link], S. S., Sooryanarayana, R., Ahmad, N. A., et al. (2020). Prevalence of dementia and quality
of life of caregivers of people living with dementia in Malaysia. Geriatrics & Gerontology International,
20(S2), 16–20

[Link] Institute for Health and Clinical Excellence and the Social Care Institute for Excellence
(2006). Dementia: supporting people with dementia and their carers in health and social care. Clinical
Guideline 42. NICE/SCIE, London [Link]/guidance/cg4

[Link] AR, Thoft DS, Lykkegaard Sørensen A. Exploring outcome measures with cognitive stimulation
therapies and how these relate to the experiences of people with dementia: A narrative literature
review. Dementia. 2022;21(3):1032-1049.

[Link], S. W. J., Kim, L. S., & Shuen, P. K. (2017). The Outcome Of Using The Cognitive Stimulation
Therapy On Demented Elderly In Malaysia. Sains Humanika.

Disclosure of Interest: None Declared

Human-centered Design Approach for Group Antenatal-Postnatal (ANC-PNC) improves accessibility

of ANC-PNC services: (2993) Shafia Rashid

ISQUA2024-ABS-2993

F. Islam 1,*, A. R. Karim 1, A. Begum 1, S. Rashid 2, N. Carbone 2, C. Welch 3, K. Ramsey 4

1
Management Sciences for Health, Dhaka, Bangladesh, 2Management Sciences for Health, Arlington,
3
Management Sciences for Health, Medford, United States, 4Scope Impact, Helsinki, Finland

Introduction: While Bangladesh has made significant progress in key maternal, child health (MNCH)
and family planning (FP) indicators in the last decade, concerted efforts are needed to reach
vulnerable, marginalized populations with high-quality, responsive services. Partnering with BRAC,
Scope and Population Council, MSH is co-designing, implementing, and evaluating the Healthy
Women, Healthy Families (HWHF) project, which introduces a group antenatal and postnatal care
(GANC-GPNC) program for young women and their partners experiencing their first pregnancy.

Methods: To develop the group model, Scope utilized Human Centered Design (HCD) to explore the
experience of health services, both existing and ideal, from the perspectives of first-time pregnant
women, recent first-time parents, community influencers as well as facility- and community-based ANC
and PNC providers. Scope conducted 10 focus group discussions (FGDs), 27 in-depth interviews (IDIs)
and 8 mock sessions with over 100 participants. After data collection, Scope, BRAC and MSH engaged

75
in a collaborative research synthesis process. Project staff systematically organized, analyzed, and
reviewed the data to identify emerging themes. These themes were iteratively tested with users as
part of co-design and subsequently the final GANC-GPNC model was developed. Implementation of
the GANC-GPNC model began in February 2022. To assess implementation experience, the HWHF
project co-developed monitoring indicators, supportive supervision tools, a cohort tracker, and a
model fidelity checklist. Project monitoring indicators track the number of sessions conducted,
number of participants, and number of facility ANC, PNC and delivery services attended. Following 6
months of implementation, Scope conducted two reflection exercises to understand group members’
experiences, and opportunities to strengthen the model. Scope identified and analyzed
implementation challenges during the first and second reflection exercises and adjustments were
made to the model design.

Results: As of December 2023, the project enrolled 4,443 FTMs for group ANC or PNC sessions,
conducted 2,221 GANC sessions for FTMs with 10,480 participants and 717 FTF GANC sessions with
3,021 participants. The project also conducted 483 GPNC sessions for FTMs with 1,645 participants
and 161 GPNC sessions for FTFs with 496 Participants. HCD and model iterations during the
implementation period contributed to a gradual increase in the number of participants attending
group sessions. Based on data from 23 months of implementation (February 2022- December 2023)
74% of enrolled mothers attended 3 GANC sessions and 57% and 32% of enrolled women attended 4
and 5 GANC sessions. First-time fathers’ participation increased by about 15% by changing the timing
of sessions and location from facility to community. The number of fathers reached for the group
sessions each quarter now surpasses the project target. After updating the timing of enrollment into
PNC sessions to after delivery and offering group sessions in the community, GPNC attendance for
FTMs increased by about 50% and continues to increase each quarter.

Image:

Conclusion: Despite initial challenges, GANC-PNC has potential to reach the most vulnerable
populations with quality information and services. Capacity building of service providers, strong
community engagement, and model adaptations are key for sustaining the GANC-GPNC model. A
comprehensive action plan and coordinated effort from relevant stakeholders will facilitate nationwide
scale.

Disclosure of Interest: None Declared

76
Eliminating Delays in Pharmaceuticals Re-ordering Process through Automation: (1141) Zarfan Ali

ISQUA2024-ABS-1141

Z. Ali 1,* and Huma Gul(Purchase),Waqas Asghar(Purchase),Ehsan Raza(Pharmacy),Maryam

Farrukh(Warehouse),Ameen Khan (IT),Sajjad Qayyum(IT),Linta Rizwan(Purchase). 1Purchasing and
Supply Chain Management Division, The Aga Khan University, Karachi, Pakistan.

Introduction: Hospitals bear the responsibility of delivering high-quality and safe patient care services,
necessitating the seamless integration of people, processes, and technology. This study addresses
challenges in the pharmaceutical supplies reordering process, currently managed through a labor-
intensive manual process. The overarching objective is to introduce advanced technology that
enhances efficiency, eliminates errors, and ensures timely medication arrangements, reinforcing
patient care within the hospital environment.

Objectives of the Project:

Automate Reordering Process:

- Implement a robust automated system.

Enhance Efficiency:

- Reduce time for generating reordering reports.

Eliminate Errors:

- Minimize errors in reorder quantity calculations.

Ensure Timely Medication:

- Procure and arrange medications promptly.

Reduce Operational Delays:

- Mitigate delays in processing and delivery.

Streamline Reordering Cycle:

- Optimize resource utilization and reduce staff workload.

Predictive Inventory Management:

- Introduce predictive analytics to prevent stockouts.

Continuous Training and Feedback:

- Implement ongoing training and feedback loops for staff proficiency.

Cultivate Continuous Improvement:

- Foster a culture of ongoing improvement within the pharmaceutical supply chain.

Achieve Breakthrough Outcomes:

77
 - Aim for an 80% reduction in reordering time and near-zero error rates.

Sustain Excellence in Patient Care:

- Address weaknesses for sustained excellence.

Cost Reduction and Operational Efficiency:

- Enhance efficiency while reducing operational costs.

These objectives collectively aim to revolutionize pharmaceutical supplies reordering, leveraging

technology for substantial improvements in patient care, efficiency, and overall hospital performance.

Methods: The PDSA methodology was the framework for this quality improvement project. It involved:

Plan:

- Identified critical improvement areas through extensive discussions.

- Defined specific goals and measurable objectives, formulating change strategies.

Do:

- Implemented changes to the manual reordering process in a controlled environment.

- Emphasized efficiency and error reduction in practice.

Study:

- Continuously monitored and evaluated revised processes.

- Utilized data collection and analysis for insights into the impact on the reordering cycle.

Act:

- Took informed actions based on findings during the study phase.

- Made adjustments and refinements to optimize the automated reordering process.

This iterative cycle continued until achieving the desired efficiency, accuracy, and timeliness in
medication arrangement. The PDSA methodology ensured sustainable changes, addressing
weaknesses in the pharmaceutical supplies reordering process. This systematic approach fosters a
culture of ongoing improvement and adaptability within the healthcare system.

Results:

Pre-Project Situation:

Before the project, the manual reordering process was characterized by being error-prone, time-
consuming, and inefficient, taking two working days to generate reports for 70 vendors and 700 items.

Post-Project Outcomes:

1. Enhanced Efficiency:

78
Automated data integration reduced the time required to generate reordering reports from two days
to a matter of [Link] and timely procurement of medicines became possible.

2. Error Reduction:

System-driven analysis significantly reduced the chances of errors in determining reorder quantities.
Overall data accuracy and supply chain reliability improved.

3. Predictive Inventory Management:

The use of predictive analytics for inventory management prevented stockouts and
overstocking. Ensured optimal inventory levels at all times.

4. Continuous Improvement:

The project established a culture of continuous training and feedback, leading to ongoing staff
development and system enhancements.

5. Breakthrough Achievements:

Reduced reordering time by 92%, ensuring the timely availability of medicines. Achieved a near-zero
error rate in reorder quantity calculations, enhancing patient safety.

In summary, the project's detailed implementation strategies and technological innovations

substantially improved the pharmaceutical supply chain, resulting in enhanced patient care, reduced
operational costs, and establishing a foundation for ongoing quality enhancements.

Image:

79
Conclusion:

Continuous monitoring and rigorous evaluation were integral throughout and after the project's
implementation, ensuring ongoing effectiveness. Regular assessments and data analysis allowed
prompt responses to challenges, fine-tuning the system and securing long-term sustainability.

In summary, the project's innovative strategies and technology-driven solutions have transformed
pharmaceutical supplies reordering, paving the way for sustained excellence in patient care. The
commitment to continuous monitoring, training, and quality ensures the maintenance of achieved
gains, demonstrating the value of embracing technology and a culture of improvement in healthcare
settings.

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References:

[Link]
[Link]

[Link]

Disclosure of Interest: None Declared

Lunchtime

Lightning Talks

Surveyor Training in China, moving from a National to an Internationally accredited programme

Introduction: (2695) A. LEE

ISQUA2024-ABS-2695

LEE 1,*, X. XU 1, L. YAM 1, H. CHEN 1, T. Fortune 1, J. WANG 1, Y. CHAN 1, J. LUI 1, C. M. LIU 1. 1Shenzhen
Hospital Accreditation Research Center, Shenzhen, China.

Introduction: China has had a National healthcare accreditation programme since 1989. The China
National 3A Hospital accreditation system (CN3A) has been a major influence on patient safety and
quality improvement, therefore providing a good foundation to build an internationally recognized
programme. With this goal in mind the Chinese government established The Shenzhen Hospital
Accreditation Research Center (SHARC) in 2020. The International Society for Quality in Healthcare’s
External Evaluation Association programmes is a key lever in SHARC’s strategy towards international
recognition. The strategy from the outset was to achieve all 3 ISQuaEEA awards but more importantly
to use these standards as the benchmark in international best practice.

The Chinese Hospital International Accreditation (CHIA) standards were accredited in February 2022.
Then followed the first phase of surveyor training and 63 Founding Surveyors were trained by January
2023. Among them, 45 who had extensive experience of the CN3A system and 18 had extensive
experience of the internationally accredited ACHS System.

This paper describes the second phase of the project, its objective were to

- Train a second batch of up to 40 surveyors

- Provide update training for the Founding Surveyors

- Compile all relevant polices and assessment methods into one surveyor training manual and

- Achieve ISQuaEEA accreditation for the surveyor training programme (STP).

This phase was planned to be completed by the end of 2023.

Methods: Established in 2022 the Surveyor Training and Development Team (STDT) are responsible for
developing all aspects of the SHARC STP’s. The STDT together with international experts conducted a

81
comprehensive literature search, resulting in a dearth of peer review evidence. A review of the relevant
abstracts from previous ISQua conferences yielded valuable experiential learnings. A STP was then
developed based on proven international experience, national expertise and principles of adult
education.

The STP has 3 stages that all trainees need to attend. These include interpretation of the CHIA
standards, legal requirements, assessment methodologies, risk assessment, collecting evidence and
report writing skills. Only Founding surveyors (already renowned experts), are excluded from onsite
practical training.

Results: There were challenges to implementing the STP’s. Covid caused disruption and the date the
ISQuaEEA STP evaluation had to be postponed. The second challenge was the revision of the ISQuaEEA
Standards for Surveyor Training Programme from 3rd to 4th edition. This demanded revision, but also
gives good guiding principles for SHARC to improve our evaluation methods especially regarding
trainers.

A second batch of 36 surveyors from China, Hong Kong and Macau were trained in July 2023. In
addition update training for Founding Surveyors was conducted in July and November 2023, to train
them to become competent trainers and team leaders.

All STP’s have been evaluated by objective and subjective methodologies. This includes evaluating both
the trainers and the trainees. Over 90% of trainees were satisfied with the competency of the trainers.
Some recommendations which have been implemented, included face to face rather than online
sessions, ethical and legal requirements, and international accreditation methods.

The third objective to prepare a comprehensive STP manual was expediated. Following extensive
stakeholder inputs, all relevant polices and assessment methods were refined and included in the STP
manual, which was published in July 2023.

The 4th objective is still in progress. The results of the ISQuaEEA of SHARC STP will be available by the
summer of 2024.

Conclusion: Using the ISQuaEEA standards as a framework has worked well for China. The greatest
success has been achieved by utilizing the expertise of the CN3A. These Founding Surveyors have
provided exemplary expertise to every section of SHARC including developing STP’s, team leader,
standard development and governance. Phase 3 of SHARC’s international strategy is now well
underway and will include training 80 or more new surveyors, continued update training and an
ISQuaEEA organizational award in 2024.

References: Nil

Disclosure of Interest: None Declared

82
Assessing the quality of facilities in all healthcare sectors: harmonization underway in France:
(2029) Amélie LANSIAUX

ISQUA2024-ABS-2029

A. CHEVRIER 1, A. LANSIAUX 2,*, A. KHALED 3. 1Improvment in quality care and safety department,
2
Improvment in quality care and safety department, 3quality of social care department, HAS, Paris,
France

Introduction: HAS defines quality assessment procedures for health, social and medico-social
establishments, while respecting the differences in professional approaches between the health and
social sectors.

Methods: In France, all health, social and medico-social establishments are now subject to periodic
quality assessment (certification for ES and evaluation for ESMS). For healthcare establishments, the
level of certification has an impact on their funding, and could potentially lead to a review of their
fields of activity by their regulatory authorities; for social and medico-social establishments, the
assessment report conditions their authorization to operate.

While this system has existed for over 20 years in the healthcare sector, with a single set of guidelines,
the social and medico-social sector was evaluated by organizations according to their own guidelines,
with no uniform methodology. HAS then drew up a common reference framework for all components
of the social sector (elderly people, people with disabilities, protected children, social inclusion), to be
published in 2022, with application starting on January 1, 2023.

These 2 missions have been entrusted nationally to the HAS since 1999 for the healthcare sector and
2019 for the social and medico-social sector.

The HAS has homogenized the principles of these assessments, particularly in establishments
combining the 2 sectors or collaborating within a mixed group of establishments, and thus facilitated
the appropriation of the approach to quickly focus on the expected requirements.

Results: These 2 missions have been entrusted nationally to the HAS since 1999 for the healthcare
sector and 2019 for the social and medico-social sector.

The HAS has homogenized the principles of these assessments, particularly in establishments
combining the 2 sectors or collaborating within a mixed group of establishments, and thus facilitated
the appropriation of the approach to quickly focus on the expected requirements.

Each of the manuals is transparent in terms of assessment methods, enabling facilities to conduct their
own self-assessments. Each reference manual is divided into 3 chapters: "The Patient" - "The Care
Teams" - "The Hospital" for the health sector, and "The Person" - "The Professionals" - "The Institution"
for the social sector.

Evaluations are carried out using the same methods, with a field-focused approach to professionals
and users: patient or accompanied tracer / targeted tracer / system audit.

The respective priority orientations nevertheless respect the specificities of each:

83
- for the healthcare sector: patient involvement/culture of relevance and outcome
evaluation/teamwork/adaptation to changes in the healthcare system

- for the social sector: the individual's power to act/respect for fundamental rights/inclusive approach
to support/ethical reflection by professionals.

Conclusion: In France, since 2022, quality assessment systems with adapted content but similar
appropriation are applicable to all healthcare establishments:

2,400 healthcare establishments, with 1,160 accreditation visits and decisions carried out by the end
of 2023

40,300 social and medico-social establishments and services, with 3,028 assessments carried out by
the end of 2023.

References: Manual HAS - Certification of hospitals for the quality of care

Manuel HAS - Référentiel d'évaluation de la qualité des établissements sociaux et médico-sociaux.

(Quality assessment guidelines for social and medico-social establishments.)

Disclosure of Interest: None Declared

The Impact of the Co-Production Model on the Health Accreditation Process in Brazil: (3030) Ana
Carla Restituti

ISQUA2024-ABS-3030

C. Restituti 1,*, S. Corral 2. 1Director, 2Accreditation , AACI Brasil and Portugal, São Paulo, Brazil

Introduction: Co-production is emerging as a promising approach to enhance and revolutionize the

way healthcare organizations and accrediting agencies interact and collaborate. Instead of a one-way
approach, co-production involves active partnership among stakeholders, resulting in accreditation or
certification that is more relevant, effective, and focused on the value added to the patient and their
ecosystem. In this context, an accreditation project coupled with an integration and monitoring
method encourages active participation of individuals in a knowledge-sharing process, prioritizing
their needs, preferences, and concerns regarding the effectiveness of their performance in achieving
the expected outcome. The American Accreditation Commission International – AACI Brazil has
innovated by redesigning contemporary practices of accreditation or certification programs and has
developed an operational mode of more inclusive content and greater value for the goals of its client
organizations. A professional called the Client Manager, who manages the client relationship, has been
introduced into the operational model. Additionally, the use of computerized tools enables the
tracking of accreditation project progression. This model allows for closer collaboration between the
accrediting agency and healthcare institutions, facilitating the exchange of knowledge and experiences
throughout the accreditation project, monitoring improvement plans, and their performance.
Objective: To assess the impact of co-production on accreditation for managers, active leaders in the
accreditation project in 5 healthcare institutions that are clients of AACI Brazil.

84
Methods: After 6 months of Client Manager follow-up, a standardized questionnaire was administered
with questions evaluating the role of the client manager and the operational model with the following
dimensions: trust, engagement, interpretation of standards, engagement, and assessing the impact of
the model for the project. Ethical considerations, including informed consent and protection of
participant confidentiality, were ensured throughout the study.

Results: The research results indicate a positive perception regarding the role of the Client Manager in
AACI Accreditation, with generally high averages (ranging from 4.3 to 4.6 on a scale of 1 to 5). The
majority (75%) of respondents would recommend the co-production model to other institutions. Job
positions vary, with a predominance of coordinators and team leaders. Respondents' experience in the
institution is diverse, with good representation across all lengths of service. Major backgrounds include
nurses, physicians, and administrators, reflecting team diversity.

Conclusion: The results suggest a positive perception regarding the role and performance of the Client
Manager in the AACI Accreditation process, as well as a general acceptance of the adopted co-
production model. The impact of co-production on health accreditation is evident in transforming
processes that were previously merely descriptive into something recognizable and truly
transformative. This collaboration-centered approach, valuing the experiences of all involved parties,
represents a significant shift in how accreditation is perceived and implemented, offering tangible
opportunities to drive excellence and effectiveness in patient care.

Disclosure of Interest: None Declared

Enhancing Pediatric Healthcare Quality and Safety: A Case Study of International Accreditation
Implementation in Iashvili Children’s Central Hospital, Tbilisi, Georgia: (2335) Lela Tsakadze

ISQUA2024-ABS-2335

L. Tsakadze 1,*, T. Vakhtangadze 2, N. Saghareishvili 3

1
Quality Department, 2Top Management, Iashvili Children's Central Hospital, 3Project Management
Department, Vian Group, Tbilisi, Georgia

Introduction: Introduction: Georgia is developing country with developing healthcare industry. To

stimulate the sector and improve patient safety and quality, Ministry of, Health of Georgia issued an
order with subject: From January 1, 2025, an institution that has obtained international accreditation
shall be defined as a provider of medical services. Main criteria to choose the Accreditation Agency for
Iashvili Children’s Central Hospital were the following: identifying and mitigating all risks to achieve
continuous improvement in quality and safety of young patients. American Accreditation Commission
International (AACI) is one of the world’s most experienced organization and following/implementing
their standards is a commitment to high-quality, safety and affordability. Main goal of the hospital and
AACI coincides with each other: “Reduce risks and save lives”. To mitigate risks AACI standard suggests

85
implementing Risk Register Form. The process is divided into several steps. The paper describes
positive impact of international accreditation on every-day-life treatment and analysis main challenges
faced during the implementation process. Introducing an Incident Report Form and Risk Committee is
a new beginning for Georgian reality to guarantee high quality and safety of patients.

Methods: Risk Register form is established in the hospital. The study and performance evaluation
includes the patients who have incidental cases during the treatment process. Any hospital employee
who discovers or directly experiences an incident, reports about it to the Patient Safety Officer. After
discovering or receiving information about an incident, an appropriate Incident Report Form is filled
out. A confidential incident report must be completed for each reportable incident occurring in any
department of the hospital. A retrospective study is used for the analysis. Descriptive statistics and
corrective action plans were applied to analyze recorded incidents, offering a comprehensive overview
of the incident trends over time. Reporting form includes 12 case-oriented questions.

Results: Over the course of the study period from June to December, a total of 21 incident reports
were documented. The current analysis highlights that the hospital successfully identified and
addressed risks, with a noteworthy observation that the highest number of incident reports occurred
in the initial month of implementation. Specifically, 8 incidents were reported during this period. As a
direct result of risk mitigation efforts, the hospital implemented a fall risk assessment system, bed rails,
and other safety measures. Patients with a history of suicide attempts were assessed as high-risk and
recruited along with a parent. Prior to the introduction of these forms, only post-exposure treatment
was reported.

Conclusion: Introducing and implementing Risk Register and Incident Report Form marked a significant
shift from the previous practice, effectively improved medical services, staff involvement in processes
(additionally, special trainings for the staff were implemented to increase their knowledge and
experience), multidisciplinary approach and the main impact is on patient safety and quality of care

References: 1. Braithwaite, J., Westbrook, M., & Travaglia, J. (2008). Attitudes toward the large-
scale implementation of an incident reporting system. International Journal for Quality in Health Care,
20(3), 184–191. [Link]

2.

Petschnig, W., & Haslinger-Baumann, E. (2017). Critical Incident Reporting System (CIRS): A
fundamental component of risk management in health care systems to enhance patient safety.
National Disability Services, Risk Incidents and Complaints Management Resource Guide.

3.

Pham, J. C., Girard, T., & Pronovost, P. J. (2013). What to do with Healthcare Incident Reporting Systems.
Journal of Public Health Research, 2(3). [Link]

Disclosure of Interest: None Declared

86
Exploring Quality of HA standards: An Observational Study of HA Scoring Guidelines and Standards
Compliance Evaluation in Thailand: (2793) Piyawan Limpanyalert

ISQUA2024-ABS-2793

A.-C. Sukkul 1, P. Limpanyalert 1,*, W. Madsathan 1, T. Sungnak 1, T. Philalai 1, B. Wisetpholchai 2

1
Healthcare Accreditation Institute, Nonthaburi, 2Thai Health Promotion Foundation, Bangkok,
Thailand

Introduction: The Healthcare Accreditation Institute (HAI) in Thailand has recently introduced the 5th
edition of hospital and health service standards (HA Standard) along with corresponding guidelines,
known as HA Scoring Guidelines, in October 2022. These tools aim to assess compliance with
established HA standards and foster quality development within healthcare organizations. Notably, the
HA Standard Edition 5th obtained international standard certification from ISQuaEEA in February 2022.
Despite these advancements, challenges regarding the reliability of accreditation programs persist,
particularly amid ongoing standards reforms. This study seeks to evaluate the implementation of the
HA Scoring Guidelines one year after transitioning from the guidelines of the HA Standard Edition 5th.
The objective of this study is to document the phenomena observed during survey visits regarding the
utilization of HA scoring guidelines for assessing adherence to HA standards and to provide insights
into the validity and reliability issues associated with HA scoring guidelines through observational
analysis.

Methods: A phenomenon observation study characterized by a descriptive approach. This included

keeping records and looking into things that were seen at different stages, such as survey visits, post-
survey focus group discussions with two different surveyor teams, and the medical anthropology
researcher observing without taking part as part of phenomenological inquiry. We observed two
surveyor teams visiting to qualify the interviews and analysis in the same hospital. The researcher
collected scores and dialogue between surveyors for analysis to evaluate the validity and reliability
issues within three primary dimensions: 1) fact-finding, 2) analysis, and 3) scoring
interpretation. Surveyors with equivalent knowledge and years of experience were divided into two
groups:

- Team A: comprised true surveyors conducting authentic surveys following standard procedures.

- Team B: consisted of experimental surveyors conducting comparative surveys, shadowing Team

A. They reviewed the same hospital self-assessment, attended meetings, and conducted on-site
surveys alongside Team A without providing suggestions. Their evaluations were based solely on the
evidence collected during the evaluation process.

Results: Finding indicated similarities between both surveyor teams in fact finding and analysis, with
discrepancies in scoring interpretation due to the abstract nature of the standards and unclear
explanation of HA scoring [Link] Result:

During the survey discussions and scoring process, several key phenomena were observed in the
dynamics influencing validity and reliability.
1) Relationships and Relationship Management: Observations revealed both formal and informal
relationships between individual surveyors, potentially limiting their ability to express independent

87
opinions about ratings. These pre-existing dynamics among team members may influence the scoring
process and the level of agreement reached during evaluations.

2) Time Management: With a relatively limited time allocated for each visit to collect evidence and
finalize scores, there were challenges in adequately exploring and documenting information necessary
for scoring. The time pressure may have led to incomplete assessments or reliance on incomplete
evidence, affecting the accuracy and reliability of the scores assigned.

3) Communication Management and Power Relations: Effective communication between surveyors

and hospital staff is crucial for accurate assessments. Observations highlighted the presence of power
dynamics between surveyors and the hospital staff, impacting the scoring process. Clear
communication, particularly regarding the HA scoring criteria, could potentially mitigate these power
imbalances and enhance the reliability of evaluations.

4) HA Accreditation Foundation Principle Impact: The principle that "HA is an Education Process"
influenced the surveyors' approach during visits, focusing on fostering learning and knowledge
exchange. Transitioning from the previous version of HA scoring to a new model requiring deeper
integration and analytical connection with HA standards posed challenges. The observed impact of this
transition on team dynamics and scoring practices underscores the importance of aligning scoring
methodologies with accreditation principles.

These phenomena highlight the multifaceted nature of the scoring process and underscore the need
for addressing organizational, interpersonal, and procedural factors to enhance the validity and
reliability of evaluations in healthcare accreditation settings.

88
Image:

Conclusion:

1. Scoring for quality certification varies with hospital context and timing, hindering direct
comparisons.

2. Future efforts aim to enhance HA scoring's validity and reliability by adjusting methods,
clarifying standards, and fostering supportive cultures. Despite ongoing HA standards reforms,
challenges to accreditation reliability persist. Evaluating program validity and reliability during new
standard implementations is crucial. Diverse surveyor perspectives could enhance credibility.
Achieving HA scoring reliability remains a goal.

3. Moving forward, efforts will focus on enhancing HA scoring's clarity, relevance, and analytical
rigor for improved assessment confidence and reliability.

References:

[Link]field D, Pawsey M, Naylor J, Braithwaite J. Researching the reliability of accreditation survey

teams: lessons learnt when things went awry. Health Inf Manag. 2013;42(1):4-10. doi:
10.1177/[Link]: 23640917

89
2. Healthcare Accreditation Institute, Thailand. HA Standard, 5th edition. Available on
[Link] (Thai version). For English version, please contact wiyawan@[Link]

Disclosure of Interest: None Declared

ACE (awareness compliance & excellence) for CSSD at a tertiary care facility: (2966) Shweta
Prabhakar

ISQUA2024-ABS-2966

S. Prabhakar 1,* and CSSD and Infection Control team. 1Quality & Patient safety , Fortis Healthcare,
Mohali, India

Introduction: In response to the recent findings from the JCI exit survey and the detailed self-
assessment of the Central Sterile Supply Department (CSSD) conducted according to guidelines from
organizations such as AAMI, APSIC, and CDC, it has become evident that there are significant gaps in
the standardized CSSD processes and adherence to uniform practices. The reports from recent external
surveys have underscored the pressing need for improvement in CSSD operations to ensure patient
safety and quality care.

The primary aim of this initiative is to address the deficiencies identified in the CSSD processes and
achieve consistent adherence to uniform practices across the hospital, encompassing not only the
CSSD itself but also extending to areas such as operating theaters by -

1. Enhance Compliance: Increase compliance with recommended guidelines for CSSD processes and
practices to ensure the safety and efficacy of sterilization procedures and equipment handling.

2. Standardization: Implement standardized CSSD processes and protocols to streamline operations,

minimize errors, and improve efficiency in sterile supply management.

3. Education and Awareness: Enhance staff awareness and understanding of CSSD protocols and best
practices through comprehensive training programs and educational initiatives.

4. Continuous Improvement: Establish a culture of continuous improvement within the CSSD and
related departments, fostering a proactive approach to identifying and addressing areas for
enhancement.

5. Achieve 100% Compliance: Strive to achieve a compliance rate of 100% with recommended CSSD
guidelines by April 2023.

To accomplish these objectives, the hospital plans to implement the ACE (Awareness, Compliance &
Excellence) program by 3M, which focuses on raising awareness, enhancing compliance, and driving
excellence in CSSD operations. Through targeted interventions and ongoing monitoring, it is
anticipated that CSSD process compliance will increase to over 90% by the specified timeline,
contributing to the overall improvement of patient care outcomes and organizational performance.

90
Methods: PDSA methodology involved process mapping to identify gaps, followed by plotting a Cause
& Effect diagram.

Compliance with CSSD practices was assessed using a self-assessment checklist, which consisted of a
questionnaire with 78 questions on the current CSSD practices and daily [Link] checklist was
formulated based on the CSSD guidelines from AAMI, APSIC, CDC, etc.

Results: Awareness:- Achieved 100% staff training on both basic and advanced CSSD modules
conducted by 3M.

Compliance:- Increased compliance score by 10%.

- Attained a compliance rate of 93.06% according to the ACE checklist.

Excellence:- Recognized as the Best CSSD in the North Zone for outstanding CSSD practices at
CAHOCON 2023.

Sustainable gains:

1. Implemented direct surveillance by CSSD staff in areas outside of CSSD where cleaning and
decontamination processes occur.

2. Successfully established a uniform CSSD process across the entire hospital.

3. Continuously monitoring the cleaning and disinfection processes in areas outside of CSSD and
working towards implementing the ACE program to ensure consistent and standardized practices
throughout CSSD.

Image:

Conclusion: The lack of uniform adherence to CSSD practices poses significant challenges to patient
safety and quality of [Link] address these issues, the hospital has initiated the ACE (Awareness,
Compliance & Excellence) program in collaboration with 3M, aimed at promoting consistent

91
adherence to CSSD guidelines and achieving excellence in CSSD practices. Through this program, all
staff members have been trained on CSSD basics and advanced modules, leading to a notable increase
in compliance scores and significant progress towards achieving our goal of over 90% compliance by
April 2023.

Furthermore, the recognition received as the Best CSSD in the North Zone at CAHOCON 2023 serves
as a testament to our commitment to excellence in CSSD practices. However, the journey towards
sustained improvement does not end here.

The key lessons learned include the importance of department ownership, the need for enhanced
skilling and continuous quality improvement of technical staff, and the necessity of effective
monitoring mechanisms to identify and address process gaps on a regular basis.

References: Reference CDC guideline –.

Reference JCI Std 7th Edition compliance requirement wrt Std -PCI-6-

Disclosure of Interest: None Declared

Impact of the OECI Designation and Accreditation Program on the Arturo Lopez Perez Foundation
(FALP), Chile: (2220) Silvia Basso

ISQUA2024-ABS-2220

S. Basso 1,*, R. Morales 1. 1Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile

Introduction: FALP is a private non-profit cancer institute located in Santiago, Chile. The institute is
accredited by the Superintendencia de Salud (Health Superintendence) through a periodic evaluation
process, ensuring compliance with minimum standards set by the Ministry of Health to guarantee
quality and safety in patien care.

In 2018, FALP became an Associate Member of the Organisation of European Cancer Institutes (OECI),
aiming to engage with leading European institutes and adhere to international standards of excellence
in oncology.

Methods: In 2019, FALP conducted a comprehensive gap analysis to evaluate its compliance with the
requirements of the OECI Accreditation and Designation (A&D) Programme. The results drove the
development of multiple improvement plans aimed at addressing identified shortcomings.

The process commenced in 2021 with the official application to the A&D Programme. Throughout
2022, FALP completed a detailed self-assessment, and in March 2023 FALP received a peer review
conducted by an auditor team appointed by the OECI Board aimed at verifying the compliance with its
standards.

Results: The overall improvement percentage from the gap analysis conducted in 2019 to the final
report, a result of the peer review process conducted in 2023, was 44.06% (increasing from 33.04% to
77.10%). In Table 1, a chapter-wise breakdown illustrates the improvement achieved during the
reference triennium.

92
In particular, the A&D Programme has facilitated the development of essential areas for the quality
and safety of care, addressing aspects where Chile faced cultural lag.

Four aspects in which the accreditation process has allowed FALP to become a pioneer in the country:

1. the development of a cancer registry and an intuitive visualization system that enables the
Foundation's Board to make decisions regarding the trajectory of cancer in the country, guiding choices
related to regionalization;

2. the introduction of the patient empowerment concept, leading to the creation of the "Department
of Education and Health Participation" and the establishment of the "Patient and Family Council". The
goal is to provide recommendations for the development of educational programs and engagement
initiatives for patients and families;

3. the definition of prevention and early detection programs. FALP has created a “Department of
Prevention and Early Detection” with the goal of establishing institutional policies for screening and
early detection and collaborating in defining public policies aimed at improving the management of
the sector in the country;

4. the definition of clinical pathways for all treated tumors and the establishment of precise monitoring
of waiting times to ensure timely and safe care for patients.

In addition to that, the work carried out for OECI accreditation has allowed FALP to reorganize the
Research Department and embark on a path to become a leader in cancer research. Illustrating recent
achievements, publications surged by +206% from 2019 to 2023.

FALP became the first OECI Cancer Centre in Latin America.

Image:

Conclusion: The results highlight an overall improvement in process organization and data
management, enabling FALP to develop deficient areas not only within the hospital but also at national
level. This accreditation has placed a strong emphasis on the continuous improvement of processes as
well as of clinical areas, in terms of outcomes, survivorship, quality of life and satisfaction.

Disclosure of Interest: None Declared

93
Pros and Cons of Survey Report Verification and Strategy for Improving The Effectiveness of It:
(3029) Yael Esthi Nurfitri Kuncoro

ISQUA2024-ABS-3029

Y. E. N. Kuncoro 1,*, E. Viora 1, T. Koentjoro 2

1
Indonesian Accreditation Agency for Health Services (ICAHS/LASKESI), Jakarta, 2Quality Management
Division, Center for Health Services Management, Faculty of Medicine, Public Health and Nursing,
Gadjah Mada University, Yogyakarta, Indonesia

Introduction: The Indonesian Government established a new policy of accreditation for primary
healthcare and developed a system for the process called SINAF (National Information System for
Accreditation of Health Service Facilities). Different from before, every survey report should undergo
a verification process conducted by verifier of the accreditation body. The verification results of survey
report will be used by the chairperson of the accreditation body in making recommendations for
determining accreditation status. Expectation of this new system did not meet due to several
limitation. The accreditation body took the initiative to develop several strategy to improve the
effectiveness of the verification process. This study aims to determine the pros and cons of survey
report verification and which strategy is the best to improve the effectiveness of it.

Methods: Pre-experimental study was conducted for 6 months. The sample of study were 150
verification report. Data were obtained from SINAF. Feedback from verifiers and surveyors were also
analyzed. A set of strategy based on ongoing analysis were implemented during 6 months. Five
indicators were used to measure the effectiveness of the implementation of the strategies

Results: There were 150 samples (7% of total reports in 6 months) used. Based on the first analysis,
we conducted the first strategy that is setting a guideline for survey report dan two weekly knowledge
sharing for 2 months. Based on the following analysis, we conducted the second strategy at the
beginning of the fifth month, that is sending a personal feedback based on the verification report. The
decrese of gap of accreditation status indicator are 16.6%, 15%, 4.3%, 3.3%, 0%, 0% respectively. The
decrease of gap of score indicator are 2.8%, 3.1%, 2.2%, 2.1%, 1.9%, 1.04% respectively. The decrese
of nonconformity of writing fact indicator are 14.4%, 9.8%, 10.2%, 7.4%, 4.3%, 3.1% respectively. The
decrese of inaccuracy of score indicator are 11.6%, 13.3%, 13.7%, 10.7%, 9.7%, 5.5% respectively. The
decrese of nonconformity of recommendation to meet the requirement of standar indicator are 12.8%,
11.8%, 13.2%, 10.8%, 9.7%, 5.6% respectively. From the feedback collected, showed that the pros of
survey report verification were improvement of the quality of survey reports, error reduction,
complaint reduction, enhance decision making and improvement of surveyors competencies. The cons
of it were cost, time consuming and inability of SINAF to provide feedback.

Conclusion: Significant decrease of all indicators were shown after the implementation of sending a
personal feedback as the second strategy. There were more pros than cons of Survey Report
Verification in improving the quality of survey process and report.

Disclosure of Interest: None Declared

94
The advantages and weaknesses of providing 13 Accreditation Organizing Institutions for
Community Health Centres: Indonesia experience: (3233) Yanti Herman

ISQUA2024-ABS-3233

R. P. Soedarsono 1 on behalf of Directorate of Health Services Quality, Y. Herman 1,*, T. Kusumawati 1, A.

Armawati 1 and Yanti Herman, Rahmi Purwakaningsih, Tri Kusumawati, Armawati

Health Service Quality, MOH Indonesia, Jakarta, Indonesia

1

Introduction: The Ministry of Health has made it mandatory for every health service facility in
Indonesia, including Community Health Centres, to take concrete steps to enhance the quality of their
health services. The best way to achieve this goal is through accreditation. The Ministry of Health is
responsible for implementing this accreditation process with the support of 13 Accreditation
Organizing Institutions (LPA). The LPA is primarily responsible for conducting accreditation surveys that
surveyors carry out. The involvement of 13 LPA is crucial in accelerating the accreditation process,
which must be completed by 2024. Given the high number of Community Health Centres in Indonesia,
which is 10.416 and the starting point of a survey that was conducted in May 2023, the participation
of 13 LPA is extremely essential. However, there are some issues with the implementation of this
accreditation process.

The objective of this study is to explore the potential advantages and challenges of implementing
accreditation for Community Health Centres, with a focus on the involvement of 13 Accreditation
Organizing Institutions.

Methods: An assessment was conducted to evaluate the implementation of accreditation surveys by

13 Accreditation Organizing Institutions from May 2023 to January 2024. The analysis was focused on
the advantages and the weaknesses of the accreditation process carried out by these institutions.
Samples were taken from all Community Health Centres that had registered in the DFO application and
were accepted by the LPA. The assessment was conducted by processing data obtained from the
National Accreditation Information System (SINAF) and DFO applications. This data included
information about accreditation results, institutions conducting surveys, number and location of
surveyors. Additionally, feedback such as complaints, suggestions, and criticism received by the
Ministry of Health via letters, e-mail, WA, and other complaint channels was also reviewed.. The data
obtained from the assessment were analysed descriptively to obtain an overview of the advantages
and disadvantages of implementing accreditation by 13 LPA.

Results: The advantages of having a Community Health Centre accredited by 13 LPA are numerous.
Firstly, it helps to speed up the achievement of accreditation targets. Currently, there are a total of
10,145 Community Health Centres targeted for accreditation, and as of January 2024, 8,196 of them
have already been accredited. This is a significant accomplishment, with 80% of the Community Health
Centres already accredited. This accomplishment supports Indonesia's Medium Term Development
Plan, which targets a 90% accreditation rate for primary healthcare.

One of the most significant advantages of having 13 accredited health centres in Indonesia is their
strategic distribution across the country.

It's beneficial to have 13 Accreditation Organizing Institutions as it increases the number of surveyors
available for conducting surveys. These surveyors are spread throughout the area, making the

95
accreditation process more efficient and effective. By January 2024, all institutions will have 6,000
surveyors available to conduct surveys.

It should be noted that the institution's implementation process for accreditation has some
weaknesses. The scores obtained by the Community Health Centres from the accreditation survey do
not always match the conditions in the field. Surveyors may give higher scores to Community Health
Centres to gain their trust. Consequently, most Community Health Centres receive a paripurna score,
which is the highest score possible, reaching almost 70%.

There are certain issues related to surveyors who have a varying degree of competencies. This has
been identified as one of the causes of inaccurate accreditation assessments, leading to less precise
results. This there are diverse surveyor abilities, although modules and curricula have been published
as standards for the implementation of training for surveyors. This affects the value of the results
received by the Community Health Centre, as the quality of the surveyors can vary.

The next issue that needs to be addressed is related to the status of the surveyors. Almost 70% of the
surveyors are civil servants who work at Community Health Centres, District/City Health Office, and
Provincial Health Office. However, there are limitations to the involvement of civil servants in carrying
out accreditation surveys. This is due to the absence of their attendance when conducting the survey.

.Additionally, a conflict of interest often arises in conducting surveys due to the accreditation
implementation policy. These issues need to be addressed to ensure that the accreditation process is
fair, transparent, and reliable.

Conclusion: The implementation of Community Health Centre accreditation involving 13 Accreditation

Organizing Institutions is undeniably advantageous. It accelerates the achievement of accreditation
targets, ensures wider coverage of accreditation throughout Indonesia, and significantly increases the
number of surveyors who will conducting accreditation surveys. However, weaknesses in the system
must be acknowledged to prevent any discrepancies. The mismatch between the scores obtained by
the Community Health Centre from the accreditation survey and the actual conditions in the field,
variable competency of surveyors attributed to diverse training programs, risk of employee disciplinary
violations due to absenteeism from work, and potential conflicts of interest during the survey process
must be addressed promptly to ensure the effectiveness and fairness of the accreditation system.

References: Undang-Undang Nomor 17 Tahun 2023 tentang Kesehatan ;

Peraturan Menteri Kesehatan Nomor 34 tahun 2022 tentang Akreditasi Puskesmas, Klinik,
Laboratorium Kesehatan, Unit Transfusi Darah, Tempat Praktek Mandiri Dokter dan Tempat Praktek
Mandiri Dokter Gigi ;

Keputusan Direktur Jenderal Pelayanan Kesehatan Nomor Hk.02.02/I/3991 /2022 tentang Petunjuk
Teknis Survei Akreditasi Pusat Kesehatan Masyarakat, Klinik, Laboratorium Kesehatan, Unit Transfusi
Darah, Tempat Praktik Mandiri Dokter, dan Tempat Praktik Mandiri Dokter Gigi

Disclosure of Interest: None Declared

96
Accreditation Surveyors According to the 5-Factor Theory of Personality: (3231) Zuhal Cayirtepe

ISQUA2024-ABS-3231

Z. Cayirtepe 1,*, S. DEMIRCI 1, F. CIZMECI SENEL 1

TÜSEB Türkiye Health Care Quality and Accreditation Institute, Ankara, Türkiye
1

Introduction: Personality characteristics affect individuals' behavior within the organization. From the
perspective of accreditation surveyors, the harmony, interaction, communication and cooperation of
health accreditation surveyors (HAS) with each other affect the success of the survey. Therefore, it is
important to identify personality traits and create compatible teams. The aim of this research is to
determine the personality characteristics of HAS, according to the Five Factor Theory of Personality
and to reveal whether their personality characteristics differ according to some variables.

Methods: This study is descriptive and cross-sectional. While the population of the study consists of
134 HASs, the sample consists of 68 HASs who agreed to fill out the personality inventory scale. Data
were collected through the The Big Five Inventory Scale. Descriptive statistical methods (frequency,
percentage, median, interquartile range) and statistical analyzes were used when evaluating the study
data. Mann-Whitney U and Kruskal-Wallis tests were used to compare groups of independent
variables. The statistical significance level was determined as 0.05. Descriptive statistics and statistical
analyzes were carried out using the Statistical Package for the Social Sciences (SPSS) 26.0 program.

Results: A total of 68 HASs participated in the research. Of the participants in the study, 54.4% were
women, 73.5% were married, 57.4% were 46 years old and over, and 42.6% had a doctorate degree. It
was determined that 51.5% of the participants had 6 years or more of experience in the field of quality
and 42.6% had 20 or more quality surveys.

The median and interquartile range values of the participants' responses to the statements in the sub-
dimensions of "The Big Five Inventory Scale" are 30.0 (27.0-32.75) for the sub-dimensions
"Extraversion" and 39.0 for "conscientiousness". (37.0-41.0), 37.0 (35.0-39.0) for "agreeableness",
39.0 (36.25-42.0) for "Openness" and 17 for "Neuroticism", It was found to be 0 (14.0-19.75). It can be
said that the scores of the participants in the subscales of "The Big Five Inventory Scale" were high,
except for the "Neuroticism" dimension. According to the results in question, it can be stated that HASs
are extroverted, responsible, easy-going, open to experience and low levels of neuroticism.

Mann-Whitney U and Kruskal-Wallis analyzes were used to evaluate whether the scores obtained by
HASs from "The Big Five Inventory Scale" sub-dimensions varied according to gender, marital status,
age, educational status, length of experience in the quality field and the number of quality surveys
performed. It was determined that women's scores on the "extraversion" and "neuroticism" subscales
were higher according to gender and the results were statistically significant. According to marital
status, it was determined that the score of single people in the "responsibility" sub-dimension was
statistically significantly higher than that of married people. No statistically significant difference was
found according to age, educational status, length of experience in the quality field and the number of
quality surveys performed.

Conclusion: As a result of the research, it was determined that HASs are extroverted, responsible, easy-
going individuals who are open to experience, that the "extraversion" and "neuroticism" aspects of
women predominate, and that the responsibility feature comes to the fore in unmarried HASs. It is

97
thought that forming survey teams by taking into account the personality and demographic
characteristics of surveyors will increase team harmony and support survey success.

Disclosure of Interest: None Declared

Ethics and Health Accreditation Standards in the Era of Artificial Intelligence: (3204) Zuhal
Cayirtepe

ISQUA2024-ABS-3204

Z. Cayirtepe 1,*, G. KORALAY 1, F. CIZMECI SENEL 1

TÜSEB Türkiye Health Care Quality and Accreditation Institute, Ankara, Türkiye
1

Introduction: The rapid proliferation of artificial intelligence applications in the field of healthcare
raises ethical concerns. Accreditation standards in healthcare, which serve as important tools in
ensuring quality and patient safety, should incorporate regulations for managing ethical concerns. The
aim of this study is to evaluate the readiness of accreditation standards that could contribute to
managing potential ethical issues in the provision of AI-based healthcare services, based on the key
ethical principles adopted by the World Health Organization (WHO) regarding the use of artificial
intelligence technologies in healthcare, and to identify areas that require improvement.

Methods: The study was conducted as a descriptive and explanatory case study. The Healthcare
Accreditation Standards Hospital Set (v3.0/2021) of the Türkiye Healthcare Quality and Accreditation
Institute which holds international accreditation, was used in the study. All accreditation standards and
assessment criteria in the set were evaluated within the framework of WHO six key ethical principles,
and document content analysis was conducted using the MAXQDA qualitative analysis program.

Results: As a result of the study, it was determined that updates and additions should be made through
regulation to 35 assessment criteria for the protection of human autonomy, 39 for the promotion of
human well-being, safety, and public interest, 43 for ensuring transparency, explicability, and
intelligibility, 62 for fostering responsibility and accountability, 24 for ensuring inclusivity and equity,
and 19 for promoting responsible and sustainable artificial intelligence, all based on WHO ethical
principles. Additionally, it was found that new standards and assessment criteria are needed for
ensuring data privacy and security, algorithmic transparency and explicability, fairness and bias
reduction, robustness, and reliability.

Table 1: Evaluation according to SAS sections according to "WHO basic ethical principles on the use of
artificial intelligence in health"

WHO Key ethical principles for use of artificial intelligence for

SAS Sections
health

98
 Promote
Promote Ensure
Ensure artificial
human well- transpare Foster
inclusiv intelligence
Protect being, ncy, responsi
eness that is
autonom human explainabil bility and
and responsive
y (n) safety and ity and accounta
equity and
the public intelligibili bility (n)
(n) sustainable
interest (n) ty (n)
(n)

Organizational Structure 1 3 3 5 1 1

Core Policies and Values 1 1 1 4 5 3

Document management 2 2 2 1 0 0

Human Resources Management 2 2 2 5 4 3

Adverse Event Reporting System 1 1 1 3 0 2

Risk Management 1 1 1 5 0 1

Education Management 1 1 1 3 0 3

Corporate Communications 1 1 1 0 3 0

Monitoring Indicators 0 1 1 6 0 2

Basic Patient Rights 6 4 8 6 3 0

Patient Safety 1 2 2 3 0 2

Access to Service 0 0 0 0 0 1

Medication Management 2 2 2 0 0 0

Patient care 2 2 2 4 1 0

Radiation Safety 1 1 1 0 0 0

Laboratory Services 2 3 3 0 0 0

Safe Surgery 4 4 4 1 0 0

Emergency Health Services 4 4 4 0 0 0

Facility Management 0 1 1 0 0 0

Information Management 1 1 1 5 5 0

Material & Device Management 1 1 1 7 0 0

Outsourcing 0 0 0 3 2 1

Emergency Management 1 1 1 1 0 0

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TOTAL 35 39 43 62 24 19

Conclusion: In conclusion, while existing accreditation standards can be a valuable assessment tool in
preventing ethical issues and reducing concerns arising from the use of artificial intelligence in
healthcare, it can be said that some updates and improvements are needed.

Disclosure of Interest: None Declared

Co-production and implementation of a handbook for the primary healthcare centers quality
documentation: (3001) Wafa Allouche

ISQUA2024-ABS-3001

W. Allouche 1,*, H. Ghannouchi 1, D. Bouras 1, A. Lassoued 1, S. Essaafi 1, C. Hamouda 1 2 and Prof Amel
Nouira, Dr Sami Boudawara
1
Instance Nationale de l'Evaluation et de l'Accreditation en santé (INEAS), 2Faculté de médecine de
Tunis (FMT), Tunis, Tunisia

Introduction: INEAS is the Tunisian national healthcare accreditation [Link] develops healthcare
accreditation standards but also supporting tools that help healthcare centers meet the [Link]
development process always involves professionals and stakeholders. A handbook for the primary
healthcare centers quality documentation was developed according to this process and made
available. A survey was conducted to study the utility,relevance and impact of this handbook on 11
centers which are pilote sites of a national program for primary healthcare promotion. The aim of this
paper is to highlight the result of the handbook co-production,its implementation and impact on
preparing 11 primary healthcare centers for accreditation and the level of professionals‘satisfaction of
this handbook.

Methods: The handbook for the primary healthcare centers was developed in a collaborative method.
A member of the accreditation department coordinated the [Link] senior healthcare experts
elaborated the handbook first draft . The accreditation department team provided a first reading. Then
the handbook draft was submitted to multidisciplinary health professionals for comments and advice
according to a reading grid. The experts collected the feedbacks, which were used to adjust the
handbook draft. A meeting involving the two experts, the accreditation department team,
multidisciplinary healthcare professionals and the different stakeholders was held to finalize and
approve the handbook final version. The handbook was published at the INEAS web site. By the same
time, as a part of a national program for primary healthcare promotion,11 primary healthcare centers
where selected to get a specialized assistance,from primary healthcare experts, in order to be
accredited. The handbook was used as a main tool for supporting [Link] surveys were conducted
to evaluate the utility,relevance and impact of the handbook percepted by each center professionals

100
and each [Link] each center the team organized a meeting to get general agreement of the answers
to submit. In the two surveys, the overall satisfaction from the handbook was evaluated.

Results: The Handbook was composed of 17 procedures and 9 instructions. They appeared in the order
of appearance in the INEAS primary health care accreditation standards. Regarding the first part
dealing with management the procedures concerned two areas: human resources’ management and
the material resources management. For the second part all the procedures were related to quality
and risk management. Regarding the third part dealing with patient care the procedures concerned
four areas: Patient record, access and continuity of care, specific patient care and management and
dispensation of drugs and medical devices. The handbook was used by 3 primary healthcare experts
to assist 11 centers belonging to 3 different types and 8 different regions. 217 multidisciplinary
healthcare professionals worked with the handbook recommendations. In only one center, the team
found that the handbook was not easy to use and in 3 centers the 3 teams found that it wasn’t easy to
adapt to their context. 54.5% of the centers considered that the handbook helped them to develop
their quality documents. The most used documents were the procedure of document management
(100%), the adverse event management instruction (100%) followed by the proactive risk management
instruction (90%). 63.6% of the centers were satisfied with the handbook and 36.4% were partially
satisfied. The 3 assisstant experts found the Handbook relevant, understandable, and easy to use. They
reported that they were satisfied from the handbook which helped them to prepare the centers for
the accreditation. Each one of them gave suggestions to develop other supporting tools (develop: a
guide for center project elaboration, a guide for clinical practices evaluation etc.).The experts and the
centers’professionals recommended actions to improve the handbook (Simplify some procedures;
add: Pain screening,assessment and monitoring procedure, Crisis and disaster management procedure
etc.).

Professionals' profiles per healthcare center type

Healcare basic center Intermediate center Mother and infant

Profile Total/Profile
(9) (1) protection center (1)

Physician 26 2 1 29

Pharmacist 1 0 0 1

Nurse 75 14 3 92

Caregiver 16 0 0 16

Senior technician 25 5 1 31

Midwife 9 1 1 11

Administrator 12 0 0 12

Workman/woman 22 2 1 25

101
Total/Structure type 186 24 7 217

Image:

Conclusion: This study highlighted the collabortive process of the handbook developedment and its
implementation experience in different contexts which gave rise to various interactions and
perceptions. The surveys' feedbacks would be beneficial for improving the handbook next version.
Other supporting tools could be developed to help the primary healthcare centers to get involved in a
quality initiative and prepare the accreditation.

This handbook concept, could be applied to the hospitals and other healhcare facility types.

References: Handdbook for the primary healthcare centers quality documentation.

[Link]
publication/manuel_procedures_csb_et_structures_de_sante.pdf

102
Disclosure of Interest: None Declared

ARTIFICIAL INTELLIGENCE IN HEALTHCARE: ADVANCING PATIENT EXPERIENCE AND OPERATIONAL

EFFICIENCY: (1182) Ahmed G. Newera

ISQUA2024-ABS-1182

A. G. Newera 1,*, M. Osama 1. 1Prince Sultan Military Hospital, Taif, Saudi Arabia

Introduction: No Show" appointments have been a significant concern in healthcare, affecting

scheduling and overall system efficiency. The prime objective for healthcare providers is to offer an
exceptional patient experience to ensure quality care. By May 2023, the "No Show" rate at Prince
Sultan Military Hospital Clinics was a concerning 30%, peaking at 65% in specific clinics. Concurrently,
the highest recorded patient satisfaction was only 69%, dropping to 64% in the first quarter of 2023.

The Prince Sultan Military Hospital Clinics suffered from continuously high "No Show" rates and less-
than-ideal patient satisfaction scores. This compromised the hospital's operational efficiency and
indicated possible gaps in patient communication, engagement, and, thus, healthcare quality.

Methods: To combat this, the hospital turned to technology, specifically the potential of artificial
intelligence (AI) in healthcare. Key strategies included sending WhatsApp appointment reminders and
providing clear instructions on what to expect during visits. Additionally, an AI-driven Chabot was
integrated into the hospital's official WhatsApp, designed to give details on over 80 services at the
clinic and provide round-the-clock support and information. Initially tested in the family medicine
department, the interventions successfully expanded to all Outpatient Department (OPD) clinics. The
goal was to decrease the "No Show" rate from 30% to 20% and raise patient satisfaction from 67% to
72% within three months.

Results: The AI integration produced significant improvements. By the third quarter of 2023, the
patient experience score was raised from 67.6% to 73.8%. The "No Show" rate also showed marked
improvement, dropping from 30% in May 2023 to 19.8% by September 2023.

103
Image:

Conclusion: Prince Sultan Military Hospital Clinics's success underscores AI's transformative role in
modernizing healthcare operations and patient experiences. Implementing AI strategically in
appointment systems and patient services can drastically enhance patient experience, refine
operational workflow, and reduce the impact of "No-show" appointments. Future steps include
incorporating AI into the broader hospital appointment system and official website and expanding
the project nationally.

References: Suk MY, Kim B, Lee SG, You CH, Hyun Kim T. Evaluation of Patient No-Shows in a Tertiary
Hospital: Focusing on Modes of Appointment-Making and Type of Appointment. Int J Environ Res
Public Health. 2021 Mar 22;18(6):3288. doi: 10.3390/ijerph18063288. PMID: 33810096; PMCID:
PMC8005203.

Liu, D., Shin, WY., Sprecher, E. et al. Machine learning approaches to predicting no-shows in pediatric
medical appointments. npj Digit. Med. 5, 50 (2022). [Link]

Theodora Oikonomidi, Gill Norman, Laura McGarrigle, Jonathan Stokes, Sabine N van der Veer, Dawn
Dowding, Predictive model-based interventions to reduce outpatient no-shows: a rapid systematic

104
review, Journal of the American Medical Informatics Association, Volume 30, Issue 3, March 2023,
Pages 559–569, [Link]

Kaplan-Lewis E, Percac-Lima S. No-Show to Primary Care Appointments: Why Patients Do Not Come.
Journal of Primary Care & Community Health. 2013;4(4):251-255. doi:10.1177/2150131913498513

Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R, Car J. Mobile phone messaging reminders

for attendance at healthcare appointments. Cochrane Database Syst Rev. 2013 Dec 5;2013(12):
CD007458. doi: 10.1002/14651858.CD007458.pub3. PMID: 24310741; PMCID: PMC6485985.

Disclosure of Interest: None Declared

Communication during telemedicine consultations in general practice: Perspectives from general

practitioners and their patients: (1722) Amy Nguyen

ISQUA2024-ABS-1722

A. Nguyen 1 2,*, S. White 3 4, T. Tse 5, J. Cartmill 4, P. Roger 6, S. Hatem 5, S. Willcock 5

1
Australian Institute of Health Innovation, Macquarie University, 2St Vincent's Clinical Campus, 3Centre
for Social Impact, UNSW Sydney, 4Macquarie Medical School, 5Department of Primary Care,
6
Department of Linguistics, Macquarie University, Sydney, Australia

Introduction: Telemedicine encompasses the use of telecommunications technologies to deliver

healthcare services and has transformed healthcare delivery, enabling remote consultations,
monitoring, and treatment. The COVID-19 pandemic significantly accelerated the adoption of
telemedicine, particularly within general practitioner (GP) clinics, serving as a critical tool to ensure
continuity of care while minimising the risk of virus transmission. The transition to telemedicine has
presented challenges in effective communication. Currently, there is a lack of comprehensive support
and guidance in this area. Clinicians have primarily relied on trial and error and ad hoc web resources
to navigate telemedicine interactions. The shift from in-person consultations to telephone or video
calls for delivery of clinical care can have a substantial impact on patient satisfaction and clinical
outcomes.

The aim of this study was to explore perspectives of GPs and patients on the interactional components
of telemedicine (both telephone and videoconferencing modalities) consultations.

Methods: Semi-structured qualitative interviews were held with telemedicine users; 15 GPs and nine
patients self-selected from a larger telemedicine study. An open-ended interview guide was used to
support the semi-structured interviews, which allowed participants to direct the interview within their
experiences of telemedicine. Interview topics included preparing for telemedicine consultations, the
conduct of the consultations as well as post-consultation activities. Deidentified transcripts from the
interviews were analysed thematically.

105
Ethics for this research was granted by Macquarie University Human Research Ethics Committee.

Results: The 15 GPs and nine patients that participated discussed many aspects of telemedicine, being
both telephone and videoconferencing modalities, during the interviews. GPs and patients discussed
factors they used to decide whether a consultation would be best conducted by telemedicine or in-
person, including the condition to be discussed, the existing doctor-patient relationship and whether
physical examination was required. For example, telemedicine was seen as a convenient consultation
method for simple indications where no physical examinations are needed. Participants also described
how they prepared for their telemedicine consultations by gathering relevant documents and reading
previous clinical notes. Participants described strategies they employed to optimise the telemedicine
interaction; improving conversational flow and building rapport, such as using small talk, asking
questions to confirm understanding and providng verbal reassurance of their presence during the call.
It was stated that telemedicine facilitated safety netting between GPs and patients, through remote
triaging to minimise unnecessary in-person presentations, whilst allowing patients to receive adequate
and timely care, and provide understanding of when they need to follow-up.

Conclusion: Patient factors including health literacy and familiarity with technology affect the transfer
of information shared during telemedicine consultations and consideration of these factors when
choosing patients for telemedicine is required. Many GPs and patients have innate communication
skills to effectively deliver and receive care through telemedicine. However, they may not be aware of
these subconscious techniques to use to optimise telemedicine consultations.

Telemedicine offers great opportunities for convenient and effective healthcare. The learnings from
the forced use of telemedicine during the COVID-19 pandemic, where both clinicians and patients
discovered that they could communicate effectively using technology, show that the use of
telemedicine is likely to remain but may still be in its fundamental stages. As its use increases, it could
perhaps be time to challenge some long-held conventions not supported by research evidence, to
expand the breasth of telemedicine. There is an opportunity to optimise telemedicine with formal
training in the techniques identified in this study. By following the communication principles garnered
from this study, including rapport building, attention to conversational flow and facilitation of safety
netting, general practice telemedicine consultations can be optimised for effectiveness and patient
safety.

Disclosure of Interest: None Declared

Comparison of Treatment Discontinuation Risk Between Oral Medication and Long-Acting

Injectable in Schizophrenia : Using PSM and IPW: (2672) Kyungmi Kim

ISQUA2024-ABS-2672

K. Kim 1,*. 1PUBLIC RELATIONS AND STRATEGY DIVISION, HIRA(HEALTH INSURANCE REVIEW &
ASSESSMENT SERVICE), WONJU, Korea, Republic Of

106
Introduction: Schizophrenia affects approximately 24 million patients worldwide, and treatment
methods include medication therapy and psychotherapy. There are two types of medication therapy:
oral medication taken daily and long-acting injectable antipsychotics administered once, which provide
sustained drug effects. Schizophrenia management particularly emphasizes relapse prevention, as the
first relapse rate within five years after initial recovery is notably high at 81.9%. Specifically,
discontinuation of antipsychotic medication increases the risk of relapse by 4.9 times. Prodromal
symptoms or signs of relapse may not be apparent or may manifest subtly, and in cases of relapse,
reintroducing treatment medication may restore symptoms to a level similar to the initial stage.
However, one in six patients may experience treatment failure despite medication adherence.
Consequently, despite the importance of antipsychotic medication therapy and continuous relapse
management in schizophrenia, there is a considerable rate of medication discontinuation. To
investigate whether there is a difference in the risk of medication discontinuation between oral
medication and long-acting injectable antipsychotics in patients with schizophrenia, statistical analysis
was conducted.

Methods: To determine whether there is a difference in the risk of medication discontinuation

between oral medication and long-acting injectable antipsychotics, we conducted Kaplan-Meier
Survival Curve and Cox Proportional Hazard Model analyses. To mitigate bias due to confounding
variables between the oral medication and long-acting injectable antipsychotic groups and adjust for
effects, Propensity Score Matching (PSM) and Inverse Probability Weighting (IPW) were performed.
Subsequently, Kaplan-Meier Survival Curve and Cox Proportional Hazard Model were fitted. PSM and
IPW are analytical methods used as causal inference techniques to minimize bias from confounding
variables, balance covariates between comparison group patients, and create a situation similar to that
of a randomized controlled trial study. (In observational studies, treatment methods vary depending
on the baseline characteristics of patients, and unmeasured confounding variables exist, making it
difficult to accurately measure the effects between comparison groups.)

Results: (unadjusted model)

To compare the risk of treatment discontinuation between medication types (oral medication vs. long-
acting injectable), we conducted Kaplan-Meier Survival Curve analysis. The results showed that
patients receiving long-acting injectable antipsychotics had a lower risk of treatment discontinuation
compared to those taking oral medication, and this difference was statistically significant with
p<0.0001. Subsequently, when performing the Cox Proportional Hazard Model, the hazard ratio (HR)
for treatment discontinuation in the long-acting injectable group compared to the oral medication
group was 0.56, indicating a lower risk of treatment discontinuation in the long-acting injectable group,
and this was statistically significant (95% Confidence Interval, CI: 0.47-0.66).

(PSM adjusted model)

Using propensity score matching (PSM) with a 1:1 nearest neighbor matching ratio, we matched 9,646
subjects before matching to 358 subjects after matching. After PSM, when assessing the risk of
treatment discontinuation based on medication type, Kaplan-Meier Survival Curve analysis revealed
that the long-acting injectable group had a significantly lower risk of treatment discontinuation
compared to the oral medication group. Additionally, when applying the Cox Proportional Hazard
Model, the risk of treatment discontinuation in the long-acting injectable group was 0.61 times lower

107
than that in the oral medication group, with a statistically significant result (95% CI: 0.48-0.79,
p<0.001).

(IPW adjusted model)

To address the extreme weighting that may occur when applying inverse probability weighting (IPW)
to propensity scores, we conducted stabilization of IPW and performed truncation to exclude patients
with excessively small or large weights. Subsequent Kaplan-Meier Survival Curve analysis showed that
the long-acting injectable group had a significantly lower risk of treatment discontinuation compared
to the oral medication group, with p=0.0012, indicating statistical significance. Furthermore, when
considering weights and applying the Cox Proportional Hazard Model, the risk of treatment
discontinuation in the long-acting injectable group was 0.62 times lower than that in the oral
medication group, with a statistically significant result (95% CI: 0.54-0.72, p<0.001).

Image:

Conclusion: Using nationwide health insurance data that all citizens of South Korea are obliged to
enroll in, we investigated whether there is a difference in the risk of medication discontinuation
between patients with schizophrenia who were prescribed oral medication and those who received
long-acting injectables in outpatient settings. Through propensity score matching (PSM) and inverse
probability weighting (IPW) analysis to adjust for confounding variables and achieve covariate balance,
we found that the risk of medication discontinuation for long-acting injectables was lower compared
to oral medication, and this difference was statistically significant. In summary, our findings suggest
that long-acting injectables may be a more favorable choice over oral medication when aiming to
minimize the risk of medication discontinuation among outpatient schizophrenia patients. Recently,
South Korea has been expanding health insurance coverage for long-acting injectables to improve
treatment persistence among patients with schizophrenia. The results of this study, which
demonstrate a lower risk of treatment discontinuation with long-acting injectables compared to oral
medication, align with the direction of health insurance policy in the country.

108
Disclosure of Interest: None Declared

Patient Perspective of the Clinical Learning Environment: (1877) Nancy Koh

ISQUA2024-ABS-1877

N. Koh 1,*, R. Dibner 1, R. Newton 1, K. Weiss 1. Accreditation Council for Graduate Medical Education,
Chicago, United States

Introduction: The Accreditation Council for Graduate Medical Education (ACGME) accredits all
postgraduate medical education programs for physicians in the US. The ACGME’s Clinical Learning
Environment Review (CLER) Program conducts periodic site visits to the hospitals and other clinical
sites that serve as clinical learning environments (CLEs) for more than 150,000 postgraduate physicians
in training. Between October 2023-April 2025, the CLER Program is implementing a special protocol
designed to understand the patients’ perspective of the CLE, including their experiences with
postgraduate physicians.

Specifically, the protocol is exploring how patients (1) perceive health care is delivered in a respectful
environment; (2) know the physicians who are taking care of them; (3) receive care that incorporates
the views of culturally diverse patient populations; (4) perceive care provided is patient centered; (5)
receive clear and consistent information from the healthcare team about their plan of care; (6) know
how to and are able to express their concerns regarding care provided by the healthcare team; and (7)
know how and are able to express their concerns regarding the well-being of their physicians and its
potential impact on their care.

Methods: For this special protocol, the CLER Program is conducting site visits to a stratified random
sample of 25 clinical sites that collectively oversee 1,171 ACGME-accredited post-graduate residency
programs and 15,021 postgraduate physicians in training. These visits primarily involve brief interviews
with patients in their inpatient rooms. The visits also include a meeting with the institution’s leader
responsible for patient experience as well as interviews with postgraduate physicians and nurses on
clinical units about their interactions with patients. All visits are conducted using a standardized,
structured questionnaire with open-ended questions that allow for richer discussions and in-depth
understanding of the experiences and perspectives of patients. The information obtained from these
visits will contribute to a national report of aggregated de-identified data regarding patient experience
in teaching hospitals and medical centers.

Results: Several early findings are emerging from the visits to date, such as: (1) many patients do not
appear to know the attending physician in charge of their care and they vary in the way they identify
their physician, including by name and physical description; (2) when patients are able to identify the
attending physician in charge of their care, few are able to identify the postgraduate physician(s)
assisting the attending physician; (3) a limited number of patients appear to understand the structure
of their physician team and the roles within the clinical care team; (4) while patients generally indicated
that their doctors go over their plan of care in a way that they can understand, there were patients
who also noted experiencing a doctor leaving their room before they understood the plan and asking
their nurse for further explanation; (5) on occasion, patients indicated there were times when they felt

109
there was a lack of coordination between their doctors in planning their care; and (6) some patients
indicated not knowing how to report or express concerns about their care.

Conclusion: The patient perspective is integral to attaining a more comprehensive understanding of

the CLE by looking at various aspects of patient experience in terms of patient safety, health care
quality, professionalism, and other areas of focus that impact patient care. The findings that emerge
from this special protocol will highlight opportunities to better shape and improve the CLE to optimize
the learner experience and patient care.

Disclosure of Interest: None Declared

THE USE OF THE UNIMETRICS PLATFORM – MANAGEMENT INFORMATION CLASSIFICATION

MODULE (CIG) FOR COSTS, RESULTS AND QUALITY MANAGEMENT IN HEALTH INSURANCE
COMPANIES IN BRAZIL, 2019 TO 2023: (1921) Fabio Leite Gastal

ISQUA2024-ABS-1921

M. Monteiro de Castro 1 2 3, F. L. Gastal 1 4 5,*, N. Otavio Beltrão Campos 1, E. Nogueira Magri Nassif 1
1
University, Unimed, Belo Horizonte, 2Board, ONA, Sao Paulo, 3Foundation, FIOCRUZ, Belo Horizonte,
4
President Board, ONA, 5Insurance Co., Unimed, Sao Paulo, Brazil

Introduction: UNIMED Cooperative System, founded in São Paulo in 1967, is the biggest medical
cooperative system in the world. It is composed of nearly 350 cooperatives and is the biggest player in
the Brazilian health insurance private market, being responsible more than 20 million lives, nearly 40%
of the market. UNIMED Faculty is the academic branch or the UNIMED System and offers
undergraduate, postgraduate, consultancy and data analysis and technological services for the
UNIMED System. In Brazil, in the second half of 2023, almost 89% of the health insurance companies’
revenues were spent paying health care providers. Alongside the provided services quality, costs
areone of the sector biggest challenges. To compare healthcare services provided to clients in terms
of costs, results, and quality, it is necessary to classify health care episodes in terms of complexity.
There are well-established initiatives in the world, such as the Diagnostic Related Groups (DRG), which
have a cost and implementation time that may not be accessible for many health services in developing
countries.

Methods: Develop and implement a health care classification model that uses administrative data
from paid bills to classify the complexity of all health care episodes, hospital, outpatient, and home
based, allowing the comparison of costs, results and quality among different providers, companies and
geographic regions in Brazil. Methodology: the algorithm set was developed by a multidisciplinary
team in a large health insurance company in Brazil and was implemented by the development team
and by UNIMED Faculty in other small, medium, and large companies of the UNIMED System, receiving
the name UNIMETRICS – Management Information Classification Module (CIG).

Results: Until the beginning of 2024, the algorithm system processed 977 million records of paid bills
since January 2019. Information from 7.5 million different customers was analyzed, totaling 71.6 billion
reais in healthcare expenses (approximately 14,5 billion US dollars in January 2024), classified into 141

110
million care episodes, including 2.5 million hospitalizations, 138 million outpatient visits and 464
thousand home visits. The maximum time for returning results after receiving the database is 90 days
and monthly updates occur on average within five business days after receiving the data. Analytics are
presented in importable files and dynamic panels, which can be customized by the clients themselves.

Conclusion: The UNIMETRICS - CIG proved to be a viable and effective alternative, both from the time
and cost point of view, for classifying health care based on administrative data, therefore contributing
for better cost management and results and quality improvement in Brazilian private health care
system.

Disclosure of Interest: None Declared

Lessons of the NuRS study. Reflections and approaches from a multi-centre big data study in the
NHS: (2928) Sarahjane Jones

ISQUA2024-ABS-2928

R. M. Cook 1, S. Jones 1,*, G. Varnals 1 and The NuRS Project Team

Staffordshire University, Stafford, United Kingdom

1

Introduction: Big data has been lauded for the past decade as the panacea to the struggles of modern
healthcare delivery (Hinton 2019). With deep-learning neural networks and similar AI driven
technologies offering to improve the efficiency of our staff – it is only a matter of time until the same
technologies are applied to operational data. While the algorithms and methodologies needed to carry
out such predictive analytics are available, the challenges that presents themselves are of data, namely
– the governance, quality, consistency, and timeliness of our operational data sets (Gerke 2020).

This session aims to share the trials and tribulations, and successes of a data driven study aiming to
examine to what extent routinely collected observational data from Trusts with the NHS can be
accessed by a research team to investigate staff retention and hospital safety.

Methods:

The process of data extraction was broken down into 5 key stages:

Initial discussion to achieve local approvals

Stakeholder discovery/ engagement

Application of data extraction protocols

In-trust data manipulation to remove identifiability risks

Transfer and quality assurance

Results: Amongst the key challenges faced in extracting large volumes of data – the inherent unease
around data sharing proved the most cumbersome and timely. Despite receiving national level
111
approvals from the national health research regulator (the Health Research Athurity) whose
responsibility was to ensure the legality of the study including data protection compliance, each Trust
wanted to perform their own independent information governance procedures. Another challenge
was the availability of appropriately skilled staff to support in the extraction, alignment and
anonymisation of the dataset using software such as R or Python.

The majority of Trusts had 1-2 individuals with strong familiarity of the different systems of interest,
resulting in mounting delays should there be instances of sickness or leave. Notably, this particular
workforce had little experience in supporting research projects and prioritisation was often low,
further exacerbating delays. The research team worked to supply as much information on how to
extract the data to ease workload pressures including writing the scripts, providing videos on how to
navigate the software and being available during extraction to take calls.

Conclusion: The promise of big data analytics to patch over problems in our healthcare service is not
impossible. The data, knowledge, and methods needed do exist and staff have the capability and
competence to drive projects forwards. However, work to include research support in business
intelligence teams into business-as-usual work loading would benefit research projects seeking to
access routinely collected data, moving towards an infrastructure similar to that of clinical research.
Efforts to centralise routinely collected data are underway and welcome but won’t necessarily include
staff administrative data, which would mean this study would still have required data from local
providers.

References: Hinton, G., et al. "AI in health: state of the art, challenges, and future directions." Yearbook
of medical informatics 28.01 (2019): 016-026.

Gerke, S., Timo M., and Glenn C.. "Ethical and legal challenges of artificial intelligence-driven
healthcare." Artificial intelligence in healthcare. Academic Press, 2020. 295-336.

Disclosure of Interest: None Declared

Patient-Centric Efficiency: Accelerating Discharge Processes for Enhanced Healthcare Satisfaction:

(3069) Shoaib Hassan

ISQUA2024-ABS-3069

D. Lalani 1,*, S. Hassan 2, T. Ahmed 3

1
Human Experience, 2Patient Experience, 3Information Technology, Evercare Hospital Lahore, Lahore,
Pakistan

Introduction: This project focuses on an in-depth review of the dynamics of the lack of efficiency in
discharge processes at Evercare Hospital Lahore, Pakistan. Aiming to review the trends and potential
bottlenecks affecting discharge procedures which took more than 240 minutes per patient. The
problems were as follows:

1. Manual initiation of discharge orders by doctors.

112
 2. Manual clearances were being taken by a porter from inpatient departments which consumed
more than 120 minutes and included:

1. Nursing clearance and medication return,

2. Pharmacy billing of medical and surgical,

3. Operating rooms procedure charging,

4. Blood bank clearance,

5. Food service & lab/Radiology clearance.

3. Due to the unavailability of porters for clearances sometimes, the discharge process was further
delayed.

4. Manual billing consumes more than 120 minutes per patient.

5. Low patient satisfaction in the discharge process.

Methods: Plan: Considering the problems identified, it was decided to develop a discharge module for
automating the processes and bringing efficiency. The following were the objectives:

1. Discharge through system.

2. Automate clearances through the system.

3. Systematic billing.

Do: In January 2023, the HIMS admission and discharge module was implemented which included the
digital transformation of the discharge and billing process. The features integrated were as follows:

1. Discharge request through the system.

2. Digital documentation by Doctors and Nursing.

3. Billing of medical and surgical through the system.

4. Clearances from various departments in the system.

5. Automation for finalizing bills at the billing office.

Check: As the system was being implemented, several observations were shared by the end user to
improve the overall processing:

1. Exclusion of departmental clearances e.g. food service, lab & radiology, OR, and Blood bank as
those can be automated.

2. Process flow changes in discharge initiation. Rights are given to medical officers for initial
documentation.

3. Gaps identified in procedures charging. Validation tools were missing, resulting in double
charging, or sometimes missed procedure charging.

4. Inaccuracy in pharmacy charging due to systematic communication errors between HIMS and
ERP systems (3rd party).

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 5. Resulting in Inaccuracy in overall billing.

Act: With consistent integrations of changes in the system, the outcomes were beyond expectations.
The discharge process was successfully automated and KPI monitoring was done through a dashboard
to improve the overall patient experience (Increased patient satisfaction, and decreased complaints).
Interventions were also being made. In line with positioning hospital SOPs that focus on improving
patient satisfaction, which will help the hospital move towards JCIA.

Results: With the system implementation, the discharge turnaround was successfully minimized from
up to 4 hours to under 45 minutes. This significant change resulted in more than 88% of patient
satisfaction in the hospital's discharge process. Eventually, the impact can be seen from the increase
in the number of inpatient admissions.

Image:

Conclusion: Significant improvements in various key areas were seen after the successful
implementation of HIMS. The integration had a positive impact on discharge turnaround time, and
improved patient satisfaction levels resulting in a substantial increase in inpatient admissions.

While concluding this phase of the project, the next phase was already aligned as the team was gearing
up to develop a corporate module to automate insurance patients' billing, and to develop an ERP
system to centralize the pharmacy charging system.

The HIMS integration has provided a more patient-centered approach to care, with enhanced
communication, coordination, and engagement throughout the entire discharge process.

Disclosure of Interest: None Declared

114
The Effect of Education Given With The Teach Back Method on Chemotherapy Symptom
Management and Quality of Life: A Randomized Controlled Trial: (3107) Belkıs Güllü Gücüyener

ISQUA2024-ABS-3107

B. Güllü Gücüyener 1,* on behalf of . and not working group

nursing, marmara university, maltepe, Turks and Caicos Islands

1

Introduction: The education that patients will receive with the Teach-Back method provides an
opportunity for them to be involved in the decision-making process in many issues such as the
preparation of care plans and to receive more medical advice from healthcare professionals. The
objective of this study was to assess the impact of patient education utilizing the Teach-Back technique
on chemotherapy symptom management and quality of life. The study aims to contribute to the
development of more effective care and education models for cancer patients.

Methods: This randomized controlled trial was conducted at the chemotherapy unit of Istanbul Private
Anadolu Medical Center Hospital from June 2022 to May 2023. Participation in the study was
voluntary. The researchers distributed the Participant Information Form, Edmonton Symptom
Diagnostic Scale (ESDS), and EQ-5D Quality of Life Scale to patients receiving chemotherapy treatment.
Participant Information Form includes 18 questions regarding the patient's age, gender, marital status,
smoking and alcohol habits, occupation, education level, chronic disease status, and prior knowledge
of chemotherapy.

Results: The study involved 80 volunteers undergoing chemotherapy treatment, with 40 in the
intervention group and 40 in the control group. Although there were statistically significant differences
between the intervention and control groups in terms of age, education level, occupational groups,
and the presence of a caregiver, there was no difference in the quality of life scores of both groups
measured before chemotherapy. This suggests that these different characteristics do not affect the
quality of life in [Link] the intervention group had lower scores, the EQ-5D quality of life
scores increased as the number of cycles increased in both groups. It is believed that chemotherapy
treatment has negative consequences on individuals and has a significant negative effect on their
quality of life. When comparing the total scores of the Edmonton Symptom Diagnostic Scale, it was
observed that the scores of individuals in the intervention group were statistically significantly lower
than those in the control group after the 1st, 2nd, 3rd, and 4th cycles.

Conclusion: While there are numerous studies in the literature that utilize the Teach-Back method,
there is a lack of resources regarding cancer patients undergoing chemotherapy treatment. Upon
examination of existing studies, it was found that positive results similar to those obtained in our study
were achieved. Our study concluded that patient education utilizing the Teach-Back method effectively
manages chemotherapy symptoms and improves quality of life.

References: [Link] E., Brown S., Szwarc J., Nesvadba N., Yelland J. Teach-Back In Interpreter-Mediated
Consultations: Reflections From A Case Study. Health Literacy Research And Practice; 5(3), e256–e261
(2021).

[Link] Literacy. Teaching aids: Teach-back method. (internet) (cited 2022 Nov 28) (Available from:
[Link] (2014)

115
[Link] E., Kuehn N., [Link] M., Selmser P., Macmillan K. The Edmonton Symptom Assessment
System ([Link]): A Simple Method for the Assessment of Palliative Care Patients. Journal of Palliative
Care 7:2/1991;6-9 (1991).

[Link]şilbalkan Ö., Özkütük N., Karadakovan A., Turgut T., Kazgan B. Validity and Reliability of the
Edmonton Symptom Assessment Scale in Turkish Cancer Patients. Turkish Journal of Cancer Volume
38, No. 2, 2008.

[Link]ırlı S. Kanserli Hastalarda Semptom Kontrolünün Değerlendirilmesi. Trakya Üniversitesi Sağlık

Bilimleri Enstitüsü Hemşirelik Anabilim Dalı İç Hastalıkları Hemşireliği Yüksek Lisans Programı, Yüksek
Lisans Tezi, 2008.

6.[Link] Erişim tarihi: 7 Eylül 2016

[Link]ğlu Süt H, Ünsar S. Is EQ-5D a valid quality of life instrument in patients with acute coronary
syndrome? Anatolian Journal of Cardiology/Anadolu Kardiyoloji Dergisi. 2011;11(2).

Disclosure of Interest: B. Güllü Gücüyener Other: No conflict of interest between the autors

Enhancing Clinical Outcomes in Diabetic Kidney Disease (DKD) through Risk Prediction and Case
Management in Patients with Diabetes: (2143) Mao Cheng-Hsien

ISQUA2024-ABS-2143

M. Cheng-Hsien 1 2,*, C. Po-Wei 1, C. Ke-Yung 1, H. Yu-Ling 3, H. Shu-Tai 1, C. Li-Nien 2, C. Pesus 4

1
Taipei Medical University Hospital, 2Institute of Health and Welfare Policy, National Yang Ming Chiao
Tung University, 3Far Eastern Memorial Hospital, 4Community Medicine Research Center & Institute of
Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan

Introduction: The incidence and prevalence of end-stage renal disease (ESRD) in Taiwan have
persistently ranked among the world's highest for over a decade, with Diabetic Kidney Disease (DKD)
being the primary cause. DKD presents a critical microvascular complication of diabetes. Our goal is to
efficiently monitor DKD progression by integrating an information alert system and implementing
targeted interventions. Additionally, we leverage machine learning to develop a predictive model for
DKD onset within three years of a Type 2 Diabetes Mellitus (T2DM) diagnosis, aiming to proactively
mitigate future comorbidities.

Methods: This retrospective cohort study conducted in Taiwan, we aimed to develop risk prediction
models for T2DM outpatients at Taipei Medical University Hospital between January 1, 2018, and June
30, 2023. Inclusion criteria required no evidence of DKD at baseline, defined as urinary
albumin/creatinine ratio (UACR) > 30 mg/g, or eGFR < 60 mL/min/1.73m2, with a 3-year follow-up.
Exclusions were applied to those aged < 18, with acute infections, malignancies, or pregnancy.

116
We employed 54 potential variables extracted from Electronic Medical Records (EMR) for predictive
modeling, utilizing five machine learning algorithms: eXtreme Gradient Boosting(XGBoost) , Support
Vector Machine(SVM), Random Forest (RF),Logistic Regression(LR), Decision Tree. Model performance
was assessed using the Area Under the Curve (AUC). Patient data underwent 5-fold cross-validation,
with partitioned into training (80%) and testing (20%) sets.

Our approach presents a management and multifactorial intervention strategy for DKD progression
based on guidelines from the American Diabetes Association (ADA) and Kidney Disease Improving
Global Outcomes (KDIGO). Screening for DKD (UACR and eGFR) is recommended at the initial diabetes
diagnosis and annually thereafter. Our care framework includes three categories: (1)continuous
tracking, (2)receive treatment, and (3)refer to nephrology treatment.

Finally, we implemented an alert system integration across COPE and the case management system.
Specific multifactorial interventions were tailored based on progression types and DKD risk prediction
level (no, low, intermediate, and high). Subsequently, the medical team tailored screening, diagnosis,
lifestyle therapies, treatment goals, pharmacologic management and intervention programs according
to patient needs.

Results: In our analysis, a total of 18,816 patients were included, with a median age of 57.9 years (IQR,
49–65 years), and 11,609 (61.7%) were male. At the 3-year follow-up, patients were categorized based
on the presence (n = 2,958, 15.3%) or absence (n = 15,858, 84.7%) of DKD. The incidence of at least
one macrovascular or microvascular complication (hypertension, cardiovascular disease, diabetic
retinopathy, diabetic peripheral neuropathy) was 54.2%.

The XGBoost model demonstrated the highest AUC (0.823, 95% CI 0.761–0.887). The SHAP plot based
on XGBoost revealed that T2DM patients with high homocysteine (Hcy), poor glycemic control, low
serum albumin (ALB), low estimated glomerular filtration rate (eGFR), high BMI, a history of chronic
heart failure, and smoking had an increased risk of developing DKD over the next 3 years.

From August 1, 2023, to January 31, 2024, the information system enabled automated prediction
functions for 12,732 T2DM outpatients. Notably, when the predicted category was intermediate or
high, the system issued warnings 1,298 times (10.2%). Impressively, the medical team responded with
execution actions to these alerts 846 times (65.2%). Furthermore, the execution rate of laboratory
tests increased compared to the previous year (1) eGFR: 6.8% (2) UACR: 14.2% (3)HbA1c: 4.3% ,
particularly in moderate or severe risk groups, the completion rate of these three tests exceeded 95%.

Conclusion: Our study provides empirical evidence and management strategies for patients with
T2DM. The alerts system proves particularly advantageous for physicians and patients who adhere to
recommended follow-up, emphasizing kidney health, function, and blood glucose control. The
implementation of early warning systems for DKD holds significant clinical value. The XGBoost model
with potential to support population management strategies by prediction 3-year DKD risk in
individuals recently diagnosed T2DM. For those displaying susceptible factors for incident DKD, early
and optimal interventions by care providers play a crucial role in delaying the progression of DKD and
potentially reducing the incidence of cardiovascular events and premature mortality.

Disclosure of Interest: None Declared

117
Afternoon

Short Orals

Quality practices in mental health: An example from Turkey: (3305) Hülya Şahin

ISQUA2024-ABS-3305

H. Şahin 1,*, S. Korkut 1. 1İl Kalite Koordinatörü, Muğla İl Sağlık Müdürlüğü, Muğla, Türkiye

Introduction: In our country, the community/hospital balance model, which focuses on patients and
families, has been implemented since 2011. Community Mental Health Centers (CMHC) were
established in Turkey after this date. Today, 177 CMHC provide services. In these centers, chronic
psychiatric patients and their families are served by a multidisciplinary team. Within the scope of
Quality Standards in Health in Turkey, there are Psychiatric Services and CMHC departments within the
hospital set. In our country, it is mandatory to implement the standards in these sections and monitor
the indicators. In our study, the indicators of a CMHC in Turkey were examined.

Methods: Retrospective method was used in the research. In this regard, in the Quality Standards in
Health - Hospital Set Indicators Monitoring section, 13 quality indicator data of the Community Mental
Health Center in our city for the years 2021-2022-2023, among the quality indicators followed for
Community Mental Health Centers, were retrospectively scanned. The data was analyzed and
compared with the targeted values. According to the analysis results, the benefits and contributions
of these centers to individuals attending CMHC, their families and society were tried to be revealed.

Results: According to the research results, data on chronic psychiatric patients with bipolar,
schizophrenic and psychotic disorders who are within the scope of CMHC service in our city were
analyzed on the basis of 13 quality indicators. These indicators include issues such as hospitalization
rates, suicide attempts, patients dying as a result of suicide attempts, substance addiction, body-mass
index, remission decision status, and center attendance, which reveal the contributions of CMHCs to
patients, their families, and society. Among the individuals attending CMHC in our city, it was observed
that there were no patients who died as a result of suicide attempt in the period examined in 2021-
2022-2023. The hospitalization rate remains low, with rates of 0.56% in 2021, 2.34% in 2022, and 1.65%
in 2023. There is a low trend again in the substance addiction indicator, with rates of 0.36% in 2021,
0.27% in 2022, and 42% in 2023. In the last case, it was understood that there were 2 substance addict
patients among 530 patients and these patients were receiving treatment at AMATEM. It was observed
that the rate of patients who were given remission was high, with an average of 81.66% over three
years. The number of patients per case manager is 105 on average over the three years. The highest
number determined by the Turkish Psychiatric Association regarding this indicator is 70. Accordingly,
the number in our city is high in terms of the effectiveness of the service. According to the indicator
results examined, CMHCs appear to have positive effects on both the course of the disease, families
and society.

Conclusion: When the rates of hospitalization, suicide, substance abuse and remission decisions are
examined in the analyzes based on quality indicators, it is seen that CMHCs established within the
scope of community-based mental health services have a great contribution from the perspective of
patients, their families and society. In addition, according to the "Number of Patients per Case
Manager" indicator, the capacity of these centers, where an average of 105 patients per case manager

118
is high in terms of effective and efficient service delivery, and where many different professional groups
provide services together, needs to be supported in terms of the number of staff.

References: Specialist Doctor Meltem Derya ŞAHİN, 2021,’’ The Importance of Increasing and Ensuring
the Continuity of Employment within the Scope of Social Inclusion of Individuals with Chronic Mental
Illness and Mental Disabilities’’, presentation.

Professor Doctor Gülsüm ANÇEL (2020),’’ Mental Health and Disorders, Psychiatry: History’’,
Presentation, [Link]

Salih KARİP, 2023, ‘’Evaluation of the Services Provided in Community Mental Health Centers by
Caregivers of Individuals with Mental Disorders and Mental Health Professionals’’, T.R. Selçuk
University Institute of Health Sciences, Doctoral Thesis.

Directive on Community Mental Health Centers, 06.03.2014, No. 9453, Ministry of Health, Official
Gazette.

Doctor. Yiğit MOĞOL, 2023, ‘’ Prediction of Alexithymia Levels in terms of Community Mental Health
Center Admission in Patients Diagnosed with Bipolar Affective Disorder’’, T.R. Health Sciences
University Erenköy Psychiatric and Neurological Diseases Training and Research Hospital, Medical
Specialization Thesis.

Disclosure of Interest: H. Şahin Other: Herhangi bir çıkar çatışması yoktur., S. Korkut Other: Herhangi
bir çıkar çatışması yoktur

Safety Culture - challenges and the perspective under the lens of equity: (1635) Aline Cristina
Pedroso

ISQUA2024-ABS-1635

A. C. Pedroso 1,*, L. Tralli 1, R. Simões 1, F. Fernandes 1, P. Tuma 1, M. Cendoroglo 1

Quality and Patient Safety, Hospital Israelita Albert Einstein, São Paulo, Brazil
1

Introduction: In 2023, a survey to assess the perception of safety culture in a Brazilian hospital, using
a structured research instrument, the AHRQ’s SOPS Hospital Survey 2.0. The research involved more
than 20,000 professionals from various health sectors (public and private) and aimed to identify
potential areas for improvement in the health sector. Until then, we were not aware of an evaluation
of these data from the perspective of equity. Therefore, questions about race, color, gender, and sexual
orientation were incorporated into this research to analyze perceptions of health safety culture
through the lens of equity. When analyzing the data from this perspective, the results were surprising
and pointed to key areas that need improvement, including staffing issues, work pace, and error
response. Notably, the research revealed significant differences in the perception of error response
between self-identified white and brown individuals, a fact hitherto unknown.

Methods: A descriptive, prospective, and quantitative study was conducted to assess the perception
of safety culture in a Brazilian hospital, using a structured research instrument, the SOPS Hospital

119
Survey 2.0. The Patient Safety Culture Survey was conducted anonymously, using the HSOPS 2.0
version of the AHRQ translated and validated for the Portuguese language, and involved more than
20,000 health professionals from the public and private sectors. Participants responded to an online
institutional survey, anonymously, via the REDCap platform. The response rate was 56%. In this edition
of the survey, two additional strategies were implemented for a more in-depth analysis. First,
questions related to equity were included, addressing aspects such as race, color, ethnicity, gender,
and sexual orientation. Secondly, a qualitative analysis of the participants’ comments on how
processes are conducted in their units or organizations, affecting safety, was carried out. The results
were statistically analyzed to identify significant differences in the perception of positive response
among different groups. In addition, comments from 1,777 participants were analyzed to provide
deeper insights into the perceptions of the measured dimensions.

Results: The study sample consisted of 9,816 collaborators who fully responded to the survey. The
study sample consisted of 4153 (42.3%) white participants, 1077 (11.0%) black, 4319 (44.0%) brown,
220 (2.2%) yellow, and 47 (0.5%) indigenous. We investigated associations of the results of the patient
safety culture survey with the demographic characteristics of the participants. The results revealed
significant differences in the perception of error response among participants self-declared as white
and brown, with a higher rate of positive response among white participants compared to browns
(estimated difference 4.4%; CI 95%: 0.3% to 8.4%; p=0.0023). However, no differences were found in
relation to other variables, such as gender and sexual orientation, in all dimensions of the survey. In
the comparison between the different categories of education in the dimensions of the instrument,
we observed that the average of participants with postgraduate/master’s/doctorate in the Error
Response dimension is higher than that of participants with incomplete high school (estimated average
difference 16.4%; CI 95%: 1.7% to 31.0%; p=0.015), with complete high school (estimated average
difference: 9.9%; CI 95%: 4.7% to 15.1%; p<0.001), with incomplete higher education (estimated
average difference: 10.3%; CI 95%: 4.1% to 16.4%; p<0.001) and with complete higher education
(estimated average difference: 10.7%; CI 95%: 4.7% to 16.8%; p<0.001). The analysis of the comments
of 1,777 participants, in response to the question: “Feel free to make comments about how things are
done or how things could be done differently in your unit or organization that may affect safety”,
provided insights into the perceptions of the evaluated dimensions. This information offers valuable
guidance to improve and strengthen the safety culture in our health system and represents a
significant advance to ensure the safety of patients and staff.

Conclusion: The study provided valuable insights into the perception of safety culture in health
institutions demonstrating key areas that need improvement, including staffing issues, work pace, and
error response. In addition, the research highlighted the need to improve equity policies in the health
environment. The results of the study are of great importance as they provide valuable guidance to
improve and strengthen the safety culture in the health system.

References: Reis, C.T., Laguardia, J., Bruno de Araújo Andreoli, P. et al. Cross-cultural adaptation and
validation of the Hospital Survey on Patient Safety Culture 2.0 – Brazilian version. BMC Health Serv Res
23, 32 (2023).

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Gandhi, T. (2022). How Workforce Perceptions of Safety Culture Differ by Race, Ethnicity, and Gender.
Press Ganey Blog. Link: [Link]
insights/how-workforce-perceptions-of-safety-culture-differ-by-race-ethnicity-and-gender

Kyung, M., Collman, N., Domeracki, S., Hong, O., & Lee, S. (2022). Racial and Ethnic Differences in the
Perceptions of Health, Work Environment and Experiences of Work-Related Symptoms Among
Cleaning Workers. Journal of Immigrant and Minority Health, 24, 1398–1407.

Disclosure of Interest: None Declared

TRESNO KOE (Indonnesian acronym for Problem-solving Respons Point for JKN Mobile Online
Registration): (3301) Tri Wahyuningsih

ISQUA2024-ABS-3301

T. Wahyuningsih 1 on behalf of RSUD Ajibarang, N. Harbani 2,*

RSUD Ajibarang, Banyumas, Indonesia, 2Director, RSUD Ajibarang, Banyumas, Indonesia

1

Introduction: Indonesia as a developing country needs a the Universal Health Coverage (UHC) to be an
integral part of achieving SDG 3 which is to ensure healthy lives and promote well-being for all
individuals of all age groups. The UHC is embedded into two core elements: Access to equitable and
quality health services for every citizen and the protection of financial risks upon using health services.
Indonesia appointed the Health Insurance Agency (BPJS) as the manager of the National Social Security
System.

Methods: TRESNO KOE (Indonnesian acronym for Problem-solving Respons Point for JKN Mobile Online
Registration) includes JKN Mobile Ambassadors and PAKE IMO. TRESNO KOE ambassador is a
teamwork of JKN Mobile ambassadors at RSUD Ajibarang that welcomes the patients and acts
proactively in providing education and guiding thr online registration process of JKN mobile. PAKE IMO
is a guide used by the TRESNO KOE team in carrying out activities, such as downloading/installing the
app, and assisting thr users/patients to register through JKN Mobile.

TRESNO KOE team is tasked with facilitating access to services and information for patients and families
visiting RSUD Ajibarang. Therefore, TRENSO KOE promotes a seamless process for patients and families
to use outpatient services, increase the coverage of JKN Mobile usage, build and maintain service
quality and hospital image, and strive to bring customer satisfaction to services.

TRESNO KOE ambassadors are assigned to the capture point of JKN mobile utilization:

Outpatient: for patients after receiving services and being given a medical appointment letter

Hospitalization: For post discharge patients and those who will have post in-patient care at the
Ajibarang Hospital Polyclinic.

Pharmacy Waiting Room : For patients who are waiting for their medicine.

JKN Mobile Corner "TRESNO KOE"

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When the TRESNO KOE Ambassadors on duty encounter a problem, they will access Pake IMO, as
follows:

1. Open the link [Link]/PakeIMO

2. Select the obstacle menu

3. Click on my menu as Tresno Koe Team

4. Read carefully the given solutions that are relevant with the problems encountered by TRESNO
KOE Ambassadors.

Results: TRESNO KOE succeeded in increasing the utilization of the online queue through Mobile JKN
RSUD Ajibarang as indicative of an upward trend from 1.93% (July) to 15.24% (August) and 26.61% in
December 2023. One of the main problems successfully addressed through TRESNO KOE is the waiting
time of JKN participants in obtaining health services that could be reduced to under 3.5 hours. In
addition to a shorter waiting time, the online queue also helped reduce the potential for disease
transmission, thus creating a safer and a more hygienic environment at health facilities. Also, health
facilities no longer need to provide parking lots and assign human resources to manage queues. This
achievement has bestowed TRESNO KOE the Digital Transformation Awards BPJS Kesehatan Year 2023.

Image:

Conclusion: RSUD Ajibarang supports the government program of UHC by initiating the efforts to utilize
digital-based services / digital transformation in hospital services through the TRESNO KOE innovation.
TRESNO KOE succeeded in increasing the use of online queue through Mobile JKN RSUD Ajibarang from
1.93% (July) to 26.21% in December 2023. This is a tangible manifestation of easy access to services
and a definite service time for patients, thus enabling them to perform their daily routines without any
disturbance to their economy while accessing equitable and quality healthcare.

References: Law No. 40 of 2024 on the National Social Security System

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Law No. 24 of 2011 concerning the Social Security Organizing Agency

Presidential Regulation No. 64 of 2020 on the Second Amendment to Presidential Regulation No. 82
of 2018

JKN Mobile Usage Guide

Health Facility Online Queue Implementation Monitoring Purwokerto Branch

Disclosure of Interest: None Declared

Health Justice in fragile and shock-prone settings: from theory to practice towards building resilient
health systems: (3441) Wesam Mansour

ISQUA2024-ABS-3441

W. Mansour 1,* on behalf of Gender, Equity and Justice Working Group of the ReBUILD for Resilience
Research Programme Consortium, J. Khalil 2, T. La 3, S. Regmi 4, G. Loffreda 5

International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom,
1

Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon, 3Burnet Institute, Yangon,
2

Myanmar, 4HERD International, Kathmandu, Nepal, 5Institute for Global Health and Development,
Queen Margaret University, Edinburgh, United Kingdom

I confirm that the submission has been approved by all authors: Yes

Introduction: Health justice represents a foundational pillar in health systems research, emphasizing
the need for fostering equitable health systems. It advocates for the equitable distribution of
healthcare resources, access to quality healthcare, and fair health [Link] health capability is
one theoretical approach that has been significantly used to explain health justice in health policy and
system research. Translating this focus on capabilities to the realm of health system resilience
underscores the importance of contextualising existing resources and abilities within ongoing
relationships, and navigating competing interests across different levels of the health system,
particularly in fragile settings. For example, in protracted conflicts settings, conflicts have destroyed
health systems and eroded the capabilities of citizens to be healthy and of governments to support
their health systems and populations. While theoretical discussions on health justice have flourished,
empirical investigations have often lagged behind, necessitating further empirical research to provide
tangible insights. This study examined the characterization and utilization of the health justice concept
in four fragile contexts in Myanmar, Nepal, Lebanon and Sierra Leone.

Methods: In ReBUILD for Resilience, we established a Gender, Equity and Justice (GEJ) Working Group
to mainstream GEJ aspects in all our research. We conducted a literature review where 40 relevant
papers were included to explore how health justice has been explained and used in health systems
research. We adopted system thinking and system and complexity theories and methods e.g., group
model building (GMB) and participatory action research (PAR) to unpack the factors that constitute the
‘systems for health’ at large and find leverage points that address inequalities and aim to redistribute
power in our four fragile contexts. Empirical insights gleaned from the Rebuild Consortium offered

123
reflective inputs, along with illustrative examples from the consortium's work on how health justice
has been applied in fragile settings.

Results: Fragility presents a critical development challenge, eroding governments and populations'
efforts to build healthy, equitable, and inclusive societies. It is useful to encompass the capability to
achieve health through addressing unjust social arrangements which lie within and beyond the health
systems. In Sierra Leone, we use PAR to strengthen the community health system and support the role
of community leaders in building local health resilience to respond to health crises. In Lebanon, the
health system struggled to cope with the multi-crisis situation leading to limited access to jobs, health
and educational services. Combining PAR and GMB has led to the formation of a Municipal Health
Committee to take charge of the governance of healthcare in the Municipality of Majdal Anjar and to
implement a resilient local health system through collaboration with local stakeholders. In Myanmar,
political instability and the military coup of 2021 has a huge impact on trust and transparency between
the stakeholders. In Nepal, using PAR to conduct a series of GMB workshops with various stakeholders
highlighted the uneven distribution of health services, limited access of the marginalised groups to
health services, low education and poor socioeconomic status as the main risk factors for low service
coverage. We collectively developed a local action plan aimed at ensuring that health services are more
accessible and responsive to the needs of marginalised people.

Conclusion: In contexts marked by fragility and conflict, the integration of health justice principles is
of paramount importance due to pervasive inequalities and vulnerabilities. This integration holds
promise for enhancing the resilience health systems in fragile contexts, enabling these systems to
better withstand shocks and disruptions. Through the incorporation of health justice principles into
research initiatives, a tangible link between theoretical foundations and practical outcomes must be
forged. The illustartive examples used in this study served as exemplars of how health justice can be
effectively embedded in projects aimed at reinforcing health system resilience. Participatory action
research aligns well with the principles of health justice by empowering communities and enhancing
their capability to actively engage in addressing health disparities, addressing root causes, and
advocating for equitable healthcare systems and policies. It shifts the focus from simply studying
disparities to actively working towards their elimination through meaningful collaboration with key
stakeholders, while sensitising those stakeholders to build a level of understanding of how GEJ can be
integrated into health services delivery and evidence-based decision making.

Disclosure of Interest: W. Mansour Grant / Research support from: This work was funded by the
Foreign, Commonwealth and Development Office (FCDO), UK Aid, under the ReBUILD for Resilience
Research Programme Consortium (PO 8610)., J. Khalil Grant / Research support from: This work was
funded by the Foreign, Commonwealth and Development Office (FCDO), UK Aid, under the ReBUILD
for Resilience Research Programme Consortium (PO 8610)., T. La Grant / Research support from: This
work was funded by the Foreign, Commonwealth and Development Office (FCDO), UK Aid, under the
ReBUILD for Resilience Research Programme Consortium (PO 8610)., S. Regmi Grant / Research
support from: This work was funded by the Foreign, Commonwealth and Development Office (FCDO),
UK Aid, under the ReBUILD for Resilience Research Programme Consortium (PO 8610)., G. Loffreda
Grant / Research support from: This work was funded by the Foreign, Commonwealth and
Development Office (FCDO), UK Aid, under the ReBUILD for Resilience Research Programme
Consortium (PO 8610).

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Benefits of external accreditation in primary care services: (3330) Ana Maria Saut

ISQUA2024-ABS-3330

A. M. Saut 1,*, L. C. Zamarco 2, M. Serpa 3, S. M. S. Fonseca 4, M. I. Takano 5, L. B. Casella 6, F. C. Ferreira

7
, C. C. D. Melo 1, F. T. Berssaneti 1
1
Production Engineering Department, USP, University of São Paulo, 2Municipal Health Secretary,
3
Deputy Municipal Health Secretary , 4Executive Secretary of Primary Care, 5Coordinator of the
*program* "Avança Saúde", 6Coordinator of Healthcare Services for the program "Avança Saúde", São
Paulo Municipal Health Department, 7Certification Unit, Fundação Vanzolini, São Paulo, Brazil

Introduction: The World Health Organization defines quality in healthcare as the probability of
increased desired outcomes consistent with evidence-based professional knowledge, focused on
individuals and assisted populations (1). Currently, there is a growing number of healthcare
organizations seeking to enhance management, quality, and safety through accreditation. However,
there is a notable lack of objective evidence regarding the impact of external accreditation on the
quality of healthcare services in low- and middle-income countries (1). This study aims to demonstrate
the benefits of external accreditation in primary care services using the Brazilian methodology of the
National Accreditation Organization – ONA.

Methods: The study covered 340 Basic Health Units (BHU) in São Paulo, Brazil, providing medical care
to approximately 7 million users of public sector. Initially, an organizational diagnosis was conducted
in all BHUs, followed by accreditation visits. Evaluations were carried out by teams of 3 to 8 surveyors,
varying based on the number of collaborators and critical service providers in each BHU. In total, 26
surveyors participated. To identify the benefits of accreditation, analyses of assessment reports were
conducted, and discussions with surveyors took place, particularly regarding improvements
implemented in the service between the organizational diagnosis and accreditation visit. Responses
were evaluated using content analysis to identify and analyze common themes. Additionally, a meeting
with representatives of the Municipal Health Department was undertaken to present the knowledge
framework and receive feedback on the clarity and applicability of the findings.

Results: The main benefits for BHUs through the accreditation process were categorized based on their
impact on stakeholders as follows:

For the user:

- Hiring an additional pharmacist per BHU;

- Inclusion of guidelines for palliative and end-of-life care in primary care;

- Consolidation of urgency and emergency protocols;

- Increased rigor in record-keeping and therapeutic plans;

- Implementation of access controls in units.

For the employee or provider:

125
- Broadening the focus on comprehensive employee health care with the identification of
epidemiological profiles and the implementation of emotional support flows and improvement
actions.

For public administration:

- Updating the algorithm for user care in emergency situations, enabling adjustments to emergency
vehicles and optimizing available resources;

- Structuring supply and medication storage processes, and managing preventive and corrective
maintenance of equipment.

For BHU:

- Engagement and motivation of teams with the opportunity for accreditation;

- Familiarity with quality tools;

- Strengthening communication and integration processes at different levels of the organizational

structure;

- Structuring and disseminating leadership strategies, enhancing clinical governance, and managing
external providers, among others;

- Standardization of processes, documents, and protocols, formalizing previously practiced but

undocumented activities, including record and file management;

- Defining and formalizing Contingency Plans;

- Updating of licenses related to the legal operation of BHUs;

- Defining and disseminating guidelines for infection prevention and control and biosafety;

- Improvement in the physical infrastructure of BHUs, providing greater safety for employees and
users.

Image:

Conclusion: While many results from the accreditation process are directly linked to healthcare quality
management, it is evident that all obtained benefits are interconnected and directly impact the safety
of user assistance. Considering the primary care network in São Paulo encompasses 7 million users,
this accreditation project has proportions to be considered one of the largest primary care projects in
the world today. The results demonstrate evidence that external accreditation directly contributes to
improving the quality and safety of users in a middle-income country like Brazil.

126
References: Health care accreditation and quality of care: exploring the role of accreditation and
external evaluation of health care facilities and organizations. Geneva: World Health Organization;
2022. Licence: CC BY-NC-SA 3.0 IGO.

Disclosure of Interest: None Declared

Advantage use of External Evaluation on Clinical Performance during Hospital Mentoring: (3192)
Dwirani Amelia

ISQUA2024-ABS-3192

D. Amelia 1,*, I. Purbaabsari 1. 1MNH, JHPIEGO, Jakarta, Indonesia

Introduction: Despite the fact that more than 90% hospitals (public and private) in Indonesia were
accredited, an analysis from Indonesia Maternal Perinatal Death Notification System by Ministry of
Health in 2022 shown a significant modifiable factor as gaps that hospitals can improve. In 2019,
Ministry of Health of Indonesia started to adapt hospital mentoring as one of the methods to improve
clinical governance in MNH care services. USAID MOMENTUM Private Healthcare Delivery (MPHD), a
5-year project was aimed to contribute to improve hospital MNH quality of care. To achieve this goal,
answers are needed to some of the most burning questions on quality of health services. Questions
such as: what need to be done after hospital accreditation? How external evaluation could be a support
for hospital without adding anxiety such as accreditation assessment? These are some of the questions
that need innovative and appraise human behaviour such as mentoring.

Methods: Hospital mentoring (HM) under USAID MPHD project was carried out by a group of experts
consisting of doctors, midwives, nurses and representatives of hospital management. They paired with
their peer from mentee hospital during HM. Mentors were selected primarily from professional
organizations, hospital staffs with quality improvement expertise and health office staffs at provincial
level, which then cascade down this mentoring capacity down to regional expert and health office at
district level. Mentee hospitals were selected based on their caseloads in MNH services and the
maternal and neonatal morbidity and mortality.

The initial assessment is carried out by both mentor and mentee, using clinical performance
monitoring tool, which cover the management of general obstetric and newborn emergency, PPH,
SPE/E, maternal sepsis, newborn asphyxia, newborn sepsis, and seizure in newborn, and infection
prevention. Standards in the performance monitoring tool was verified by several verification criteria
that include inputs and processes which is important for manager to follow up.

HM was carried out in a hybrid manner, 3 cycles of 3-days visit by mentors to mentee hospitals, which
preceded by a 4-hours call for preparation. The period between one HM and another is 6-8 weeks. The
achievements and challenges were discussed during every contact, and a follow-up action plan was
placed. In addition, a communication to the hospital management and owner was took place to
advocate action plan.

127
Mentors conduct monitoring, in addition to online discussions or telephone conversations, also by
following up action plans, and advocacy to hospital management or owners, and the local health office
as needed.

Results: From October 2022 to September 2023 through HM using clinical performance monitoring
tools both external and independent, there was an increase in hospital performance in MNH services
in all MPHD intervention provinces. HM managed to increase the performance of MNH services from
an average of 49% to 80%. At the same time a decrease in iMMR 47.81 to 39.54 per 100,000 births,
OCFR decreased by 0.15 to 0.07, and iNMR 6.02 to 5.32 per 1000 live births was observed. Additional
analysis comparing the performance of hospital who have obtained HM and have not obtained HM, a
lower iMMR, OCFR and iNMR was shown by hospitals that have earned HM.

Conclusion: External evaluation of hospital clinical performance through hospital mentoring provide a
safe environment and role modelling to mentee hospital and promote hospitals to perform much
better

Disclosure of Interest: None Declared

An exploratory study into the perceived impact of the accreditation on health care quality and its
associated cost among accredited healthcare organizations (HCOS) in India: (2940) Prashanth Nag

ISQUA2024-ABS-2940

P. Nag 1,*, S. K. Arya 1, V. Siddharth 1, A. R. Singh 1, N. Sharma 1

Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
1

Introduction: India's healthcare landscape is characterized by diversity, catering to a broad spectrum

of society through a mix of public and private providers. With a thriving $372 billion industry and an
impressive 39% Compound Annual Growth Rate, the private sector dominates, delivering over three-
fourths of healthcare services. Modern quality management demands meticulous monitoring to
ensure adherence to rules and regulations. Despite the current voluntary nature of accreditation in
India, recent interest from the government and insurance sector signals a positive shift. This study aims
to offer valuable insights into the cost-benefit dynamics of accreditation within the Indian healthcare
system. It seeks to contribute to ongoing initiatives aimed at fortifying quality management and
enhancing patient safety. Objectives include describing the integration of accreditation in the
healthcare delivery system, gauging the perceptions of accredited Healthcare Organizations (HCOs)
regarding accreditation's impact on healthcare quality, and identifying various cost centers linked to
achieving and sustaining accreditation.

Methods: We crafted a semi-structured questionnaire as our research instrument, employing a multi-

step development process that included a Systematic Review, Focused Group Discussion, and Face and
Content validation. The questionnaire was distributed to a substantial number of accredited

128
Healthcare Organizations (HCOs) nationwide, accredited by organizations such as NABH, NQAS, or JCI.
The aim was to capture a diverse range of responses, contributing valuable data for subsequent
analysis. Descriptive and summary statistics were employed to establish a broad understanding of the
data across hospitals, with statistical analyses conducted at a significance level of α = 0.05. The
outcomes of the study were summarized as Mean or percentage, as [Link] Student t-test or
ANOVA test was utilized to assess significant changes among the various study groups.

[NABH - National Accreditation Board for Hospitals and Healthcare Providers; NQAS - National Quality
Assurance Standards; JCI - Joint Commission International]

Results: Out of the 121 responses received, 91 underwent analysis for data accuracy, adhering to
predefined inclusion criteria. Respondents holding designations like Vice President, CEO (Chief
Executive Officer), MD (Managing Director), and MS (Medical Superintendent) were categorized as
top-level managers, given their pivotal roles in steering the hospital's strategic direction and overall
success. In contrast, mid-level managerial positions, including DMS (Deputy Medical Superintendent),
AMS (Assistant Medical Superintendent), Quality Head, and Quality Manager, were considered
alternatively. Mean scores of the questions involved in the study were tabulated in various
subheadings based on accrediting organisations, level of care, hospital specialty, hospital ownership,
hospital bed strength and the designation of the respondents (Image).

Accreditation demonstrates positive effects on structural factors, process-related measures, and

outcomes, encompassing improved efficiency, safety culture, patient satisfaction, reputation
enhancement, staff satisfaction, and reduced errors. Despite these advantages, the notable costs
associated with accreditation, such as consultancy fees, infrastructure upgrades, equipment
enhancements, and staff training, underscore the importance of strategic resource allocation to
optimize financial impact for healthcare organizations. The healthcare industry's financial sensitivity
presents a hurdle for accreditation initiatives, sparking concerns about their potential impact on care
quality in India.

Image:

129
Conclusion: Accreditation emerges as a pivotal tool for enhancing care quality in the rapidly expanding
healthcare sector, garnering interest from both government and insurance sectors. Our findings reveal
a pervasive adoption of accreditation in India, notably through indigenous standards like NABH and
NQAS. This nationwide dispersion of accreditation signifies its widespread influence. Moreover, the
observed trend suggests that accredited healthcare organizations (HCOs) experience heightened

130
efficiency and effectiveness in the treatment process, evident through improved key performance
indicators (KPIs) across various studied parameters.

Disclosure of Interest: None Declared

Factors Affecting the Sustainability of Hospital Accreditation Program Establishment and

Implementation in Low- and Middle-Income Countries (LMICs): (1619) Reece Hinchcliff

ISQUA2024-ABS-1619

D. Dharmagunawardene 1 2, M. Avery 3, P. Bowman 2, R. Hinchcliff 2 3,*

Ministry of Health, Colombo, Sri Lanka, 2School of Public Health and Social Work, Queensland
1

University of Technology, 3School of Applied Psychology, Griffith University, Brisbane, Australia

Introduction: Hospital accreditation programs can produce significant Quality and Safety (Q&S)
benefits, but many programs in LMICs are discontinued shortly after their establishment. Ineffective
implementation and the discontinuation of programs represent a waste of scarce resources and a lost
opportunity to improve Q&S. The aim of this study was to synthesise published evidence to provide
guidance to stakeholders responsible for implementing hospital programs sustainably in LMICs.

Methods: This scoping review used established, robust methods (Joanna Briggs Institute - JBI
framework). Search terms were “Accreditation,” “Health,” “Hospital,” and the country list of LMICs.
There were no time or language restrictions. Screening and thematic analysis procedures were
validated by the research team.

Results: The initial search yielded 3,406 sources, with 32 included for the final analysis. Table 1
summarises selected factors identified as key influences on the implementation and sustainability of
programs. Selected key factors are further explained below.

Table 1: Factors reported to influence the implementation and sustainability of hospital accreditation
programs in LMICs

Main Factor Sub-Factor Description Number of Publications

Legislation and
28
Governance

Laws, ordinances,
Legislation 15
regulations, policies

Operating and
Governance 26
controlling systems

Establishment
32
Characteristics

131
 A desired level of
performance against
Standards which actual 27
performance is
measured

External peer reviewers

Surveyors of performance against 16
standards

Financial and other

strategies useful to
Incentives 14
promote and sustain
accreditation programs

Implementation of
28
Surveys

Activities conducted
Pre-survey activities prior to the external 11
peer review

Activities and
Survey Process communication of 14
external peer review

Specific characteristics
of external peer review
Survey Characteristics 22
of performance against
standards

Integration with legislation was more prominent in long-standing accreditation programs. Authors
suggested that dependence on governments should be balanced, to avoid political interference, by
creating multi-stakeholder accreditation committees.

A common approach in standards development was the adaptation of international standards using
multi-stakeholder participation and implementation, with or without pilot testing. Authors
recommended a balance between structural, process and outcomes-focused standards. Self-
assessment, followed by periodic, on-site surveys, and awarding of accreditation for 2 – 3 years was
the common implementation approach. Mandatory programs created opportunistic behaviours, while
voluntary programs had lower numbers of accredited hospitals.

Several factors proposed to impart positive influence on accreditation program establishment and
implementation were identified in the publications. Standards should facilitate stepwise
implementation to promote continued motivation among staff and minimize the negative impact of

132
organisational capacity limitations. Surveyors should have qualities of professionalism, and preferably
be reputable and experienced health staff. A balance between national and external surveyors to
ensure cost-effectiveness, contextual understanding and objectivity, and the utilization of induction
and continuous training of surveyors for improving the credibility of the surveys, were also
recommended.

The importance of using and balancing monetary (linkages with insurance reimbursements, increased
funding for accredited facilities, promotion of medical tourism and performance-based financing) and
non-monetary (recognition, branding, appreciation) incentives were highlighted. Monetary incentives
were viewed as potentially driving opportunistic behaviours, but their absence may reduce
organisational motivation to continue participation. Other activities proposed to facilitate sustainable
implementation included educational surveys and initial situation analysis. When combined with
facilitated quality improvement, these were believed to enhance the awareness of ground-level staff.
The use of information and communication technology for timely and accurate data management was
also suggested.

Figure 1 depicts the relationship between these factors in the form of a conceptual framework, which
will be discussed during the intended presentation.

Figure 1: Relationship between factors influencing accreditation program establishment and

implementation

Image:

Conclusion: There is an emerging evidence base to guide the initial establishment and ongoing
implementation of hospital accreditation programs in LMICs. Health stakeholders involved in these
processes should harness the information synthesised in this presentation to support their efforts to

133
achieve sustainable programs that maximise Q&S benefits for health services, systems, and
consumers.

Disclosure of Interest: None Declared

JCI Enterprise Accreditation – Quality Improvement for Complex Health Systems: (3311) Joel
Andrew Roos

ISQUA2024-ABS-3311

J. A. Roos 1,*, R. Quicho 2

1
International Accreditation, 2Standards Development, Joint Commission International, Oakbrook
Terrace, United States

Introduction: Healthcare organizations continue to increase in size and complexity via mergers and
acquisitions, while adding other sites of care delivery to include surgical and ambulatory care centers,
laboratories, and other specialty centers. While these organization strive to function as a centrally run
healthcare system, their complexity creates challenges in achieving standardization of operational and
clinical processes.

This session will highlight the Joint Commission International (JCI) Enterprise Accreditation which
evaluates system-wide governance, policies and procedures and their implementation across
individual facilities to ensure coordination and standardization. Enterprise accreditation represents an
additional level of accreditation focusing on the system.

Methods: First, an overview of the new Enterprise Accreditation standards and survey process will be
provided.

Enterprise accreditation standards focuses on these key areas: governance and leadership; human
resource coordination; quality performance improvement; and system alignment.

To date, 10 Enterprise Accreditation surveys have been successfully completed by healthcare

organizations ranging in size from 3 to 24 individual facilities. An analysis of all survey findings was
performed to assess for trends and commonalities among these surveys. Key lessons, safety issues and
problems were identified and quantified where applicable.

A summary of customer feedback was also obtained and presented.

Results: A summary of the characteristics of the organizations undergoing enterprise accreditation will
be presented.

Key findings or survey trends: The most common observations from the 10 accredited enterprise
organizations show improvement opportunities in aligning system-wide governance and leadership
structure. 50% of all standards that were scored from all organizations were identified in the
Governance and Leadership Structure (GLS) chapter. Examples of specific findings will be shared.

134
Customer feedback: Customers value the streamlined survey approach that Enterprise accreditation
offers at a systemwide level. Multi-site organizations that are under one system identify the JCI
Enterprise accreditation approach as a tool to improve system alignment, resource allocation, and
communication strategies.

Conclusion: As healthcare organization increase in size and complexity, the governance and leadership
of these organizations grow in importance. However, achieving and optimizing alignment within the
organization becomes more difficult. The JCI Enterprise Accreditation standards and survey process
serve as a useful method for larger healthcare standards to improve this alignment, resource allocation
and communication.

Disclosure of Interest: None Declared

'Healthcare in my happy place': co-designing digital health to support access to care in First
Nations remote communities: (3014) Tim J Shaw

ISQUA2024-ABS-3014

T. J. Shaw 1,*, V. Khanal 2, N. Newton 1, E. Stone 1, A. Von Huben 1, S. Norris 1, K. Coombes 2, A.

puruntatameri 2, J. wakerman 2, D. Russell 2

University of Sydney, Sydney, 2Menzies, Alice Springs, Australia

1

Introduction: Digital health presents opportunities to improve access to care for remote First Nations
communities and promote safe and effective care. However, there have been many false starts in using
technology in First Nations communities and little is known regarding the preferences of First Nations
community members regarding how technology can be used in a safe, culturally appropriate way.

Methods: This project used a co-design methodology in a remote island community in the Northern
Territory in Australia to better understand preferences for how digital technology can be applied in a
culturally appropriate way and develop a ‘technology stack’ to support these preferences. Focus group
discussions (formal and informal), and one-on-one interviews were held with over sixty community
members, remote area health practitioners and health clinic managers in the community.

Results: Community members expressed a strong desire to not travel away from their community for
their healthcare when possible. A health appointment on the mainland could be a four-day trip for a
30 minute consultation, as it involves travel in a light aircraft and return flights may not be available.
This is a major barrier to accessing health care for many patients. Community members were
interested in using telehealth to reduce the need to travel. They preferred telehealth with a known
health professional but accepted that in an emergency situation that may not be possible. Female
community members expressed interest in accessing telehealth for health and wellness checks outside
of the health clinic in areas such as the Women’s Centre. This included accessing a female health
professional when only a male General Practitioner was available in the clinic. A majority of community
members indicated that they had access to technology such as mobile phones but did not often use
these for health care purposes. Cost to access technological devices and the internet are major barriers
to usage. Community members did not often use the internet to proactively access information on the

135
internet but expressed interest in having targeted health information sent to them via SMS messaging
and through links on local social media sites and message boards.

Conclusion: The data from this study indicate that there is strong community support to use digital
technology to improve culturally safe access to care in remote communities. This includes delivering
telehealth solutions in non-clinical environments such as community centres which are a “happy
place” for community members. The results of this study are being used to inform the roll out of an
integrated digital health program that comprises establishing telehealth in the community, improved
outpatient telehealth from the clinic and distributing targeted health information through tools such
as SMS push messaging. Special care is needed to ensure that techniolgies used in remote communities
do not impact safety and quality.

Disclosure of Interest: None Declared

Efficiency of AI Models in Complication Detection after Surgery: (2311) Julia Vetter

ISQUA2024-ABS-2311

J. Vetter 1,*, M. Strobl 1, T. Hochstrasser 2, T. Königswieser 3, G. Halmerbauer 2, S. Winkler 1

1
Bioinformatics Research Group, University of Applied Sciences Upper Austria, Hagenberg, 2Process
Management and Business Intelligence, University of Applied Sciences Upper Austria, Steyr,
3
Salzkammergut Klinikum, Oberösterreichische Gesundheitsholding, Gmunden, Austria

Introduction: Different types of surgery (hernia repair, cholecystectomy, etc.) show different
complication rates. In recent years, we have shown that it is possible to implement retrospective
complication detection using artificial intelligence (AI) [1]. Since 2015, the University of Applied
Sciences Upper Austria and the Oberösterreichische Gesundheitsholding (OÖG) develop the platform
LeistungsVergleich Medizin (LeiVMed) for collecting, monitoring, and analyzing patient data. In this
study, based on the stored routine data, we evaluate two different approaches for the identification of
medical cases affected by complication(s). Therefore, we train machine learning (ML) models: on the
one hand, individual models are trained for each of the seven different medical case classes
(cholecystectomy, colectomy, hernia repair, hip arthroplasty, prostatectomy, rectum operation, and
thyroidectomy), and on the other hand, models that comprise all categories.

Methods: Our data basis consists of information about patients from 12,156 surgical cases from
different Austrian hospitals. This dataset includes information about services provided before, during,
and after their stay in the hospital, as well as risk factors and complications. For modeling, the already
proven multi-model ensemble (MME) approach was used, which combines ML models derived from
various ML algorithms (e.g., random forest, genetic programming, neural networks, etc.). The MMEs
were trained for each medical case class and for all data aggregated. Model selection was performed
by using MMEs with a 20% false negative rate (FNR), which should guarantee the detection of 80% of
all cases affected by a complication. For evaluation, the check rate was used, i.e., the fraction of all
cases classified as complicated, implying the number of cases that need to be reviewed to identify 80%
of all complicated cases.

136
Results: The results show that AI-based complication identification using all data delivers statistically
significantly (p < 0.05) better results, especially compared to the individually trained models of
colectomy, thyroidectomy, and rectum surgery (see Figure 1). For these three case classes, over 45%
of the cases were classified as complicated. This means, on average, 49.32% have to be reviewed
manually to detect 80% of all patients affected by a complication. For the aggregated MME, the
average check rate is 27.49%. No significant difference is recognized compared to the medical case
classes prostatectomy and hip arthroplasty. Only two case classes (cholecystectomy and hernia repair)
show better results. Here, fewer cases need to be reviewed (on average, 21.87% and 22.36%,
respectively).

Image:

Conclusion: Sensitive retrospective complication detection offers great potential for improved and
more efficient collection and review of complicated cases after surgeries. In our study, modeling that
includes all data from all medical case classes proved to be more successful for most case classes, as
fewer cases are incorrectly classified as complications. In the case of hernia repair and
cholecystectomy, where the individually trained MMEs led to slightly improved results, a potential
combination of multiple MMEs (case class specific and aggregated) should be considered when
integrating the trained models into an existing system. However, an MME trained using all data may
offer the capability to classify later-on added cases from unseen medical case classes.

References: [1] Strobl, M., Vetter, J., Halmerbauer, G., Königswieser, T., & Winkler, S. M. (2022) Using
Explainable Artificial Intelligence for Data Based Detection of Complications in Records of Patient
Treatments. International Conference on Computer Aided Systems Theory. Cham: Springer Nature
Switzerland. S. 173-180.

Disclosure of Interest: None Declared

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Optimizing Hospital Readmission Reduction with Predictive Machine Learning and Bundle Care
Models: (2057) Mao Cheng-Hsien

ISQUA2024-ABS-2057

M. Cheng-Hsien 1 2,*, C. Po-Wei 1, C. Ke-Yung 1, H. Yu-Ling 3, H. Shu-Tai 1, C. Li-Nien 2, C. Pesus 4

1
Taipei Medical University Hospital, 2Institute of Health and Welfare Policy, National Yang Ming Chiao
Tung University, 3Far Eastern Memorial Hospital, 4Community Medicine Research Center & Institute of
Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan

Introduction: Unplanned hospital readmissions not only reflect the hospital's capabilities and quality
but also lead to patient harm and increased expenses. Previous studies suggest that many
readmissions could be prevented, highlighting the importance of identifying at-risk patients as a critical
step in enhancing care quality. Our goal was to develop and evaluate machine learning models to
predict 14-day readmissions based on derived features. By integrating an information alerts system
and implementing a bundled care approach, our aim is to effectively mitigate avoidable readmissions.

Methods: This retrospective cohort study conducted in Taiwan aimed to develop risk prediction
models for all inpatients discharged from Taipei Medical University Hospital between January 1, 2020,
and June 30, 2023. Exclusions comprised patients aged < 20 years, those admitted for cancer-related
treatment, baby birth, psychiatric condition, deceased during admission, or with planned
readmissions. We extracted detailed electronic health records(HER) across seven categories: Discharge
abstract, Ambulatory utilization, Hospitalization procedures, Nursing assessment and recording,
Medication orders, Vital signs, Lab test results.

Initially, we evaluated over 229 potential variables were evaluated using six supervised machine
learning approaches: eXtreme Gradient Boosting(XGBoost) , Artificial neural networks(ANN), Support
Vector Machine(SVM), Random Forest (RF),Logistic Regression(LR), Decision Tree. Model performance
was assessed using the Area Under the Curve (AUC). Patient data underwent 5-fold cross-validation,
partitioned into training (80%) and testing (20%) sets. The top-performing models and daily systems
were then employed to automate data collection for daily calculation of readmission risk for each
patient.

The integration of alerts was implemented across three major information systems, namely COPE,
nursing systems, and nursing station displays, to notify each inpatient of potential future risks.
Furthermore, specific care bundles were formulated based on three risk levels (>80 %, 50%~80%,
<50%). Subsequently, the medical team then tailored discharge plans, transitional care, and
telemonitoring to ensure patients' continuity of care at home while maintaining communication
regarding any changes in their condition.

Results: A total of 101,635 patients (56% female, 44% male, 41% aged 65 years or older) were included
for training and evaluating models, with 2,337 (2.30%) experiencing readmission within 14 days of
discharge for any reason.

The eXtreme gradient boosting (XGBoost) model outperformed with the highest AUC (0.79), accuracy
(0.93), and F1 value (0.78). Conversely,Logistic regression (LR) performed substantially worse than the

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other five models, with an AUC of 0.67. Utilizing the Shapley Additive Explanations (SHAP) method, we
identified key indicators for the risk of 14-day readmissions, including prior readmissions, extended
length of stay, increased hospital care utilization, frequent physician office visits, numerous
prescriptions, chronic conditions, low hemoglobin levels, diminished foot muscle strength, frailty
indicators, and the involvement of younger physicians. Subsequently, employing recursive feature
elimination (RFE) recursively removes the weakest features, we reduced the variables to 27 potential
predictors for the 14-day readmission prediction model, while maintaining the same AUC. These
streamlined features offer clinical teams more intuitive insights.

From August 1, 2023, to January 31, 2024, the information system facilitated automated prediction for
15,732 hospitalized patients. Notably, when the predicted value exceeded a moderate threshold
(>50%), prompting bundle care implementation, the system issued 2,076 warnings (13.2%).
Impressively, the medical team responded to these alerts 1,873 times (90.2%), and subsequently
implemented the recommended guidelines with a completeness rate of 88.5%. Concurrently, the
calculated readmission rate within 14 days during this period was 2.08%.

Conclusion: In our study, the XGBoost predictive model had the best predictive performance and
potential clinical application perspective. It can be used to identify high-risk patients at the early stage
of hospitalization. Moreover, we integrated alerts functions into various information systems and
implemented bundle care based on different risk levels. This approach enhances attention and enables
more efficient, targeted interventions for high-risk patients, potentially surpassing the effectiveness of
traditional care strategies.

Disclosure of Interest: None Declared

Leveraging advanced analytics and electronic health data to monitor trajectories of medicine use
in residential aged care: insights from the MED-TRAC studies: (2991) Nasir Wabe

ISQUA2024-ABS-2991

N. Wabe 1,*, R. Urwin 1, A. Timothy 1, I. Meulenbroeks 1, K. Seaman 1, A. Nguyen 1, M. Raban 1, Y. Xu 1, V.

Mumford 1, J. Westbrook 1 and The MED-TRAC working group including Ms Desiree Chantelle
Firempong (Email: desireechantelle.firempong@[Link])

Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie
1

University, Sydney, Australia

Introduction: Medication-related issues are widespread in residential aged care facilities (RACFs). The
increasing availability of routinely collected electronic data in RACFs enables the application of
advanced analytical techniques, such as Group-Based Trajectory Modelling (GBTM), to identify and
monitor medicine use over time. This is critical for gaining valuable insights into the quality of
medication management and for informing strategies aimed at improvement. We present results from
the MED-TRAC (MEDicine use Trajectories in Residential Aged Care) studies, conducted as part of a
large five-year project funded by the Australian National Health and Medical Research Council. This
was a three-part study focusing on three areas of medicine use: polypharmacy, psychotropics and
cardiovascular disease (CVD) medicines.

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Methods: We employed a longitudinal cohort study design using electronic health data from 2,837
newly admitted permanent residents from 30 RACFs in New South Wales, Australia. In Study 1,
polypharmacy was defined as the concurrent use of 9 or more regular medicines. Study 2, focused on
psychotropics, and included three medicine classes: antidepressants, antipsychotics, and
anxiolytics/hypnotics. Study 3, examined CVD medicines, and included six medicine classes (e.g., beta-
blockers, diuretics). In each study, the prevalence of medicine use was measured weekly over 36
months. We applied GBTM—a technique commonly used in clinical research to identify distinct
subgroups within a population that follow similar patterns of change over time—to characterise
medicine use trajectories over 36 months. This study was reviewed and approved by the Macquarie
University Human Research Ethics Committee (ref: 520231126749629).

Results: In Study 1, we identified five polypharmacy trajectory groups, including one group
representing 25% of residents with persistently high polypharmacy (Fig 1). In Study 2, 6-group and 4-
group trajectories were identified for dementia and non-dementia cohorts respectively. One in three
residents with dementia, and one in five without dementia, concurrently used multiple psychotropics
often for extended periods, which may put residents at risk. In Study 3, two to three distinct medicine
use trajectories were identified across CVD medicine classes, with the highest rate of use observed for
beta-blockers, and up to a quarter of residents discontinuing a CVD medicine class. Each trajectory
group in the three studies exhibited distinctive baseline characteristics, providing a foundation for
tailoring interventions to enhance medicine use in RACFs.

Image:

Conclusion: Our MED-TRAC studies revealed varied patterns of medicine use in RACFs, with a notable
proportion of residents following potentially inappropriate medicine use trajectories. These findings
represent a preliminary step toward identifying opportunities for early and targeted interventions to
improve prescribing practices in RACFs.

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References: NA

Disclosure of Interest: None Declared

Digital Medical Devices for Professional Use: A new framework initiated by the French National
Authority for Health (HAS): (2033) Simon Renner

ISQUA2024-ABS-2033

S. RENNER 1, A. ROCHEREAU 1, C. COLLIGNON 1, A. LANSIAUX 1,*

Haute Autorité de Santé, Saint-Denis, France

1

Introduction: In the French healthcare landscape, most digital medical devices (DMDs) intended for
professional use (e.g. diagnostic or clinical decision support systems) currently fall outside the national
Health Technology Assessment (HTA) framework designed for reimbursement. Such DMDs are often
based on artificial intelligence (AI) or even generative AI, raising specific questions on robustness,
validation, … Consequently, healthcare professionals (HCPs) may integrate DMDs into medical
procedures without being fully informed about their performance or limitations and thus request
guidance or HTA assessments to help them to choose relevant DMDs. A systematic assessment from
an HTA point of view cannot yet be considered due to the number of existing DMDs and the rapid
market turnover. Moreover, the overall absence of robust evidence to support their clinical
performance and relevance represents an additional challenge for HTA bodies as well as HCPs. In this
context and to address the growing integration of DMDs into medical practice, the French National
Authority for Health (HAS) has begun to build a new trust framework for DMDs for professional use
and AI in care, with the idea of promoting the diffusion of suitable digital innovation without adding
additional constraints for companies. This tailored framework will include support for both
professionals and hospitals to assist their selection of relevant DMDs, as well as core assessment
works, to be developed over the next months.

Methods: After an initial review of the uses and requirements of the various stakeholders, the need to
support healthcare professionals and facilities in their selection of DMDs was selected as the first
phase in the implementation of the framework. Following a literature review, a taskforce of 27
independent experts (HCPs, AI experts, methodologists, ...) was established to produce a guide
designed to help HCPs in their selection of relevant DMDs for professional use. The guide was
developed with the aim of being applicable to all DMDs for professional use, identifying the key
questions to be asked prior to integration. Significantly, all questions identified are not meant to
provide specific answers, but rather to offer points of consideration for informed decision-making and,
ultimately, to promote the safe use of DMDs, while stressing the need for rigorous evaluation. A draft
of the guide was released for public consultation, allowing all stakeholders to contribute.

Results: This guide is the first step towards an innovative framework for DMDs for professional use
and AI and aims to help HCPs and buyers in their selection of DMDs for professional use by identifying
questions regarding the technology, its development, and pre-purchase actions to establish. The

141
primary questions relate to the evidence available, the technology's functioning principles (particularly
if machine or deep learning is involved, which data were used for training and validation), the
organizational, environmental, and economic consequences associated with the DMD's integration,
the IT resources required, as well as legal and regulatory issues. Finally, the guide intends to promote
pre-purchase experimentation as well as the identification of KPIs to assess a DMD’s integration
consequences and performance.

Conclusion: This guide is one of HAS' first contributions towards a trust framework for DMDs and AI
technologies. Other tools and new innovative HTA frameworks dedicated to DMDs are under
discussion to address evolving evaluation needs for clinical decision support systems, where AI and
generative AI are rapidly spreading.

Disclosure of Interest: None Declared

Global Impact through a Local Lens: Introducing a Localized Accreditation Framework for Georgia:
(1254) Katerina Tarasova

ISQUA2024-ABS-1254

K. Tarasova 1 2,*, G. Pkhakadze 2 3

Health Standards Organization, 2Accreditation Canada, Ottawa, Canada, 3David Tvildiani Medical
1

University, Tbilisi, Georgia

Introduction: Since 2014, the Public Health Institute of Georgia (PHIG) has been instrumental in
advocating for the mandatory independent international accreditation of healthcare institutions
within Georgia. Through a strategic blend of advocacy methods, including extensive social media
campaigns, academic involvement, and continuous dialogues with healthcare stakeholders and
governmental bodies, PHIG's persistent efforts led to the historic 2022 decree requiring all state-
funded Georgian hospitals to undergo independent international accreditation. In 2023, PHIG entered
into a strategic partnership with Accreditation Canada (AC), leveraging each organization's strengths
and expertise to initiate the accreditation process for over 23 healthcare facilities across Georgia. The
partnership's main objective was to implement international accreditation standards tailored to the
Georgian healthcare context, aiming to elevate care quality through the Qmentum International™
framework. This initiative sought to marry PHIG's deep understanding of local healthcare needs with
AC's global accreditation expertise to foster continuous quality improvement within Georgian
healthcare facilities.

Methods: Underpinning this collaborative effort was the formation of a local expert team, well-versed
in Georgian, with extensive healthcare experience. This team conducted a thorough analysis of
Georgian healthcare legislation versus Accreditation Canada's standards, identifying opportunities to
synergize local practices with international benchmarks. All training sessions and visits were conducted
in Georgian at the healthcare facilities to ensure maximum relevance and impact. The strategic
partnership emphasized weekly in-person coaching sessions, bi-monthly staff trainings on

142
accreditation matters, monthly process evaluations, and quarterly strategic meetings with senior
management.

Results: The strategic partnership between PHIG and AC has facilitated the accreditation process for
more than 23 healthcare facilities actively engaging with the Qmentum International™ framework.
This collaboration has proven effective in adapting the accreditation model to the Georgian healthcare
system, showcasing its potential for broader application in similar contexts internationally.

Conclusion: The strategic partnership between PHIG and AC highlights the significant impact of
leveraging combined strengths and expertise in overcoming linguistic, financial, and cultural barriers
to implement a localized accreditation framework. This initiative not only aligns Georgian healthcare
practices with international standards but also serves as a scalable model for enhancing global
healthcare quality. The commitment to delivering training in Georgian and on-site underscores a
pragmatic approach to education and quality improvement, establishing a new standard for
accreditation efforts worldwide.

Disclosure of Interest: None Declared

Through the eyes of the health care providers: Exploring the state of patient safety culture in a
selected hospital in North West Province, South Africa: (2601) Sabelile Tenza

ISQUA2024-ABS-2061

S.-W. Kim 1,*

Internal Medicine, Kyungpook National University Hospital, Daegu, Korea, Republic Of

1

Introduction: Korea's healthcare system, anchored by national health insurance, provides broad access
to medical services. The introduction of private insurance supplements has altered healthcare usage
dynamics, notably affecting emergency department (ED) visits and the lengths of hospitalizations. This
study evaluates the role of private insurance within a predominantly national health system, focusing
on its implications for ED congestion and the distribution of healthcare resources.

Methods: In 2023, this observational study analyzed medical records from a 950-bed tertiary hospital
in Korea, focusing on patients who utilized the ED and were subsequently admitted. Participants were
categorized by their insurance type: those with national health insurance alone or those with both
national and private insurance. The study expanded to assess insurance status, ED visit frequency,
hospital stay duration, and total medical expenses to provide a comprehensive perspective on how
insurance influences healthcare access and financial outcomes.

Results: Data from 36,338 patients were analyzed, with 26,199 (72%) covered solely by national
insurance and 10,139 (28%) also holding private coverage. Patients with private insurance had a
significantly higher average number of ED visits (1.4 ± 0.9) compared to those with only national
insurance (1.2 ± 0.6, p < 0.001) and longer hospital stays (7.6 ± 8.8 days vs. 3.6 ± 6.0 days, p < 0.001).

143
Their hospital charges were also significantly greater (5,479 ± 6,972 USD vs. 1,909 ± 3,995 USD, p <
0.001), underscoring the influence of private insurance on escalating healthcare utilization and costs.

Conclusion: This study reveals the substantial impact of supplemental private insurance on healthcare
utilization in South Korea, leading to more frequent ED visits, longer hospital stays, and increased costs.
Highlighting a universal challenge, these results underscore the need for policy reforms to align the
advantages of private insurance with the goals of healthcare system efficiency and equity on a global
scale.

References: Agarwal, Exploring Health Insurance Status and Emergency Department Utilization Health
services research and managerial epidemiology 2:2015
Cho, Factors related to the frequent use of emergency department services in Korea BMC Emerg Med
23:1–10, 2023

Disclosure of Interest: None Declared

Analysis of enablers and barriers to After Action Review of patient safety events in an Irish hospital
and identification of behaviour change techniques to support implementation: (2998) Siobhan E
McCarthy

ISQUA2024-ABS-2998

S. E. McCarthy 1,*, M. Finn 1, A. Walsh 2, C. Hogan 3, T. Keane 1, L. Jenkins 3, L. Schwanberg 3, G. Valentelyte

4
, D. Williams 5, N. Rafter 2
1
Graduate School of Healthcare Management, 2Department of Public Health and Epidemiology, RCSI
University of Medicine and Health Sciences, 3National Quality and Patient Safety Directorate, Health
Service Executive, 4Healthcare Outcomes Research Centre, 5School of Medicine, RCSI University of
Medicine and Health Sciences, Dublin, Ireland

Introduction: After Action Review (AAR) is a non-hierarchical facilitated approach to learning from
patient safety events and is included in the Incident Management Framework for the Irish health
system. A national- level implementation strategy, co-designed by the Health service Executive (HSE)
and RCSI University of Medicine and Health Sciences, involved an organisational readiness assessment
and the training of staff as AAR facilitators using simulation. Approximately 500 staff in the health
system have been trained, yet little is known about enablers and barriers to AAR post the training or
about how to refine the implementation strategy to promote uptake, and consequent learning and
improvement from events. Objectives were to (1) train hospital selected staff as AAR facilitators, (2)
explore enablers and barriers to implementation six months post the training and (2) identify evidence-
based behaviour change techniques and policy recommendations to promote AAR uptake. These
formed part of a larger mixed-methods study at an Irish hospital1.

Methods: Fifty staff were trained as AAR facilitators. Focus groups explored enablers and barriers to
AAR implementation, using an interview protocol informed by the Theoretical Domains Framework
(TDF). Framework analysis was applied to the data and key TDF enablers and barriers were mapped
to the Behaviour Change Wheel to identify behaviour change techniques to enhance uptake of AAR.

144
Participation in the research by trained facilitators was voluntary and the study was approved by the
RCSI and study site Research Ethics Committees.

Results: Four focus group discussions with 14 AAR facilitators were conducted. Domains which
contained the richest data on processes acting as enablers and barriers to AAR implementation were
identified2. Subsequently, multiple behaviour change techniques were identified to promote uptake.
For example, open-access video simulations of AAR have been made available3.

Conclusion: To promote implementation of AAR, it is beneficial to have an in-depth understanding of

enablers and barriers, so that evidence-based strategies to promote uptake can be identified. These
new implementation strategies will require testing for implementation outcomes and effectiveness.

References: 1. McCarthy SE, Keane T, Walsh A, Mellon L, Williams DJ, Jenkins L, Hogan C, Stuart
C, Rafter N. Effect of after action review on safety culture and second victim experience and its
implementation in an Irish hospital: A mixed methods study protocol. PLoS One. 2021
16(11):e0259887.

2. Finn M, Walsh A, Rafter N, Hogan C, Keane T, Jenkins L, Mellon L, Schwanberg L, Valentelyte G,

Williams D, McCarthy SE. Applying the Theoretical Domains Framework to identify enablers and
barriers to After Action Review: an analysis of implementation in an Irish tertiary specialist hospital.
Saf Sci. 2024 (accepted in press).

3. McCarthy SE, Hogan C, Jenkins L, Schwanberg L, Williams DJ, Mellon L, Walsh A, Keane T, Rafter
N. Videos of simulated after action reviews: a training resource to support social and inclusive learning
from patient safety events. BMJ Open Quality. 2023;12(3).

Disclosure of Interest: None Declared

What’s in a Learning Health System? A rapid review of emerging definitions, models, and
frameworks: (3002) Georgia Fisher

ISQUA2024-ABS-3002

G. Fisher 1,*, L. Ellis 1, M. Saba 1, S. Spanos 1, C. L. Smith 1, Y. Zurynski 1, J. Braithwaite 1

1
Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health
Innovation, Macquarie University, Sydney, Australia

Introduction: The concept of a Learning Health System (LHS) continues to be globally embraced by
researchers, managers, and clinicians that aim to create high quality and safe health systems. To
achieve these goals and provide safer, higher quality care, it is essential that LHSs are well defined,
designed according to established theory, and underpinned by evidence-based frameworks and
models. This rapid review aimed to comprehensively describe how LHSs are defined, their underlying
models and frameworks, and the theories that are used in their development.

Methods: The PubMed, Embase, and Scopus databases were searched for articles about LHSs
published between 01/01/2018 to the 31/12/2023. Articles were included that had an explicit focus

145
on LHSs; described a definition, model, or framework of an LHS; were peer reviewed; and were
published in English. Each review team member screened a portion of titles and abstracts, and then
full texts against the review criteria, and their decisions were then checked by another reviewer. Each
reviewer extracted data from a portion of the included full texts, which was then checked for accuracy
by another reviewer. We extracted data related to study design, LHS type and setting, LHS definitions
and their citations, and details of LHS models and frameworks. The quality of each study was appraised
by a tool relevant to its design. Data that described each study design and LHS setting were
summarized using descriptive statistics, and all LHS definitions were narratively synthesised. LHS
models and frameworks underwent a thematic framework analysis using the modified Institute of
Medicine (IoM) LHS model1, comprising Science and Informatics, Patient – Clinician Partnerships,
Continuous Learning Culture, Incentives, and Structure and Governance. We also inductively analysed
any data that did not fit into these categories to identify other key LHS domains in the literature.

Results: The search returned 983 unique records. A total of 573 records were excluded at title and
abstract screening, followed by a further 184 at full text review. A total of 226 full texts were included
in this review. Most descriptions of LHSs were published in high-income countries, including the USA
(n = 132), Canada (n = 34), and the UK (n = 15). There were 109 descriptions of LHSs that had been
implemented in real world settings, 114 propositions of theoretical or future LHSs, and five articles
that did both. While most studies described LHSs for general healthcare (n = 25), there was an
enormous array of LHS foci, including oncology (n = 11), COVID-19 (n = 8), paediatrics (n = 8), and
genomics (n = 4). The most used definitions of LHS were by the IoM (now National Academy of
Medicine). All five LHS domains were common in included models and frameworks, however, the most
prevalent focus was on Science and Informatics and creating a Continuous Learning Culture. Two
additional key LHS domains were identified: Equity, particularly related to vulnerable communities;
and Ethics, particularly related to digital data privacy.

Conclusion: The growth of the evidence base for LHSs is exponential. Models and frameworks of LHSs
have firmly left the realm of pure theory and are now being implemented in a wide variety of real-
world health settings. However, greater investigation of LHSs in low- and middle-income health
systems is needed. Further, while key domains of LHSs are frequently being addressed, the widespread
addition of Equity and Ethics should be considered in future iterations.

References: 1. Zurynski, Y., ... & Braithwaite, J. (2020). Mapping the learning health system: a
scoping review of current evidence. Sydney: Australian Institute of Health Innovation and the NHMRC
Partnership Centre for Health System Sustainability.

Disclosure of Interest: None Declared

Mortality 30 days after acute myocardial infarction: Results of a French national indicator based on
medico-administrative data: (3283) Linda Banaei-Bouchareb

ISQUA2024-ABS-3283

L. Banaei-Bouchareb 1,*, A. COQUELIN 1, N. LE GUEN 1, S. MORIN 1, A. Lansiaux 1, L. MAY-MICHELANGELI

. Haute Autorité de santé, Saint Denis, France
1 1

146
Introduction: Since 2015, the Haute Autorité de santé (HAS) - or French National Authority for Health
- has been developing outcome indicators based on national medico-administrative databases, using
a robust method conceived to improve care quality and safety. This work is achieved with a
multidisciplinary working group of healthcare professionals, medical information coding doctors and
patients.

In 2022, an outcome indicator in cardiology has been validated by HAS. It assesses mortality 30 days
after acute myocardial infraction (MI) based on the French national health data system.

The aim of this retrospective study presents a 2021 data analysis and results of the indicator measuring
mortality 30 days after MI, at the national and hospital levels.

Methods: All adult patients with a hospital stay for acute MI (principal diagnosis ICD-10 codes: I21.0,
I21.1, I21.2, I21.3, I21.4, I21.9) that occurred between January 1st and November 31st, 2021, in the
French national data system were selected. Main exclusion criteria were patients not admitted from
their home, without a permanent address in France, with death not related to in-hospital care (e.g.
palliative care, discharge against medical advice) and/or stays with data or linkage problems.

Mortality was looked for at 30 days from admission, within acute MI stays and after discharge, in and
out of hospitals. Adjustment factors are age, gender, STEMI (ST segment elevation myocardial
infarction), 11 comorbidities detected within 3 years before admission, 3 acute and severe
complications during the acute MI stay, supplementary universal healthcare for individuals on low
income. Crude mortality rates and a “standardized ratio of observed on expected mortality” were
calculated.

Results: 754 hospitals and 77 417 acute MI stays were assessed. Overall, 30 days mortality rate was
5.9%. It was significantly higher in females (8,2%), in patients with STEMI (7.9%), with a history of
stroke (11%), heart failure (12.8%), kidney failure (12.6%), diabetes (8.35%) and cancer (8.7%). 72% of
mortality occurred during the initial MI stay.

Among 521 hospitals with at least 10 MI stays, 91% had a standardized ratio within 2 standard-
deviation (SD) limits of the funnel plot; 3 (0.6%) above +3 SD, 40 (7.7%) were outliers between +2 SD
and +3 SD and 2 (0.4%) outliers below -3 SD.

Conclusion: HAS validated an outcome indicator measuring mortality 30 days after acute MI at the
national and hospital levels, using a robust method. National analysis using claim data are consistent
with previous studies. Results of this indicator at the national and hospital levels have been made
available to hospitals since December 2022, based on 2021 and 2020 data. National figures were
similar in 2020, despite 5% less MI stays. HAS is expecting the feedback of French hospitals regarding
the use of this indicator as a tool for quality improvement and risk management.

Disclosure of Interest: None Declared

147
Lightning Talks

Perception of stakeholders’ readiness and recommendations for health system policy

and implementation in scaling up Hospital-at-Home care model: A descriptive qualitative study:
(1859) Crystal Min Siu Chua

ISQUA2024-ABS-1859

C. M. S. Chua 1 2,*, E. W. Z. Lim 3, W. H. See Tho 3, Y. F. Lai 1 4

1
MOH Office for Healthcare Transformation, 2Alice Lee Centre for Nursing Studies, 3Department of
Pharmacy, National University of Singapore, Singapore, Singapore, 4School of Public Health, University
of Illinois Chicago, Chicago, United States

Introduction: Amid escalating healthcare demands due to shifting demographic patterns, innovative
care models like the Hospital-at-Home (HaH) emerge as promising solutions. The study aims to assess
Singapore's health system readiness for implementing the HaH model and to identify ground and
policy strategies for its widespread adoption.

Methods: This study used in-depth semi-structured individual interviews on 32 healthcare

stakeholders (HaH programme leads, programme implementers, and health ministry’s policymakers)
between October to November 2023. Interviews were transcribed and thematically analysed using
Bruan and Clarke’s (2006) six-step inductive approach.

Results: Perceived readiness and recommendations to scale were supported by four themes: (1)
Overall readiness towards HaH, (2) Recommendations for ground implementation, (3) Key policy
enablers for HaH, and (4) Envisioning the future approach to service delivery and collaborations.
Thematic analysis revealed the intricacies of scaling up HaH through the multi-stakeholders’
perceptive. Overall, most stakeholders expressed readiness and are motivated to scale HaH, though
they require resources and strategic direction. The importance of having streamlined processes, up-
skilled workforce, adequate resources, and sound financing mechanism is key to scaling up HaH.

Conclusion: The findings contribute significantly to the body of implementation science, offering
evidence-based policies, guidelines, and protocols for HaH care models. Our study's results offer
valuable insights not only for Singapore, but also for countries with similar healthcare challenges,
paving the way for effective and efficient healthcare delivery amid changing demographic landscapes.

References: Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research
in psychology, 3(2), 77-101. [Link] 10.1191/1478088706qp063oa

Disclosure of Interest: None Declared

148
AI tracking Multidisciplinary Decision Making: Enabling a regional support tool: (3392) Dominic
Van Loggerenberg

ISQUA2024-ABS-3392

D. Van Loggerenberg 1,*, C. van Loggerenberg 2, C.-A. Benn 3, T. Volschenk 1

1
Research, Netcare Breast Care Centre of Excellence, 2Emergency Medicine, Life Health Care,
Johannesburg, 3Immunology, University of Pretoria, Pretoria, South Africa

Introduction: The integration of AI in Healthcare allows for a unique opportunity to replicate advanced
decision-making systems that are not limited by resources and regional constraints. Within the LMI
environment of South Africa, Multi-Disciplinary care is recognised as the preferred gold standard.
However, this service is not easily offered to all patients. AI-driven decision-making tools help bridge
this gap.

Methods: The BCCE is in the process of developing and training an AI-adjacent MDM decision-making
tool that incorporates internal patient scoring systems, global guidelines and time-based pattern
analysis to replicate the decision-making making process of their large (35+) specialist Breast Oncology
MDM.

Initial development digitalised the patient intake and discussion form, including clinical, radiological
and pathological reports that were scored alongside patient-specific treatment co-morbidities. This
was matched on a three-fold track aligning with international guidelines, MDM decision-making
considerations and uniquely a low-resource solution as an alternative to international/first choice
solutions.

Results: Initial development of the AI tool required re-analysis and integration of patient intake and
discussion to expand on the historical triple assessment (Clinical Radiological and Pathological) to
include a deeper clinical review of co-morbidities and advanced patient clinical and demographic
considerations.

The correlation between International guidelines and MDM team decisions aligned for the greater
majority of patients, deviating only from what was considered novel treatment options that were
discussed with reference to new studies and potential changes to guidelines that have not reached a
global consensus.

The largest deviation was the specific task of generating minimal accepted treatment options for cases
that would not be addressed at facilities capable of providing first-choice treatment. The benefit and
implementation of this data are still in their conceptual phase and have not been integrated into a live
case environment.

Conclusion: The demonstrable benefits of AI decision-making tools in LMI environments can assist in
providing top-tier care in the form of academic expertise and experience regardless of the regional and
infrastructural limitations. If care is taken to align the supportive tools with the limitations of their
matched environments, optimal care choices that match the standards of Multi-disciplinary teams can
be provided in environments that previously would not.

Disclosure of Interest: None Declared

149
A Comprehensive Survey of the Clinical Trial Landscape on Digital Therapeutics: (2275) Han Yao

ISQUA2024-ABS-2275

H. Yao 1,*, Z. Liao 2, X. Zhang 1, X. Zhang 1, M. Li 1, L. You 1, Y. Liu 1

1
School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union
Medical College, Beijing, 2National Clinical Research Center for Infectious Disease, Shenzhen Third
People’s Hospital, Shenzhen, Guangdong Province, China

Introduction: Digital therapeutics (DTx) is an emerging and groundbreaking medical intervention that
utilizes health software to treat or alleviate various diseases, disorders, conditions, or
injuries. Although the potential of digital therapy is enormous, it is still in its nascent stage and faces
multiple challenges and obstacles. The purpose of this study is to provide an overview of all DTx-related
clinical trials in [Link] and to promote the advancement of DTx.

Methods: Two reviewers and one expert collaborated to evaluate data from all clinical trials of digital
therapeutics registered on [Link] as of August 8, 2023. Our analysis encompassed trials that
utilized digital therapies independently, as well as trials that combined digital interventions with
traditional clinical approaches. Incomplete trials, interventions lacking an evidence-based foundation,
and digital interventions unrelated to treatment, management, or prevention purposes were excluded
from our analysis. By utilizing official disclosures, we extracted and analyzed basic information about
product launches and primary outcome measures from these clinical trials.

Results: We conducted a thorough review of all digital therapy studies registered on [Link],
analyzing a total of 280 eligible trials categorized into treating a disease (141, 50.4%), managing a
disease (120, 42.9%), and improving a health function (19, 6.8%). Registered and completed trials of
digital therapies have primarily focused on mental and behavioral disorders, neurological disorders,
and endocrine, nutritional, and metabolic disorders, which together represent 59.3% of trials
conducted. Digital therapies have undergone three phases of development, with the number of
relevant studies increasing annually. However, their trial design and conduct remains inconsistent and
inadequate, and many studies remain small with limited evidence for their trial endpoints.
Randomized controlled trials (RCTs) comprised 67.5% of completed clinical trials on digital therapies.
Furthermore, 36 trials (12.9%) involved products that were already approved for marketing. As the
digital therapy industry is still in its early stages and lacks a standardized system for clinical design,
clinical design and endpoint selection vary across marketed products.

Image:

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Conclusion: The increasing number of clinical studies on digital therapeutics and their demonstrated
ability to address a wide range of healthcare challenges highlights the growing importance of digital
therapeutics in shaping the future of digital healthcare. However, despite their potential, digital
therapeutics still face significant challenges in achieving widespread dissemination and adoption.
There is a lack of a comprehensive, detailed, and harmonized global classification of digital therapies,
as well as clinical trial specifications and standards for different technology modalities. Furthermore,
there is a need to further explore ways to assess the methodology and quality of relevant study
designs, strengthen regulation, standardize trials to ensure clinical efficacy, enhance data security
measures, and improve the quality of healthcare services by advancing evidence-based approaches.

References: 1. Makin S. The emerging world of digital therapeutics. Nature 2019; 573(7775):
S106-9.

2. Recchia G, Capuano DM, Mistri N, Verna R. Digital therapeutics-what they are, what they will
be. [Link]: 10.31080/ASMS.2020.04.0575

3. Palanica A, Docktor MJ, Lieberman M, Fossat Y. The need for artificial intelligence in digital
therapeutics. Digit Biomark 2020; 4(1): 21-5.

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 4. Digital Therapeutics Alliance. Understanding DTx. [Link]
dtx/what-is-a-dtx/ Date: Date accessed: Aug. 15, 2023

5. Choi MJ, Kim H, Nah HW, Kang DW. Digital therapeutics: emerging new therapy for neurologic
deficits after stroke. J Stroke 2019; 21(3): 242-58.

Disclosure of Interest: None Declared

Use process control and digital transformation to improve operating room efficiency: (1807) Hsing-
Hao Su

ISQUA2024-ABS-1807

Hsing-Hao Su* 1, 2, Yaoh-shiang Lin3, Jin-Shuen Chen3, Chia-Cheng Yu4, Yuan-Yi Chia5, Wang-Chuan
Juang6, Gwo-Ching Sun5, Fu-Lien Chuang7, Shu-Ling Wang1, 7 and Operating Room Working Group: Ms
Hsiang-Yi Liao, Ms Li-Hua Lin, Mr Chun-Ming Chen
1
Operating Room, 2Otorhinolaryngology, head and neck surgery, 3Hospital Headquarter, 4Surgery,
5
Anesthesia, 6Quality Management Center, 7Nursing, Kaohsiung Veterans General Hospital, Kaohsiung
City, Taiwan

Introduction: The operating room (OR) accounts for a large part of the hospital's revenue. It is also a
department with complex operating procedures, intensive resources and high costs. As competition
in the healthcare industry intensifies, it is necessary to find management methods to improve
operating room usage efficiency and patient safety. Multiple factors have been found to contribute to
ineffective operating room care and patient safety. These factors range from surgical scheduling,
preoperative assessment and care, operating room management and postoperative recovery, to
human factors such as insufficient manpower, equipment and instruments that add to the
complexity.

Methods: There are multiple time points for patients to go from the ward to the operating room for
surgery, including waiting after registration, entering the operating room, arrival of the
anesthesiologist, completion of induction of anesthesia, completion of preoperative preparation by
the surgeon, start of surgery, completion of surgery, and transfer to the recovery room and connect
the next patient to the operating room. Each node has a time record, and improvement strategies
are proposed through process control and analysis of various delay factors. Based on patient safety,
surgeons and anesthesiologists set time benchmarks for different surgeries, and we control those
who exceed the time limit. In addition, an electronic whiteboard is used to display the current status
of each operating room, anesthesia and operating surgeons are notified via text messages, and AI is
used to optimize scheduling and improve surgical utilization.

Results: With the determination of the hospital superintendent to advance the first incision time, the
operating room saves about 400 hours every quarter compared with the previous period. Through
the process control with digital transformation, including connection time, anesthesia induction
time, and surgical preparation time all have been reduced, and the average number of operating
room hours required for each operation has also been reduced. After improving efficiency, it is
equivalent to save totally about 2300 hours per quarter compared with before. The total number of

152
surgeries has increased compared to the past, and the number of overtime hours worked by nurses
has also decreased. It is worth mentioning that the complication rate of patients did not increase
during this period.

Conclusion: Smart surgery management integrates patient safety, humanity, digital transformation,
and all aspects of surgery. Our series achieve the goal of reducing the overtime burden and
improving performance of operating room.

Disclosure of Interest: None Declared

The digital direct-to-consumer telemedicine revolution: Consumer perspectives of benefits and

pitfalls: (2466) Louise Ellis

ISQUA2024-ABS-2466

L. Ellis 1,*, K. Churruca 1, S. Spanos 1, M. Saba 1, D. Foo 1 2, J. Braithwaite 1

Australian Institute of Health Innovation, Macquarie University, 2Healthdirect, Sydney, Australia

1

Introduction: With the advent of the COVID-19 pandemic, telehealth rapidly became the ‘new
normal’.1 The pandemic acted as a catalyst for policy makers and providers to embrace telehealth as
an accepted form of health service delivery and as a solution to meeting continued increased demand
for services.2 At the same time, consumers’ expectations of healthcare have changed, with many
consumers now looking for seamless digital health care experiences similar to those found in the
online retail sector, thereby avoiding the hassle and frustrations of wait times and in-person
consultations.3 In recent years, Australia and other countries have witnessed the exponential rise of
private direct-to-consumer (DTC) services. Providing virtual care services that are marketed directly to,
and initiated and paid by the patient, they offer services ranging from general practitioner services
through to targeted treatment pathways for specific issues or conditions (e.g., weight loss, or sexual
health concerns).2 With limited existing research in this area, this study examines DTC consumers’
perspectives of their use of such services, including benefits and concerns.

Methods: An anonymous online survey of a sample of 206 DTC consumers was conducted in
November 2023. Participants were recruited through an Australian digital healthcare company that
features a number of distinct DTC brands. The survey included a combination of quantitative and
qualitative questions asking about their use of DTC services, perceived benefits, and about any issues
or concerns they may have.

Results: Two-thirds of survey participants were accessing DTC services for prescription skincare (67%),
followed by men’s health treatments (36%), and reproductive healthcare (5%), with 10% of
participants accessing multiple DTC services. The vast majority of participants reported positive
experiences of their use of these services: 92% agreed that using DTC services had given them ‘greater
autonomy when managing their health’ (92%); and 92% agreed that they had been provided with
153
‘sufficient information, advice and support in relation to their health concern/s’. Most commonly,
participants accessed DTC telemedicine due to its ‘convenience’ (47%) and ‘choice’ (i.e., wide range of
products and services available) (34.5%). Open ended responses revealed that participants also
appreciated the ‘anonymity’ that DTC services provide, especially for sensitive issues such as erectile
dysfunction. Nevertheless, participants raised concerns, particularly around the costs associated with
the prescribed medications (19%) and privacy concerns over ‘how their information is being used’
(15%), as well as the ‘lack of integration’ of these services with the wider health system (12%).

Conclusion: DTC telemedicine is a fast-growing industry offering significant advantages to healthcare

consumers, including improved access, convenience, choice and anonymity. From a policy perspective,
some of the biggest concerns with DTC services centre on the cost and effectiveness of treatments,
the lack of follow-up and monitoring, and the lack of regulation.4,5 These services also often feature
strong digital marketing campaigns and are commercially driven, bringing into question the extent to
which profits are being prioritised over the health of consumers.2 This is one of the first studies of DTC
consumers perspectives and experiences; however, as the DTC industry continues to grow, there is a
need for long-term research and evaluation.

References: 1 Ellis LA et al. (2021) JMIR mental health, 8(12), e32948; 2 Foo D et al. (2023) MJA, 219(8).
344-347; 3 Tomlin W et al. (2023). EY, June 20; 4 Bollmeier SG et al. (2020) Missouri Medicine, 117(4),
303; 5 Cohen AB et al. (2020) The Lancet Digital Health, 2(4), e163-e165.

Disclosure of Interest: None Declared

Prioritising electronic health record optimisation to reduce technology-related prescribing errors

and improve patient safety: results from two tertiary paediatric hospitals: (2387) Magda Z Raban

ISQUA2024-ABS-2387

M. Z. Raban 1,*, A. Merchant 1, E. Fitzpatrick 1, B. Rahman 1, L. Li 1, J. Westbrook 1

Australian Institute of Health Innovation, Macquarie University, Sydney, Australia

1

Introduction: While electronic health records (EHRs) can improve care, they can often lead to
unintended consequences. One such unintended consequence affects medication safety in the form
of technology-related errors (TREs), which have been found to account for up to 40% of prescribing
errors after the implementation of an EHR. Addressing TREs to improve medication safety requires an
understanding of how they occur, i.e. their underlying mechanism. However, EHR managers are often
flooded with requests for system optimisation, and thus prioritising optimisation is crucial.

One approach to prioritising quality improvement initiatives is the use of the Pareto principle to
identify the causes contributing to 80% of the effects, i.e. the vital few. Targeting the vital few will
deliver the largest quality and safety gains. In this study, we aimed to examine the relative frequency
of TRE mechanisms to identify priority areas for EHR optimisation to reduce TREs at two tertiary
paediatric hospitals and examine whether the priorities differ by site.

154
Methods: Electronic medication charts and records of ~1200 patient admissions each at two tertiary
paediatric hospitals were reviewed for prescribing errors by an experienced clinical pharmacist. Each
prescribing error was assessed to determine whether it was technology-related. A TRE was defined as
an error where the functionality or design of the EHR likely contributed to the error. Each TRE was then
examined to identify the underlying mechanism of the error, or how the error happened. Mechanisms
were classified using the Technology-Related Error Mechanism (TREM) classification, which has 7
categories of mechanisms. Pareto charts were generated to identify the TRE mechanisms that
contributed to 80% of the TREs and explore possible EHR enhancements.

Results: There were 10,596 and 8335 medication orders reviewed for errors at hospital 1 and 2,
respectively. Of the 1638 (hospital 1) and 1841 (hospital 2) prescribing errors identified, 28% were
assessed as technology-related. At both hospitals, four mechanisms contributed to 86% of TREs (Figure
1). When examining results by site, the same four mechanisms contributed to 80% of the errors,
however their relative frequency differed. For example, at hospital 1, the top error mechanism was
errors that occur when using new workflows (33% of all errors), and at hospital 2, the top mechanism
was editing errors (24% of all errors).

Examples of errors that occurred when using new workflows included failure to view the updated
medication profile prior to prescribing. Examples of errors in system configuration included rounding
rules in the dose calculator which resulted in dose errors for younger children.

Image:

Conclusion: Understanding the relative contribution of the underlying mechanisms of TREs can assist
in prioritising EHR optimisation activities. In this study, among other mechanism errors, addressing
dose calculator rounding rules was a low hanging fruit that would address a large portion of errors.
Recommendations from these results are available in the Health Innovation Series on e-Medication
Safety.1

155
References: 1. Health Innovation Series: e-Medication Safety.
[Link]
people/centres/australian-institute-of-health-innovation/our-projects/Health-Innovation-
Series/health-innovation-series-e-medication-safety

Disclosure of Interest: None Declared

How well do electronic health records support medication administration in paediatric hospitals?:
(2422) Magda Z Raban

ISQUA2024-ABS-2422

M. Z. Raban 1,*, A. Woods 1, T. Badgery-Parker 1, L. Li 1, J. Westbrook 1

Australian Institute of Health Innovation, Macquarie University, Sydney, Australia

1

Introduction: Accurate documentation of clinical care is important to ensure care quality, safety and
continuity, and is a professional responsibility of healthcare workers. Electronic health records (EHRs)
are being implemented in hospitals worldwide to support these objectives. Automation in EHRs can
improve documentation efficiency, however little is known about the impact of EHRs on the accuracy
of documentation. Accurate documentation of medication administration is particularly important
given that medication errors continue to be the leading cause of incidents in hospitals. Few studies
have examined how effectively EHRs support medication administration documentation and
processes, and the design features that facilitate accuracy. Thus, we aimed to compare the accuracy
of medication administration documentation in an EHR with paper medication charts at a tertiary
paediatric hospital.

Methods: This was part of a larger study examining the impact of an EHR on medication errors in a
tertiary paediatric hospital, Sydney, Australia. Trained nurse observers recorded details of medication
administrations before and after implementation of electronic medication management in an EHR.
Recorded details included whether the medication administration was signed for, time of signing, and
the method of administration (e.g. route of administration). The observed data were then compared
to the nurses’ documentation on medication charts to identify discrepancies. The outcomes were the
proportion of administrations with: i) no signature; ii) no time; iii) inaccurate documentation of method
of administration, and iv) ancillary instructions not matching doctors’ instructions. Ancillary
instructions could be automated in the EHR, or added by a pharmacist on paper charts. We also
examined the difference in the administration time documented compared with the actual time
medication was given.

Results: Observers captured details of 5137 administrations given by 298 nurses. Few administrations
had no signature, with no difference (p=0.33) between EHR (1.0%, n=29) and paper charts (1.3%,
n=27). Similarly, administrations with no time documented were infrequent on paper charts (1.2%,
n=26) and in the EHR (0.3%, n=10, p<0.001). However, the proportion of administrations with
inaccurate documentation of the method of administration (e.g. route) was higher in the EHR This

156
inaccuracy occurred most frequently for paracetamol, piperacillin/tazobactam and cefazolin, and was
related predominantly to the route of administration (e.g. IV injection vs infusion). There was a conflict
between ancillary instructions and the doctors’ prescription in 1.0% (n=21) of administrations from
paper charts compared with 2.3% (n=28) from the EHR (p<0.001). The documented time of
administration was less than 5 minutes from the actual administration time for 63.2% (n=639) of
administrations on paper charts compared with 81.8% (n=2339) of administrations in the EHR
(p<0.001).

Conclusion: The completeness and accuracy of documentation of medication administrations was

generally high using paper or EHR charts except for the method of administration. We found 1 in 10
administrations had an inaccurate method of administration in the EHR, which may have important
implications for patient care. Auto-population of this data field in the EHR likely facilitates inaccurate
information. Allowing nurses to annotate details of an administration when signing off may improve
accuracy. EHR use was associated with a reduction in the time lag between administration and
recording time of administration suggesting improved efficiency in the process.

Disclosure of Interest: None Declared

Community engagement to build a bridge: an empirical examination of the strategic large-scale

redesign of future health services: (2252) David Greenfield

ISQUA2024-ABS-2252

K. Eljiz 1, D. Greenfield 1,*, A. Derrett 2

School of Population Health, Faculty of Medicine and Health, University of New South Wales,
1

Western Sydney Local Health District, Sydney, Australia

2

Introduction: Community engagement can result in better health outcomes across multiple
morbidities. Hence, community engagement is being conducted in multiple ways, transforming how
health services conceptualise, organise and deliver care, including through the community
participating in long term care and strategic planning. The challenge for healthcare policy makers,
managers and practitioners is finding ways to effectively collaborate with patients and the broader
community to plan, deliver and evaluate services. The study purpose is to examine how health
managers engage the community with the strategic redesign of health services. We present strategies
and actions for those tasked with managing large scale redesign and building new healthcare facilities.

Methods: The study setting is a large health district in New South Wales, Australia and focused on four
large scale redevelopment projects, total value at A$2.8 billion. The study employed a multi-methods
design comprising semi-structured interviews and focus groups. Participants were professionals (n=24)
involved in the strategic planning of health facility redevelopment. Thematic analysis was used to
identify, analyse and report common responses.

Results: Three issues emerged as significant factors influencing engagement, including: establishing a
new mindset to service planning and delivery; future proofing service delivery; and, management of
stakeholder expectations. Collaborating with diverse populations introduces more ideas driving

157
creative approaches to developing models of care and questioning about what other interventions can
occur. Moreover, the benefits then extend further beyond the building process as engaging with the
community leads to better health outcomes across multiple health issues that significantly impact
individuals, populations and the healthcare system.

Conclusion: Large scale redevelopment projects provide a platform for the strategic redesign of health
services. When doing so, engaging the community with strategic planning, implementation and
evaluation of healthcare services can lead to improved care outcomes. Community engagement with
a forward-thinking lens fosters an environment that allows flexible, strategic planning. Additionally,
strategic community engagement provides opportunities for codeveloped systems, structures and
processes that facilitate ongoing engagement.

Disclosure of Interest: None Declared

From Bits to Brilliance: Enhancing the Efficiency of Cancer Registry Coding Quality Review by
Human-factors engineering digitalization at a Medical Center in Taiwan: (1784) Mau-Shin Chi

ISQUA2024-ABS-1784

W.-M. Chen 1, Y.-Q. Chen 1, C.-K. Lin 2, M.-C. Chou 3, C.-Y. Cheng 4, J.-Y. Lee 5, S.-M. Hou 6, M.-S. Chi 7,*
1
Cancer Registration Division, Cancer Prevention and Management Center, 2Information Department,
Application System Maintenance Section, 3Cancer Prevention and Management Center, 4Department
of Chest Medicine, 5Center for Quality Management, 6Superintendent Office, 7Department of
Radiation Therapy & Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

Introduction: Ensure precise coding through medical record reviews is crucial for cancer registration.
The current review process involves case selection, reviewer assignment, form printing, binding, and
distribution, followed by statistical analysis and reviews. Completion time of the review process sits
between one week to two months. Cancer registrars spent significant timings in the follow-ups,
primarily due to misplaced paper forms requires reprinting, and incomplete fields after form retrieval.
The primary goal of the study is to identify determinants impacting review process by interdisciplinary
team to formulate strategies achieving 50% reduction in the overall reviewing time.

Methods: This study centers on the review physicians and employs a questionnaire survey about the
reviewing process. The questionnaire underwent prior expert validations before deployed to 38
reviewing physicians. The results were discussed to the interdisciplinary team using SIPOC Model to
enhance mutual understanding (Fig. 1). Through collaborative brainstorming, augmented by in-depth
analysis using ChatGPT, we consider a user-centric approach and integrate a human-factors
engineering to minimize errors and maximize convenience. This integration is designed to filter cases
and automatically assign 15% of newly diagnosed cases for review. Following validation by cancer
registrars, the system then assigns tasks to review physicians, and streamlining communication
through SMS. The process was then optimized with ECRS method for quality review (Fig. 2). A statistical

158
analysis of review records is conducted to calculate computer operation steps and process timing,
affirming the improvements.

Results: Survey results show that 61% of physicians temporarily delay tasks due to the time-consuming
review steps, especially handling paper forms and dealing with misplacement issues. The introduction
of a human-factors engineering digitalization system enables physicians to conveniently conduct
computer-based reviews within the hospital or via VPN-secured channels. Statistical analysis shows a
reduction in computer operation steps from an average of 16 to 11 per medical record. The median
total review time significantly decreased from 19,199 (13.33 days) to 7,048 minutes (4.89 days),
achieving a completion rate of 126.5% and progress rate of 63.3%. This streamlined digital process not
only reduces workload for cancer registrars but also brings intangible savings in manpower resources
and costs. It aids in the smooth transition to paperless operations and sustains our improvements (Fig.
3).

Image:

Conclusion: The study successfully achieved its primary goal of 50% reduction in overall review time.
The introduction of structured information systems by human-factors engineering digitalization
enhancement, and the electronic forms optimized the review process, and provided economic
benefits. The digitalizing processes may hold a potential to improve healthcare operations, particularly
in cancer review and cancer care quality.

159
References: 1. China Medical University Hospital. (2015). Towards a Paperless Hospital: Smart
Electronic Health Records. In Proceedings of the 15th National Healthcare Quality Award Competition.
[Link]

2. Christian Hospital Cheng-Der in the David Medical Foundation. (2016). Professional Review:
Smart Electronic Submission of Reviewed Medical Records. In Proceedings of the 16th National
Healthcare Quality Award Competition. [Link]

3. Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien. (2015). Exploring the
Effectiveness of Outpatient Paperless Review Submission. In Proceedings of the 15th National
Healthcare Quality Award Competition. [Link]

4. Chu, H.-Y., Chang, C.-Y., Lin, L.-J., Chiu, S.-H., Chen, S.-Z. (2013). "Development of an Electronic
Health Record Quality Review System." Journal of Medical Record Information Management, 12(1),
31-45.

Disclosure of Interest: None Declared

Digital Health Transformation: “What and How to Achieve Success?”: (2667) Rr Tutik Sri Hariyati

ISQUA2024-ABS-2667

R. T. S. Hariyati 1 2,*, A. Sheikh 3 4, D. D. Dharmajaja 2 4

1
Faculty of Nursing Universitas Indonesia, Depok, 2KARS, Jakarta, Indonesia, 3
The University of
Edinburgh, Edinburg, United Kingdom, 4IsQua Board, Dublin, Ireland

Introduction: Digital health transformation aids in improving health care quality and reducing health
costs since health services-related information is open for people and helps them to avoid disparities
in the standards of health services provided. Many efforts have been implemented to make the digital
health transformation a success, including the creation of a digital ecosystem, that the team has helped
accelerate society's adoption of the disruptions influenced by the digitalization transformation.

Methods: This research aims to analyse assistance in accelerating the implementation of electronic
medical records and data integration of "SATU SEHAT Indonesia." The design used was descriptive
qualitative through Focus Group Discussions (FGD) with eleven (11) participants from the team
working group (TWG) formed by the government to help implement digital health transformation.
Other participants are users and leaders of organizations involved in EMRs [Link] FGD
was conducted in the meeting online room and was held for about 60 minutes. All information from
the participants were recorded by tape recording. At the end of the meeting, a number of unclear
questions were asked again. All data in this study have been verified and reached saturation at the end
of the interview. The FGD ended when all questions were answered, and all participants submitted
their information. Transcipts were read twice to catch any writing error, then the data were organised,
extracted to find meaningful using thematic approach.

Results: The results of the transcrips analysis obtained four themes. The themes namely Team Working
Group tasks, benefits of EMRs, human resource and infrastructure constraints, and the need digital

160
transformation regulation. The perceived benefits are time effectiveness, fully documented reporting,
easy coordination, bridging referrals, and the costs should be cheaper. The policies required are
regarding data release, data security and confidentiality. TWG's task is to help develop standardization,
assist adoption & implementation, utilization and data analysis.

Image:

Conclusion: Many strategies are needed in implementing digitalization, including regulations and
efforts to reduce obstacles due to the inability of human resources and infrastructure. The TWG is
expected to be able to oversee implementation through standardization, assisting adaptation and
utilizing data for health quality.

References: Kementrian Kesehatan. (2022). Peraturan Menteri Kesehatan Republik Indonesia Nomor
24 Tahun 2022 Tentang Rekam Medis.

Ngusie, H. S., Kassie, S. Y., Chereka, A. A., & Enyew, E. B. (2022). Healthcare providers’ readiness for
electronic health record adoption: a cross-sectional study during pre-implementation phase. BMC
Health Services Research, 22(1). [Link]

Setyadi, D., & Nadjib, M. (2023). The Effect of Electronic Medical Records on Service Quality and Patient
Satisfaction: A Literature Review. Journal Research of Social Science, Economics, and Management,
2(12), 2780–2791. [Link]

161
Woldemariam, M. T., & Jimma, W. (2023). Adoption of electronic health record systems to enhance
the quality of healthcare in low-income countries: A systematic review. BMJ Health and Care
Informatics, 30(1). [Link]

Disclosure of Interest: None Declared

A Sustainable Health Technologies Innovation Model To Improve LRS Clinical Outcomes: (3327)
Stefano Bergamasco

ISQUA2024-ABS-3327

T. M. Judd 1 2, Y. David 3,*

Liaison Director, Global Clinical Engineering Alliance, 2STAG MEDEV, World Health Organization,
1

Marietta, 3President, Global Clinical Engineering Alliance, Houston, United States

Introduction: Access to innovations in health technologies (HT) and the capacity to implement locally
is one of the pillars identified by the World Health Organization’s (WHO) global strategy. Health
innovation aims to develop and deliver new or enhanced health policies, systems, products,
technologies, services, and delivery methods to improve people's health. Medical devices, oxygen
sources, digital health tools, and personal protective equipment are defined as HT having potential to
improve quality of life and health outcomes and improve efficacy. However, access to high quality, safe,
appropriate, and affordable HT is not equitable, most severely in low resource settings (LRS). The
COVID-19 pandemic heightened the need for connected and innovative HT, especially in LRS. The
authors participated in two rapid WHO evidence-based innovation assessments with teams that
addressed the following dimensions, resulting in two Innovation Compendia published in 2021 & 2022:
(1) clinical assessment; (2) WHO specification comparison; (3) regulatory compliance assessment; (4)
technology evidence assessment; (5) health technology and engineering management assessment
(authors’ focus area; Figure 1); and (6) intellectual property and potential of local production.

Our global professional organization GCEA contracted with WHO’s Medical Device Unit for these
assessments and voluntarily engaged 100 reviewers from fifty LRS countries to collect on-the-ground
evaluation of products for the two Compendia.

Methods: As noted, the process for accepting HT into the Compendia is multidisciplinary, beginning
with call for submission, an initial review for completeness, and then based on the material and
evidence submitted, assessments are conducted followed by a synthesis of the findings, with final
deliberation and selection of HT included in the Compendium. The submission and screening process
eliminates technologies that do not fulfil the basic HT criteria, and the assessment method for ranking
technologies and review of results are continuously being monitored and improved.

Results: For example, the 2022 Compendium presents manufacturer/developer-reported information

and multidisciplinary assessment results of 15 HT, that were classified as either commercially available
(7), or prototypes (8). Each technology is presented summarizing the product specifications, the
synthesis of all WHO group assessments, and related WHO guidance material.

162
The Compendia shed light on advantages and challenges associated with implementing innovative HT
in LRS and can be used by governments, NGOs and other stakeholders to support adoption decisions.
They also aim to foster greater collaboration between Ministries of Health, procurement officers,
donors, technology developers, manufacturers, clinicians, academics, and the public to ensure
increased investment in appropriate HT and a connected move toward universal access to essential
HT.

Image:

163
Conclusion: Global medical device sales are expected to rise to reach $658USD billion by 2028. WHO’s
Collaboration Unit co-led the first World Health Innovation Forum (WHIF) in November 2023 with
India’s AMTZ, now a WHO Collaborating Centre and World Trade Center site facilitating global HT
innovation. Combined with WHO’s assessment model, and WHIF/AMTZ efforts at commercialization,
the future for bringing necessary and significant innovation in LRS where most needed is brighter.

References: 2021: [Link]

2022: [Link]

2028: [Link]

GCEA: [Link]

WHO: [Link]
technology/medical-devices

AMTZ: [Link]

Disclosure of Interest: None Declared

Development of AI-based fall prevention models from the perspective of artificial intelligence in
healthcare: (2804) Ya-Ting Ke

ISQUA2024-ABS-2804

Y.-T. Ke 1,*1Nursing , Chi Mei Medical Center, Tainan, Taiwan

Introduction: To examine the current state of fall prevention through the integration of artificial
intelligence (AI) technology and the deployment of "Intelligent Fall-Prevention Lighting and Alert
Systems" in healthcare settings.

Methods: This research entailed developing an AI algorithm for human skeletal image recognition and
establishing a workflow for bed-exit alert software, which were then incorporated into a holistic AI-
based fall prevention framework for clinical validation.

Results: The project successfully developed an AI algorithm for human skeletal image recognition and
established a workflow for bed-exit warning software. The preliminary validation of the fall-prevention
lighting system achieved a detection accuracy rate of up t

Conclusion: The application of AI for bed-exit alerts and patient recognition marks an innovative step
in fall prevention strategies. The use of AI technology in clinical care settings is an anticipated future
trend, which has the potential to improve the quality of care. However, as AI technology rapidly
evolves, continuous validation and enhancement of accuracy in the complex environment of clinical
care remain challenging and necessitate ongoing effort.

164
References: Aranda-Gallardo, M., Morales-Asencio, J. M., Canca-Sanchez, J. C., Barrero-Sojo, S., Perez-
Jimenez, C., Morales-Fernandez, A., de Luna-Rodriguez, M. E., Moya-Suarez, A. B., & Mora-Banderas,
A. M. (2013). Instruments for assessing the risk of falls in acute hospitalized patients: A systematic
review and meta-analysis. BMC health Services Research, 13, 122. [Link]
6963-13-122

Ben Hadj Mohamed, A., Val, T., Andrieux, L., & Kachouri, A.(2013). Assisting people with disabilities
through Kinect sensors into a smart house. International Conference on Computer Medical
Applications (ICCMA), 1-5. [Link]

Callis, N. (2016). Falls prevention: Identification of predictive fall risk factors. Applied Nursing Research,
29, 53-58. [Link]

Disclosure of Interest: None Declared

Use of Artificial Intelligence to Improve Radiology Service Efficiency: (1939) Yung-Cheng Wang

ISQUA2024-ABS-1939

C.-C. Kuo 1, Y.-C. Wang 2,*, W.-C. Tseng 2, Y.-F. Lei 1, P.-C. Wang 1, B.-H. Zhao 3
1
Department of Quality Management, 2Department of Radiology, 3Department of Information
Technology, Cathay General Hospital, Taipei, Taiwan

Introduction: In recent years, AI has fostering the flourishing development of high-tech medical
practices. However, the domain of low risk AI in the work office is crucial yet lacks widespread AI
implementation. Recognizing delays in the radiographic examination scheduling, our institution has
sought to enhance the smoothness of these examinations. To achieve this, the team has embraced
human factors engineering principles, incorporating intelligent technology to establish the "
Automatic Registration and Distribution System (ARDS)." This system is designed to embody a
patientcentric service approach, Promoting with the institution's goals for ESG. By leveraging
intelligent information assistance in operational processes, it aims to reduce patient waiting times,
enhance the efficiency and resilience of staff, and reinforce healthcare quality and patient safety.

Methods:

Aspect of equipment

1. Establishment of the ARDS: Built on the Infrastructure framework, ARDS automatically

interfaces with HIS, RIS, PACS, and other systems. It assists in completing medical orders and
radiological diagnostic reports, integrating software such as scheduler check-in kiosks and queuing
machine. It can automatically transmit, recognize, and distribute physician reports.

165
 2. Implementation of the Bidirectional Feedback APP for Alert and Critical values : ARDS
interfaces with the automated APP to notify ordering physicians through various channels like push
notifications and messages. Ordering physicians can use the APP to contact discharged patients.

Aspect of patient

1. Special Priority Mechanism for Specific Patient Groups: Establishes a prioritization mechanism
for elderly individuals, women, children, and special cases. It provides clear test numbers and
preparation instructions, reducing the time patients spend waiting for examinations.

2. Implementation of Human Factors Design in the Check-In Machine Interface: Incorporates

design elements such as text color, size, font, and background colors based on human factors concepts.
This provides a more comfortable experience for patients using the check-in machine for
appointments, ensuring a clear understanding of scheduling and any contraindications.

Aspect of staff

ARDS extracts patient information from HIS, automatically populating the correct examination sites.
This reduces the risk of data entry errors and incorrect examination positioning. It can decreases the
radiographer’s mental workload and enhancing the resilience.

Results:

1. The patient waiting time for examinations has been reduced by approximately 15 minutes.

2. The patient waiting time for reports has been decreased by approximately 37 hours.

3. Patient satisfaction is 94%.

4. 100% critical values are notified within 2 hours, and 100% alert values are notified within 24
hours.

5. Saved paper, ink, and labor costs amount to NT$640,000, reducing carbon emissions by at least
6,322 kgCO2.

Conclusion: Our institution pioneered the ARDS, it can help infection control, addressing space
constraints, shortening time, the system establishes a prioritization mechanism for vulnerable and
special cases, this aligns with promoting the Sustainability Accounting Standards Board in the
healthcare industry, effectively reducing the mental workload on radiographers, optimizing
operational performance, and enhancing the [Link] ARDS optimizing the selection criteria
for examination items, improving clinical execution convenience and it also simultaneously reduces
manual interventions to decrease the occurrence of patient safety incidents or medical dispute events,
significantly shortens report times, and enhances perceptible healthcare quality. With the
establishment of ARDS system modules, aiming to improve patient examination safety and efficiency,
future expansion to other examination items and other medical centers is envisioned.

Disclosure of Interest: None Declared

166
Good healthcare simulation practices: recent works in France: (1910) Zineb Messarat-Haddouche

ISQUA2024-ABS-1910 : Z. Messarat-Haddouche 1, M.-C. Moll 2, J.-C. Granry 2, C. Legris 1,*, L. May-

Michelangeli 1, A. Lansiaux 1

Haute Autorité de santé, Saint-Denis, 2Société francophone de simulation en santé, Paris, France
1

Introduction: Healthcare simulation is a learning-based teaching method aimed at all healthcare

professionals. It can be employed to provide training and to improve professional practices and risk
management. To encourage the use of healthcare simulation, in 2012 the French National Authority
for Health (HAS) published a review of existing initiatives at national and international level, with
proposals for action (e.g. promotion as a method of continuing professional development), as well as
a good practice guide for organisations wishing to implement and offer simulation programmes to
professionals. In 2015, it provided simulation infrastructures with a guide enabling them to self-assess
their practices and thus steer a voluntary approach to quality improvement. Recently, following the
development of simulation infrastructures, the HAS and the French-language Healthcare Simulation
Society (SoFraSimS) wanted to take stock of current practices and organisations in order to update the
2012 good practice guide.

Methods: Between 2016 and 2020, SoFraSimS conducted a trial with volunteer simulation structures
to assess the relevance and exhaustiveness of the good practice criteria (teaching programmes, human
resources, equipment and premises) set out in the guide. To do this, specially trained simulation
experts (from the medical and paramedical professions) visited each structure and met the teams.
They discussed the results of a self-assessment (score calculated on the basis of a rating grid) that
teams had undertaken to carry out in the four years prior to the visit. A visit report was given to the
structure and included the issues raised, any recommendations for improving practices, if applicable,
and a classification of the structure based on the three types of organisation defined in the guide (type
1: single activity; type 2: activities with limited diversity; type 3: all types of activities).

Results: Ten structures were assessed during the trial (four type-3 structures, four type-2 structures
and two type-1 structures). The results revealed that certain practices, which had not been fully
developed in the guide, needed to be improved: with regard to simulation programmes, for example,
it was found that the quality of the scenarios was particularly variable and that document management
was sometimes not sufficiently developed. In terms of organisation, few resources were dedicated to
simulation-based training and few structures were involved in continuing professional development.
In addition, the assessment of a structure conducting solely in situ simulation highlighted the need to
specifically address good practice for this type of activity (equipment installation plan, patient
information, management of consumables and hygiene practices).

Conclusion: The results of this trial led to initiation of an update process for the healthcare simulation
good practice guide, with the updated version due to be published in early 2024. There are also plans
to update the guide for the assessment of healthcare simulation infrastructures, including the rating
elements, so that, in addition to resources, the quality of programmes is taken into account. In
addition, the classification of structures, seen by participants as a promotional tool, could be made
compulsory for all simulation structures.

Disclosure of Interest: None Declared

167
Case Report: Assisted Village Project By Rizki Amalia Medika Hospital Support National Program
Against Stunting Wasting: (2710) Anggrieni Wisni

ISQUA2024-ABS-2710

A. Wisni 1,*, J. Murdiyanto 1, S. yulianto 1 1Surveiyor, KARS, Yogyakarta, Indonesia

Introduction: Stunting or short children is a problem of chronic malnutrition caused by inadequate

nutritional intake over a long period of time due to providing food that is not in accordance with
nutritional needs. (UNICEF, 2012). The results of the Indonesian Nutritional Status (SSGI) survey show
that the prevalence of stunting in Indonesia in 2022 is 21.6%, the prevalence of stunting in Yogyakarta
in 2022 is 16.6%. Meanwhile, the prevalence of stunting in Kulon Progo Regency is 14.9% in 2021 and
will increase by 15.8% in 2022.

To participate in reducing the stunting rate, Rizki Amalia Medika Hospital launched the Assisted Villages
for Stunting and Wasting program. Based on the results of the RAM hospital coordination meeting, the
Panjatan area was proposed as an activity area for the Assisted Village. This is based on the prevalence
of stunting in this area which is still quite high, namely 15%. The next consideration is because the
Panjatan area is not the Stunting Locus for Kulon Progo Regency in the next 2 year period. This is
important for optimizing activities so that they do not overlap with other agency programs.

The Panjatan area was chosen as a target village because it is ranked 2nd in the prevalence of stunting
and wasting with a figure of 16.1% in 2022, so there is a gap of 2.1% with the national target in 2024.
The area was also chosen because it is an area that is easy to reach and has better cross-sectoral
support

Methods: Goals

Dissemination of the results of the 2022 Rizki Amalia Medika Hospital assisted village project to
support the national program againt stunting wasting

Method

This research method is a Case Report

Results: One of the RAM hospital programs is the existence of an Assisted Village Project in the
Panjatan Area. The spectrum of activities carried out by the hospital team are:

Toddler care

Elderly care

Toddler care is held once a month in all hamlets in the Panjatan Village area on a rotating basis. Toddler
care activities include:

Weight measurement

Height measurement

Screening nutritional status

Education on nutrition and growth and development

168
Providing additional food

Below are information from Toddler Care Activities

Panjatan I (July) 17 All toddlers have normal nutritional status

Panjatan II (August) 19 All toddlers have normal nutritional status

Panjatan III ( September) 20 Of the 20 toddlers, 2 toddlers had poor nutritional status (1 toddler below
the red line and 1 toddler below the yellow line)

Panjatan IV (November) 16 All toddlers have normal nutritional status

Panjatan V (December) 14 All toddlers have normal nutritional status

For toddlers with poor nutritional status, follow-up is carried out as follows:

Accompaniment by the nutrition and midwifery team of Hospital's Assisted Villages for one week as
moral support. During this period, cross-sectoral coordination was also carried out to prepare the next
intervention steps.

Based on the recommendation of the Hospital Assisted Village team, the two stunted toddlers above
were referred by the Community Health Center as first health fascilities to the pediatrician at Rizki
Amalia Medika Hospital.

Further examination and diagnosis were carried out by the dr. Banani Sidiq, M. Sc, Sp. A as pediatrician
in Rizki Amalia Medika Hospital

The results after month intervention showed as the following conclusions:

Child A: Increasing body weight about 300 grams. Increasing body height about 1 cm. Increasing
haemoglobin from low to normal (increase of 1.8 g/dl). Improvement in growth and development to
normal (able to walk). Increasing height, haemoglobin and growth development in child A is good.
However, the weight gain is less because the child cannot taook full dose of milk and protein calories.

Child C: Increasing body weight about 1000 grams. Increasing body height about 1 cm. The increase in
child C's weight and height is good. Haemoglobin and growth and development in the normal category.

Based on observations, it was found that the intervention result in an increase in weight, height and
growth and development of stunted toddlers in hospital assisted village.

Conclusion: Rizki Amalia Medika hospital's assisted village project can detect stunting, wasting
toddlers. The interventions implemented involve cross-sectoral aspects. The intervention stages are
initial assistance, carrying out a referral process, establishing a diagnosis, nutritional intervention,
home visits and monitoring and evaluation. The results of one month's intervention resulted in an
increase in weight, height and growth and development of stunted toddlers in hospital assisted village.

References: -

Disclosure of Interest: None Declared

169
They Save Your Life, We Give it Back: A Quicker, Safer Track to Specialty Beds: (3401) Allison Philpot

ISQUA2024-ABS-3401

A. Philpot 1,* on behalf of Medical Affairs, Patient Flow, J. Lapeer 1 on behalf of Medical Affairs, Patient
Flow, J. Boyce 1 on behalf of Medical Affairs, Patient Flow, S. O'Brien 1, C. Szabo 2

Medical Affairs, 2CEO/Administration, Providence Care Centre, Kingston, Canada

1

Introduction: Where acute care hospitals saves lives in urgent medical emergencies, subacute
hospitals provide specialty services to help patients regain quality of life as quickly as possible.
Transitions into these specialty programs rely on well managed transitions between acute and
subacute organizations. This study analysed data collected at Providence Care Hospital (PCH), a
subacute care specialty hospital with 334 beds, located in Kingston, Canada, and how efforts were
successful in shortening the patient journey back to a life they once knew.

In June 2022, the standard referral-to-admission process took 8-18 days depending on service, leading
to bottlenecks in coordination and delays for patients requiring specialty care. In response to escalating
healthcare demands, an 18-month initiative sought to establish a seamless transition of patients
between acute and subacute care. This initiative sought to reduce administrative and systematic
barriers, improve patient flow, optimize efficiency, and increase access to subacute specialty care
services in rehabilitation, complex medical and mental health services.

Methods: A multifaceted approach was taken to improve access to beds. First, a 3-tier model for
patient assessment was initiated, shifting accountability to Medical Affairs and physicians. Using this
model, floor occupancy became the major factor in access to referral assessment: unit occupancy
>95% triggers full assessment, 85%-95% mandates direct communication between acute and subacute
physicians, <85% leads to automatic admission without assessment. Second, the referral form to
transfer from acute to subacute was reduced from 7 to 3 pages. Third, a “blanket repatriation
agreement” was created between the acute and subacute care centres to reduce physician hesitancy
to admit new patients. This agreement stipulated that the acute care centre readmit any patient who
was transferred to subacute care if they were deemed inappropriate upon arrival. Finally, subacute
care nursing assessors were embedded into high-referring units in acute care to identify suitable
candidates for subacute care through rounds, and social workers were restructured to optimize
discharges.

Results: Data were analyzed using PCH’s PowerBI statistics regarding unit occupancy, admissions, and
wait times. After 18 months of implementing these changes, specialty bed occupancy increased by
13% from 82% in Q2 of 2022, to 95% in Q3 of 2023. Total admission numbers increased over 7% per
quarter, meaning more patients got access to programs to improve quality of life. The patient journey
into specialty services, such as Complex Medical and Rehabilitation, witnessed a notable reduction of
14.4% in wait times.

170
Image:

Conclusion: The success of this quality improvement initiative can be attributed to cross-hospital
efforts, innovative tools, and a strategic restructuring of processes and accountability. The creation of
cooperative agreements, and the reorganization of resources positively impacted patient wait times
and access. This initiative stands as a testament to the effectiveness of collaborative strategies in
optimizing patient journeys and indeed, changing long-term outcomes for patients following a
traumatic event.

Disclosure of Interest: None Declared

Increasing the Capacity for Cervical Cancer Screening for Women on Anti-Retroviral Therapy at
ALERT Comprehensive Specialized Hospital: A Quality Improvement Project: (1094) Abeba Aleka
Kebede

ISQUA2024-ABS-1094

Abeba A. Kebede* 1, Yordanos Mengistu 1, Retina Mamo1

Clinical Governance and Quality , Alert Comprehensive Specialized Hospital , Addis Ababa, Ethiopia
1

Introduction: Cervical cancer is potentially preventable, unlike other reproductive organ cancers.
Effective screening programs lead to a significant reduction in morbidity and mortality associated
with cancer, especially in high-risk women who are living with HIV/AIDS. Ethiopia's first national
guidelines were released in 2015, with only 5% of women aged 30-49 having received cervical cancer
screening in the previous five years. Estimated cytology-based cervical cancer screening is 1.6% in
urban settings and 0.4% in rural areas (WHO household survey, 2003). In Ethiopia, cervical cancer
(13.4%) is among the major causes of cancer. About two-thirds of reported annual cancer deaths
occur among women. The main reasons for high cancer mortality include low awareness of cancer

171
signs and symptoms, inadequate screening and early detection and treatment services, and
inadequate diagnostic and treatment facilities. one of the initiatives in Health Sector Transfromation
Plan 2 (HSTP II) is to increase the proportion of women 30-49 years of age screened for cervical
cancer from 5% to 40%. Baseline data collected from ALERT Comprehensive Speiclaized from Tikmit
to Tahsas in the year 2014 E.C. (October to December of 2021 G.C.), showed only 15% of the target
population in this three-month period screened for cervical cancer screening at ART clinic in ALERT
hospital. Due to the aforementioned factors, this quality improvement was started with the aim of
increasing cervical cancer screening from 15% to 80% of the target in the months of Yekatit 10 to
Ginbot 10, 2014 E.C. (Feb 17th, 2022 to May 18th, 2022 G.C.).

Methods: This quality improvement project was implemented in ALERT Comprehensive Specialized
hospital from Yekatit 10 to Ginbot 10 2014 E.C [Feb 17th 2022 to May 18th 2022 G.C]. Model for
improvement was used to increase coverage of cervical cancer screening among ART-taking clients of
ALERT Comprehensive Specialized Hospital. Fishbone analysis was used to identify the root cause.
Progress was followed with the run chart.

A multidisciplinary team from the ART department and the Clinical Governance and Quality
Directorate was established. The team consists of general practitioners, nurses, quality officers,
adherence case managers, and data encoders.

ART-taking clients of ALERT Hospital were the target population of this quality improvement project.
QI members received basic QI training organized by the Regional Health Office in Addis Ababa and
ICAP. The use of a fishbone diagram was made for root cause analysis. On the driver diagram, change
ideas were placed. Using a focusing matrix, change ideas were ranked in order of feasibility and ease
of implementation.

Interventions included attaching a tag sticker at triage for identifying eligible clients, updating
clintent charts on smart care daily, escorting eligible clients by the Adherence case managers (ACM),
and assigning cervical cancer focal at the ART clinic.

Results: This QI has increased the number of women seen at the cervical ca screening unit from 20%
to 78.2%, and the number of women seen at the cervical ca screening unit from 15% to 59%.

Among 624 women who were eligible for cervical cancer screening in this quarter, 305 were VIA
negative and 19 were VIA positive. 14 of the VIA-positive women were treated with thermal ablation,
and 4 of them received cryotherapy. One patient was referred for LEEP. 164 pap smears were sent;
among these, we have received 43 results. From 43 results 17 CIN I, 1 CIN II, and 1 CIN III were found.
The rest 24 were negative. The total number of eligible women screened for cervical cancer in this
quarter was 367 (58.8%). Total number of eligible women seen at cervical cancer screening unit in
this quarter was 488 (78.2%).

172
Image:

Conclusion: The improvement of the triage system, teamwork among care providers, quality officers,
data encoders, and adherence case managers, detailed health education given to clients about
cervical cancer, technical and material support from our supporting organizations, and regular
meetings held once a week with fruitful discussion among the team—which served as a monitoring
and evaluation tool—all contributed significantly to the success of our QI project.

Disclosure of Interest: None Declared

173
Day 2 – Thursday 26th September

Morning

Short Orals

Can ‘living’ guidelines be made, and if so, will they be used? An evaluation of the Australian Living
Stroke Guidelines: (2390) Peter D Hibbert

ISQUA2024-ABS-2390

P. D. Hibbert 1 2,*, L. K. Wiles 2, Y. Zurynski 1, C. L. Smith 1, C. J. Molloy 1 2

1
Australian Institute of Health Innovation, Macquarie University, Sydney, 2IIMPACT in Health, Allied
Health and Human Performance, University of South Australia, Adelaide, Australia

Introduction: Keeping best practice guidelines up-to-date with rapidly emerging research evidence is
one of the key challenges to delivering evidence-based care. ‘Living guidelines’ approaches enable
continual incorporation of new research, assisting healthcare professionals to apply the latest evidence
to their clinical practice. However, our understanding of how living guidelines are developed,
maintained and applied is limited. The Stroke Foundation in Australia was one of the first organisations
to apply living guideline development methods for their Living Stroke Guidelines (LSGs)(Figure 1),
presenting a unique opportunity to evaluate the process and impact of this novel approach. The
objective for this project was to undertake a mixed methods evaluation of the Living Stroke Guidelines
(LSGs) approach.

Methods: A mixed-methods study was conducted to understand the experience of LSGs developers
and end-users. We used thematic analysis of 29 semi-structured interviews and online survey data
(n=228 responses) to determine the feasibility, acceptability, and facilitators and barriers of the LSGs.
An inductive thematic analysis of the transcribed interview data was undertaken using a team-based
approach. Website analytics data were also reviewed to understand usage. Following individual
analysis, the website analytics (quantitative), survey (quantitative and qualitative) and interview
(qualitative) data were integrated according to a triangulation protocol.. Ethics approvals were
obtained from Macquarie University Human Research Ethics Committee (ID: 7918).

Results: The findings were congruent between all groups and data sources. Overall, the living
guidelines approach was both feasible and acceptable to developers and users. Users indicated
increased trust in the LSGs (69%), likelihood of following the LSGs (66%), and frequency of access
(58%), compared with previous static versions.

Convening and coordinating skills are vital to the success of living guidelines programs, which was a
strength of the Stroke Foundation team. Facilitators to use included collaboration with
multidisciplinary clinicians and stroke survivors or carers. Opportunities for improvement noted by
users included increasing search functionality; enabling sharing of guideline sections; and
development of a mobile app. Increased workload for developers, workload unpredictability, and
limited information sharing, and interoperability of technological platforms were identified as barriers.
There was enthusiasm for ensuring the continuation and embedding of the living guidelines approach;
however, concerns about sustainability and ongoing funding were raised.

174
Web analytics data showed individual access by 16,517 users in 2016 rising to 53,154 users in 2020, a
threefold increase. There was also a fourfold increase in unique LSG pageviews from 2016 to 2020.

Image:

Conclusion: This study is one of the first evaluations of living guidelines and demonstrates that this
approach to stroke guideline development is feasible and acceptable, that these approaches may add
value to developers and users and may increase guideline use. Future evaluations should be embedded
along with guideline implementation to capture data prospectively

Disclosure of Interest: None Declared

175
Development of a national mapping tool for quality and patient safety assurance in the hospital
settings: the MaQPS instrument, structure- criteria- rating methodology and verification method:
(2225) Angeliki Katsapi

ISQUA2024-ABS-2225

A. Katsapi 1,*, D. Kaitelidou 2, A. Karaiskou 3, M. Tsana 1, F. Rizos 1, H. Karanikas 4

1
Euro-Mediterranean Institute of Quality and Safety in Healthcare, 2Department of Nursing, National
and Kapodistrian University of Athens, 3National Agency for Quality in Healthcare, Athens,
4
Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece

Introduction: High-reliability organizations operate at safe levels and are characterized by systematic
approaches that foster a robust culture of quality [Link] focus on protocols,
standardization of daily practice, use of error prevention tools and learning from experience.

WHO asserts that the 1st step in establishing strategic pillars for a national quality programme is to
conduct a situational analysis, to determine the current national state of quality, including priorities,
challenges, capacity, governance, and resources.

Although there are international standards, sustaining well-controlled environments, there is lack of
practically- driven methods to determine the minimum criteria for quality assurance and patient safety.

To bridge the gap, a set of requirements is developed to identify the current state of quality in hospital
care and the applied mechanisms, to identify national priorities and strategies of a national quality
plan for healthcare.

Methods: Mapping for Quality and Patient Safety- MaQPS, was developed as part of a holistic
framework in 2 stages:

- review the different models currently used worldwide and agree on a comprehensive framework to
assess the level of compliance of hospitals with quality and safety standards in a unified approach

- develop a set of criteria and methods for compliance assessment based on international references
and European regulatory requirements.

The structure is based on ΕΝ 15224- Healthcare Quality Management Systems and is a systematized
analysis of the standard requirements into basic compliance tasks with references on valid guidelines,
basic quality and safety [Link] reflects key functions and processes of the hospital in terms of the
application of basic legal and regulative requirements and the basic international safety and quality
assurance standards in the full range of main and supportive services of the facility.

Results: The tool is focused on key areas: Organization, Governance, Patient Safety, Quality assurance,
Improvement, Workforce, Resources Management, Emergency Management, KPIs.

MaQPS differs from other tools as it incorporates patient safety and clinical aspects into a quality
assurance assessment framework through a systematic approach that provides a practical and
traceable pathway to identify deficiencies and benchmark among healthcare providers.

The developed tool is also includes specifications for the quality measurement system to ensure
traceable metrics according to the European Statistics Code of Practice.

176
Conclusion: Mapping the existing compliance status in an objective and structured way is the 1st step
in developing plans and strategies to improve quality and safety in health systems.

MaQPS will evolve as being part of a holistic framework which is under research.

References: Hussein M,Pavlova M,Ghalwash M,Groot [Link] impact of hospital accreditation on the
quality of healthcare: a systematic literature [Link] Health Serv Res.2021 Oct 6;21(1):1057.
Shaw [Link] is not a stand-alone [Link] Mediterr Health J.2015 May 19;21(3):226-31.
Handbook for national quality policy and strategy: a practical approach for developing policy and
strategy to improve quality of [Link]: World Health Organization; 2018.
World Health [Link] Office for the Eastern [Link] safety assessment
manual- 2nd [Link]: 978-92-9022-119-7

Disclosure of Interest: None Declared

Accreditation of Healthcare Facilities in France: A Lever for Developing Good Digital Practices and
Preventing Cyber Risks: (2920) Anne Chevrier

ISQUA2024-ABS-2920

A. Lansiaux 1, A. Chevrier 2,*, I. Dorléans 2, S. Ollivier 2, P. Méchain 2, L. Kéribin 2

DAQSS, 2Accreditation, HAS, Paris, France

1

Introduction: The swift evolution of digital technology in healthcare, coupled with the increasing
threat of cyberattacks targeting hospitals, has led to the development of national action plans. These
plans aim to promote cybersecurity, digital development, and best practices, involving management,
healthcare professionals, and patients.

To leverage theses plans effectively, the French High Health Authority (HAS), the Digital Health Agency,
and the Digital Health Delegation have collectively worked to strengthen digital requirements in the
accreditation for the quality and safety of care in French hospitals.

HAS has established criteria to assess digital practices and cybersecurity within hospitals, while also
concurrently focusing on improving the digital proficiency of surveyors tasked with conducting these
evaluations during accreditation visits.

Methods: - The digital criteria were co-constructed with national bodies specialized in digital
health and experts and underwent consultations with stakeholders, including public and private
hospital federations and patient representatives.

- The 7 additional digital criteria aim to evaluate and promote digital transformation and
cybersecurity plans among hospital management. They also seek to raise awareness among healthcare
professionals about the risks of cyberattacks and proper digital tool usage.

- Test visits confirmed the understanding of the criteria and validated the methodology.

177
 - In the summer of 2023, HAS orchestrated a comprehensive recruitment campaign for 175 digital
surveyors, referred to as “EVN”, possessing specific digital competencies. Webinars featuring
testimonies from institutions that have encountered cyberattacks were used to raise awareness among
establishments and healthcare professionals.

- The selection of EVNs was conducted in partnership with national bodies specializing in digital health.

- Starting from September 2023, these EVNs underwent mixed-format training, including remote
and in-person sessions. Team leaders received enhanced training for mentoring EVNs. All surveyors
completed a module on digital challenges and the new criteria.

- A post-experience review after 140 visits integrating the digital criteria (regardless of
establishment size), involving surveyors and HAS project managers, will identify improvement actions
to be undertaken.

Results: By early 2024, less than a year after the project's launch, 100% of visits include a digital
surveyor and a team trained in digital issues.

This was made possible thanks to:

- Determination of the following seven criteria :

Establishment's mastery of digital security risk

Secure identification of professionals in the information system

Use of the information system for patient record access

Security of medical information communication

Patient's access to their record

Patient information

Adherence to good patient identification practices

- Recruitment and training of 175 digital surveyors

- Training of 100% of the 160 coordinators and 640 other surveyors.

The first results of digital investigations will be presented in mid-2024.

Conclusion: Digital technology has become an essential element in the functioning of the healthcare
system, playing a decisive role in the quality of care.

The successful completion of this project was possible thanks to the commitment of stakeholders,
healthcare facilities, professionals, and the expertise of HAS, recognized by ISQUA in their 2022
accreditation report on the organization and training program of experts.

Disclosure of Interest: None Declared

178
The best results for Virtual Surveys: (1930) Fabio Leite Gastal

ISQUA2024-ABS-1930

F. L. Gastal 1 2 3,*, G. Lolato 4, P. Goes Cruz 5, A. Ruggiero 6

1
President Board, ONA, Sao Paulo, 2University, Unimed, Belo Horizonte, 3Insurance Co., Unimed, 4COO,
5
CEO, 6CFO, ONA, Sao Paulo, Brazil

Introduction: The National Accreditation Organization (ONA) is responsible for developing and
managing Brazilian health quality and safety standards. ONA develop quality and safety standards for
the accreditation of organizations providing healthcare services in all Brazil. It is also made up of a set
of structures, processes, and institutions whose purpose is to make the accreditation process viable in
Brazil.

Objective: Demonstrate the best results for Virtual Surveys.

Methods: The methodology of Virtual Survey has some objectives how: elaboration for
accomplishment of virtual surveys on Organization of Health Care model, establish rules and guidelines
for performing virtual surveys on national methodology and project to be presented and approved by
ONA’s Board of Directors. ONA organize a project and involve the direct participation of all
representatives of the National Brazilian Accreditation System by ONA (Certified Accreditation
institutions (IACs), professionals, members of the Board and invited specialists), define technical
ONLINE Squads that mobilized and prepared the technical materials, a focus discussion groups and
consensus and prepared and submitted draft guidelines to the Risk Analysis Committee and ONA’s
Board for final deliberations. Some important actions were discussed and implemented, as follow:
Virtual survey model development based on international GUIDELINES (ISQua & IAF/ISO), periodic
discussions on the suggested survey model, virtual survey method validation, test the proposed model,
ONA Integrare System parameterization for the proposed changes in the new model, publication of
the guideline with the rules of the virtual survey model, development of a course to prepare the team
and monitor the results. The workflow to implement the project has passed through some steps. These
steps were necessary to put in practice a virtual survey, as follow: Risk analysis - Ona’s Certified
Accreditation institutions (IACs)should conduct a risk analysis based on the risk matrix to determine if
the healthcare organization was in a favourable position to receive the virtual survey team; prepare
the healthcare organization when the surveyor organization should contact the client to inform about
the virtual survey regarding the documentation that must be presented during the virtual meetings;
organize the agenda with the healthcare organization; prepare the Program to survey; Separate the
documents required; Perform the survey; perform the visit report and approve the visit report with
Certification Committee by ONA. ONA will provide electronic tools for virtual survey: registration of all
documentation and opinion of the surveyor’s team.

Results: The marks of the project are: Virtual Survey Proposal Approval by Board of Directors, virtual
Survey model test and concluded, system parameterization for the proposed changes in the new
model and preparation of involved personnel. Since the implementation in 2020, ONA has 2.342Virtual
Surveys and 201 Hybrid Surveys. The impact of the result, there was a reduction in the financial impact
to the institutions that compose SBA/ONA (Brazilian National Accreditation System by ONA). The cost
of virtual survey decreased considerably when analysed in comparison to the indirect costs related to
transportation/travelling, accommodation, food, and ONA fee for on-site assessment.

179
Conclusion: This initiative is very relevant in the Brazilian context with a very large territory and very
expensive logistics costs for the evaluation on-site process. The indirect cost is the strongest barrier
for the health services in the small communities and the poorer states. This new external virtual survey
methodology makes it possible to extend the capacity to expand the accreditation services for new
health services clients and populations.

References: 1) [Link]

2) [Link]

Disclosure of Interest: None Declared

Beyond Standards: Exploring the Impact of Hospital Accreditation on Patients’ Experience: (1368)
Mahi Mahmoud Al-Tehewy

ISQUA2024-ABS-1368

M. M. Al-Tehewy 1,*, A. El-Bokl 2. 1Healthcare Quality, 2business adminstration , Ain Shams University,
Cairo, Egypt

Introduction: Patient experience includes the range of interactions that patient has with the health
care system. It is believed that accreditation positively influence quality of care, however, little is
known about how it affects patient’s experience. Objective: to measure and compare patient’s
experience in an accredited and non-accredited hospital and to identify possible personal factors that
may affect patients' experience.

Methods: Methods: a comparative cross-sectional study was done among patients admitted at two
Ain Shams University hospitals, one accredited and one non-accredited hospital. A random sample of
patients were interviewed using HCAHPS (Hospital Consumer Assessment of Healthcare Providers and
Systems) survey which include 18 substantive items that encompass critical aspects of the hospital
experience (communication with doctors, communication with nurses, responsiveness of hospital
staff, cleanliness of the hospital environment, quietness of the hospital environment, pain
management, communication about medicines, discharge information, overall rating of hospital, and
recommendation of hospital to others).

Results: Results: the sample included 206 patients, divided equally among the two hospitals, with
mean age of 41.9±15.4 years and 61.2 % of them were males. The percentages of positive response
in all patient experience dimensions were significantly higher in accredited than non-accredited
hospital (p>0.05) except in dimension of communication about medicines. Linear regression analysis
revealed that in addition to accreditation, gender, education, and type of job significantly affect the
total score of patient experience, (p>0.05).

Conclusion: Conclusions: this study provides initial evidence of the positive impact of hospital
accreditation process on improving patient experience. The study highlighted communication of
information to patient as an area that need improvement.

Disclosure of Interest: None Declared

180
Quality improvement (QI) as an essential tool for disaster preparedness: How New Orleans (NOLA)
assures safety for persons living with HIV (PLWH) in its healthcare system as hurricanes surge:
(3414) Bruce D Agins

ISQUA2024-ABS-3414

B. D. Agins 1,*, A. Thompson 1, L. Fidelak 2, E. Arnold 3, G. Rebchook 3, W. Steward 3, D. Murdock 4, V.

Chantala 4
1
Inf Dis Epidemiology, UCSF, San Francisco , 2Public Health, UNC, Chapel Hill, 3Medicine, UCSF, San
Francisco , 4HIV/AIDS Program, New Orleans Department of Health, New Orleans, United States

Introduction: As climate change advances, healthcare systems must adapt to assure continuity of care
for people with chronic conditions and benefit from application of quality improvement (QI) methods
to prepare and respond effectively for climate disasters. New Orleans (NOLA) has faced repeated
hurricanes which pose a substantial threat to access to healthcare services and especially medications
for people living with HIV (PLWH). The NOLA HIV/AIDS Program convened a QI Collaborative in
partnership with UCSF through which systems thinking, particularly through process mapping and the
generation of block and hierarchical task analysis diagrams, led to redesign of care processes and
innovations through the phases of preparation, response during hurricanes and post-hurricane
management to ensure safe and coordinated access to health care for PLWH. Policymakers
participated with providers and community members to identify areas resulting in plans to improve
jurisdiction-wide health emergency response systems.

Methods: Data were collected from 10 provider and 2 policymaking agencies. Process maps and
changes were presented at QI Collaborative learning sessions, following which the agency narratives
and reports underwent coding. Interventions were categorized into thematic domains. Community
members participated on provider teams and also participated as a formal advisory council team.

Results: Domains of interventions and changes were grouped into 4 categories: 1) before disaster; 2)
disaster warning; 3) during disaster and 4) after disaster. Strategies identified in the preparatory phase
included patient preparation plans including “stay kits” and “go kits” depending on decisions to
evacuate during the disaster, strategies for continued medication supply, language appropriate
resources, communication channels, transportation service plans and securing access to medical
history. Similar changes were developed for the period of disaster warning with emphasis on
emergency communication channels, especially social media. During disasters, staff identified
processes for communication with patients and tracking for assurances of safety and medication
supply, whereas after disasters, emphasis on patient well-being, mental health and security were
included in communication strategies, along with tracking of clinical continuity of care and viral load
suppression. Jurisdictional strategies included streamlining of communication channels on social
media, identification of safety centers, strengthening cross-state communication systems to allow
uninterrupted medication supply and development of resources and information channels for patients
with limited access to internet and poor digital literacy. Additionally, coordination with multiple state
agencies was strengthened through panel discussions and interactions between their government
agency staff with the provider and consumer communities. Specific changes related to Hurricane Ida
(August 2021) are described in the Table below.

181
Conclusion: QI methods, particularly systems thinking, offers an important strategy for health systems
to ensure safety and quality of care for people with chronic conditions in the settings of climate
disasters. Collaborative participation of policymakers, providers and community members in these QI
activities. These processes of QI initiatives can be applied to emergency response processes in
healthcare systems to address preparedness for the multiple types of disasters that will inevitably
ensue with the progression of global warming and climate change.

Disclosure of Interest: None Declared

Pioneering accreditation standards for low-carbon, sustainable and resilient hospitals: (1637)
Sylvia Basterrechea

ISQUA2024-ABS-1637

S. Basterrechea 1,*, R. Quicho 2

International Hospital Federation, Geneva, Switzerland, 2Joint Commission International, Chicago,

1

United States

Introduction: The healthcare sector is a major contributor to climate change, which causes harm to
populations both locally and globally. Hospitals must act to implement practices which will decrease
their carbon and environmental footprint, increase their resilience in the face of disruptive climate
events and increase sustainability for their operations, people (patient population, communities and
staff), environment and planet.

Addressing the lack of dedicated frameworks and standards is a pressing need for the healthcare sector
to be able to: 1) address climate change as part of its operations, including quality and safety of care;
2) assess its performance and progress towards sustainable, low-carbon and resilient healthcare
delivery; and 3) define strategies and priorities.

This session will present the journey of Joint Commission International (JCI) and of the International
Hospital Federation’s Geneva Sustainability Centre (GSC) to develop and deliver the first set of
international environmental sustainability standards for hospitals.

Methods: Global healthcare organizations are witnessing a growing demand for more support and
guidance to implement processes for low-carbon, resilient and sustainable healthcare. JCI and the GSC
collaborated in 2023 to develop accreditation standards for environmental sustainability according to
specific criteria.

The process included consultations with a technical advisory panel and a public review. The full
process, from development of the content to publication of the accreditation standards, lasted from
May 2023 to July 2024.

182
Results: The field review provided relevant data regarding attitude towards the proposed standards
and the perceived readiness to implement them. It also provided an indication of the current practices
being implemented – or not – in relation to the standards globally. This demonstrates the need for
environmental sustainability-related standards to be included in accreditation processes and related
efforts to push this agenda forward.

The development and review processes allowed to ensure that all criteria were met to provide the first
set of five international environmental sustainability standards for hospitals. The five areas covered by
the standards are:

1. Governance, tracking and reporting

2. Employee engagement and empowerment

3. Use of environmental resources, green operations and processes

4. Procurement and supply chain

5. Infrastructure and service resilience

This sets the foundations for a solid framework of parameters that would influence principles and
processes for licensing, accreditation and certification globally, and ensure a large-scale impact for the
sector.

Conclusion: Climate change must be addressed at all levels of the healthcare delivery. The standards
developed through this process offer a robust entry point for all hospitals to get started and improve
actions for sustainability. It demonstrates that organizations can increase the quality of their services
while complying with international accreditation standards and, in consequence, improve health
outcomes of the populations they serve.

Developments include a licensing process to make those standards available for other accrediting
organizations outside of the United States to use as part of their own accreditation processes, as well
as a certification programme for hospitals willing to demonstrate extended efforts for sustainability.

This also provides an example of successful collaboration to contribute to fostering the transition
towards low-carbon, resilient and sustainable healthcare.

Disclosure of Interest: None Declared

183
Desflurane-Sparing Anesthesia Practice: Tackling Climate Change from the Operating Theatre:
(1733) Annemarie Chrysantia Melati

ISQUA2024-ABS-1733

A. C. Melati 1,*, R. Palupi 2

Anesthesiology and Critical Care, 2Quality, Premier Bintaro Hospital, South Tangerang, Indonesia
1

Introduction: World Health Organization (WHO) emphasized that climate change was an important
issue in the 21st century. Closed monitoring on the carbon footprint is essential to determine measures
to reduce gas emission, including in anesthesia practice. In modern anesthesia, the use of anesthetic
gases, such as sevoflurane, desflurane, isoflurane and nitrous oxide, is relatively common in daily
practice. Anesthetic gas undergoes minimal changes in vivo and more than 95% of these gasses are
released back to the troposphere. Sevoflurane and desflurane might be found in our troposphere for
1.1 and 14 years, respectively. Hence, anesthetic gasses play an important target for reducing medical
carbon emissions. We conducted a quality improvement study to assess and evaluate the impact of
sustainability intervention, which was a desflurane-sparing practice, on the environmental and
financial cost in our hospital.

Methods: This was a quality improvement study promoting an environmental sustainability in Premier
Bintaro Hospital. On January 2023 we gradually removed desflurane from the operating theatre and
on April 2023 there was no desflurane used in the operating theatre. We did a series of education for
our anesthesiologists and anesthesia nurses as well as other staffs in the operating theatre.
Retrospectively, usage (in bottles) and expenditure for sevoflurane and desflurane from January 2018
to December 2023 were obtained from the Department of Pharmacy. Year 2018 and 2019 represented
the data before COVID-19 pandemic. Global warming potential and CO2equivalent (CO2e) were utilized
to measure the environmental impact of these agents. To measure the CO2e of anesthetic gas then we
utilized this calculation: mass (kg) times with its GWP. The value of GWP100 of sevolurane was 130 and
desflurane was 2450. One bottle of desflurane (240 ml) had CO2e of 886 kg and one bottle of
sevoflurane (250 ml) had CO2e of 49 kg.

Results: This study generated that the total number of bottles of sevoflurane and desflurane purchased
between January 2018 and December 2023 increased by 12.43% from 62,830 bottles to 70,639 bottles.
There was a slight decrease in year 2020 which was most likely contributed by the COVID-19 pandemic.
Nevertheless, the number of desflurane bottles decreased significantly by 94.15% from 50,830 bottles
to 2,972 bottles in year 2023. Following the project initiation to reduce the use of desflurane, total
carbon emission in year 2023 from anesthetic gasses decreased significantly by 86.96% from year
2018. In year 2018, desflurane made up 98.71% of the annual CO2e which was steady until year 2022.
However, in year 2013 desflurane only contributed to 44.26% of the annual CO2e. Combined
sevoflurane and desflurane costs decreased by 22.8% from year 2018 to year 2023. Our hospital
successfully saved around $5000 in year 2023 from the desflurane-sparing practice.

184
Image:

Conclusion: There was a substantial reduction in carbon emissions following the implementation of
desflurane-sparing anesthesia practice in our hospital. Additionally, there was reduction in money
spent for the anesthetic gasses as well. This finding emphasized that desflurane-sparing practice may
be one answer to tackle climate change crisis in the operating theatre.

References: 1. Wyssusek K, Chan KL, Eames G, et al. Greenhouse gas reduction in anaesthesia practice:
a departmental environmental strategy. BMJ Open Qual. 2022 Aug;11(3):e001867. 2. Davies JF,
Trajceska L, Weinberg L. The financial and environmental impact of purchased anaesthetic agents in
an Australian tertiary hospital. Anaesth Intensive Care. 2023 Mar;51(2):141-8. 3. Ryan SM, Nielsen CJ.
Global warming potential of inhaled anesthetics: application to clinical use. Anesth Analg. 2010
Jul;111(1):92-8.

Disclosure of Interest: None Declared

An evaluation on the effect of climate change on health: The case study of quality employees:
(3217) Elif Özyurt

ISQUA2024-ABS-3217

E. Özyurt 1,*, K. AVCI 1, F. ÇİZMECİ ŞENEL 1

TÜSKA, Ankara, Türkiye

1

Introduction: In the 21st century, climate change is one of the biggest problems in many fields,
including health. It is predicted that in the next 30 years, climate change due to global warming will
increase its severity on public health. It is expected that disasters such as heat fluctuations, floods,
droughts, fires will increase the incidence and prevalence of many diseases, especially infections,
chronic diseases such as cardiovascular and pulmonary diseases, and psychological diseases. It is clear
that all these unfavourable situations may cause disruptions in the supply chain, medical treatment,
appointment times, care services and every aspect of the healthcare system, including the
psychological health of healthcare professionals. It is also possible that the health system will become
more fragile as climate change increases health inequalities in the society and risks on vulnerable
groups in addition to negatively affecting the health system. Quality and Accreditation studies have a
fundamental role in preparing for risks and strengthening the health system. In this study, it is aimed
to measure the awareness of health professionals involved in accreditation and quality studies in line

185
with being prepared for situations that may develop as a result of the impact of climate change on
health and health services and strengthening health systems.

Methods: Semi-structured interviews were conducted between December 2023 and January 2024
with 10 health professionals working as TÜSKA Standards of Accreditation in Health (SAS) auditors and
quality workers in a health institution. As a Data Collection Tool, the "Awareness of Quality Employees
Regarding Climate Change in Health Services" Form, which was prepared by the researchers by taking
the opinion of 2 researchers who are experts in the field, was applied to the participants after the pilot
application. After the pilot applications, the interview forms were made suitable for the application
according to all these results. Content analysis technique was used to analyse the data.

Results: 8 (80%) of the participants, consisting of TÜSKA SAS auditor (2), quality director (1) and quality
employee (7), have Master's degree and 2 (20%) have PhD degree. The data were analysed in 8 themes
and these themes were divided into categories and their contents. In this study conducted to
determine the perception levels of quality and accreditation unit employees regarding quality and
accreditation studies in line with being prepared for situations that may develop as a result of the
impact of climate change on health and health services and strengthening health systems; As can be
seen in Table 1, it was seen that the majority of the participants had a high level of awareness in the
interviews related to the themes of the causes of climate change, problems that may occur, where
health institutions are in relation to climate change, willingness to take part in efforts to combat
climate change, what to do within the scope of quality and accreditation studies on the subject, and
how the results of climate change will affect health services.

Image:

186
Conclusion: In order to be prepared for the health problems caused by climate change and to take
action quickly, effectively and efficiently, it is very important to carry out improvement studies on a
global scale. In this direction, within the scope of quality and accreditation studies, it would be an
effective step to develop new dimensions and standards to be prepared for the adverse health
conditions caused by climate change. At the same time, the importance of organising training
programmes to increase the awareness of the society, supporting health professionals with training in
terms of being prepared for the problems arising from climate change and new diseases, and
developing quality and accreditation standards that encourage health institutions to act proactively in
social contribution activities for climate change should be prioritised on every platform.

Disclosure of Interest: None Declared

187
Exploring the Implementation of Sustainable Operational Strategies in Healthcare Institutions:
(2531) Syuan-Fang Jian

ISQUA2024-ABS-2531

S.-F. Jian 1,*, C.-I. HUANG 1, S.-H. LU 1

Taipei Medical University Hospital, Taipei, Taiwan

1

Introduction: The healthcare industry exhibits exceptionally high energy consumption and carbon
[Link], initiatives for achieving net-zero carbon emissions have been
[Link], Taiwan's policies and regulations regarding net-zero carbon emissions do not
specifically include the healthcare [Link] Medical University Hospital has proactively initiated
the institutionalization of sustainable operational strategies.

Methods: We adopted an organizational institutionalization approach by first establishing a Center for

Sustainable Development, simultaneously founding a Sustainable Development Committee. We
allocated resources to train a total of 33 multi discipline sustainability planners, These individuals serve
as seeds for sustainability, and in the future, they will leverage their influence within their respective
professional domains to become the navigators of sustainable operations within the hospital.

In response to the international call for net-zero sustainability, we became one of the first hospitals in
Taiwan to sign the Healthcare Sustainability Initiative.

Before the establishment of the center in 2022, we have actively participated in sustainability awards,
winning a total of 3 sustainability action awards and individual performance awards in 2022, along
with an outstanding youth award. In 2023, we received a total of 7 awards, ranking as the top hospital
in Taiwan. Our individual performance award spans across all three ESG dimensions and SDGs,
establishing our hospital's medical sustainability as a topic of societal concern.

Subsequently, we renamed the center as the Sustainability Development Office, hiring dedicated staff
while retaining part-time personnel to facilitate cross-departmental communication.

As part of establishing the foundational infrastructure( initiated the issuance of sustainability reports
and conducted greenhouse gas inventories). Moving forward, we plan to conduct phased interviews
with sustainability planners to guide partners in formulating departmental sustainable operational
strategies. We value professional proposals and judgments, respecting their expertise, and aim to
develop highly feasible healthcare sustainability initiatives.

Results: In 2022, we received 4 sustainability awards.

In 2023, we received 7 sustainability awards, ranking as the top hospital in Taiwan.

In March 2023, Center for Sustainable Development, Sustainability Development Committee, and
Healthcare Sustainability Advocacy were established.

In May 2023, the greenhouse gas emissions inventory was initiated.

In August 2023, the Sustainability Development Office was established, and 33 sustainability planners
obtained certification.

188
In October 2023, the recruitment of full-time staff began.

In December 2023, the 2022 Sustainability Report was issued, and internal audits of greenhouse gas
emissions were completed.

In January 2024, internal audits of greenhouse gas emissions were completed, and the 2023
Sustainability Report was initiated.

In February 2024, external audits of greenhouse gas emissions were conducted, and the evaluation of
proposed sustainability strategies by some sustainability planners was initiated. Enrollment in the 2024
Sustainability Awards was also completed.

Image:

Conclusion: Our strategy begins with people, prioritizing partnerships before pursuing infrastructure,
fostering societal engagement, and implementing balanced, sustainable healthcare services. This
strategy contribute to the broader understanding of sustainable practices in healthcare management,
offering valuable implications for the enhancement of operational efficiency and long-term viability in
medical institutions.

Disclosure of Interest: None Declared

189
Digital Health Stakeholders’ Views: Using Electronic Medical Records in Improving Communication
between Hospitalised Patients and Health Professionals across Transitions of Care: (2038) Guncag
Ozavci

ISQUA2024-ABS-2038

G. Ozavci 1 2,*, T. Bucknall 13

, K. Gray 4, N. Wickramasinghe 5 6, C. Adams 7, R. Harrison 7, E. Manias 8 9
1
School of Nursing and Midwifery, Faculty of Health, Deakin University, 2Nursing Research, 3School of
Nursing and Midwifery, Faculty of Health, Alfred Health , 4Centre for Digital Transformation of Health,
University of MelbourneUniversity, 5Health Innovation Research Institute , Swinburne University of
Technology, 6Digital Health, La Trobe University, 7Center for Health Systems and Safety Research,
Macquarie University, 8Faculty of Medicine, Nursing and Health Sciences, Monash University, 9School
of Medicine, Faculty of Health, Deakin University, Deakin University, Melbourne, Australia

Introduction: Electronic medical records (EMRs) implemented in hospitals contain all the information
about managing patient care. Little is known about how health professionals use EMRs to facilitate
communication with patients, especially those with complex care needs and polypharmacy. This
project aimed to understand the complexity of individual and organisational influences on
communication between patients, families, and health professionals in using EMRs, from the
perspectives of digital health stakeholders. It also aimed to address challenges to achieve better
models of health care services, by investigating current and new engagement strategies and insights
to enhance communication with patients and families in using the EMRs.

Methods: A qualitative exploratory design included focus groups or interviews with key stakeholders
working in digital health across three states in Australia. Transcripts were analysed inductively by using
reflexive thematic analysis.

Results: A total of 21 stakeholders across sixteen Australian organisations participated in focus groups
or interviews. Stakeholders included: chief allied health officer (n=1), chief nursing information officers
(n=4), chief clinical information officers (n=3), chief medical information officers (n=2), deputy director
of medical services (n=1), director of allied health (n=1), lead of electronic decision support (n=1),
manager of nursing policy practice and clinical standards (n=1), lead of digital health portfolio (n=1),
digital patient experience officers (n=2), digital health partner for nursing services (n=1), nurse unit
manager (n=1), emergency medicine consultant (n=1), health service manager (n=1). Four main
themes were generated: 1) Clinician-centric focus of EMR system, 2) Requirement for patient-centric
design patient portals, 3) Benefits of EMRs on the communication across transitions of care, 4)
Strategies to improve communication with patients via EMR. Use of EMRs by health professionals in
communication appeared limited to mimicking the paper-based system, with missed opportunities for
effective use of the EMRs, in particular, during hospital discharge when explanations were given to
patients with multiple chronic conditions. . EMRs facilitated communication processes in admission
and at discharge compared to other time periods inpatient settings and they were helpful in outpatient
settings to print out results to patients. Stakeholders suggested patient-centric portal design in
supporting patient education and autonomy across care transitions; however, there was lack of
motivation in teaching patients how to access the portals by health professionals, in addition to
inconsistent portal design and adoption across Australian hospitals.

190
Conclusion: EMRs were mainly used to enhance health professionals’ practice rather than
communicating with patients and their families. Although the benefits of EMRs on communication at
care transitions were emphasised, missed opportunities still exist to educate patients during their
hospital stays. Health professionals need teaching resources and ongoing training to improve
communicating with patients and families when using EMRs. Patient portals need to be designed to
ensure required information is provided to patients in a way that can be easily accessible and
understandable by patients. Design of change management strategies are needed in hospitals, which
incorporate the patient and family voice, to improve communication with patients and families via
EMRs.

Conflict of Interest*: This work was funded by an Australian Research Council Discovery Project Grant
(DP220100884). The funding body has had no influence on any aspect of this work.

Disclosure of Interest: None Declared

Using the cohort effect to boost improvement projects in ovarian cancer: (2213) Helen Crisp

ISQUA2024-ABS-2213

H. Crisp 1,*, L. Woolnough 2

Consultancy, Crisp QI Ltd, 2IMPROVE UK Team, Ovarian Cancer Action, London, United Kingdom
1

Introduction: Ovarian Cancer Action , a UK charity, funded projects to improve care and subsequent
survival of women with ovarian cancer. A 2021 UK national audit of ovarian cancer services showed
unwarranted variation in care, diagnosis, treatment and survival rates for women. The aim of the
programme was to address the inequality that women with ovarian cancer face from diagnosis to
surgery and treatment, using evidence and sharing best practice to improve services. Applications
were invited for up to 8 funding awards of £100,000 ($125,500 USD). 7 projects were funded to help
to reduce inequalities. The programme provided learning and exchange sessions to enhance QI skills
and share best practice between projects.

Methods: After scoping and design, the programme put out a call for proposals, publicised through
professional cancer networks. Applications were assessed by senior clinicians and a patient advisory
group of ovarian cancer survivors. The programme wanted to enhance the project grants by creating
a ‘cohort effect’, supporting learning between teams. Just making grants and leaving busy clinical
teams to ‘get on with it’ could lead to slipped timescales, lack of motivation and projects failing through
lack of support. The Programme Manager held individual catch up meetings with each project every 4
months (more frequently if needed) advising on challenges such as project staff recruitment and
engaging with patient groups. This kept projects engaged and expedited practical solutions.

In addition, five learning events were planned to establish and support a cohort effect over the
implementation year:

- Online virtual launch event

- Mid-way learning exchange event

191
 - Online seminar on qualitative research methods to support project evaluation

- Online webinar on producing a comprehensive improvement report

- End of programme learning exchange and celebration.

Projects shared progress and learned from each other. For 3 projects doing prehabilitation, the
programme organised extra meetings to facilitate in-depth sharing of methods and materials. There
was an agreed combined data set, enabling more robust analysis of a larger sample.

Projects used QI methods to implement their service changes to reduce inequalities linked to age,
socio-economic status, ethnicity and geography of service provision. Developing prehabilitation
helped to get older women fitter for surgery, introducing a one-stop clinic rather than 4 or 5 separate
hospital appointments was less strain on patients, developing information materials on genetic testing
with language, images and concepts ensured these were suitable to different ethnic groups.

Results: Proactive programme management facilitated practical learning in leadership and change
management. 6 of 7 projects included patient involvement as a meaningful component. Projects had
patient representation in the steering group, to provide feedback on materials and engaging patients.
5 of 7 projects addressed age inequalities, improving active treatment and therefore better clinical
outcomes for older women. Clinical data comparing cohorts of women pre- and post project show
average age of patients treated increased, as more older women got active treatment. Early data show
decreased hospital length of stay post-surgery when prehabilitation completed. Rates of acceptance
for genetic testing increased across all ethnicities with tailored information [Link]
developed patient information materials, policies, procedures and data templates, disseminated at a
national UK cancer conference. Materials are available online for teams doing similar work. QI skills
training encouraged teams to do further work in service improvement.

Conclusion: The programme aimed to help services start to tackle poor and inequitable outcomes in
ovarian cancer. Teams lacked of knowledge on quality improvement approaches and skills were built
up A small programme of 7 centres' improvement projects cannot by itself change cancer outcomes,
but the teams gained a quality oversight of their service, recognising where improved service delivery
could positively impact.

The programme successfully used the cohort effect for teams to learn from each other and support
successful projects. It has promoted service improvement in ovarian cancer and put QI on the
professional map in this sector. The programme showed that small projects can generate service level
improvements, with the potential to translate into improved clinical outcomes.

References: Ovarian Cancer Audit - Feasability Pilot

[Link]
ogical_cancer/gynaecological_cancer_hub/ovarian_cancer_audit_feasibility_pilot

Disclosure of Interest: None Declared

192
Learning from Soft Intelligence for Patient Safety: Development and Piloting of a Tool for
Continuous Data Capture and Sensemaking: (2899) Jonathan Benn

ISQUA2024-ABS-2899

J. Benn 1 2,*, C. McCrorie 3, U. Nwulu 2, J. Granger 2

1
School of Psychology, University of Leeds, Leeds, 2Patient Safety Research Collaborative, Yorkshire &
Humber, 3School of Human and Health Sciences, University of Huddersfield, Huddersfield, United
Kingdom

Introduction: Over the last two decades, patient safety incident reporting systems have formed a
fundamental component of safety intelligence in healthcare, despite acknowledged limitations in
capacity to support learning (Benn, 2009; Macrae, 2016). To enhance monitoring, analysis and
learning, new frameworks for measurement and monitoring have emerged, designed to complement
a reactive focus on past harm with more proactive use of intelligence (Vincent, 2014; Hollnagel,
2015). “Soft intelligence” refers to the processes and behaviours associated with capture and use of
information that is often difficult to quantify for intervention (Martin, 2015). Staff narratives, as a form
of soft intelligence, are potentially a rich resource for organisational learning and collective
sensemaking (Waring, 2009). Unstructured, spontaneous employee narratives may capture important
nuanced tacit knowledge and experience concerning how to adapt to maintain safety in the face of
dynamic risks. Digital capture and feedback of soft intelligence in near real-time is a promising concept
but there is limited research in this area to support potential solutions. In this study, we report the
results of work in the UK to develop a soft intelligence tool for patient safety, including a 12-month
pilot study. Our specific research aims were to:
1) explore the feasibility of continuous capture of staff experiences in the form of staff-generated safety
and wellbeing narratives;
2) evaluate the patient safety learning potential of unstructured narrative data;
3) develop a framework for monitoring, sensemaking and prioritisation of potential signals concerning
patient safety in soft data.

Methods: We used co-design principles and qualitative research methods to develop and pilot a data
collection tool for soft intelligence based on the SenseMaker® digital platform, in a large academic
perioperative services centre in the South of England, including nursing staff, healthcare assistants,
allied health professionals, anaesthetists and surgeons, working across two sites. The work was
structured in two phases. In Phase 1, staff submitted 271 narratives over 14 months. To understand
the safety-relevant content of narratives, the text was qualitatively analysed using thematic analysis
involving inductive and deductive coding. In Phase 2, a revised data collector and self-coding
framework was co-designed based upon insights from phase 1.

Results: Staff narratives were a rich source of information on dynamic risks, opportunities to enhance
system resilience, safety best practice, saves/catches and compensatory strategies. Content was both
event-driven and captured non-event tacit knowledge on patient and staff safety. A hierarchical coding
framework for safety learning potential was developed with upper levels of the framework linked to
contextualised novel recommendations for safety improvement and compensatory practices either in
response to or anticipation of emerging vulnerabilities. Self-coded narrative content supported

193
monitoring of sentiments linked to staff concerns over time, staff feedback and dialogue between staff
groups.

Conclusion: Our analysis demonstrates the potential value of capturing staff experiences and tacit
knowledge as a form of safety intelligence, above and beyond incident or event-driven data. Feedback
from this data may have the potential to promote safety culture through encouraging staff to think
proactively about safety and engage in more open dialogue concerning safety. If we can attend to and
learn from softer signals in routine practice we might proactively develop and promulgate strategies
based upon understanding how clinical work systems and healthcare professionals effectively and
routinely adapt to maintain safety.

References: Benn, J. [Link]. (2009). Feedback from incident reporting..... BMJ Quality & Safety, 18(1),
11–21.

Macrae, C. (2016). The problem with incident reporting. BMJ Quality & Safety, 25(2), 71–75.

Martin, G. P., [Link]. (2015). Beyond metrics? Utilizing ‘soft intelligence’.... Social Science & Medicine
(1982), 142, 19–26.

Vincent C., [Link]. (2014). Safety measurement and monitoring in healthcare..... BMJ Quality and Safety,
23(8), 670–677.

Disclosure of Interest: None Declared

An online-based patient safety culture survey at 20 healthcare facilities in six districts in Indonesia:
a benchmarking study: (3080) Poppy Elvira Deviany

ISQUA2024-ABS-3080

P. E. Deviany 1,*, D. Amelia 1, S. Qomariyah 1

USAID-Momentum Private Healthcare Delivery (MPHD), Jakarta, Indonesia

1

Introduction: Patient safety culture is a critical component of quality of care not only to protect the
patients but also health providers. An in-depth understanding of patient safety culture will assist
healthcare facilities in improving the quality of services. Healthcare facilities, as an organization, should
continuously develop and improve a culture that pays attention to quality and patient safety. This
requires the measurement of values, beliefs, and norms within the organization, as well as attitudes
and behaviors. The Indonesia Ministry of Health (MOH) is at the beginning stage of regulating patient
safety culture surveys for healthcare facilities. This study aimed to capture existing patient safety
culture in public and private healthcare facilities through an online-based patient safety culture survey
and supported the MOH in preparing a national guideline.

Methods: The survey was a one-time measurement using questions adapted from the patient safety
culture questionnaire by the Agency for Healthcare Research and Quality, version 2.0. Staff from
healthcare facilities individually completed the online survey in September 2023. The survey was
conducted in 20 selected healthcare facilities including public hospitals (n=6), private hospitals (n=7),

194
and primary healthcare facilities (n=7) in six districts of the Momentum Private Healthcare Delivery
working area in three provinces i.e., North Sumatra, Banten, and South Sulawesi.

Results: Survey responses were obtained from 95% of the target (2,504 of 2,629 individual staff). The
ten dimensions of safety culture were analyzed separately for hospital and primary healthcare
facilities, scored between 0 to 100. Of the 13 hospitals, the overall score was 71; two safety culture
measures with the highest scores were teamwork (score=91) and organization learning-continuous
improvement (score=88). Measures with the lowest score for hospitals were reporting patient safety
events (score=27) and staffing and work pace (score=45). There was no difference in the results of
safety culture measures between public and private hospitals. Of the seven primary healthcare
facilities, the overall score was 69 and the two highest scores were on teamwork (score=91) and
organization learning-continuous improvement (score=88). The lowest scores at primary level facilities
were reporting patient safety events (score=12) and staffing and work pace (score=48).

Image:

Conclusion: Survey results indicate a moderate level of patient safety culture in hospitals and primary
healthcare facilities with major areas of improvement in the reporting of patient safety events and
staffing and work pace. The high response rate shows the potential use of an online-based approach
to implement the survey. Recommendations based on the results of safety culture measures for
individual facilities will increase their capacity to develop strategies and manage safety culture.
Findings from this study are relevant to support the MOH in developing national guidelines on patient
safety culture surveys for hospitals and primary healthcare facilities.

Disclosure of Interest: None Declared

195
Analysis of barriers and facilitators of patient safety culture assessments in Brazil using the
consolidated framework for implementation research: (3492) Zenewton André da Silva Gama

ISQUA2024-ABS-3492

Z. A. D. S. Gama 1 2,*, M. M. M. Costa 3, H. T. Santana 3, N. G. Linhares 4, K. E. A. Semrau 2, R. L. Molina 2

1
Collective Health, Federal University of Rio Grande do Norte, Natal, RN, Brazil, 2Ariadne Labs, Harvard
University, Boston, MA, United States, 3Gerência de Vigilância e Monitoramento em Serviços de Saúde,
Brazilian Health Regulatory Agency - Anvisa, Brasília, DF, 4Nursing undergraduate course, Federal
University of Rio Grande do Norte, Natal, RN, Brazil

Introduction: The World Health Organization (WHO) Global Patient Safety Action Plan 2021-2030 set
the goal of increasing the number of countries and health services that regularly use patient safety
culture surveys.

In Brazil, the Integrated Plan for Health Management of Patient Safety 2021-2025 proposed to conduct
these assessments with specific goals for the participation of hospitals in each state, an online platform
to administer the questionnaires, support for the use of the platform, webinar guidance, and support
for hospitals through representatives of the national health surveillance system.

In the 2021 and 2023 national assessments, just over 15% of invited hospitals participated (305 and
366 hospitals, respectively). We designed a study to understand facilitators and barriers of
implementing patient safety culture assessments in Brazil using the Consolidated Framework for
Implementation Research (CFIR).

Methods: This was a sequential exploratory mixed methods study design. The project was designed in
two phases: (1) Qualitative data collection and analysis and (2) Quantitative data collection and
analysis.

The participants were coordinators of Patient Safety Centers (NSP) of public and private Brazilian
hospitals that did not carry out an assessment of the patient safety culture in their hospital in 2023.
We invited all coordinators of PSC registered in the National Health Surveillance Agency – Anvisa.

An electronic questionnaire was used about “what were the barriers to participation in the safety
culture assessment?” After collecting the data, the responses were classified according to the CFIR
constructs and a second questionnaire was applied to the same target universe to quantify the
importance of the previously identified barriers.

Qualitative data were presented in a theoretical model in the form of a cause-effect diagram and
quantitative data about barriers will be prioritized with a Pareto Diagram.

This study is exempt from ethical IRB based on article 1 and item 7 of the Resolution nº 510, 2016,
from the National Health Council.

Results: 82 coordinators of Patient Safety Centers from 22 of 27 states participated in the qualitative
consultation. The responses categorized according to the CFIR gave rise to the following theoretical
model of barriers in Figure 1.

The main facilitators were: need to simplify and reduce the number of questions in the questionnaire
(n=24), expand communication about the national assessment (n=13), increase support for Patient

196
Safety Centers with training and videos on the Patient Safety Culture assessment (n=8), facilitate the
administration of the questionnaire and professionals' access to the questionnaires (n=7).

Image:

Conclusion: The identified barriers and facilitators are crucial to designing a strategy to increase the
dissemination and implementation of safety culture assessments in Brazil.

Disclosure of Interest: None Declared

Incorporating safety into patient experience daily huddles: its association with patient safety
culture in ambulatory centers: (2349) Alejandro Arrieta

ISQUA2024-ABS-2349

A. Arrieta 1,*, C. Arregui Reyes 2

1
Global Health, Florida International University, Miami, United States, 2Quality Department, Asociación
Chilena de Seguridad, Santiago, Chile

Introduction: Patient safety culture (PSC) is associated with fewer adverse events [1,2] and better
health outcomes [3]. Despite its relevance, research on PSC has mostly focused on developed countries
and hospitals. There is a need to explore the effect of intervention strategies to improve PSC in
ambulatory settings, especially from developing countries [4]. In this study, we evaluate if the
incorporation of structured patient safety discussions into a patient experience daily huddle was
associated with an improvement in PSC.

Methods: Diálogos Diarios (DD) is a well stablished 15-minute daily huddle implemented in 85 medical
centers from a private Chilean health network. DD starts at the beginning of all workdays to improve
teamwork and motivate staff experience. The intervention (DD+safety) added a conversation on
patient safety and safety incidents. To evaluate its association with PSC, we implemented the
Healthcare Management Americas (HMA) survey [5] for ambulatory settings, an instrument based on
the Spanish version of the Agency for Healthcare Research and Quality’s Medical Care Survey on
Patient Safety Culture, and culturized to Chile’s health system. A total of 1450 responses were collected

197
from staff who took the HMA survey in the year 2021 (when only DD was in place) and in 2023 (after
the DD+safety implementation) to perform a pre-post evaluation. A multivariate regression analysis
clustered by medical center was estimated to assess the association between awareness of the
DD+safety and different dimensions of PSC.

Results: A total of 455 staff completed the HMA survey in 2021 (24% response rate) and 995 completed
it in 2023 (55% response rate). Our results show a significant improvement in multiple dimensions of
PSC associated after the intervention (see Figure 1), in particular among those who reported to aware
of the DD+safety program. The largest statistically significant improvements were observed in
communication about errors (from 26 to 50 percentage points increase in positive responses),
organizational learning (from 23 to 37 percentage points increase), and teamwork (from 16 to 36
percentage points increase). Additionally, DD+safety was associated with a 28 percentage points
increase (p-value<0.001) in the proportion of staff who rated as very good or excellent the systems and
clinical processes that the medical office has in place to prevent, catch, and correct problems that have
the potential to affect patients. Additional results show that leaders consistently have a better
perspective of PSC compared to clinical staff, while non-clinical staff tend to have a worst perspective
in multiple dimensions of PSC. We also observed that larger centers usually have lower PSC scores
compared to centers with less than 40 staff.

Image:

Conclusion: This study suggests that adding a structured patient safety discussion to daily hurdles in
ambulatory settings could improve PSC in key dimensions like communication about errors,

198
organizational learning and teamwork. Our results are consistent with previous analysis on safety
huddles [6,7], mostly performed in hospitals and developed countries.

References: [1] Groves, P. S. (2014). The Relationship Between Safety Culture and Patient Outcomes.
Western Journal of Nursing Research, 36(1), 66-83.

[2] Han, Y., Kim, J. S., & Seo, Y. (2020, Jan). Cross-Sectional Study on Patient Safety Culture, Patient
Safety Competency, and Adverse Events. West J Nurs Res, 42(1), 32-40.

[3] DiCuccio, M. H. (2015, Sep). The Relationship Between Patient Safety Culture and Patient
Outcomes: A Systematic Review. J Patient Saf, 11(3), 135-142.

[4] World Health Organization (WHO). (2021). Towards eliminating avoidable harm in health
care. Global patient safety action plan 2021, 2030.

[5] Arrieta, A., Suárez, G., & Hakim, G. (2018). Assessment of patient safety culture in private and public
hospitals in Peru. International Journal for Quality in Health Care, 30(3), 186-191.

[6] Franklin, B. J., Gandhi, T. K., Bates, D. W., Huancahuari, N., Morris, C. A., Pearson, M., ... & Goralnick,
E. (2020). Impact of multidisciplinary team huddles on patient safety: a systematic review and
proposed taxonomy. BMJ Quality & Safety.

[7] Wahl, K., Stenmarker, M., & Ros, A. (2022). Experience of learning from everyday work in daily
safety huddles—a multi-method study. BMC Health Services Research, 22(1), 1-14.

Disclosure of Interest: A. Arrieta Consultant for: <USD25,000, C. Arregui Reyes Employee of:
>USD25,000

First national survey to measure patient safety culture within healthcare facilities in France: (2840)
Amélie Lansiaux

ISQUA2024-ABS-2840

N. Terrien 1, V. Garcia 1, S. Genevois 1, L. Misrahi-Guillaume 2, A. Lansiaux 2, C. Legris 2,*

1
Fédération des organismes régionaux et territoriaux pour l’amélioration des pratiques et des
organisations en santé, Besançon, 2Haute Autorité de santé, Saint-Denis, France

Introduction: Patient safety culture is a set of behaviours and attitudes that contribute to patient safety
and that are shared collectively throughout the organisation (teams, healthcare facilities). In France,
patient safety culture is one of the assessment items for healthcare facility certification. Before putting
in place actions aimed at developing a safety culture, it is first of all necessary to assess its level. To this
end, the French National Federation of Regional Quality and Safety Support Organisations (FORAP) and
the French National Authority for Health (HAS) have been promoting this type of survey since 2010
and wanted to conduct the first national survey to measure patient safety culture within healthcare
facilities in France in 2023.

199
Methods: The survey was proposed to all French healthcare facilities between 1 May and 30 June
2023, via a dedicated platform. A validated French-language version of the “Hospital Survey On Patient
Safety Culture” (Agency for Healthcare Research and Quality) was used. The aim of the questionnaire
was to anonymously and individually collect professionals' perceptions of patient safety on a work
group level. Hence ten dimensions were measured via 43 questions. The survey participation rate had
to be at least 60% at each work group for the results to be representative. In addition, the completion
rate for each questionnaire had to be at least 50%. If the average score for a dimension was ≤ 50%
then it was a dimension with a high potential for improvement. Conversely, if the average score for a
dimension was ≥ 75% then this was a dimension perceived as being well developed in the healthcare
facility.

Results: Out of a total of almost 3,000 French healthcare facilities, 661 (private and public) participated
in the survey, corresponding to 50,071 respondents. Of these, 47,974 completed 50% or more of the
questionnaire. After having selected only work groups with a participation rate of at least 60%, the
results were analysed for 27,389 respondents. Of the ten safety culture dimensions measured, five of
them had an average score below 50% and therefore appear to require the implementation of priority
improvement actions. These concerned human resources (32%), a non-punitive response to errors
(35%), teamwork between the facility’s departments (39%), management support for healthcare
safety (44%) and the overall perception of safety (48%). The average scores of the other five
dimensions (adverse event report frequency; teamwork within the department; etc.) were all between
50 and 74%, highlighting potential room for improvement.

Conclusion: The roll-out of the national survey included assistance from each Regional Quality and
Safety Support Organisation to provide step-by-step guidance on interpreting, taking ownership of and
sharing the results of the patient safety culture assessment. The aim was to define the most
appropriate improvement actions. These elements were presented during a national webinar, along
with the tools available to improve patient safety culture (safety walkarounds, guide to analysing care-
related adverse events, continuous improvement programme for teamwork, accreditation of
physicians and medical teams, etc.). A new national survey is planned for 2027 as part of a national
programme for improving patient safety.

Disclosure of Interest: None Declared

200
Enhancing Maternal Health Care through Patient Feedback: The Role of Women's Education in
Quality Improvement: (2955) Elisabeth Ezekiel

ISQUA2024-ABS-2995

D. Al Abbas 1,*, D. Al Muallem 2, Z. Alsaffar 3. 1Obstetrics and Gynecology, 2Nursing Manager , 3Quality,
Qatif Health Network, Qatif, Saudi Arabia

Introduction: Cervical cancer is a global public health [Link] proven effectiveness of

intervention measures, such as vaccination (1) and screening,makes cervical cancer a largely
preventable disease. (2) Among women globally, Cervical cancer is the fourth most common neoplasm
and the fourth leading cause of cancer death (3) The literature demonstrated that, unlike global trends,
cervical cancer incidence in Saudi Arabia is increasing. In addition to that, a high proportion of it is
discovered in advanced stages. This state of late discovery was attributed to the absence of efficient
preventive and screening programs.(4) By 2030, the yearly incidence of cervical cancer is expected to
jump to 700,000, and the number of deaths is predicted to increase if no further intervention is done
(5)

Methods: The study aim to evaluate the prevalence of abnormal Pap smear results among women
who were screened at Qatif Central Primary Health Care Centers, between November 2022 and
December 2023, with the aim of establishing a mandatory national screening program based on the
findings

The project has adopted a continuous approach by implementing a newly established cervical
screening program at Primary Health Centers (PHCs), which utilizes Pap smear tests for asymptomatic
women. This program is overseen by family physicians. Additionally, the project includes training for
family physicians to implement national guidelines, raising awareness, and developing key
performance indicators to monitor progress

Results: A sum of 626 Pap smears were conducted, aiming to reach 2% of married women annually,
equivalent to approximately 44 Pap smears per month. This endeavor resulted in the detection of
specific cases of ASCUS, LSIL, HSIL, and Adenocarcinoma, prompting the need for further examination
and referral for additional assessment.

Image:

201
Conclusion: The introduction of a compulsory cervical cancer screening program in the Qatif region
marks a significant stride towards enhancing women's health. This initiative prioritizes early detection
and prevention, aiming to mitigate the impact of cervical cancer through proactive measures

References: [Link] M, Xu L. Efficacy and safety of prophylactic HPV vaccines. A Cochrane review of
randomized trials. Expert Rev Vaccines. 2018;17:1085–1091

[Link] V, Wentzensen N, Mackie A, et al. The IARC perspective on cervical cancer screening. N Engl
J Med. 2021;385:1908–1918.

3 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018:
GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer
J Clin. 2018; 68: 394-424

[Link] and Predictive Factors of Cervical Cancer Screening in Saudi Arabia: A Nationwide Study:
Cureus. 2023 Nov; 15(11): e49331

Monitoring Editor: Alexander Muacevic and John R Adler

Fatimah H Alkhamis,1 Zainab Alabbas S Alabbas,1 Jwaher E Al Mulhim,1 Fadk F

Alabdulmohsin,1 Mariyyah H Alshaqaqiq,1 and Eithar A Alali1

5. A cervical cancer-free future: first-ever global commitment to eliminate a cancer. [ Nov; 2023 ].
2020. [Link]
commitment-to-eliminate-a-cancer: Disclosure of Interest: None Declared

202
Safety Culture Redefined: A Leadership Perspective in Healthcare Transformation: (1354) Gaurav
Loria

ISQUA2024-ABS-1354

N. Nishit 1, G. Loria 2,*, Y. Nayak 1

Apollo Hospitals, Delhi, 2Apollo Hospitals, Hyderabad, India

1

Introduction:

Ensuring patient safety and maintaining a high standard of care within healthcare organizations are
paramount objectives, especially in the wake of the challenging circumstances posed by the COVID-19
pandemic. Through the lens of annual safety culture surveys administered among a diverse workforce,
this study unveils the nuanced evolution of the hospital's safety culture across 12 dimensions. Ranging
from communication openness to organizational learning—and continuous improvement, these
dimensions provide a comprehensive view of the multifaceted elements that contribute to shaping
the safety culture within a healthcare institution. Employing a robust assessment tool developed by
the Agency for Healthcare Research and Quality (AHRQ) facilitates a thorough understanding of the
hospital's safety culture landscape.

Examining data from 2019 to 2023, we highlight positive trends in aspects like communication
openness, feedback mechanisms, and organizational learning. Simultaneously, we draw attention to
persistent challenges concerning staffing levels and fostering a non-punitive response to errors.
Through comparative analysis with the AHRQ database and an exploration of branch-specific
differences, we offer insights designed to extend beyond the immediate hospital setting, providing
valuable lessons and recommendations for healthcare organizations worldwide.

Methods: Our study employed an annual safety culture survey tool developed by the Agency for
Healthcare Research and Quality (AHRQ). This survey comprises 42 items measuring 12 dimensions,
including communication openness, feedback mechanisms, and organizational learning. The survey
also gauges outcomes such as patient safety grade and the number of reported events. Utilizing a five-
point Likert scale, responses ranged from strongly disagree to strongly agree.

The survey was administered online to all hospital employees across multiple branches in India.
Participation was voluntary and anonymous to encourage candid responses. Data analysis included
descriptive statistics such as mean scores, standard deviations, frequencies, percentages, and
confidence intervals. Additionally, a comparative analysis with the AHRQ database was conducted to
contextualize our findings. Ethical considerations were carefully observed, and the study adhered to
all relevant guidelines and regulations.

Results: Our analysis of the safety culture survey data spanning from 2019 to 2023 reveals noteworthy
trends in various dimensions. Positive associations were observed in communication openness,
feedback mechanisms, and organizational learning, indicative of a progressively improving safety
culture.

However, challenges were identified, particularly in relation to staffing levels and the establishment of
a non-punitive response to errors. These findings underscore the multifaceted nature of safety culture
within the hospital.

203
Conclusion: In conclusion, our study highlights the positive evolution of safety culture within the
hospital over the past five years, particularly in dimensions such as communication openness,
feedback mechanisms, and organizational learning. While these improvements are commendable,
challenges persist, notably in staffing levels and fostering a non-punitive response to errors.

These findings have direct implications for clinical practice, emphasizing the need for continued efforts
in enhancing communication, feedback processes, and organizational learning. Addressing staffing
challenges and cultivating a culture that encourages open reporting of errors without fear of
punishment are critical steps toward sustaining and further improving patient safety.

Our study contributes practical insights, grounded in data, to guide healthcare organizations in their
ongoing pursuit of excellence in safety culture. The nuanced understanding gained from our findings
informs targeted interventions and emphasizes the pivotal role of leadership in shaping a positive
safety culture for improved patient outcomes.

Disclosure of Interest: None Declared

Correlation between patient safety culture and the safety-relevant attitude of supervisors in
Austrian hospitals: Potential for improvement: (2846) Guido Offermanns

ISQUA2024-ABS-2846

G. Offermanns 1 2,*, A. Kratki 1

1
University of Klagenfurt, Klagenfurt, 2Karl Landsteiner Institute for Hospital Management, Vienna,
Austria

Introduction: Inadequate hospital care results in a significant number of adverse events, which are the
leading cause of morbidity and mortality in the health sector worldwide. These incidents also burden
health systems considerably, with an estimated 10% to 15% of health expenditures directly attributable
to patient safety incidents. To ensure patient safety and quality in health care, a safety-centred attitude
from the direct supervisor is essential. The safety-related attitude relates to, among other things,
punctuality, fairness, efficiency of treatment, and the focus on patients. Regarding the attitude of direct
supervisors in a hospital setting, this study addresses the following research question: Do healthcare
supervisors have consistent safety attitudes across different clinics/areas of work, and how is patient
safety related to supervisor safety attitudes?

Methods: The data were collected from June to September 2023. The validated Patient Safety Climate
Inventory Austria (PaSKI AUT) was used to assess patient safety in two Austrian hospitals under one
ownership. For data analysis, 525 questionnaires (response rate of 51%) were used. The manually
completed questionnaires were transferred into an SPSS file and then analysed using descriptive
statistics such as the Spearman correlation and significance tests. Kruskal-Wallis and post-hoc tests
with a Bonferroni correction were used to analyse possible differences in different clinics/areas

204
between the variables ‘safety-related attitude of the direct supervisor‘, ‘punctuality‘, ‘fairness‘,
‘efficiency of treatment‘, ‘patient orientation‘ and ‘level of patient safety‘.

Results: The Spearman correlation showed a positive relationship between the level of patient safety
and the safety-related attitudes of the supervisor (ρ = .37, p < .001). Kruskal-Wallis and post-hoc tests
revealed significant differences between the main areas of work, such as internal medicine and other
facilities, as well as in the safety-related attitude of the direct supervisor (p < .05). Further differences
emerged in the working areas and between the variables ‘patient orientation‘, ‘punctuality‘, ‘efficiency
of treatment‘ and ‘level of patient safety (p < .05).

Conclusion: Regarding the research question, there are significant differences between working in
clinics/areas regarding views on patient safety and other variables, as well as a positive correlation
between the variables of patient safety and safety-relevant attitudes of supervisors. It could thus be
shown that in some departments, the standards for patient safety are provable lower than in others,
including the relevant reasons. Better attitudes on the part of direct supervisors and the introduction
of targeted instruments would help to improve patient safety. In a follow-up a qualitative analysis with
semi-structured interviews could be used to determine the reasons for these differences between
departments. The study was conducted as a cross-sectional study. To test the effectiveness of the
implemented changes, measurements will be taken again at a second point in time, which will be a
longitudinal study.

Disclosure of Interest: None Declared

Findings from Ireland’s first National End of Life Survey; a survey of bereaved people on care
provided to relatives and friends in the last three months of life: (3184) Donnacha O' Ceallaigh

ISQUA2024-ABS-3184

D. O' Ceallaigh 1,*, C. Foley 1, D. Rohde 1, T. O'Carroll 1, E. Tuohy 1, R. Flynn 1

1
National Care Experience Programme, Health Information and Quality Authority (HIQA), Dublin,
Ireland

Introduction: The National End of Life Survey is Ireland’s first national survey to ask bereaved people
about the care provided to relatives and friends in the last months and days of life. The aim of the
survey is to learn from people’s experiences of end-of-life care in order to improve services provided
both to people who are dying and to their loved ones, as well as to replicate areas of good experience
across healthcare services and settings.

Methods: People who registered the death of an adult relative or friend (aged 18 and over) who died
between 1 September and 31 December 2022 were eligible to participate. Sudden and unexpected
deaths were excluded. Eligible participants received a survey pack by post between March and June
2023, with the option of completing the survey by paper or online. The survey questionnaire consisted
of 110 questions, and captured experiences of care provided in the last three months of life in

205
hospitals, hospices, nursing homes and at home. The survey included questions on pain management,
respect and dignity, emotional support, communication with healthcare staff, the provision of
information and coordination of care within and between services.

A communications plan was successfully implemented to maximize the survey’s response rate. This
included raising awareness of the survey via social media, information webinars and radio
advertisements.

Results: Approximately 9,500 bereaved people were invited to participate in the survey, of whom
4,570 people chose to take part (48% response rate). Findings indicate that the majority of
respondents reported that the care their relatives and friends received was either good or very good
and that their relatives and friends were treated with respect and dignity. However, respondents also
reported that the care provided could been coordinated better, both across and within services and
settings where their relatives and friends received end-of-life care.

Conclusion: The survey represents the first standardised national approach to capturing the
experiences of bereaved people to improve end-of-life care in Ireland. Nominated healthcare
professionals were provided with access to the findings through the National End of Life Survey
dashboard, and are using the findings to inform the development of quality improvement plans to
improve experiences of end-of-life care.

Disclosure of Interest: D. O' Ceallaigh Employee of: Health Information and Quality Authority (HIQA),
the regulatory body for health and social care services in the Republic of Ireland. , C. Foley Employee
of: Health Information and Quality Authority (HIQA), the regulatory body for health and social care
services in the Republic of Ireland. , D. Rohde Employee of: Health Information and Quality Authority
(HIQA), the regulatory body for health and social care services in the Republic of Ireland. , T. O'Carroll
Employee of: Health Information and Quality Authority (HIQA), the regulatory body for health and
social care services in the Republic of Ireland. , E. Tuohy Employee of: Health Information and Quality
Authority (HIQA), the regulatory body for health and social care services in the Republic of Ireland. , R.
Flynn Employee of: Health Information and Quality Authority (HIQA), the regulatory body for health
and social care services in the Republic of Ireland.

Lightning Talks

Integrating Cervical Cancer Screening Program as Modle of Care in Eastern Health Cluster: (2753)
Dalia Al-OUF

ISQUA2024-ABS-2753

Z. A. Al-Turaifi 1,* on behalf of Maternity and children hospital dammam, M. Alshehabi 2 on behalf of
Modle of care team, D. Al-OUF 1

206
1
MCHD lab, Eastern Health Cluster-Maternity and children hospital dammam , 2Modle of care, Eastern
Health Cluster, Dammam, Saudi Arabia

Introduction: Cervical cancer is a major global health burden, especially for women who face
significant challenges due to limited resources and limited access to healthcare services. The Pap
smear is a commonly used technique in many contexts, and cervical cancer screening programs are
essential for the early detection and prevention of the disease. This article discusses the
implementation and effectiveness of Pap smear-based cervical cancer screening programs in Saudi
Arabia's infrastructure screening program, as well as the associated barriers and potential solutions.

Methods: The development of an effective cervical cancer screening program involves various
key analysis and engagement activities. The following steps are typically conducted: 1- Needs
assessment: This involves conducting a literature review to gather data on cervical cancer incidence
and mortality rates. 2- Stakeholder mapping and consultations through surveys, interviews, and focus
group meetings conducted to understand their perspectives and needs 3- Program design: Clinical
guidelines and evidence on screening best practices are reviewed. Also, the impact on the yearly
budget and the cost-effectiveness of potential program approaches are assessed. 4- Pilot testing: The
program processes typically around 100 cases, for a period of 3 months then scale up phase to 1000
cases per year as 2% married women from each primary healthcare that is involved in this project
through the evaluation of feasibility testing. 5- Public awareness campaigns designed for primary
healthcare centers. 6- Monitoring and evaluation: Screening rates, follow-ups, and outcomes are
tracked to assess whether the program is achieving its goals whicg are facilitated using software such
as Redcap, developed by Eastern Health Cluster (EHC).

By following these steps, a comprehensive and effective cervical cancer screening program was
developed and established.

Results: The performance and embed change in this screening program, several approaches
implemented. Continuous Quality Improvement (CQI): data analysis, and feedback mechanisms in
identify areas for improvement. (KPIs) can be demonstrated through improved screening rates and
increased adherence to recommended follow-up [Link] systematic recall and
reminder systems was effective strategy to encourage timely and regular screening facilitated by care
coordinators. These KPIs was calculated through RedCap , which used in evaluating this program
include the percentage of pap smears performed, average wait time from pap smear to lab result,
percentage of pap smear rejections, average wait time from lab result to primary healthcare receipt of
results, average wait time from a positive result to referral to a tertiary hospital, percentage of time
between secondary and tertiary hospital referrals, percentage of patients with positive cervical cancer
results, and cervical cytology classification rates based on CAP classification rate percentile as a
benchmark. By tracking these KPIs over time, program managers an evaluate the effectiveness of the
cervical cancer screening program, identify areas for improvement, and make decisions to optimize
early detection, treatment modalities, and prevention of cervical cancer.

207
Image:

Conclusion: Recommendation: Documenting challenges and lessons at each phase of a cervical cancer
screening program is crucial for refining implementation approaches. Pilot testing helps uncover and
anticipating challenges during the scale-up phase, such as supply chain management for test kits. User-
friendly digital tracking systems, such as RedCAP. Continuous improvement of screening tests and
tools based on evolving technologies. Partnering with secondary institutions to explore introducing
emerging technologies like HPV DNA testing can be considered for future scale-up
phases. Standardizing pathological reports and assessments across implementers helps achieve long-
term centralized coordination and strengthens referral pathways from screening to treatment.
Upgrading lab facilities by improving infrastructure and installing state-of-the-art equipment leads to
faster and improved healthcare services. In conclusion, Pap smear-based cervical cancer screening
programs have the potential to reduce the burden of cervical cancer . However, successful
implementation requires collaborative efforts between governments, healthcare organizations, and
international partners are essential for developing sustainable and comprehensive cervical cancer
screening programs that can make a significant impact on women's health in early staged cervical
cancer through national health screening program in Saudi Arabia.

Disclosure of Interest: None Declared

208
Improving Performance for Private Practice Midwife through online Client Satisfaction Survey:
(2260) Damaryanti Suryaningsih

ISQUA2024-ABS-2260

D. Suryaningsih 1,*, N. Nuwirman 2

Program Management, 2Public private partnership, USAID-MPHD, Jakarta, Indonesia

1

Introduction: In Indonesia the role of midwives as the front-liner in maternal and new-born delivery
service is important as the majority of people would go to midwives during pregnancy and maternity.
The Ministry of Health conducted Basic Health Research and reported that in November 2018, about
85% of pregnancy care among women between the age of 10-54 years was performed by midwives.
As for birth attendance, the data show similar result; in which 62.7% of births were attended by
midwives. Those figures indicate that the midwives are still the primary providers of pregnancy and
delivery care in Indonesia. The midwives referred to this report are private midwife practitioners.

In a public service, customer satisfaction is one of the foundations for institutions that must be
strengthened. As a health service provider, midwives also need to pay attention to the satisfaction of
the patients they serve. Patient satisfaction is a level of patient feelings that arise as a result of the
performance of the health services they receive after the patient compares them with their
expectations. Measuring patient satisfaction is an indicator to determine the quality of health services
and patient expectations have an important role as a comparison standard in evaluating satisfaction.
Service satisfaction has also become an obligation for service providers as mandated by Indonesia Law
25 of 2009 concerning Public Services.

USAID MOMENTUM Private Healthcare Delivery Project (2021-2025) support Indonesian Midwives
Association to conduct Customer Satisfaction Survey of private midwife clinic.

The survey objectives are:

1. To obtain information and experiences of patients receiving maternal and new born health
services and families

2. To obtain and get feedback from recipients of maternal and new born services as material for
improving service quality and improving policies

3. Increase the awareness of midwives providing services to continuously improve the quality of
their services.

Methods: Cross sectional study. The study was conduct in 3 districts in Indonesia. Sample using
purposive sampling, 10% of a total of private midwife practice in each district. The data collection
carried out through online survey. The population are recipients of maternal and new born services
from selected private practice midwife in the last 3 months. The sample will be selected using Krejci
and Morgan tables. The data will be processed using the Community Satisfaction Survey data
processing framework in accordance with Ministerial Regulation 14 of 2017.

Results:

Main questions Perception score Conversion Score Quality Performance

209
1. Clarity of service
3,43 85,85 B Good
information provided

2. Patient understanding
3,18 79,57 B Good
of service procedures

3. Midwives' speed in
3,35 83,8 B Good
providing services

4. Reasonable service
3,04 76,17 C Fair
costs/tariffs

5. Conformity between
the services received and 3,32 83,05 B Good
those expected

6. Competence/ability of
midwives in providing 3,41 85,31 B Good
services

7. Politeness and
friendliness of midwives 3,5 87,62 B Good
in providing services

8. Quality of facilities and

infrastructure at the 3,25 81,26 B Good
facility

9. Availability of
3,29 82,2 B Good
complaint channels

10. Follow up on
3,26 81,47 B Good
complaints given

Average 3,307 84,29 B Good

From 1085, 962 clients responded to the survey. From 10 questions IKP, 9 were good and only question
“reasonable service cost question” was fair.

Conclusion: The result can be to improve the service of private practice midwife, and the survey online
can be a routine feedback system in Indonesian Midwife Association

Disclosure of Interest: None Declared

210
Enhancing Diversity in Health Research through Research Engagement Network (REN): A
Hyperlocal Community- Based Approach in Northwest London (NWL): (2622)
Ganesh Sathyamoorthy

ISQUA2024-ABS-2622

N. Dsouza 1, G. Sathyamoorthy 1,*, K. Ahmadi 1, K. Dharmayat 1, E. Kwong 1

Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
1

Introduction: Communities championing their own health is crucial to providing sustainable and
integrated health services of the future. However, research in integrated care has an
underrepresentation of population groups, particularly ethnic minority communities, that are at
increased risk of developing diseases. Community-based participatory research is where community
and research stakeholders have meaningful dialogue. Embodying this approach, the Research
Engagement Network (REN) initiative, which is an iterative programme, strives to promote diversity in
research participation in NWL region, an area of over 3 million population, through three strategies:
community-based health roadshows, Community Research Champions (CRCs), and the Partnership
Forum (PF). Our objective was to engage a diverse range of communities, facilitate meaningful
conversations with the CRCs about diversity in research and contribute to shaping research priorities
by gathering insights and perspectives from the community.

Methods: We utilised a bottom-up, hyper-local, community-based approach to engage with diverse

communities in two most ethnically diverse districts in NWL. Multiple trained CRCs facilitated
discussions on diversity in research. The Partnership Forum, consisting of independent chairs, was
established to strengthen networking between Primary Care Networks, statutory bodies, and
academic partners. Furthermore, partnerships were established between academia, public health, the
voluntary sector, and primary care networks to create multi-agency collaboration. Agile project
management helped increase community engagement through multi-agency health "roadshows"
events, fostering a collaborative approach to community health.

Employing a mixed-methods approach, we gathered valuable insights from roadshows, identified

issues, and evaluated current challenges and readiness for research participation. Additionally, we
collaborated with stakeholders to co-create innovative solutions iteratively to tackle obstacles and
drive positive change.

Results: The health roadshows engaged more than 1,200 residents, offering health checks, community
services, and research participation opportunities. Trained CRCs facilitated discussions, with feedback
showing 95% and 92% recognise the importance of and understand health research, respectively, and
75% express willingness to participate. While slightly more than half (55%) knew where to look for
research findings (55%), it forms a basis to strengthen community engagement. The project highlighted
the voluntary sector's potential, showcasing collaborative impacts on NWL with potential applicability
to additional districts.

The project's impact spanned five key areas (Figure 1). It created safe spaces that fostered relationships
and trust, addressed language barriers to encourage greater engagement with health and research
partners, and contributed to reducing social isolation by identifying community issues such as digital

211
inclusion. The success of this initiative has laid the groundwork for REN2, which will continue to build
on these outcomes and expand to other districts regionally while focusing on key healthcare needs.

Image:

Conclusion: This project demonstrated that the three-pillar strategy— community-based health
roadshows, CRCs, and the PF effectively engaged diverse communities, fostered meaningful
conversations, and shaped research priorities. These collaborative efforts had a positive impact on
communities, emphasising the ongoing need to address health disparities. As the income gaps widen
and with ageing populations, it is essential to involve communities, creating integrated sustainable
healthcare. This community model strategy is currently being scaled up within the region and is the
basis of translation both nationally and internationally.

Disclosure of Interest: None Declared

212
Interdisciplinary collaboration and computer-assisted home healthcare referral in the emergency
department: An innovative model in Taiwan: (3245) Hung-Jung Lin

ISQUA2024-ABS-3245

H.-J. Lin 1,*. 1Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan

Introduction: Home healthcare (HHC) provides continuous care for disabled patients. However, HHC
referral after the emergency department (ED) discharge remains unclear. Thus, this study aimed its
clarification.

Methods: A computer-assisted HHC referral by interdisciplinary collaboration among emergency

physicians, case managers, nurse practitioners, geriatricians, and HHC nurses was built in a tertiary
medical center in Taiwan. Patients who had HHC referrals after ED discharge between February 1, 2020,
and September 31, 2020, were recruited into the study. A non-ED HHC cohort who had HHC referrals
after hospitalization was also identified. Comparison for clinical characteristics and uses of medical
resources was performed between ED HHC and non-ED HHC cohorts.

Results: The model was successfully implemented. In total, 34 patients with ED HHC and 40 patients
with non-ED HHC were recruited into the study. The female proportion was 61.8% and 67.5%, and the
mean age was 81.5 and 83.7 years in ED HHC and non-ED HHC cohorts, respectively. No significant
difference was found in sex, age, underlying comorbidities, and ED diagnoses between the two
cohorts. The ED HHC cohort had a lower median total medical expenditure within 3 months (34,030.0
vs. 56,624.0 New Taiwan Dollars, p = 0.021) compared with the non-ED HHC cohort. Compared to the
non-ED HHC cohort, the ED HHC cohort had a lower ≤1 month ED visit, ≤6 months ED visit, and ≤3
months hospitalization; however, differences were not significant.

Conclusion: An innovative ED HHC model was successfully implemented. Further studies with more
patients are warranted to investigate the impact.

References: 1. Bureau, U.S.C. Projections by age and sex composition of the population. 2017
[cited 2021 September 18]; Available from:
[Link]

2. Directorate General of Budget, A.a.S.D.o.E.Y., Taiwan. National Statistics Bulletin. 2021 [cited
2021 August 8]; Available from: [Link]

3. Department of household registration, T. National demographics. 2021 [cited 2021 August 8];
Available from: [Link]

4. National Health Insurance Administration, M.o.H.a.W., Taiwan. National Health Insurance

Home Medical Integrated Care Pilot Project. 2015 [cited 2021 August 8]; Available from:
[Link]

5. American College of Emergency, P., et al., Geriatric emergency department guidelines. Ann
Emerg Med, 2014. 63(5): p. e7-25.

6. Association, A.H. Summary of New CMS Flexibilities for Acute Hospital Care at Home Program.
2020 [cited 2021 August 12]; Available from:

213
[Link]
[Link].

7. Center, C.M.M. Introduction of Chi Mei Medical Center. 2020 [cited 2021 August 30]; Available
from: [Link]

8. Huang, C.C. Introduction for Geriatric Emergency Department. 2016 [cited 2021 September 1];
Available from: [Link]

9. Huang, C.C., et al., Elderly and nonelderly use of a

dedicated ambulance corps’ emergency medical services in Taiwan. BioMed Res Int, 2016. 2016: p.
1506436.

10. Ke, Y.T., et al., Prevalence of geriatric syndromes and the need for hospice care in
older patients of the emergency department: A study in an Asian medical center. Emerg Med Int,
2020. 2020: p. 7174695.

Disclosure of Interest: None Declared

Hub and Spoke Model: To Nurture Quality Improvement of Neonatal Services across four
Nahdatul Ulama Hospital Network in East Java Province, Indonesia: (3072) Istiyani Purbaabsari

ISQUA2024-ABS-3072

Purbaabsari 1,*
. 1Technical Team , USAID-Momentum Private Healthcare Delivery, DKI Jakarta,
Indonesia

Introduction: The Indonesia Long form survey in 2020 documented the neonatal mortality rate of 9,3
per 1000 live birth. Poor quality care is one of the major contributing to this number. According to
Indonesia Ministry of health report 2020, asphyxia still become the second major cause of death after
low birth weight. Momentum Private Health Care Delivery (MPHD), a 4-year USAID-funded project,
supports the government to introduce Hub and Spoke model for neonatal services quality
improvement. This hub and spoke model implementation aim to nurture quality improvement (QI)
culture in the participated facility.

Methods: The hub and spoke model (HSM) have been used to strengthen weak peripheral settings by
connecting them to a more advanced resource hub. This hub and spoke model started to implement
across four Nahdatul Ulama Hospital Network (LKNU Hospital) in August 2023. LKNU mentor hospital
which have advanced QI skill were designated as hub and 3 other LKNU hospital as spokes. This model
was combining offline workshop and online interactive session using WhatsApp Channel message,
WhatsApp Class and Zoom virtual session. Asphyxia aim statement collaborative, measurement and
bundle of care (BoC) that created from driver diagram developed by QI expert faculty in national level.

214
Results: One basic QI skill workshop, WhatsApp channel session where message regarding detail list
of asphyxia BoC were shared through WhatsApp Group every day in one week, one zoom session for
spokes to define their aim statement targets, measurements and list of selected BoC that will test using
PDSA cycle and three online learning session were conducted. 14 QI projects were successfully
completed by spokes hospital. After, the use of admission screening, partograph and fetal heart rate
monitoring observation in 2nd stage of labor become their routine services. Aggregated Indicator on
percentage of newborn asphyxia as an outcome indicator that hospital need to decrease, showed data
from January- August 2023 (before implementation) were 1,73%, 3,61%, 3,09%, 1,66%, 3,57%, 0,84%,
4,88% and 2,87% respectively. And data from September - December 2023 were 1,49%,1,99%, 2,40%
and 0,78% respectively were below the median line (2,42%) which indicates a better direction of this
outcome indicator.

Conclusion: Hub and spoke can addressed gap related resource and time in offline mentoring, because
this model uses more online sessions. Hub and spoke allows several hospitals to work collaboratively
that can accelerate quality of care improvement. Various components of the health system at all levels
need to work in synergy to sustain improvement in quality of care. Hospital will not be able to carry
out QI initiative alone, active participation of District Health Office and local government can play
important role to create a quality improvement culture in the health system.

References: Indonesia Long form survey , 2020

Indonesia Ministry of health report 2020

Disclosure of Interest: None Declared

Establish a Diversified Palliative Care Network in Long-term Care Institutions: (2397) Jheng-Ling Li

ISQUA2024-ABS-3297

A. Vasconcelos 1,*, F. Stapf 1, M. Dirlando Conte de Oliveira 1, G. Colombo 1, M. Cendoroglo Neto 1, S.

Klajner 1, D. Tavares Malheiro 1, V. Damazio Teich 1

Hospital Israelita Albert Einstein, São Paulo, Brazil

1

Introduction: Cerca de quarenta e cinco porcento dos pacientes recebem serviços médicos com
benefícios mínimos ou nenhuns (cuidados de baixo valor). Além de aumentar os custos para o sistema
de saúde, a realização de procedimentos invasivos sem indicação apresenta riscos potencialmente
evitáveis à segurança do paciente.

Methods: Determinar se um programa gerenciado de melhoria da qualidade pode prevenir

colecistectomias e cirurgias para tratamento de endometriose com benefício mínimo ou nenhum
benefício para as pacientes. Estudo clínico antes e depois realizado em um hospital privado de São

215
Paulo, Brasil, cujo principal modelo de remuneração médica é a taxa por serviço. Foram avaliadas todas
as pacientes cujo cirurgião agendou colecistectomia ou cirurgia para endometriose entre 1 de agosto
de 2020 a 31 de maio de 2021. Limitação à realização de procedimentos que não atendam aos critérios
previamente definidos ou cuja indicação não tenha sido validada por conselho de especialistas

Results: As características clínicas das pacientes e o desfecho foi a redução na realização de

colecistectomias e cirurgias para tratamento de endometriose cuja indicação não foi validada por
conselho de especialistas. Isto permitiu uma redução anual estimada de custos para o sistema de
saúde de US$ 484.356,35.

Conclusion: In a hospital with private practice and fee-for-service medical remuneration, the definition
of clear criteria for indicating surgery and the analysis of cases that do not meet these criteria by a
board of reputable experts at the institution resulted in a statistically significant reduction of low-value
cholecystectomies and endometriosis surgeries.

References: Abrão MS, Petraglia F, Falcone T, et al. Deep endometriosis infiltrating the recto-sigmoid:
critical factors to consider before management. Hum Reprod Update 2015;21:329–39Practice
Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated
with endometriosis: a committee opinion. Fertil Steril 2014;101:927–35Committee on Quality of
Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for
the 21st Century. Washington: National Academies Press, [Link] AH, Radomski TR. Reducing low-
value care and improving health care value. JAMA 2021;325:1715–6Schwartz AL, Zaslavsky AM,
Landon BE, et al. Low-value service use in provider organizations. Health Serv Res 2018;53:87–
119Sakorafas GH, Milingos D, Peros G. Asymptomatic cholelithiasis: is cholecystectomy really needed?
A critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy. Dig Dis Sci
2007;52:1313–25Attili AF, De Santis A, Capri R, et al. The natural history of gallstones: the GREPCO
experience. Hepatology 1995;21:655–60Gutt C, Schläfer S, Lammert F. The treatment of gallstone
disease. Dtsch Arztebl Int 2020;117:148–58ABIM Foundation. Choosing wisely: an initiative of the
ABIM foundation. n.d. Available: [Link]/clinician-lists/ sages-routine-
cholecystectomy-for-asymptomatic-cholelithiasisAbbott J, Hawe J, Hunter D, et al. Laparoscopic
excision of endometriosis: a randomized, placebo-controlled trial. Fertil Steril 2004;82:878–84

Disclosure of Interest: None Declared

216
Municipality rehabilitation after hospital admission: (1847) Lars Morsø

ISQUA2024-ABS-1847#

L. Morsø 1 2,*, S. Birkeland 1 3, S. Bie Bogh 1 2

1
OPEN Research Unit, Odense University Hospital, 2Department of Clinical Research, 3Department of
Regional Research, University of Southern Denmark, Odense, Denmark

Introduction: Rehabilitation is recommended as part of the solution to future demographic challenges

posed by an increasing number of individuals with reduced functional capacity and chronic illnesses.
Estimates indicate that one in three is in the need of rehabilitation at some point of life.
In the 2011 WHO report on disability rehabilitation is defined as ’a set of measures that assist
individuals who experience, or are likely to experience, disability to achieve and maintain optimal
functioning in interaction with their environments’.

In some countries, rehabilitation guidelines on aim, content, and duration are widely available,
whereas patients’ right to access rehabilitation and referral pathways is only described sparsely. In
Denmark, individuals encountering a functional impairment during the hospitalisation possess the
right to have prescribed a rehabilitation plan (RP). The hospital exclusively prescribes the RP, with the
majority of rehabilitation services administered at the municipality level. In 2021, approx. 200.000 RPs
were issued in Denmark. Studies indicate that not all patients who could benefit from rehabilitation
are referred. If certain sociodemographic characteristics are decisive for the prescription and the
execution of the RP, it would compromise the principle of equal access to healthcare services.

The study aims to investigate potential disparities of individuals discharged with a rehabilitation plan
from the hospital, explore the initiation of rehabilitation at the municipality level, and assess the extent
to which rehabilitation plans are activated within 7 days following discharge.

Methods: The current study is a registry-based investigation including all acute hospital contacts from
Odense University Hospital (OUH) during the years 2015 to 2020. The study utilises rehabilitation
referrals, demographic and municipal data from a population of residents in Odense Municipality.

Descriptive analyses include patient characteristics, information on municipality-based services or care

and residential status. The odds ratios (OR) for the prescription of a RP and the OR of an activated RP
within 30 days are estimated using logistic regressions. A Kaplan-Meier plot illustrates the cumulative
incidence of RP activations to determine the 30-day cutoff. The likelihood that the RP would be
activated within period of 7 days were also estimated.

Results: The cohort comprised 308,030 residents of Odense Municipality discharged from the hospital
from 2015 to 2020. Overall, 10,511 (3.5%) received an RP after hospital admission. Recipients of a RP
were older, were single, had allocated domestic help and were ethnic Danes.

Men were less likely to have a RP prescribed (OR 0.95 [0.91; 0.99]). The results showed significantly
lower odds for patients receiving nursing care (OR 0.94 [0.89; 0.98]). In contrast, the likelihood of
having a RP prescribed increased, not surprisingly, with age, with the 80+ age group having the highest
odds of receiving a RP (OR 9.30 [8.43; 10.26]). The odds also increased if the RP receiver was of Danish
ethnicity (OR 1.60 [1.47; 1.75]).

217
For the overall prescribed RPs (n= 10.511), 37% (3,887) were initiated within the legislative
requirements of seven days, 68.1% (7,042) of the perceived RPs were initiated within 30 days, and
71.6% (7525) had initiated the RP in the municipality at 60 days. The results showed that non-initiation
of the RP within 30 days substantially increased the risk of not initiating the RP at all.

Conclusion: The study's findings indicate that several variables appear to be associated with the
issuance of a RP. Some of these variables are intuitively sensible (e.g., increased age), while others may
potentially reflect unequal access to municipal rehabilitation services (e.g. gender and ethnicity).
Potential inequality was not reflected in initiation of the RP. 37% of those who had prescribed a RP did
start within the legally bound period of 7 days. If a RP was not initiated within 30 days chances were
small for initiation at all.

Disclosure of Interest: None Declared

Tumor markers changed among hepatitis C adults after antiviral therapy: Implication for primary
healthcare: (1815) Mei-Yen Chen

ISQUA2024-ABS-1815

M.-Y. Chen 1,*

Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan

1

Introduction: In the real world, primary healthcare providers frequently find themselves explaining
and addressing the significance of tumor markers. Traditionally, α-fetoprotein (AFP) is clinically utilized
as a tumor marker for liver cancer; carbohydrate antigen-125 (CA125) is associated with ovarian
cancer; carbohydrate antigen 19-9 (CA 19-9) is linked to gastrointestinal malignancies, and
carcinoembryonic antigen (CEA) is employed to detect colorectal cancer. However, some elevated
tumor markers are not specific for cancer diseases. Therefore, clinicians should consider this
nonspecific elevation not only for tumor signs but also associated with cardiometabolic disorders.
Chronic hepatitis C (CHC) is the leading cause of liver cirrhosis and hepatocellular carcinoma. Direct-
acting antivirals (DAAs) are highly effective in virus clearance. Longitudinal effects on the tumor
markers changed are lacking. This study aims to explore the long-term effects on tumor markers, liver,
and renal function changes after receiving antivirals.

Methods: An observational and longitudinal cohort study was applied to the western coastal Yunlin
County, Taiwan. Between July 2017 and December 2021, 191 rural adults with CHC participated in this
project. The outcomes measured included four tumor markers and liver and renal function changes
before and after DAAs therapy.

Results: The findings showed that the exception of the tumor marker of CEA, AFP, CA125, and CA19-9
had significantly reduced (p<0.001), and all biomarkers of liver and renal function also significantly

218
improved (p<0.001) after antivirals treatment. The regression coefficient of interaction indicated that
females had a better chance in the GPT (p<0.05) and GGT (p<0.01).

Conclusion: This study demonstrated DAAs therapy significantly reduced tumor markers of AFP,
CA125, CA19-9, and liver and renal function in rural adults with CHC after a longitudinal observation.
These findings implied that primary healthcare providers and clinicians should initiate case finding in
the disadvantaged area and encourage adults with CHC to receive DAAs therapy.

References: References

Akinwunmi BO, Babic A, Vitonis AF, Cramer DW, Titus L, Tworoger SS, Terry KL. Chronic medical
conditions and CA125 levels among women without ovarian cancer. Cancer Epidemiol Biomarkers Prev.
2018;27(12):1483-1490.

Baskiran DY, Sarigoz T, Baskiran A, Yilmaz S. The significance of serum tumor markers CEA, Ca 19-
9, Ca 125, Ca 15-3, and AFP in patients scheduled for orthotopic liver transplantation: do elevated
levels really mean malignancy?

J Gastrointest Cancer. 2022 doi: 10.1007/s12029-021-00798-5.

Edula RG, Muthukuru S, Moroianu S, Wang Y, Lingiah V, Fung P, Pyrsopoulos NT. CA-125. Significance
in cirrhosis and correlation with disease severity and portal hypertension: a retrospective study. J Clin
Transl Hepatol. 2018; 6(3):241-246.

Hu X, Zhang J, Cao Y. Factors associated with serum CA125 level in women without ovarian cancer in
the United States: a population-based study. BMC Cancer. 2022; 22(1):544.

Kuwano A, Yada M, Nagasawa S, Tanaka K, Morita Y, Masumoto A, Motomura K. Serum α-fetoprotein

level at treatment completion is a useful predictor of hepatocellular carcinoma occurrence more than
one year after hepatitis C virus eradication by direct-acting antiviral treatment. J Viral Hepat.
2022;29(1):35-42

Maebayashi T, Ishibashi N, Aizawa T, Sakaguchi M, Okada [Link] radiotherapy for

hepatocellular carcinoma induced by hepatitis C and the relationships of changes in
carbohydrate antigen 19-9 with AFP and PIVKA-II. Cancer Radiother. 2021; 25(3):242-248.

Disclosure of Interest: None Declared

219
My Voice Our Stories: using storytelling data to inform public policy and address unmet needs:
(3357) Michael T Hager

ISQUA2024-ABS-3357

M. T. Hager 1,*

Administration, Ready, Aim, Innovate, New York, United States

1

Introduction: While quality initiatives typically have access to expansive quantitative data for analysis
to inspect for deficiencies, qualitative data sources are lacking to inform on nuanced contexts that play
into quantitative results. Without such qualitative data, there is risk for biases to influence the
interpretation of quantitative data. The degree to which traumas and other factors weigh on
individuals and communities is invisible. There is risk that incorrect inferences will lead to development
of ill-fitting interventions that solve the wrong problem. Storytelling projects offer solutions by creating
sources of valid mixed-methods data for analysis. Our presentation will layout the scientific methods
used to create such storytelling projects and how Ready Aim Innovate (RAI) developed its code book
for the purpose of coding stories.

Methods: My Voice Our Stories (MVOS) is rooted in community-based participatory research,

evidence-based co-design, and implementation science. We use mixed methods data analysis to
identify unmet needs that drive poor and inequitable outcomes. We work with stakeholders to identify
population, geography, and issue of focus for analysis. We create frames that are appropriate to
develop stories that focus the primary issue using a trauma informed lens. The openness of
interpretation by participants limits bias in developing stories that will lead to actionable findings.
Storytelling workshops focus on a range of artful expression including spoken and written word,
photography and videography, and fiche. Boal's Theatre of the Oppressed provides the analytical
framework where expert coders review stories for social and personal determinants of health that
drive outcomes according to the literature. Coded data produce themes related to the risk and
outcomes relationship. Themes are presented back to storytellers for confirmation. Community-
confirmed results are taken to meetings with government and program leads and civil society partners
to identify solutions that meet community needs. Stories are shared at a community storyslam for
stakeholders to interact with storytellers. Stories are shared through social media and websites to build
momentum.

Results: Through July 2024, six cohorts will have been completed involving diverse groups from across
NJ. Stories from nearly 50 diverse community members have been used collected to drive change.
Themes collected to-date center on missed opportunities long before an HIV diagnosis that could
prevent exposure to personal and social risks that play into HIV infection risk. Depending on the service
population, this takes a different form, but relates to formal and informal supports available to
vulnerable people, particularly youth, that have lasting harmful or protective effects over time. Among
the three cohorts that have already been completed, numerous specific policy recommendations have
been made to the state department of health and relevant county public health entities. Among the
recommendations is a focus on creating educational materials for teachers and police departments
related to working with sexual and gender minorities. Another example includes the recommendation
that the department of education collaborate with the department of health on youth empowerment
activities for young black and brown girls in resource limited settings. There are additional results

220
beyond health system structures to share. New relationships with museums, public libraries, and other
entities formed through this work. New relationships with local businesses have created new safe
spaces in communities and strengthened bonds within neighborhoods. One company has committed
to creating a fund to further works that government would be unable to fund.

Conclusion: Community storytelling effectively infuses community perspectives into care system
evaluation to drive program enhancement through partnerships. It is possible to capitalize on the
importance and popularity of storytelling to mobilize communities, tap into different perspectives, and
scan for opportunities that can make a lasting impact. The use of community storytelling has been
proven successful in bringing together stakeholders around a common purpose and examine collective
steps to bring about an end to the HIV epidemic. According to Boal's body of work Legislative Theater
multiple nations around the world are already utilizing these methods for exactly that purpose across
a range of needs present in their societies.

References: Mayotte C, Kiefer C. (2018). Say It Forward: A Guide to Social Justice Storytelling.
Haymarket Books. ISBN: 9781608469581

McHugh, N., Baker, R. & Bambra, C. Policy actors’ perceptions of public participation to tackle health
inequalities in Scotland: a paradox?. Int J Equity Health 22, 57
(2023). [Link]

Scott, J. T., Larson, J. C., Buckingham, S. L., Maton, K. I., & Crowley, D. M. (2019). Bridging the research-
policy divide: Pathways to engagement and skill development. The American

journal of orthopsychiatry, 89(4), 434–441. [Link]

Disclosure of Interest: None Declared

Association between PM2.5 exposure and incident Metabolic Dysfunction-Associated Steatotic

Liver Disease (MASLD): a Cohort Study: (3390) Wei-Chun Cheng

ISQUA2024-ABS-3390

W.-C. Cheng 1 2 3,*, P.-N. Cheng 2, C.-Y. Li 3 4 5

1
Department of Gastroenterology and Hepatology, Tainan Hospital, Ministry of Health and Welfare,
2
Department of Internal Medicine, 3Department of Public Health, College of Medicine, National Cheng
Kung University, Tainan, 4Department of Public Health, College of Public Health, China Medical
University, 5Department of Healthcare Administration, College of Medical and Health Science, Asia
University, Taichung, Taiwan

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a

significant global health challenge, characterized by systemic inflammation and metabolic
dysregulation with fat deposition in liver. Recent redefinitions of the disease [1] highlight its growing
prevalence and the associated increase in morbidity and mortality [2]. While lifestyle and behavioral

221
factors are well-recognized contributors, emerging evidence suggests a link between MASLD and
environmental factors, such as air pollution [3]. This study explores the association between
particulate matter with an aerodynamic diameter ≤ 2.5 μm (PM2.5) exposure and the development of
MASLD within a health checkup cohort.

Methods: We conducted a cohort study including individuals who participated in health checkups from
2012 to 2015, were free of MASLD at baseline, and underwent at least one subsequent health checkup
by 2017. The three-year average exposure to PM2.5 prior to the health checkups was evaluated. MASLD
diagnosis was based on sonographic evidence of hepatic steatosis, coupled with at least one of five
cardiometabolic criteria [1]. A time-dependent Cox regression model was utilized to analyze multiple
health checkup data, tracking each participant until MASLD diagnosis, death, or the study's end on
November 30, 2022.

Results: The study encompassed 19,464 participants without baseline MASLD. Over a median follow-
up of 14.1 months, 3,220 individuals (16.5%) developed MASLD, and 580 (3.0%) died. Factors such as
higher education/income levels, increased consumption of fried foods, elevated body mass index, and
dyslipidemia were linked to a higher hazard for MASLD. Conversely, female gender and regular physical
activity were protective factors. Notably, increased PM2.5 exposure was significantly associated with
MASLD, exhibiting a covariated-adjusted hazard ratio of 1.009 (95% confidence interval: 1.003-1.015)
per µg/m3 increase, accounting for mortality as a competing risk. Sensitivity analysis using Fine-Gray
subdistribution hazard models corroborated these findings.

Conclusion: This study identifies a significant association between three-year average PM2.5 exposure
and the incidence of MASLD in health checkup participants. These findings underscore the importance
of addressing PM2.5 exposure, alongside dietary and lifestyle modifications, to mitigate the global
MASLD epidemic.

References: 1. Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. A multi-
society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology.
2023;78:1966–86.

2. Golabi P, Paik JM, AlQahtani S, Younossi Y, Tuncer G, Younossi ZM. Burden of non-alcoholic fatty
liver disease in Asia, the Middle East and North Africa: Data from Global Burden of Disease 2009–2019.
J Hepatol. 2021;75:795–809.

3. Cheng WC, Wong PY, Wu CD, Cheng PN, Lee PC, Li CY. Non-linear association between long-term
air pollutionexposure and risk of metabolic dysfunction-associated steatotic liver disease. Environ
Health Prev Med. 2024 in press. [Link]

Disclosure of Interest: None Declared

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Massive Closure of Pediatric Clinics and Exodus of Pediatricians in Korea: (1692) Jin Yong Lee

ISQUA2024-ABS-1692

J. H. Koo 1,*, H. Yeo 2, H. J. Ahn 3, J. Y. Lee 4 5

1
Innovation Center Operation Division, 2International Policy Research Division, 3Healthcare Coverage
Research Division, Health Insurance Review and Assessment Service, Wonju, 4Department of Health
Policy and Management, Seoul National University College of Medicine, 5Public Healthcare Center,
Seoul National University Hospital, Seoul, Korea, Republic Of

Introduction: In recent times, the closure of pediatric clinics and a shortage of pediatricians have
emerged as prominent concerns in the Korean healthcare system. The declining number of pediatric
specialist applicants and the decreasing availability of pediatric clinics pose a substantial threat to the
health of the pediatric population. This research aims to provide evidence for policy proposals tailored
to pediatric clinics by determining the number of closures during the pandemic, analyzing the
economic losses, and tracking the relocation patterns of pediatric specialists from closed clinics.

Methods: We analyzed health insurance claims data from the Health Insurance Review and
Assessment Service to identify the status of pediatric clinic closures during the pandemic and
comprehensive trends in total health insurance medical expenses for pediatric clinics from 2018 to
2022. Additionally, as of December 2022, we meticulously tracked the occupational status of
representatives from closed pediatric clinics during the pandemic, aiming to determine if pediatric
specialists had transitioned away from their specialties. This study received review exemption approval
from the institutional review board of the Health Insurance Review and Assessment Service (2023-
044-001).

Results: As of December 2019, among the 2,228 pediatric clinics in operation, the number of clinics
still operational in December 2022 was 1,864, indicating that 364 clinics (16.3%) had closed. In 2020,
following the declaration of the COVID-19 pandemic, total health insurance medical expenses in clinic-
level medical institutions exhibited a marginal decline of 0.2% compared to the preceding year, while
pediatric clinics decreased by a whopping 42%. Tracking pediatricians from closed clinics revealed that
among the 364, only 59 (16.2%) had either reopened their pediatric clinics or found employment in
other pediatric clinics. Of the remaining 305 people, 65 (17.9%) were estimated to be retirees, and 240
(65.9%) were employed at medical institutions other than pediatric clinics.

Conclusion: In South Korea, where the pediatric population has consistently decreased due to the
impact of low birth rates, a decline in the number of pediatricians is a natural phenomenon. However,
the ongoing shortage of pediatric specialist applicants and the mass closure of pediatric clinics pose a
significant threat to pediatric primary healthcare, potentially exacerbating the burden on hospital-level
(or higher) medical institutions. Notably, as revealed in this study, only 16.2% of pediatricians who
closed their pediatric clinics re-entered the field, with most opting for retirement or pursuing
alternative medical departments or other hospital types, indicating the challenges of sustaining a
viable practice solely within the pediatric domain. Despite the overall decline in the pediatric patient
population, there has been an increase in medical demand attributable to the rising incidence of
complex chronic diseases. In South Korea's healthcare system, anchored in fee-for-service
reimbursement, a sharp decline in the number of patients immediately affects doctors' income. The
current system faces challenges in ensuring the sustainability of pediatric clinics while delivering high-

223
quality healthcare to children. This underscores the imperative to explore various incentive programs
or alternative payment systems tailored to pediatrics, a discipline grappling with the impact of
declining birth rates.

Disclosure of Interest: None Declared

Price determinants of medical procedures, devices, and medicine: A comparative analysis of

national health insurance in five countries: (1746) Jiyoung Keum

ISQUA2024-ABS-1746

J. Keum 1,* and -

Health Insurance Review and Assessment Service (HIRA), Wonju-si, Korea, Republic Of
1

Introduction: In 2017, Gore Medical stopped supplying artificial blood vessels for pediatric cardiac
surgery, which it had been the exclusive supplier of in Korea. The media reported the low
reimbursement price as one reason. There is a conflict between medical providers who want to set
high prices and policymakers who want to set adequate prices for medical services since the latter
have the authority to reduce non-transparent prices, proposed by medical providers. However, there
is a lack of discussion about what are appropriate prices and what factors influence these prices.
Consequently, this study compares medical prices worldwide and, where differences exist, determines
the combined effect of causal factors. Governments can use this result to help establish policies to
determine medical prices.

Methods: I surveyed the official prices of 202 procedures and 2,594 devices covered by health
insurance in Korea, Japan, Taiwan, Australia, and France, as of Feb 2022. I analyzed the 37 literature
on international medicine price comparison and retrieved price data from each country’s Ministry of
Health. Analysis of variance was performed to compare the prices. Finally, I selected the different
components of the healthcare system (medical demands, resources, services, financial support for the
health insurance system, public level of healthcare, and regulatory strength) which is considered when
determining the price of medical care. The combination of the contributing determinants influencing
medical fees was derived through fuzzy set qualitative comparative analysis.

Results: Regarding purchasing power parity, procedure fees, and medicine prices are highest in Japan,
while medical device prices are highest in Australia. A significant difference was observed in the price
of medical procedures and medical devices between the study countries, within the 1% significance
level in ANOVA. As a result of conducting an Fs/QCA with the measured values of the level and
determinants of the medical price in each country, 19 combinations of causal conditions determine
high and low medical costs. Through the minimization process, the combination of causal conditions
is identified as factors determining high medical prices are abundant medical resources, low demand,
and poor financial support from the health insurance system; conversely, low medical prices are
related to high service demand, strong regulation, and limited public health insurance.

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Conclusion: Determinants of high medical prices
When resources are abundant, but medical demands and the financial support of the health insurance
system are low, medical providers could offer a price higher than the original price in the process of
price setting. Because revenue is “number of patients (demands) × quantity of medical services
supplied × medical price” from the perspective of medical providers. In this context, policymakers who
are from low-demand countries may not have a choice but to accept healthcare providers’ high prices
since providers may avoid supply. Therefore, the health insurance system must increase financial
support for medical services with low demand and should provide adequate incentives to prevent
private healthcare providers from reducing or withdrawing supply owing to low demand. Furthermore,
medical providers should not supply orphan drugs and new medical technologies according to the
national demand and economic situation.

Determinants of low medical price

The increase in the amount of healthcare provided leads policymakers to implement regulations such
as cost containment to curb the increase, resulting in lower medical prices. Conversely, low prices also
induce medical providers to increase the number of medical services to secure their profits. Therefore,
it is necessary for the system to gradually ease regulations to appropriately determine medical prices.
Moreover, policies must be implemented with appropriate incentives for medical providers to improve
the quality and decrease the quantity of medical services such as pay for coordination and pay for
performance.

Disclosure of Interest: None Declared

Patient Safety Leadership WalkRounds™ and Patient Focused Methodology collaborate to create a
culture of safety: (2375) Ke-Yung Zhuang

ISQUA2024-ABS-2375

K.-Y. Zhuang 1,*, P. J. Lu 1, S.-T. Hsiao 2

Quality Management Department, 2Taipei Medical University Hospital, Taipei, Taiwan

1

Introduction: We have practiced Patient Safety Leadership WalkRounds™ (PSLW) since 2021, in
conjunction with managers' participation to create a safety culture and encouraged clinical numbers
to participate to report all adverse events.

Although the reporting of overall adverse events has made progress over the past few years, front-line
healthcare workers’ (HCW) participation in the reporting of near-miss events has been unsatisfactory.

The Department of Quality Management established the PSLW 2.0 in October 2023 to improve the
reporting rate of near-miss events and to re-emphasis the importance of patient safety and to enhance
a safety culture.

Methods: Participants：A total of 15 units were selected, which included 455 HCWs from 11
paraclinical units, and 4 clinical wards which had the least and highest adverse-event reporting rate.

225
Unit managers, safety and quality officers and various key stakeholders responsible for medical quality
were required to attend the interviews, whilst other HCWs were encouraged to attend.

Measure: Between January to August 2023, the adverse event reporting rate for all 15 units were
collected. We also conducted pre and post PSLW surveys, which investigated the adverse-event-
reporting awareness (AER) & the patient-safety culture awareness (PSC) of the unit. We assessed work
norms, with a collection of subscale measures of awareness of adverse event reporting and the degree
of patient-safety culture in the unit. Example question included information about what events needed
reporting (e.g., no matter the incidents have harm incidents yet, I should report the event. etc.)" PSLW
2.0 typically lasts 1 hour, and incorporated a tracer process (e.g., Patient Focused Methodology, PFM),
which emphasized the value of “direct observation of the clinical environment” and the “chatting” with
a wide range of stakeholders including both the frontline staffs and managers.

Results: The PSLW 2.0 took place between October 20th and November 23rd 2023. There were 136
HCW who participated in the PSLW, with a 89.9 percent response rate for the adverse-event-reporting
(AER) awareness survey. The most positively perceived dimensions in the AER survey were「Hospital
management will pay attention to responds and take action to address patient safety concerns」,
which is at 64.3 percent. Followed by「managers support for the reporting member when patient has
an adverse event」, which is at 60 percent. The following dimensions showed significant improvement
(p<0.001) after the PSLW2.0. These were「have an award after the report」、「need to implement
the notification for adverse event」 and 「No harm incidents don’t need reporting」. The adverse-
event reporting rates also showed significant improvement from 6 % to 41% (p<0.001) across all the
15 participating units.

In the (PSC) survey,「Patient Safety related events are treated fairly」and 「patient safety is a top
priority, manager, or clinical Leader support for Patient Safety」showed statistically significant
improvement (p<0.001) for all score domains between the pre & post PSLW2.0 surveys.

During the PSLW 2.0, we identified 46 problems, of which 21 of them related to patient safety, such as
“how to use patient safety report ”, “patient safety report system is not friendly” and “what incident
needs reporting” to which solutions were facilitated.

Conclusion: At Taipei Medical University Hospital, we combined WalkRounds with PFM in PSLW 2.0.
We demonstrated that through this method, the adverse-event reporting rate and the patient-safety
related awareness were improved in all the participating units. Positive response from frontline
workers was also obtained via the facilitated resolutions of important clinical problems which further
enhanced mutual trust across clinical units in our hospital.

Disclosure of Interest: None Declared

226
“Working with babies brings me a lot of joy – also brings me routine, money and stability” Keeping
paediatric nurses in nursing: (1322) Laurel Mimmo

ISQUA2024-ABS-1322

M. Cruickshank 1 2,* on behalf of SCHN Nursing Workforce Working Group, L. Mimmo 2 3 on behalf of
SCHN Nursing Workforce Working Group
1
School of Nursing & Midwifery, University of Technology Sydney, 2Nursing Research Unit, Sydney
Children's Hospitals Network, 3Macquarie University, Sydney, Australia

Introduction: Retaining skilled nurses is an urgent global priority. Little is known of the specific issues
facing the retention of paediatric nurses – a highly specialised workforce. While the COVID-19
pandemic did not impact the paediatric population as much as the adult population, the effect of
public health strategies to mitigate the spread of COVID-19 exposed children and family members
isolated in their homes to situations that were unfathomable to paediatric medical and nursing staff.
Attempting to meet these demands pushed clinical teams to their emotional limits and sometimes
beyond.

Paediatric healthcare professionals reported higher disengagement, exhaustion, and burnout than
colleagues caring for adult patients. A perceived increase in patient volume and acuity resulted in
experienced staff resigning, requesting shorter work hours, and moving to casual work.

Replacement of staff has been through the recruitment of new graduates, who, in turn, have struggled
with a slow transition to independence and in adapting to the realities of shift work. This is due to
disrupted undergraduate education and disadvantageous clinical experiences; clinical placement sites
could not accommodate student experiences due to the restrictions of the pandemic. New Graduates
are further disadvantaged by the concurrent resignation of experienced staff and decreased access to
support from clinical nurse educators who are regularly deployed back to the bedside to fill the shift
numbers. This study explored the challenges of retaining paediatric nurses across four tertiary
paediatric settings in 2023.

Methods: Eight focus groups supplemented a cross-sectional survey of paediatric nurses to identify:
(i) factors that influence their decision to stay in or leave the nursing profession, (ii) specific long- and
short-term strategies that inspire nurses to stay in the profession and build their nursing careers. The
survey and free text incorporated qualitative and quantitative elements to capture demographics and
favourable and challenging aspects of current roles. A validated instrument measured exhaustion and
fatigue, augmented by proposed incentives to stay. Ethics approval was obtained.

Results: 217 nurses completed the survey, and 32 participated in focus groups. 91% of survey
respondents scored above the criteria for burnout – mostly from high exhaustion scores, with average
for bedside nurses (43) scoring higher than managers (36), educators (38) and advanced practice
nurses (40). 63% of respondents considered or had applied for another position within the past 6
months – 34% in a profession outside nursing.

Paediatric nurses valued working with their colleagues (31%), caring for children and families (24%),
the paediatric environment (24%), financial security (15%) and professional opportunities (6%). There

227
was a range of experiences between and within professional groups, while priorities for retention
varied between professional groups. Levels of exhaustion, fatigue and impact on work-life balance
within this speciality were exacerbated by challenges of workload; patient volume and acuity; lack of
senior staff, skill mix, staff shortages; demanding, abusive family members; inability to take leave, meal
breaks, leave replacement; travelling time; and inflexible rosters.

Conclusion: Nurses caring for children in tertiary paediatric settings appreciate their specialised roles
and enjoy working with children and families. They find teamwork, professional opportunities, support
of managers, flexibility, and stability of work as incentives to remain. Conversely, nurses' quality of
work is diminished when they do not feel respected, valued or appreciated and by perceptions that
management and leadership are not listening to their concerns but focused on financial concerns and
meeting the budget.

References:

[Link] College of Nursing & Health Professionals Bank 2022. ‘Nurse leadership during disruptive
events ACN Canberra.

[Link] G et al Impacts of COVID-19 and workloads on NSW nurses and midwives’ mental health
and wellbeing. 2023. Adelaide, Australia.

[Link] J, Shaw N, Hooke N, Cruickshank M. Tales from the frontline – This child is caring for their
siblings and parents! ACIPC Annual Scientific Meeting Sydney. 2022

4. Kase SM et al, Compassion fatigue, burnout, and compassion satisfaction in pediatric subspecialists
during the SARS-CoV-2 pandemic Pediatric Research, 91;1;2022;143-8

[Link] S et al. Impact of COVID-19 on New Graduate Nurses' Transition to Practice. Nurse Educator,
46;4;2021;209-14

Disclosure of Interest: None Declared

Changing ‘the way we do things around here’: Improving organisational culture for staff and
residents in residential aged care: (2270) Maree Saba

ISQUA2024-ABS-2270

K. Churruca 1,*, L. Ellis 1, M. Saba 1, J. Braithwaite 1. 1Macquarie University, Sydney, Australia

Introduction: Over the past decade, Australia’s aged care sector has encountered challenges related
to an aging population with a high burden of disease, workforce retention, numerous public inquiries
into care quality and safety, and the COVID-19 pandemic further exacerbating staff exhaustion and

228
burnout. International research suggests a positive organisational culture may be protective against
staff burnout; having a good culture is associated with higher quality care, and residents’ experiencing
more positive care experiences and better health outcomes.1,2 In this presentation, we describe
findings from our research program examining organisational culture in residential aged care facilities
(RACFs), to understand the association of culture with contextual factors and workforce, safety and
quality outcomes; and how organisational culture can be improved for the benefit of staff and
residents.

Methods: We present findings from: an integrative review of 92 studies on organisational culture in

RACFs;3 a policy analysis of the final report of the Royal Commission into Aged Care Quality and Safety;4
and our ongoing mixed method study in 62 RACFs. Our study includes a longitudinal organisational
culture survey, ethnographic fieldwork, and an effectiveness-implementation evaluation of an
intervention to address unprofessional staff behaviour and improve culture.

Results: Eleven studies in our review looked at culture in relation to staff outcomes (job satisfaction,
organisational commitment) in RACFs. Studies (n=15) looking at clinical governance and care processes
also found an association with the organisational culture of the RACF; however, among studies looking
at the relationship between culture and clinical outcomes (n=9), results were more equivocal. The
empirical evidence for culture change interventions (n=5) was generally limited and of low quality. In
our analysis of the Australia’s enquiry into the quality of care (the Royal Commission report), culture
was frequently (n=42) highlighted as a problem in RACFs and aspirational qualities for culture were
proposed (n=28). However little guidance was provided on how culture could be improved. We discuss
how these findings have informed the development of our organisational culture survey for aged care
and present findings from its first round, including associations between cultural dimensions (e.g.,
teamwork, leadership, person-centred care), staff outcomes (burnout, intention to leave), quality
indicators, and resident wellbeing. We also consider the existing evidence base for the culture change
program and results of the formative research into its implementation.

Conclusion: Despite recognition of the importance of organisational culture in aged care among
policymakers and academics, our research highlights numerous gaps in understanding and improving
culture. Our longitudinal research aims to address some of these limitations, so that we can better
leverage positive organisational cultures, realising their impacts in a more engaged, stable workforce
and higher wellbeing among residents.

References: 1. Braithwaite, J., et al., Association between organisational and workplace cultures,
and patient outcomes: systematic review. BMJ Open, 2017. 7(11).

2. Li, Y., et al., Perceived patient safety culture in nursing homes associated with "Nursing Home
Compare" performance indicators. Medical Care, 2019. 57(8): p. 641-647.

3. Churruca, K., et al., An integrative review of research evaluating organisational culture in

residential aged care facilities. BMC Health Services Research, 2023. 23(1): p. 857.

4. Churruca, K., et al., Cultures of aged care delivery: Qualitative content analysis of Australia's
Royal Commission into Aged Care Quality and Safety. Australasian Journal on Ageing, 2023.

Disclosure of Interest: None Declared

229
Resilience in Australian Healthcare: Analysing Team Factors for Adaptive Capacity: (2159) Maree
Saba

ISQUA2024-ABS-2159

M. Saba 1,*, T. Schroeder 1, J. Long 1, S. Spanos 1, E. Leask 1, L. Ellis 1

Australian Institute of Health Innovation, Macquarie University, Sydney, Australia

1

Introduction: Resilient healthcare represents a transformative shift in healthcare systems,

emphasising their capacity to adapt their functioning and sustain high-quality care despite expected
or unexpected challenges or conditions.1 This concept has gained prominence over the past decade. It
diverges from traditional safety paradigms by equally valuing the analysis of successes alongside
errors. This study identified how variability and changes within teams, organisations, and national
healthcare systems enable or hinder the adaptive capacity of hospital teams within two Australian
hospitals.

Methods: We employed a comparative case study design focusing on teams in one public and one
private hospital, examining the hindrances and enablers influencing team adaptive capacity. There
were four teams from each hospital: structural (ward-based team whose members comprise different
disciplines), hybrid (comprised of permanent and rotating members), responsive (react to time-limited
emergencies), and coordinating (facilitate workflow across organisational units). Data collection
occurred from March to November 2023. Observations and semi-structured interviews were
conducted. Data were analysed utilising a combination of inductive and deductive coding according to
the Concepts for Applying Resilience Engineering (CARE) model2 and Hollnagel’s framework of
resilience potentials.3

Results: Several significant factors were identified as enabling or hindering adaptive capacity,
including: 1) technology and resources; 2) roles, procedures, and work; 3) staff competence and
knowledge; and 4) team culture and relational factors. Access to technology and resources was
essential for optimising efficiency across both hospitals, and important for monitoring patients and
optimising organisational processes. Technologized trolleys used by structural teams, paging systems
by responsive and hybrid teams, and electronic patient management applications by coordinating
teams underscored the importance of resource availability. Well-defined roles and procedures
supported teams. Structures that promoted adaptive capacity included: daily huddles by the hybrid
and coordinating teams, and strategic two-member teamwork in structural and responsive teams.
Staff competence and knowledge emerged as important aspects of a team’s capacity to adequately
adapt to challenges. Common knowledge of pressures amongst experienced staff allowed for sufficient
preparation. The need to upskill staff was particularly evident in the hybrid and responsive teams.
Team culture was established as fundamental for adaptive capacity. Observations revealed that team
members of all team types actively supported each other. Additionally, internal support systems
fostered relational factors and promoted overall wellbeing within teams.

Conclusion: This study contributes insights into how team skills, organisational and system factors
hinder or enable adaptive capacity within hospital teams of two Australian hospitals. The four
identified factors contribute to an understanding of how to enhance the capacity of hospital teams
and explores how macro-level and meso-level structures can effectively reinforce adaptive capacity.

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References: 1. Hollnagel E et al. Resilient Health Care. Ashgate Publishing; 2013.

2. Anderson J et al. Implementing resilience engineering in healthcare quality improvement: CARE

model feasibility study. Pilot Feasibility Stud. 2016.

3. Hollnagel E. Safety-II in practice: developing resilience potentials: Taylor & Francis; 2017.

Disclosure of Interest: None Declared

Implementation experiences of providing care coordination for children with medical complexity in
rural Australia: (2619) Raghu Lingam

ISQUA2024-ABS-2619

K. A. Hutchinson 1,*, R. Lingam 2, H. Smithers-Sheedy 2, Y. Zurynski 1 and Rural Kids Guided Personalised
Service (RuralKidsGPS) Investigator Group
1
Australian Institute of Health Innovation , Macquarie University , 2Paediatric Population Health,
School of Woman's and Children's Health , University of New South Wales, Sydney, Australia

Introduction: Limited care coordination and planning for children living with medical complexity (CMC)
leads to missed and duplicated care, increasing costs for the health system and families compounded
by living rurally, necessitating enhanced local solutions. The Rural Kids Guided Personalised Service
(RuralKidsGPS)1 is an integrated model of care coordination implemented in four rural local health
districts across New South Wales, Australia and modelled on the KidsGPS program in tertiary children’s
hospitals in Sydney. RuralKidsGPS aims to smooth pathways through healthcare by connecting CMC to
local health services, coordinating care and care teams, and building families’ capacity for self-
management. This study aims to explore barriers and enablers to implementation by analysing the
experiences of staff delivering and supporting RuralKidsGPS, to inform future implementation and
contextual adaption plans for scaling the model across diverse health settings.

Methods: The implementation evaluation is informed by qualitative methods using semi-structured

interviews with nurse coordinators (n=11), healthcare professionals (n=13), health managers (n=8) and
researchers (n=6). Underpinned by the Consolidated Framework for Implementation Research (CFIR),
a hybrid deductive/inductive approach to a thematic analysis was conducted to identify barriers and
facilitators as experienced by staff involved in delivering and implementation of RuralKidsGPS.

Results: The key emergent themes emphasise the significance of local context, efficient workflow
processes, strong leadership, and appropriate resources as fundamental to acceptability,
implementation, and sustainable delivery of RuralKidsGPS. The central role of the care coordinators
was ‘building clinical relationships around the family’ to optimise care quality, experiences, and equity
of access for families with CMC. The care coordinator's resourcefulness, local knowledge, and ability
to leverage local resources and networks within health, social care, and disability systems, enabled

231
delivery of family-centred care across diverse socio-economic and cultural backgrounds. However, the
timely implementation and delivery of RuralKidsGPS care coordination has been impacted by limited
sharing of healthcare information across jurisdictions, natural disasters (widespread floods) and
workforce changes and shortages. Invaluable support and leadership from local healthcare managers
and professionals, enabled nurse coordinators to adapt and implement RuralKidsGPS to fit within their
local context. Delivery of the model was hampered by limited service resourcing causing concerns
about managing service demand with high levels of psychosocial and medical complexity among
children and families, and geographical location which contributed to professional isolation among
coordinators. Therefore, ensuring adequate service resourcing and professional connectivity,
streamlining workflows, and empowering families to navigate healthcare were significant challenges,
whilst recognising that these factors are crucial for model adoption and sustainability.

Conclusion: Findings emphasise the significance of pre implementation planning and adapting
integrated models of care to local contexts, and the importance of building co-designed pathways and
processes, strong support networks, and trusting relationships to enable team-based interdisciplinary
care coordination for CMC. Building capacity of families to navigate complex healthcare systems and
to enable self-management where possible, are crucial for managing demand on RuralKidsGPS and its
sustainability.

References: 1Lingam, R., Smithers-Sheedy, H., Hodgson, S., Hutchinson, K., Morris, T.M., Hu, N., Nassar,
N., Schroeder, E.-A., Rana, R., Dickins, E., Bula, K. and Zurynski, Y., 2023. Evaluation of RuralkidsGPS; A
Novel Integrated Paediatric Care Coordination Model of Care in Rural Australia – a Mixed-Methods
Study Protocol. International Journal of Integrated Care, 23(4), [Link]:
[Link]

Disclosure of Interest: None Declared

Psychosocial complexity and limited preparation for transition to adult services for young people
living with type-1 diabetes results in care fragmentation: A multi-method study: (2270) Yvonne
Zurynski

ISQUA2024-ABS-2270

K. Churruca 1,*, L. Ellis 1, M. Saba 1, J. Braithwaite 1

Macquarie University, Sydney, Australia

1

Introduction: Over the past decade, Australia’s aged care sector has encountered challenges related
to an aging population with a high burden of disease, workforce retention, numerous public inquiries
into care quality and safety, and the COVID-19 pandemic further exacerbating staff exhaustion and
burnout. International research suggests a positive organisational culture may be protective against
staff burnout; having a good culture is associated with higher quality care, and residents’ experiencing
more positive care experiences and better health outcomes.1,2 In this presentation, we describe
findings from our research program examining organisational culture in residential aged care facilities

232
(RACFs), to understand the association of culture with contextual factors and workforce, safety and
quality outcomes; and how organisational culture can be improved for the benefit of staff and
residents.

Methods: We present findings from: an integrative review of 92 studies on organisational culture in

RACFs;3 a policy analysis of the final report of the Royal Commission into Aged Care Quality and Safety;4
and our ongoing mixed method study in 62 RACFs. Our study includes a longitudinal organisational
culture survey, ethnographic fieldwork, and an effectiveness-implementation evaluation of an
intervention to address unprofessional staff behaviour and improve culture.

Results: Eleven studies in our review looked at culture in relation to staff outcomes (job satisfaction,
organisational commitment) in RACFs. Studies (n=15) looking at clinical governance and care processes
also found an association with the organisational culture of the RACF; however, among studies looking
at the relationship between culture and clinical outcomes (n=9), results were more equivocal. The
empirical evidence for culture change interventions (n=5) was generally limited and of low quality. In
our analysis of the Australia’s enquiry into the quality of care (the Royal Commission report), culture
was frequently (n=42) highlighted as a problem in RACFs and aspirational qualities for culture were
proposed (n=28). However little guidance was provided on how culture could be improved. We discuss
how these findings have informed the development of our organisational culture survey for aged care
and present findings from its first round, including associations between cultural dimensions (e.g.,
teamwork, leadership, person-centred care), staff outcomes (burnout, intention to leave), quality
indicators, and resident wellbeing. We also consider the existing evidence base for the culture change
program and results of the formative research into its implementation.

Conclusion: Despite recognition of the importance of organisational culture in aged care among
policymakers and academics, our research highlights numerous gaps in understanding and improving
culture. Our longitudinal research aims to address some of these limitations, so that we can better
leverage positive organisational cultures, realising their impacts in a more engaged, stable workforce
and higher wellbeing among residents.

References: 1. Braithwaite, J., et al., Association between organisational and workplace cultures,
and patient outcomes: systematic review. BMJ Open, 2017. 7(11).

2. Li, Y., et al., Perceived patient safety culture in nursing homes associated with "Nursing Home
Compare" performance indicators. Medical Care, 2019. 57(8): p. 641-647.

3. Churruca, K., et al., An integrative review of research evaluating organisational culture in

residential aged care facilities. BMC Health Services Research, 2023. 23(1): p. 857.

4. Churruca, K., et al., Cultures of aged care delivery: Qualitative content analysis of Australia's
Royal Commission into Aged Care Quality and Safety. Australasian Journal on Ageing, 2023.

Disclosure of Interest: None Declared

233
Lunchtime

Lightning Talks

Turning data into safety: A data-driven approach to mitigating risks for aging adults with type 2
diabetes: (2954) Amy Nguyen

ISQUA2024-ABS-2954

N. Afzal 1,*, A. Nguyen 1, A. Lau 1

1
Macquarie University, Faculty of Medicine, Human and Health Sciences , Australian Institute of Health
Innovation, Sydney, Australia

Introduction: The rising prevalence of type 2 diabetes among aging populations intensifies the need
for safe and independent home living. However, progressive functional decline associated with the
condition elevates fall risks and hinders activities like medication management and navigation. While
self-management digital interventions exist, limited research explores the home environment's impact
on safety and independence. This study leverages data from real-world home environments of
individuals with type 2 diabetes to identify environmental challenges posed by physical layout,
furniture arrangement, lighting, and clutter. Through this study, we aim to mitigate hazards before they
arise by anticipating future decline in vision, cognition, and mobility associated with type 2 diabetes.

Methods: We aim to analyze a unique dataset of ≈ 5,000 images per patient captured by body-worn
cameras worn by 26 elderly individuals with type 2 diabetes (1). Drawing on established activity
classifications (2), manual coding of the images allow us to identify various aspects, including health
management activities like diet, exercise, and medication interactions; technological interactions
involving smartphones and health monitoring devices and environmental context, assessed using a
validated tool (3), encompassing lighting and furniture organization etc. By anticipating potential
functional, physical, and cognitive limitations, we will identify areas where future decline might pose
greatest challenges. Finally, by combining insights from all these aspects, targeted recommendations
for optimization will be formulated through digital interventions and environmental modifications
aiming to improve safety and independence for this population. The study received ethical approval
from the Macquarie University Human Research Ethics Committee (reference number:
52023558051768).

Results: Preliminary analysis of four patients (n=22 images) revealed recurring environmental hazards
such as clutter and inadequate lighting. Additionally, potential impacts of functional decline such as
visual, fine motor skill, cognitive and mobility challenges due to accessibility and navigational barriers,
falls/ trips risk, etc. were also identified.

Conclusion: Through image analysis, risks associated with mobility, cognition, and daily activities
arising from potential health decline were identified. These risks can be mitigated by using proactive
solutions, combining smart technology interventions and accessible environment modifications, to
empower safer, independent living. This holistic approach could not only enhance individual well-being
but also potentially reduce reliance on assisted living facilities, contributing to a more sustainable and
cost-effective healthcare ecosystem.

234
References: Yin K, Harms T, Ho K, Rapport F, Vagholkar S, Laranjo L, et al. Patient work from a context
and time use perspective: a mixed-methods study protocol. BMJ Open. 2018;8(12):e022163.

Xiong H, Phan HN, Yin K, Berkovsky S, Jung J, Lau AY. Identifying daily activities of patient work for type
2 diabetes and co-morbidities: a deep learning and wearable camera approach. Journal of the
American Medical Informatics Association. 2022;29(8):1400-8.

Clemson L, Fitzgerald MH, Heard R. Content validity of an assessment tool to identify home fall hazards:
The Westmead Home Safety Assessment. British Journal of Occupational Therapy. 1999;62(4):171-9.

Disclosure of Interest: None Declared

Privacy as a Ruse? Reframing legal and ethical challenges to improve engagement with quality
improvement using health data: (3278) Kavisha Shah

ISQUA2024-ABS-3278

K. Shah 1 2,*, A. Janssen 1

1
Department of Medical Science, The University of Sydney, 2Digital Health Cooperative Research
Centre, Sydney, Australia

Introduction: Health professionals are increasingly expected to use health data for quality
improvement as data systems become more sophisticated. While this expectation is codified in
professional codes of conduct and clinical governance standards, there are no existing guidelines or
frameworks to determine how health data should be used for performance management. This
approach has been met with growing concerns about medico-legal risks (i.e., disclosure) and ethical
issues (i.e., transparency) as health professionals and organisations worry about unjustifiable harm to
their reputation. The objective of this project is to understand the perspective of key stakeholders
towards implementation of evidence-based improvements from an ethical and legal lens.

Methods: Semi-structured qualitative interviews with health professionals, administrators and

representatives from professional associations and regulatory bodies. Interviews were transcribed and
analysed thematically using a predominantly inductive approach to create codes then themes.
Deductive reasoning was applied to the open-ended codes to ensure themes were appropriate and
meaningful to project objectives (1). Two reviewers coded the first three transcripts line-by-line and
then grouped into themes, with any disagreements discussed until consensus was reached. Themes
were iteratively updated as new codes or themes emerged among the remaining transcripts. Ethics
approval received from the University of Sydney Human Research Ethics Committee.

Results: Twelve qualitative interviews have been conducted to date. Preliminary analysis reveals
health professionals are overwhelmingly worried about performance data being used punitively
against competent health professionals. Both reasonableness and proportionality emerged as
desirable principle-based constraints on performance management to minimise the risk of punitive
disciplinary measures but neither appear to be enforced. Privacy and disclosure were also repeatedly

235
highlighted as a concern due to the implications of public reporting on the psychological safety of
health professionals. To this effect, health administrators emphasised the importance of establishing
an open dialogue and creating a culture of learning within the organisation to model reflexive
practices.

Conclusion: Recent findings suggest healthcare as an industry has struggled to address legal and
ethical challenges around the use of health data for quality improvement due to the limited guidance
available to key stakeholders. Key guidance includes robust operational governance, interpersonal
support, and effective controls on administrative decision-making. Systems that lack these features
have witnessed limited engagement with performance data and, at times, professional unwillingness
to meaningfully observe mandates. The conceptualisation of privacy and disclosure as barriers, for
example, does not reflect the true scope of privacy legislation which anticipates use of data for this
purpose. Beyond citing the name of the applicable legislation, no interviewee could explain how the
law impedes use of health data for performance management. This misconception illustrates that
leaders have few resources to drive change through evidence-based performance management, and
knowledge gaps in clinical ethics and medico-legal risks continue to act as illusory barriers to sustaining
use of quality improvement initiatives.

References: (1) Byrne D. A worked example of Braun and Clarke’s approach to reflexive thematic
analysis. Quality & quantity. 2022 Jun;56(3):1391-412.

Disclosure of Interest: None Declared

Advancing Patient Safety and Quality Education for a Sustainable Future: (2494) Mabel Sim

ISQUA2024-ABS-2494

M. Sim 1,*, A. Loh 1, F. Abdul Hathi 1, Z. Foo 1, K. H. Tan 1

1
SingHealth Duke-NUS Institute for Patient Safety & Quality (IPSQ), Singapore Health Services Pte Ltd,
Singapore, Singapore

Introduction: In the ever-evolving landscape of healthcare, the pursuit of excellence in patient safety
and quality (PSQ) remains a paramount goal. The achievement of these goals requires continuous
learning and a capable PSQ workforce. This abstract explores how SingHealth Duke-NUS Institute for
Patient Safety & Quality (IPSQ) advance its PSQ education through development of modular graduate
programs, to build a sustainable pipeline of leaders and expertise for the Asia Pacific region.

Methods: The methods involved both assessing learning needs (LNA) and design an applied learning
curriculum. The LNA helped to identify gaps in knowledge, skill deficiencies, competency evaluation,
job role relevance, and staying current with trends in PSQ. It revealed significant needs for a structured
program covering PSQ topics that are in line with current trends and confirmed the absence of a similar
program in Southeast Asia. Recognizing the need to address the gaps in PSQ education, the decision
was to develop formal education programs to foster academic and professional exchanges with shared
learning opportunities.

236
The design of the applied learning curriculum is a collaborative effort with strong support from
healthcare leaders and domain experts. The graduate programs offer flexible learning through
stackable modular approach and smart classroom, providing global education and experiential
learning, engaging regional and global participants and faculty with relevant Asia Pacific case studies.
Key elements include self-directed learning, leadership education and interprofessional learning,
integrated through effective pedagogy. The curriculum development began by reviewing existing
materials, including course outlines, syllabi, and learning resources, assessing integration into
academic programs and transformative learning. Subsequently, healthcare leaders and domain experts
designed the curriculum, integrating contemporary teaching methodologies, innovative technologies,
regional case studies, and practical scenarios to make learning pertinent and enhance critical thinking
and problem-solving skills among healthcare professionals.

Results: The collaborative effort resulted in the co-creation of a comprehensive range of academic
programs, including a Graduate Certificate, Graduate Diploma, and Master’s degree in Patient Safety
and Healthcare Quality. These programs received endorsement from esteemed academic partners,
Duke-NUS Medical School and the National University of Singapore.

The oversight of the programs is effectively supported by a dedicated team of 7 distinguished senior
healthcare leaders, and more than 20 domain experts, all possessing extensive experience and
knowledge in the field.

The inaugural cohort was successfully launched in August 2024 with 28 enrolled inter-professionals
from different healthcare organisations. The cohort comprised of 9 doctors, 9 nurses, 3 allied health
professionals and 7 healthcare administrators. The feedback from the inaugural cohort was positive:

1. 100% of respondents (26 out of 26) agreed they have acquired new skills and/or knowledge
from the programme.

2. 92.3% of respondents (24 out of 26) rated they can apply what they learnt in the programme
in their work.

Image:

237
Conclusion: The evolution of the PSQ program from 20 standalone continuing education programs to
a comprehensive academic model aligns to the Strategic Objective 5 - Health worker education, skills
and safety of World Health Organization Global Patient Safety Action Plan 2021 - 2030. It supports
patient safety within health professional postgraduate education and continuing PSQ development,
with an emphasis on interprofessional learning to establish a robust education framework for a
sustainable future in PSQ.

Disclosure of Interest: None Declared

Root Cause Analysis and strategies to implementing actions based on lessons learned from sentinel
events: (3388) Mayara Santos

ISQUA2024-ABS-3388

L. Carvalho Moura Tralli 1,*, A. C. Pedroso 1, M. Santos 1, F. P. Fernandes 1, A. De Sá Mendes 1, R. Simões

1
, P. Tuma 1, M. Cenderoglo 1

Quality and Safety, Albert Einstein Hospital, São Paulo, Brazil

1

Introduction: It is one of the stages of Root Cause Analysis (RCA), designing and implementing an
action plan based on lessons learned from an event being necessary to create a system that is able to
adapt to shifting and unexpected conditions without a reduction in quality of care . Work developed
in the Department of Patient Safety in a Brazilian Hospital, aiming at achieving high reliability

Methods: Aiming to improve the action design and implementation stage, we will deal with the
strategy from the implementation of the Action Center with time dedicated to improving processes.
This retrospective, non-randomized implementation study evaluated the impact of an “Action Center”.
Being a quality improvement project and not a research study, this project did not request approvals
from the Institutional Research Board. The management method was implemented using quality
improvement techniques (Plan-Do-Study-Act (PDSA) cycles). The researchers evaluated the impact of

238
implementing the center from January to October 2022.
To classify sentinel events, we used the Conceptual Structure of the International Classification for
Patient Safety – WHO, 2009 adapted with an internal nomenclature where we identified the main
critics of the events and subsequently designed the actions.

Results: Problem an Assessment of problem and analysis of its causes:

From January to October 2022, 8,385 events were reported, being categorized according Joint
Commission standard in 3,886 without damage, 2,556 near miss, 1,238 mild, 651 moderate, 16 severe
and 08 catastrophic. Severe and catastrophic events are classified by Conceptual Framework for the
International Classification for Patient Safety – WHO, 2009 (figure 1 - The framework presents the type
of events, process, problems based on the WHO and its details according to the internal nomenclature.
In addition, we present a summary of the main actions in progress).

Considering the sentinel events analyzed, we identified the as root causes, arranged in an Ishikawa
diagram: 9 Assessment care, 3 Human Factors, 3 Environmental ,3 Care planning, 2 Continuity of care,
2 Rules/Policies/Procedures, 1 Care, 1 Communication and 1 Special Interventions.

Intervention and Strategy for change:

28 meetings were held with the leaders and professionals involved with the aim of discussing the case
and sharing the lessons learned, generating an average of 42 hours of brainstorming for improvements,
involving 110 professionals, 23 of them leaders, forming work teams with an average of 4
professionals.

186 actions were prepared, an average of 7.75 actions per sentinel event, of which 84 were
intermediate, 55 stronger and 47 weak. From this, the management process for implementation
begins, being carried out as follows: periodic meetings with an interval of 15 days after the first RCA
meeting, with the objective of checking the status of immediate actions and planning the steps for
implementing actions by through the 5W and 3H tool adapted in a software.

Biweekly meetings are held to check the status of the KANBAN method, where we observe whether
actions that have any impediments or barriers are removed and offered [Link] measures were
also tested prior to implementation and presented for feedback to patient committees

Measurement of improvement and Effects of changes:

All actions are managed in monitoring software, allowing you to see the status in real time and in a
decentralized way. A report is sent monthly to CEO, informing the progress of actions based on the
number of actions completed per plan. Of the 186 actions, 46% are completed, 35% are in progress
and 19% are overdue. Of the completed actions, the average time for implementation was 109 days.
When we look at the progress from a classification perspective, we have: 60% of the weak actions
completed, 46% of the intermediate ones and 33% of the strong ones, with an average execution time
of 95, 106 and 150 days respectively.

239
There was a 25% decrease in events that cannot be exclusively associated with o núcleo de ações
implementations, but we believe this is a reflection of better management by the teams implementing
changes.

We measured the improvements after implementing the core:

Pre Action center Post Action center

(jan a octo/2021) (jan a octo/2022)

No. of sentinel events 32 24

Nº of actions 153 186

Protected time for the

Leadership-centric actions and
deployment of the action plan
Action elaboration strategy security staff without
together with the executing teams
protected time
and leaders

Excel spreadsheet centralized Software that allows sharing with

Information management
in the security team the executing team

Dashboard Access centralized decentralized

Report to board without with

Average execution time of actions in days 113 109

% actions delivered on time 14% 94%

There was an 80% increase in actions broken within the planned period, with emphasis on the actions
highlighted in figure 1.

Image:

240
Conclusion: Bring about change, involve professionals and patient committees,
having robust monitoring and management systems are key steps to guarantee the implementation
of the proposals arising from the RCA. This work has the challenge of measuring changes through
indicators in order to identify the recurrence of similar events after strong actions implementation,
which require time, investment and technologies incorporation.

References: [Link] Health Organization (WHO). The International Classification for Patient Safety.
Geneva: WHO; 2009. WHO/IER/PSP/2010.2.

[Link] Commission. Root Cause Analysis in Health Care: Tools and Techniques. 6th ed. Oakbrook
Terrace, IL: Joint Commission Resources; 2022.

Disclosure of Interest: None Declared

241
The impact of nurse outcomes on nurse-perceived patient outcomes in South African hospitals:
(3189) Alwiena J. Blignaut

ISQUA2024-ABS-3189

S. K. Coetzee 1, A. J. Blignaut 1,*, E. Fourie 2

1
School of Nursing Science, 2
Department of Statistical Consultation, North-West University,
Potchefstroom, South Africa

Introduction: Patient safety and quality of care remain global top healthcare priorities (WHO,
2022). Although nurses are often implicated for lapses in patient safety and quality of care (Vaismoradi
et al., 2020), their general wellbeing, including physical, mental, and emotional health, is often not
considered in affecting these patient outcomes (Assaye et al., 2022). As nurses’ perceptions give
valuable insights into the general performance of their institutions of employment (Tvedt et al., 2014),
their perceptions on patient safety and quality of care as correlated with nurse outcomes (such as
physical and mental health, emotional exhaustion, job satisfaction and intention to leave), will provide
a way forward in supporting both nurse- and patient wellbeing. To determine the relationship between
nurse outcomes and nurse-perceived patient outcomes.

Methods: A cross-sectional survey was completed by 2260 nurses from four private hospital groups,
and 2294 nurses across all levels of public hospitals. Measures included intent to leave, job
satisfaction, and compassion fatigue questions, the Maslow Burnout Inventory Emotional Exhaustion
subscale, the PROMIS10 Global Health Survey, an overall grade on patient safety and quality of care
and adverse events reporting.

Results: Most nurses suffered from physical- and mental health symptoms (n=3074, 88.1% and
n=2703, 75.8% respectively). 43.9% (n=1673) of nurses suffered from emotional exhaustion and
almost a third reported job dissatisfaction (n=1325, 32.1%). Nurses were most dissatisfied with their
salary/wages (n=2785, 68.2%) and appreciation (n=2682, 66.2%). One quarter of nurses (n=1078,
25.6%) intended to leave their jobs, while a quarter of these intended to leave nursing as career
(n=302, 24.5%). All negative nurse outcomes were experienced more severely by public healthcare
nurses than by private healthcare nurses with global physical health, global mental health, emotional
exhaustion, and job dissatisfaction differing more than ten percent between sectors. 13.1% (n=483)
of nurses felt patient safety in their units were poor or failing, while 5.6% (n=206) reported quality of
care as poor. Private hospital nurses reported higher patient safety and quality of care grades than
public hospital nurses (Cramer’s V=0.251; p=0.000 and Cramer’s V=0.196; p=0.000
respectively). Adverse events were reported by more than 80% of nurses to occur never or only a few
times a year. Global physical health was correlated significantly with overall patient safety (OR=4.0,
95%CI=3.0-5.4), overall quality of care (OR=3.7, 95%CI=2.6-5.2) and confidence in post-discharge care
(OR=3.6, 95%CI=2.8-4.7). Global mental health correlated significantly with overall quality of care
(OR=3.3, 95%CI=2.5-4.3). Emotional exhaustion significantly impacted perceptions on overall patient
safety (OR=3.4, 95%CI=3.0-3.8) and overall quality of care (OR=3.6, 95%CI=3.0-4.3). Job satisfaction
correlated significantly with overall quality of care (OR=3.5, 95%CI=3.0-4.2).

Conclusion: Wellness strategies aimed at nurses’ physical-, mental- and emotional wellness is of
paramount importance in preventing a mass exodus from the nursing profession as well as prioritizing
patient safety and quality of care. Addressing nurses’ job satisfaction by attending to their need for

242
appreciation, might be an easy and effective strategy in mitigating both negative nurse and patient
outcomes. Interventions aimed at alleviating negative nurse outcomes might inadvertently also
mitigate negative patient outcomes.

Disclosure of Interest: None Declared

Relation Between The Implementation Of International Patient Safety Goals (IPSG) And Patient
Satisfaction At The Persahabatan Centre General Hospital: (2760) Endah Nurohmah

ISQUA2024-ABS-2760

A. Yussianto 1,* on behalf of The Persahabatan Centre General Hospital, A. Yussianto 1 on behalf of The
Persahabatan Centre General Hospital and Endah Nurohmah

Quality Control Comitte, The Persahabatan Centre General Hospital, Jakarta, Indonesia
1

Introduction: Implementation of the International Patient Safety Goals (IPSG) at the Persahabatan
General Hospital (RSUP Persahabatan) reflects the commitment to safe and quality health services.
The aim of this implementation-program is to improve the patient’s safety level through 6 steps of
safety-goals. This research will explore the relationship between the implementation-program and the
level of patient-satisfaction Persahabatan Central General Hospital

Methods: This is quantitative research with descriptive analytics using a cross sectional study
approach. The research was conducted through direct observation on IPSG implementation-program
on the questionnaires of patient satisfaction that have been validated, using purposive sampling
techniques in accordance with inclusion and exclusion criteria to obtain a sample of 68
people. Statistical analysis, including descriptive and correlation analysis, was carried out to provide
an overview of the characteristics and to evaluate the relationship between IPSG implementation-
program and patient satisfaction. The questionnaire consists of 3 parts. Questionnaire A (demographic
characteristics questionnaire) consists of initial, age, gender, occupation and patient treatment
room. Patients as respondents will answer questions according to the question column provided.
Questionnaire B (questionnaire on patient perceptions on safety implementation) consists of 21
questions that have been adapted to IPSG standards by selecting 1 of the 4 prepared statements,
never, rarely, often, and always. Questionnaire C (assessing the level of patient satisfaction in the
dimensions of tangible (real evidence), reliability, responsibility (responsiveness), assurance
(guarantee) and empathy. Consists of 23 questions using Likert scale, very satisfied, satisfied,
dissatisfied, very dissatisfied.

Results: Correlation analysis shows a significant relationship between IPSG implementation-program

and patient satisfaction (p-value=0.000, p <0.005). Survey on the patient satisfaction showed that
85.3% of respondents expressed satisfaction with the service, while 14.7% expressed
dissatisfaction. In this study, only few patients (2 out of 68) expressed dissatisfaction with the health-
services when patient-safety program is implemented. In contrast, there was a significant increase in
the number of dissatisfied patients (7 out of 9) when patient-safety implementation program is not

243
implemented. These findings show that the level of patient satisfaction is statistically influenced by the
level of IPSG implementation. In other words, the implementation of patient safety standards, as
regulated by IPSG, has a positive impact on patient perception and satisfaction at Persahabatan Central
General Hospital.

Conclusion: The level of IPSG implementation-program at Persahabatan Central General Hospital has
a positive correlation with the level of patient satisfaction. The result shows that increasing the
implementation of IPSG can contribute positively to improve patient satisfaction in the context of
health-care service. The finding emphasizes the importance of implementing patient safety standards
in improving patient’s experience and service quality in hospitals.

References: Arikunto,S. 2018. Prosedur Penelitian: Suatu Pendekatan Praktik. Jakarta: Rineka Cipta.

Daud A. (2020). Komite Nasional Keselamatan Pasien : Sistem Pelaporan dan Pembelajaran
Keselamatan Pasien Nasional (SP2KPN). Jakarta : Kementeri Kesehat Republik Indones.

Hadi, I. (2017). Buku Ajar Manajemen Keselamatan Pasien. Yogyakarta: Deepublish

JCI. (2017). Joint Commission International Accreditation Standards for Hospitals: Including Standards
for Academic Medical Center Hospitals (6th ed.). Joint Commission International.

Kementerian Kesehatan RI. (2017). Peraturan Menteri Kesehatan Republik Indonesia Nomor 11 Tahun
2017 Tentang Keselamatan Pasien. Jakarta: Kementerian Kesehatan RI

1. KEMENKES, RI. (2022). NOMOR HK.01.07/MENKES/1128/2022. Standar Akreditasi Rumah Sakit

tentang Insiden Keselamatan Pasien. Jakarta. Mentri Kesehatan RI

Kuncoro, Mudrajad. 2018. Metode Kuantitatif Teori Dan Aplikasi Untuk Bisnis Dan Ekonomi. Edisi
Kelima. Sekolah Tinggi Ilmu Manajemen YPKN: Yogyakarta.

Notoadmojo, Soekidjo. 2018. Metodologi Penelitian Kesehatan. Jakarta : Rineka Cipta

Nursalam. (2017). Metodologi Penelitian Ilmu Keperawatan: Pendekatan Praktis. ([Link], Ed.) (4th
ed.). Jakarta: Salemba Medika).

Disclosure of Interest: None Declared

Validating rates of nursing-sensitive adverse events in administrative healthcare data in Ireland: A

retrospective chart review study: (2557) Anna Connolly

ISQUA2024-ABS-2557

A. Connolly 1,*, M. Craig 1, F. Bane 2, M. Unbeck 3 4, M. Kirwan 1

1
School of Nursing, Psychotherapy and Community Health , Dublin City University , 2Healthcare Pricing
Office , Health Service Executive, Dublin, Ireland, 3School of Health and Welfare, Dalarna University,
Falun, 4Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden

244
Introduction: In-hospital adverse events (AEs) present an ongoing patient safety challenge for health
systems. They are disproportionately experienced by older adults given the higher prevalence of co-
morbidities and emergency admissions in patients aged over 65 and the complexity of their care.
Pneumonia, urinary tract infections, pressure ulcers and delirium, known collectively as failure to
maintain (F2M) events, commonly occur in older patients when the demand for nursing care exceeds
supply. Accurate monitoring and measurement of AEs is key to improving patient safety and healthcare
quality and reducing the economic and human cost of these events. Hospital in-patient enquiry (HIPE)
data, Ireland’s primary source of clinical, administrative, and demographic data on hospital discharges,
is used to inform the planning, provision and measurement of acute hospital services therefore, it is
essential that this data accurately represents a patient’s encounter with the healthcare system.
Retrospective chart reviews are often used to validate administrative healthcare data as medical charts
are often considered a gold standard source of patient information.

Objectives

To determine prevalence of F2M events in older adults in Ireland.

To quantify the rates of F2M events in HIPE data in one model 4 hospital in Ireland.

To validate F2M event rates by comparing the chart review findings to the HIPE data.

Methods: A total of 1000 randomly selected admissions of inpatients aged over 65 from a model 4
hospital in Ireland in 2022 were reviewed using a two-stage retrospective chart review. Using a co-
productive approach, the researchers collaborated with healthcare professionals and patient
representatives to design and develop a data collection instrument and structured protocol to guide
the chart review. Each chart underwent a primary review to identify admissions containing evidence
of F2M events. A secondary review was conducted on these admissions to confirm the presence of the
AEs and gather further information for costing these AEs in future research as part of this project. The
chart review was conducted blindly, and the researchers were not exposed to the quantified rates of
AEs in the HIPE data until after the chart review had been completed.

Results: The prevalence of F2M events in older adults in Ireland in one model 4 hospital have been
investigated. Based on preliminary findings from the 726 admissions reviewed to date, 172 (24%) of
the admissions were identified through the primary review as having experienced at least one AE.
These admissions then underwent a secondary review, through which 270 AEs were identified by the
reviewers. The secondary review identified 69 cases of pneumonia, 36 UTIs, 93 pressure sores and 72
cases of delirium.

Conclusion: The rates of AEs identified through the retrospective chart review in this study are in line
with findings from previous studies that explored the rates of AEs through two-stage retrospective
chart reviews. The provisional findings from this study will inform the next phase of this research by
providing a baseline for which the rates of AEs identified in the HIPE data will be validated against. This
will make visible the true rates of these AEs and may allow for improvements in the accuracy of this
data. Accurate data will facilitate benchmarking of AE rates across hospitals and countries and provide
an opportunity for improvements in patient safety and healthcare quality.

Disclosure of Interest: None Declared

245
Reducing Vascular Complications via Femoral Artery Approach for Post Elective Procedure in
Improving Patient Safety: (1943) Arni Azura Abd Karim

ISQUA2024-ABS-1943

A. A. Abd Karim 1,*, S. J. Abdul Rahman 1

Invasive Cardiovascular Laboratory , National Heart Institute , Kuala Lumpur, Malaysia

1

Introduction: Cardiac catheterization and percutaneous intervention can result in problems at the
vascular access site. In the Invasive Cardiovascular Laboratory (ICL), vascular access-site problems via
the femoral route can result in severe morbidity and mortality. To maintain patient safety and
effectiveness, clinical management has set a goal of reducing femoral artery vascular complications to
less than 3% in post-elective patients.

Methods: In this project, the Plan-Do-Study-Act (PDSA) method was applied. Vascular problems in the
femoral artery have been observed to range between 2% and 4% in patients having diagnostic and
interventional procedures from January to March 2019 (a pilot study). Significant causes for femoral
complications will be recorded, including numerous punctures, failed closure devices, obesity, high
blood pressure, dialysis patients, and [Link] are inclusion and

exclusion criteria measured that exclude Primary or Emergent Percutaneous Coronary Intervention
(PCI) procedures, Electrophysiology (EP), and Right and Left Heart Catheterization procedures, and the
vascular complication was resolved in 6 hours.

Results: Since the start of the trial study in 2019, femoral artery complications have steadily decreased.
Continual improvements are being made for femoral artery complications. These are the initiatives:

1. Reinforce ICL Team to raise Vascular Complication Form if there is any vascular complication
occurred.

2. Ward round by ICL Nurses after all procedures are completed

3. Established ICL Vascular Complication Task Force Team

4. Femoral artery puncture under fluoroscopy guidance by primary team

5. For difficult case to puncture under peripheral ultrasound

6. Policy review on sheath removal by primary team.

Conclusion: Continuous monitoring by the primary team and the ICL team is vital for reducing femoral
artery complications. Patient involvement plays an essential role in understanding the causes of
femoral artery complications and developing prevention interventions. The engagement of all
stakeholders fostered a cultural shift, confirming the view that vascular complications are everyone's
business.

Disclosure of Interest: None Declared

246
Improving malaria case management quality by reducing irrational use of antimalarials - A systems
thinking approach in four southern states (Akwa Ibom, Cross River, Ebonyi, and Oyo) in Nigeria:
(2540) Augustine Firima

ISQUA2024-ABS-2540

A. Firima 1,* on behalf of RBM Case Management WG, I. Nglass 1 and Chinwe Nweze1, Ubong Umoren1,
Tochukwu Nwokwu1, Jay Thomas1, Kenechukwu Ogbene1, IniAbasi Nglass1, Olatayo Abikoye1,
Abiodun Ojo1, Uchenna Nwokenna1, Tom Hall2, John Bosco Ndabarinze², Thetard Rudi2, Lawrence
Nwankwo3, John Orok4 , Veronica Momoh5, Jules

PD, MSH, Abuja, Nigeria

1

Introduction: Nigeria has the highest global burden of malaria accounting for 27% and 31% of global
malaria cases and deaths respectively in 2022. Accurate diagnosis and treatment are essential for
effective malaria control, reducing presumptive treatment and irrational use of antimalarial medicines.
However, non-adherence to the national malaria diagnosis and treatment guidelines, non-availability
of malaria commodities, and poor-quality reporting continue to affect quality case management
services. In four states (Akwa Ibom, Cross River, Ebonyi, and Oyo), the President’s Malaria Initiative for
States (PMI-S) project supported the state governments to train 5,174 health workers in the four
states, conducted regular (monthly and quarterly) supervision, and introduced an innovative strategy
for archiving used malaria RDT cartridges, cross checking them against reported positive cases for
accuracy verification, as part of efforts to improve the quality of malaria case management in the
states. PMI also provides malaria commodities to 1,924 (65%) out of the 2,978 public health facilities
in the four states to improve commodity availability.

Methods: In this study, we examined four years of National Health Management Information System
data (October 2019 to September 2023) from 2,978 public health facilities across four states (Akwa
Ibom: 538, Cross River: 1065, Ebonyi: 534, Oyo: 841). We analyzed trends in clinical diagnosis, RDT
stock out rates, and malaria Rapid Diagnostic Test (RDT) positivity rates.

Results: From 2019 to 2020, 24,853 (Akwa Ibom), 34,619 (Cross River), 7,214 (Ebonyi), and 146,008
(Oyo) of fever cases were clinically diagnosed with malaria representing 8.4%, 11.7%, 1.2%, and 26.3%
of all malaria cases across the four states respectively and were treated with antimalarial drugs.
However, from 2022 to 2023, this dropped to 3,775 (Akwa Ibom), 6,263 (Cross River), 946 (Ebonyi),
and 6,264 (Oyo) which represents 1.5%, 2.2%, 0.3%, and 1.4% of the total malaria cases by the end of
the fourth year in the four states respectively. Also, RDT stock out rates dropped from 33%, 44%, 14.4%,
and 33.2% to 4%, 3.8%, 4.1%, and 9.3% in Akwa Ibom, Cross River, Ebonyi, and Oyo respectively, over
same periods. Similarly, malaria RDT test positivity rates (TPR) reduced from 76% (Akwa Ibom), 79%
(Cross River), 81% (Ebonyi), and 76% (Oyo) in the first year to 49% (Akwa Ibom), 60% (Cross River),
55% (Ebonyi), and 51% (Oyo) in the fourth year. Our findings showed that over the 4-year study period,
presumptive treatment significantly reduced by 85% (Akwa Ibom), 82% (Cross River), 87% (Ebonyi),
and 96% (Oyo) from year 1 to year 4 (t=5.77, p value <0.0001) while malaria RDT TPR reduced by 35%
(Akwa Ibom), 24% (Cross River), 32% (Ebonyi), and 33% (Oyo) over similar period (t=23.46, p value
<0.0001).

Conclusion: Presumptive diagnosis and TPR decreased following scale up of service delivery support
and reduced stock out of RDTs in the four states. Other interventions such as insecticide treated net

247
mass campaigns held in the four states at different periods during the four-years study period may also
contribute to the reduction of TPR. These reductions in clinical/presumptive diagnosis and malaria TPR
indicate a significant positive shift in healthcare practices contributing to reduction in presumptive
treatment of malaria, reducing drug wastages, and improving malaria commodity availability for
patients who need them.

References: 1. World Malaria Report, WHO, 2023

2. District Health Information System (DHIS2)

Disclosure of Interest: None Declared

Evaluation of Nurses' Attitudes and Knowledge Levels Regarding Safe Medication Use Process:
(2806) Birkan Tapan

ISQUA2024-ABS-2806

N. Nane 1, A. Kurt 2, M. B. Demirbaş 2, B. Tapan 2,*

Sağlık Kuruluşları Yöneticiliği, 2Sağlık Yönetimi, Demiroğlu Bilim Üniversitesi, İstanbul, Türkiye
1

Introduction: As technology develops, the element of quality in health service delivery is becoming
increasingly prominent. One of the important elements in this regard is patient safety. The concept of
patient safety is included in the understanding of "first do no harm", which was first expressed by
Hippocrates and is the generally accepted principle of medicine. The aim of patient safety is to create
a safe environment for patients and their relatives who receive healthcare services, to prevent, protect
and treat them from worsening their current situation. One of the most important issues to achieve
this goal is drug safety. This study is a descriptive cross-sectional study planned to determine the
thoughts and knowledge of nurses about medication error reporting. The aim of this study is to
determine the errors and knowledge deficiencies and to prevent medication errors and near misses.

Methods: This study is a descriptive cross-sectional study planned to determine the thoughts and
knowledge of nurses about medication error reporting. The study included 105 nurses working in a
private group hospital who agreed to participate in the study between November 28, 2023 and
February 05, 2024 and completed two months of orientation training. Descriptive Characteristics
Questionnaire, Thoughts on Reporting Medication Errors Form and Medication Error Knowledge Status
Determination Form were used to collect the data.

Results: When the reasons for not reporting medication errors of the nurses participating in the study
were examined, 8.8% (n=10) stated that it would be perceived as personal incompetence, 2.6% (n=3)
stated that it would harm their professional life, 4.4% (n=5) stated that it would jeopardize their job,
4.4% (n=5) stated that reporting would not be useful, and 0.9% (n=1) stated that reporting was
unnecessary, It was determined that 9.6% (n=11) did not know how to report, 28.9% (n=33) thought

248
that they could solve it among themselves, 0.9% (n=1) thought that it would be recorded in the
personnel file, and 30.7% (n=35) did not report because they had not encountered medication errors
before.

Conclusion: It was found that there was no significant relationship between total experience, working
time in the institution and educational status of the nurses participating in the study and medication
error reporting, and the scores of the employees with a working time between 0-3 years in the
institution were higher than those with a working time of more than 3 years. Among those who
received medication safety education, 22.2% reported that they always reported medication errors
and 83.3% reported that they never reported medication errors. No significant difference was found
between nurses who received and did not receive medication safety education according to the
reporting status of medication errors (p>0.05). A significant difference was found between nurses who
perceived reporting of medication errors as a success criterion and those who did not (p < 0.05). In the
trainings provided for reporting for patient safety, it is important to consider error reporting as an
important part of the system and not as a punishment for the employee. It is recommended that
institutional strategies should be developed and trainings should be planned to improve nurses' ability
to reflect their knowledge on medication error reporting into practice.

Disclosure of Interest: None Declared

Improve the correctness of patient self-care after joint replacement surgery: (3277) Chen Chan
Kuo

ISQUA2024-ABS-3277

C. C. Kuo 1,*, S.-W. HSU 1, Z.-T. DING 1, H.-Y. CHIEN 1, C.-T. Lin 1

Nurse, Chang-Gung Medical Foundation Linkou Chang-Gung Memorial Hospital, Taoyuan, Taiwan
1

Introduction: According to the 2020 National Health Insurance Medical Statistics of the Ministry of
Health and Welfare, the 65-74 age group accounts for about 40.5% of the largest number of patients
with degenerative arthritis. Degenerative arthritis is accompanied by swelling, pain, stiffness, limited
squatting, difficulty climbing stairs and walking, etc., which affects the quality of daily life and self-care
ability of individuals, leading to an increase in the need for joint replacement surgery. The most
important thing after surgery is to prevent wound infection. After discharge from the hospital, continue
to take care of the wound properly to avoid wound infection and promote healing. Poor wound healing
affects quality of life.

Methods: To resolve these problems, wound care education checklist, wound care cue-card, wound
care video clips, wound condition red flag cue-card, and customized wound care pack have been
proposed and implemented.

249
Results: The result showed the proper wound care rate performed by a joint replacement patient at
home has raised to 96.8%, which effectively improved the post operation wound care quality.

Conclusion: The purpose of this project is to improve the accuracy of wound self-care for patients after
joint replacement surgery, increase the consistency of nursing staff's wound care education for
patients after joint replacement surgery, remind patients of wound assessment and care steps, and
understand that wound abnormalities require immediate return to the hospital. This project provides
guidance for patients to correctly perform wound self-care and abnormal observation when they
return home, effectively improving the quality of care and avoiding wound infection and readmission
after returning home, which increases medical costs.

References: Liu, Y. J., Wang, P. H., Chang H. M., & Lin L. Y. (2020). Exploring Teaching Competence of
Nurses and Its Influencing Factors. VGH Nursing,37(1),55-64.

Chang, H. L., & Chung, Y. C. (2022). Development the Home-Based Postoperative Rehabilitation
Manual in Patients After Total Knee Replacement. Changhua Nursing, 29(1), 19-28.

Huang, S., Chiang, Y. M., Huang H. C., & Kuo, M. L.(2020). Using Multimedia Nursing Guidance to
Improve Self- Care Accuracy in Patients with Total Knee Replacement. Chang Gung Nursing, 31(4), 503-
516.

Keller, J. M. (1983). Motivational design of instruction. In C. M. Regality (Ed.), Instructional design

theories and models: An overview of their current status, 384-434. U. S., Springer Verlag.
[Link] 1250-3_2

Reslan, H. A., Moustafa, S. M., Saghieh, S., Sharara, E. S., & Badr, L. K. (2018). Does intervention improve
the outcomes of patients after total knee replacement surgery. International Journal of Orthopaedic
and Trauma Nursing, 31, 26-31. [Link]

Disclosure of Interest: None Declared

Enhancing Taiwan Patient-safety Reporting Volume through Patient Safety WalkRounds: (2645)
Chien-Kai Lo

ISQUA2024-ABS-2645

C.-K. Lo 1,*, Y.-C. Lai 1, Y.-S. Tasi 1, C.-C. Wang 2

Medical Quality Division, 2Deputy Superintendent, En Chu Kong Hospital, New Taipei City, Taiwan
1

Introduction: The Taiwan Ministry of Health and Welfare initiated the Taiwan Patient-safety Reporting
system (TPR) in 2003, adopting a non-punitive approach to collect abnormal events related to patient
safety in the hospital of Taiwan. However, the reported incidents in Taiwan's hospitals are generally
lower than the international average. This study aims to investigate the application of Patient Safety
WalkRounds to enhance the reporting volume in the Taiwan Patient-safety Reporting system.

250
Methods: The Institute for Healthcare Improvement (IHI) suggests that Patient Safety WalkRounds can
serve as a tool to connect top-level executives with frontline staff, demonstrating the commitment to
patient safety and support for personnel. This study conducted monthly Patient Safety WalkRounds
from April to December 2023. The Patient Safety WalkRounds team included the Deputy Medical
Director, Medical Director, and staff members. Representatives conducted 15-20 minute interviews in
various units with unit leaders and clinical staff. The objectives were to 1. demonstrate the hospital's
commitment and support for patient safety, 2. establish communication channels among staff,
supervisors, and managers regarding patient safety, and 3. encourage the reporting of abnormal
events to identify improvement opportunities. Pre-visit meetings were held to establish consensus on
the visit schedule and content. After the visit, feedback was provided, and follow-up items were
confirmed. The study utilized non-parametric sign tests to analyze the reported abnormal events
before and after Patient Safety WalkRounds in each unit.

Results: From April to December 2023, a total of 28 wards and medical units were visited. In the pre-
data from April to December 2022, 12 units reported zero events, with a median of 3, mode of 1, and
a maximum of 72 reported events. In the post-data from April to December 2023, 2 units reported
zero events, with a median of 1, mode of 0, and a maximum of 289 reported events. Among the 28
units, 21 units showed an increase in reported abnormal events, 3 units remained the same, and 4
units showed a decrease. Implementation of Patient Safety WalkRounds significantly increased the
reported abnormal events in units (p=0.003).

Conclusion: The results of this study indicate a significant increase in reported abnormal events in
units after the implementation of Patient Safety WalkRounds. The process of Patient Safety
WalkRounds enables clinical units to understand the importance of Patient-safety Reporting and clarify
which incidents should be reported but were previously overlooked. The most significant change
observed is the increased willingness of many units to report abnormal events. The study's limitation
is that the post-data collection period coincided with the implementation of Patient Safety
WalkRounds, potentially underestimating the actual effectiveness. Future research will continue to
monitor relevant data.

Disclosure of Interest: None Declared

Implementation of patient blood management program in transfusion practice of orthotopic liver

transplantation: (2126) Chueng-He Lu

ISQUA2024-ABS-2126

C.-H. Lu 1,*, T.-W. Chen 2

Anesthesiology, 2Surgery, Tri-Service General Hospital, Taipei, Taiwan

1

Introduction: Orthotopic liver transplantation (OLT) can require substantial usage of blood products.
Higher rates of transfusion have been associated with increased length of hospital stay, higher rates of
infection, graft failure, and mortality. This study was a retrospective analysis to assess the transfusion

251
utilization and patient outcomes of implementation of patient blood management (PBM) program in
OLT.

Methods: This is an observational study of graduated PBM implementation for adult OLT recipients
(age >=18 years) from August 31, 2001, through December 26, 2022. Allogeneic transfusion utilization
and clinical outcomes were assessed over time through segmented regression with multivariable
adjustment comparing observed outcomes against projected outcomes in the absence of PBM
activities.

Results: In total, 574 recipients were included. Total allogeneic transfusions decreased (34% red blood
cell, 61% fresh frozen plasma, and 27% platelets) over the study time frame except cryoprecipitate
(21% increased). Comparing final year with baseline, total blood product utilization was reduced by
approximately 68%. One-year mortality, ICU and hospital length of stay, and incident in-hospital
adverse events were lower than projected at the end of the study time frame.

Conclusion: Patient blood management implementation during OLT was associated with substantial
reductions in transfusion utilization and improved clinical outcomes. Broad-scale implementation of
PBM is feasible without signal for patient harm.

Disclosure of Interest: None Declared

252
Language Services for Limited English Proficient Patient Quality and Safety - Dashboard and Data
Driven Process Improvement (3477) Samuel Verkhovsky

ISQUA2024-ABS-3477

S. Verkhovsky 1,*

Quality, Safety and The Value Institute, Dartmouth Health, Lebanon, United States
1

Introduction: Professional Interpreter Services are critical to ensuring patients with Limited English
Proficiency (LEP) receive safe and effective care in settings and geographies where English is the
predodominant language. Without professional interpreters, LEP patients encounter numerous
barriers in accessing healthcare and experience higher risk in healthcare outcomes. Without
documentation and measurement of LEP patient encounters and interpreter utilization, improvement
efforts are challenged.

Methods: We implemented changes in the way that we identify patients primary language needs from
simply asking whether an interperter is needed to asking which language they prefer to discuss their
health information in. We implemented electronic medical record documentation of interpreter
utilization and we started using a dashboard to track encounters where LEP patients are seen and how
interpreter services are utilized, whether in person, video or telephonic.

Results: Early results indicate that we have an improved grasp of understanding the volume, rate and
distribution of instances where and when Limited English Proficient patients are seen. We have started
to build a data infrastructure which allows us to monitor and track whether interpreter services are
used, and their modality.

This work allows us to stratify health outcomes by LEP status. We have found statistically significant
differences in important primary care metrics between LEP patients and English speaking patients.

Conclusion: This data driven work allows us to target professional language services in areas where
they are needed. We are able to see where LEP patients are seen, understand their language barriers
and intervene with needed services. Published literature has shown that Limited English Proficiency
is an independent driver of health disparities. There are numerous care associated outcomes that LEP
patients are at an increased risk of suffering. By understanding these risks and measuring where
patients are seen, we can target needed services to make sure that they are able to communicate with
their care providers using qualified medical interpreters.

References: 1) American Commmunity Survey 2021,

2) US Census Bureau 2020 Decennial

3) Dartmouth Health Informatics

4) Overcoming the challenges of providing care to LEP patients. The Joint Commission Quick Safety
Issue 12 May 2015

Disclosure of Interest: None Declared

253
The ADR journey – improving adverse drug reaction management to decrease the risk of patient
harm: (1307) Linda Velta Graudins

ISQUA2024-ABS-1307

L. V. Graudins 1 2,*, A. K. Aung 3 on behalf of Alfred ADR Review Committee and Alfred Adverse Drug
Reaction Review Committee

Pharmacy, Alfred Health, 2Pharmacy and Pharmaceutical Sciences, Monash university, 3General
1

Medicine , Alfred Health, Melbourne, Australia

Introduction: Adverse drug reactions (ADR) are ubiquitous and pose a known risk with most
medications, yet they are not optimally managed. Alfred Health is a metropolitan teaching hospital
with a multidisciplinary active ADR Review Committee. Its database of fifteen years of ADR reports
forms the basis for research, including ADR knowledge gaps and evaluation of patient-centred
communication.

Our long-term goal is to improve ADR management to enhance patient safety. Objectives are to
develop resources to ensure clinicians recognise ADRs for early intervention; improve accurate ADR
documentation and reporting; and ensure effective communication to patients and healthcare
professionals to decrease risk of ADR- related patient harm.

Methods: This multifaceted project commenced in 2021 by determining gaps in clinician knowledge
about medication allergies, using a 13-question case-based questionnaire. Using the results of the
questionnaire, gaps in knowledge, specifically in hypersensitivity and other allergy-related reactions,
were targeted. An educational program was developed in 2023, initially using Powerpoint slides and
face-to-face tutorials and then translating the information into interactive modules. Multiple iterations
of Plan-Do-Study-Act (PDSA) cycles led to the final program version. The effectiveness of these
educational interventions will be evaluated by participants and by determining the number of ADR
reports submitted. The quality of reports and completeness of information will be specifically
evaluated by using the Adverse reaction QUality Algorithm (AQUA-12) tool, which was developed and
tested by independent assessors, with excellent inter-rater correlation.2 The hospital's consumer
engagement team was asked to review patient-specific resources.

Results: The ADR education program (ADREP) was developed, with input from medical, allergy and
pharmacist clinicians with education experts developing the interactive platform to address identified
knowledge gaps 1. The six self-directed interactive modules cover pharmacology and immunological
mechanisms, causality evaluation and methods of communicating recommendations for safer
medication use to patients. The program uses real-life scenarios to highlight key concepts, with several
interactive multiple-choice questions for each module. To determine the baseline ADR report quality,
70 ADR reports were assessed using the AQUA-12 tool. Patient-specific written materials were
developed including advisory letter and ADR card and information leaflets focusing on severe
cutaneous adverse reactions Patients’ ADR documentation was made available via the hospital's
patient portal.

Conclusion: To address gaps in knowledge, ensure timely ADR recognition and management after an
ADR diagnosis, a comprehensive targeted educational resource was developed for clinicians. As the
ADR educational modules become more widely available, the AQUA-12 tool will be used to regularly

254
assess and monitor ADR report quality. Patient resources were reviewed and made more widely
available. On-going research into accessibility of ADR information for patients and clinician
engagement in ADR management will further enhance medication and patient safety.

References: 1. Mazzoni D, Tee HW, Menezes SL, Graudins LV, Johnson DF, Newnham ED, Kelley PG,
Zubrinich CM, Goh MSY, Trubiano JA, Aung AKA Survey on Knowledge Gaps in Assessment and
Management of Severe Drug Hypersensitivity Reactions: Multicenter Cross-Sectional Study of
Australian Health Care Providers. J Clin Pharmacol 2021; 61(1): 25-31.

2. Aung AK, Zubrinich CM, Goh MSY, Snyder B, Tang MJ, Khu CYL, Lee JI, Graudins LV. Development
and Application of Adverse Drug Reactions Reports Quality Algorithm (AQUA-12) Score: A Single-Centre
Quality Improvement Initiative. Eur J Clin Pharmacol 2023; 79(4): 513-522.

3. Aung AK, Walker S, Khu YL, Tang MJ, Lee JI, Graudins LV. Adverse drug reaction management in
hospital settings: review on practice variations, quality indicators and education focus. European J Clin
Pharmacol. 2022; 78(5): 781-791.

Disclosure of Interest: None Declared

A Bibliometric Analysis of Studies on Sustainability and Quality in Healthcare Services: (2749)

Ahmet Yesildag

ISQUA2024-ABS-2749

A. Yesildag 1 2,*, S. Bostan 1, I. Simsir 3 4

1
Health Management, Karadeniz Technical University, Trabzon, 2Health Sciences Institute, Ankara
University, 3Türkiye Institute for Health Policies (TUSPE), Health Institutes of Türkiye (TUSEB), Ankara,
4
Department of Healthcare Management, Sakarya University of Applied Sciences Faculty of Health
Sciences, Sakarya, Türkiye

Introduction: In addition to being a sector that consumes significant resources and generates harmful
and toxic waste, the healthcare industry is characterized by technology-intensive and costly service
delivery, resulting in serious concerns about its carbon footprint. In recent years, these concerns have
brought attention to the social, economic, and environmental sustainability of healthcare services. In
the context of sustainability in healthcare, quality can be defined as the ability to provide services
while maintaining current standards in the future. Given the sensitivity of this definition, both practical
and academic activities and works on this subject have increased. Therefore, this study aims to conduct
a bibliographic analysis of academic studies conducted globally on the sustainability and quality focus
of healthcare services.

Methods: In this bibliographic analysis research, publications indexed in the Web of Science (WOS)
database were searched using the keywords "health care" or "healthcare" and "sustainability" and
"quality." As of February 6, 2024, a total of 3746 publications were identified. All bibliographic
information related to these publications was downloaded from the database and transferred to the

255
Bibliometrix software running on R Studio. Using the program, publications on the examined topic
were analyzed in terms of annual publication count, researcher profiles, journal names, countries,
institutions, citations, keywords, trending topics, authors, and international collaboration in
publications.

Results: When examining the included studies by publication year, a continuous increase in
publications from 1992 to 2024 was observed (9.9%), with the highest number of publications in 2023
(n=548). The included studies involved 18,182 authors, with the most prolific authors being
Braithwaite J, Churruca K, De, and Ellis LA. The citation order of authors in the subject group was
Alexander JA, Damschroder LJ, and Aron DC. The top journals with the most publications were
Sustainability, BMC Health Services Research, BMC Open, and Implementation Sciences. The three
countries with the highest number of publications were the United States, Australia, and the United
Kingdom. The top institutions with the most publications were the University of Toronto, Monash
University, and the University of Calgary. The most cited studies were Damschroder LJ et al., 2009
Implement SCI, Stirman SW et al., 2012 Implement SCI, and Chambers DA et al., 2013 Implement SCI.
In addition to these findings, collaboration clusters of universities, authors, and countries were
schematized. Examining the external keywords in the studies revealed concepts such as quality
improvement, covid-19, primary care, telemedicine, hospital, patient safety, evaluation, education,
nursing, management, telehealth, mental health, mhealth, ehealth. Furthermore, sustainable
development goals, climate change, carbon footprint, transformation, and telemedicine were
identified as trending concepts. Additionally, areas for future research were determined, including the
integration of sustainability and quality studies in topics such as telemedicine, digital health, cost-
effectiveness, self-management, physical activity, and medical education.

Image:

Conclusion: The analysis findings serve as a valuable resource for academics and practitioners
interested in understanding current trends and priorities in the field. The identified authors, topics,
journals, and countries in the forefront of sustainability and quality in the context of discussing the
environmental impact of healthcare services have been highlighted. In this context, the integration of
digital technologies in sustainability and quality is seen to have significant implications.

Disclosure of Interest: None Declared

256
Assessment of sustainable healthcare practices in Indonesian hospitals: A focus in water,
sanitation, and care waste management interventions: (2761) Hanny Rono Sulistyo

ISQUA2024-ABS-2716

J. Kim 1,*, E. Choi 2, S. Kim 2, S. Kim 2, S.-K. Park 2, S. Choi 2

Health Insurance Review & Assessment Service, 2Health Insurance Review & Assessment Service,
1

Wonju, Korea, Republic Of

Introduction: The Cone Beam CT (CBCT) is useful for diagnosing bone changes in teeth and maxilla.
Since its coverage began in 2008, it expanded to cover the sinuses, and the upper and lower
extremities. As the procedure has been selected for intensive review since 2014, there have been
efforts to maintain a reasonable level of its utilization, however it has been continuously on the rise in
accordance with increased coverage for implants. As such, this study is aimed to analyze the increase
in health insurance coverage, the status of CBCT equipment over the past decade (from 2013 to 2022),
and their utilization in the medical field.

Methods: In order to conduct the analysis, 4,782,594 patients have been selected from a pool of
5,993,172 cases that were associated with the CBCT billing codes within the health insurance claims
data spanning from 2013 to 2022. The number of exams and fees were analyzed by year, age group,
type of medical facility, department, and age of the equipment. The program SAS Enterprise Guide 7.1
(SAS Institute Inc., Cary, NC, USA) was used to create and analyze the datasets.

Results: The number of CBCT equipment and their medical usage has sharply increased in the past ten
years due to increased coverage for their use. The number of CBCT scanners increased from 4,146 in
2013 to 16,603 in 2022, representing a yearly average increase of 16.7%. This growth rate is
significantly higher than that of regular CTs (2.2%). The number of scanners per 1 million inhabitants
in South Korea increased from 81.1 in 2013 to 322.8 in 2022, indicating a 3.9-fold increase. Dental
hospitals/clinics own 14,921 (as of 2022) which makes up 89.9% of all CBCT scanners. In 2022, the
majority of scanners in use had been operational for less than five years, accounting for 50.8% (8,442
units). However, the number of scanners aged from 10 to 15 years increased by 75.2% compared to
2013, suggesting a rise in the presence of older equipment.

CBCT exam fees rose from KRW10.9 billion in 2013 to KRW61.9 billion in 2022, reflecting a yearly
average increase of 21.3%. The number of exams conducted increased from 230.5 thousand in 2013
to 1.117 million in 2022, indicating a yearly average increase of 18.9%. The number of billing
institutions increased from 2,603 in 2013 to 11,501 in 2022, which is a 4.4-fold increase. Since coverage
was offered for the otolaryngology department in 2015, there has been a 29.0% increase compared to
the previous year; and coverage was offered for upper and lower extremities in 2016, which led to a
383.4% increase compared to the previous year. The number of implants and CBCT exams showed a
high correlation coefficient of 0.93 (p<0.001) since implants became billable in 2014.

Conclusion: In the unique Korean environment, where the people have easy access to dental facilities,
the number of CBCT exams carried out by dental clinics, which own the majority of the scanners,
increased with the rise in coverages offered. Furthermore, it is hypothesized that the increased cases
of non-billable procedures (such as implants) that guarantee high profits for dental clinics are
correlated with an increase in CBCT exams, though further in-depth analysis is needed to confirm this.

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Repeat CBCT exams increase the patients’ exposure to radiation, and financial burden, therefore
reasonable levels of use must be maintained. In order to achieve this, we must firstly, establish the
optimal number of coverage for the exam, secondly, provide differentiated insurance fees depending
on the age of the scanner, and thirdly, put in place a monitoring system and management mechanism
for non-billable exams.

Disclosure of Interest: None Declared

ELECTRONIC WITNESS SYSTEM IN FERTILITY CENTER: STAFF AND PATIENTS PERSPECTIVES: (2050)
Quyen Dang

ISQUA2024-ABS-2050

H. Pham 1,*, H. Bui 1, Q. Dang 1, A. Le 1, T. Ho 2

IVFMD Phu Nhuan, My Duc Phu Nhuan Hospital, 2IVFMD, My Duc Hospital, Ho Chi Minh, Viet Nam
1

Introduction: In a fertility clinic, biological sample identification, processing, and traceability are
extremely important for in-vitro fertilization (IVF) procedures. A mix-up of gametes and embryos has
the highest grade of severity. Electronic witnessing systems (EWS) have been introduced as a
safeguarding measure to address these critical considerations. These systems are vital in reducing the
risk of biological sample mix-ups, particularly human error. The study aimed to explore the staff’s
perceptions and patients’ experiences at an IVF clinic operated with an EWS.

Methods: EWS using radio frequency identification (RI WitnessTM, Cooper Surgical, Denmark) was
applied in our fertility clinic. To evaluate the influence of EWS on the viewpoints of staff and patients,
a survey was conducted from December 1, 2023, to January 31, 2024. The study engaged
embryologists/operation managers and patients at IVFMD, My Duc Phu Nhuan Hospital, Ho Chi Minh
City, Vietnam. Participants were administered a Likert scale questionnaire (1 to 5) to assess their
perceptions and experiences with EWS.

Results: There were 27 staff (24 embryologists and 3 operation managers) and 242 patients engaged
in the study. The ages of staff and patients were (29.8 ± 4.4 and 33.2± 4.6, respectively). The results of
the staff questionnaire within the laboratory indicated a strong agreement on the effectiveness of EWS
in reducing the risk of sample mix-up (77.8%), with a majority expressing increased security while
working in a laboratory equipped with an EWS (92.6%). 40.7% of staff agreed that EWS could help
reduce double witness time compared to conventional double check, while 14.8% did not. Moreover,
a survey of 242 patients (235 women and 7 men) demonstrated that 96.3% had significant concerns
about sample mix-ups. Implementing EWS reduced these concerns in 90.9% of patients, and 98.3%
felt comfortable with an IVF center equipped with EWS. The study provided valuable insights into the
practical implications of EWS in assisted reproductive practices.

Image:

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Conclusion: The integration of EWS into the IVF clinic plays a safety role, effectively minimizing the
potential biological sample mix-ups. This enhances the overall security and confidence of both patients
and staff and establishes a robust system for sample mix-up prevention in assisted reproductive
practices.

References: 1. de los Santos, Maria José, and Amparo Ruiz. "Protocols for tracking and witnessing
samples and patients in assisted reproductive technology." Fertility and sterility 100.6 (2013): 1499-
1502.

2. Forte, Marina, et al. "Electronic witness system in IVF—patients perspective." Journal of

assisted reproduction and genetics 33 (2016): 1215-1222.

3. Holmes, Rebecca, et al. "Comparison of electronic versus manual witnessing of procedures

within the in vitro fertilization laboratory: impact on timing and efficiency." F&S Reports 2.2 (2021):
181-188.

Disclosure of Interest: H. Pham: None Declared, H. Bui: None Declared, Q. Dang: None Declared, A.
Le: None Declared, T. Ho Speaker bureau of: Merck, Merck Sharp & Dohme, and Ferring

259
Implementation of Patients Safety Checklist (PASC) in Surgery, a Stepped Wedge Cluster RCT -
Effects on Patient and Implementation Outcomes: (3561) Arvid Steinar Haugen

ISQUA2024-ABS-3561

K. Harris 1 2, H. Wæhle 1 3 4, A. Storesund 1 2, R. Tangvik 1 5, S. Harthug 1, Å. Tepstad 1 6, A. S. Haugen 7,* and

The PASC study group
1
Department of Anaesthesia and Intensive Care , Haukeland University Hospital, 2Institute of Health
and Social Sciences, Western Norway University of Appliec Sciences, 3Department of Global Health and
Primary Care, University of Bergen, 4Department of Research and Development, Haukeland University
Hospital, 5Department of Clinical Medicine, University of Bergen, 6Department of Medicine, Haukeland
University Hospital, Bergen, 7Faculty of Health Sciences, • Department of Nursing and Health
Promotion Acute and Critical Illness, Oslo Metropolitan University, Oslo, Norway

Introduction: Background Involving patients in patient safety and quality of care is warranted. To
empower patients, optimise preparations for surgery and involve patients in their own safety, a novel
tool – the Patient Safety Checklist (PASC) was developed (1). Patients use the checklist before and after
surgery. In a Stepped Wedge Cluster Randomized Controlled Trial we aim to investigate the impacts of
the checklist on patient and implementation outcomes across surgical specialties in Norwegian
hospitals.

Methods: Method This trial includes patients from a wide range of surgical specialities, including
elective surgical patients, in both control and intervention arms of the trial. The study has three main
work packages (WP) and investigates: WP 1) Effects on morbidity and mortality, WP 2) Self-screening
of patients’ nutritional status prior to admission, WP 3) Implementation of the checklist. Further, we
investigate health economic consequences of checklist implementation, and how it impacts patients’
health literacy. In the trial we also investigate patients’ and healthcare’ personnels` experiences with
the checklist. The trial was approved by REK West (2016-1102). [Link], ID: NCT03105713.
Funded by the Norwegian Council of Research (ID: 320475)

Results: Result More than 5600 patients have been enrolled in the trial. Data collection has been
ongoing from November 2021 until March 2024. Quality control and analysis of data is ongoing, and
the main results are due to be revealed within end of 2024.

Conclusion: Conclusion

Involving patients in their own safety and optimising their preparations by using the PASC checklist is
feasible. The impact of PASC on patient outcomes is currently being investigated.

References: Reference

- Harris K, Søfteland E, Moi AL, Harthug S, Ravnøy M, Storesund S, Jurmy E, Thakkar B, Haaverstad
R, Skeie E, Wæhle HV, Sevdalis N, Haugen AS. Development and validation of patients’ surgical safety
checklist. BMC Health Serv Res. 2022. 22: 259 February, doi: 1186/s12913-022-07470-z

Disclosure of Interest: None Declared

260
Short Orals

Advancing Co-design Research Tools for Evidence-Based Quality and Patient Safety Improvements:
Insights from the Development of the Irish National Quality and Patient Safety Competency
Framework: (1426) Dimuthu Wasana Rathnayake

ISQUA2024-ABS-1426

D. W. Rathnayake 1,*, M. Browne 2, V. Hanlon 2, G. Moore 2, J. Fitzsimons 2, S. Horan 2, A. De Brún 1

1
Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), University
College Dublin, 2Health Service Executive , Dublin, Ireland

Introduction: Co-design methods promote shared approaches to decision-making and participatory

actions to co-produce policies, strategies, and interventions (1). Co-produced quality and patient safety
(QPS) strategies guided by strong evidence are recommended due to the growing complexity of
healthcare. The literature lacks detailed coverage of specific co-design research methods (2) and
evolving co-design methods have resulted from diverse applications in action research. The Health
Service Executive Ireland initiated a research-based co-design project, engaging all key national
stakeholders and patient partners to co-produce the QPS competency framework. This paper aims to
share insights from our project, proposing various co-design tools and design considerations for
researchers, and encouraging the adoption of co-design methods in creating patient-centred health
services through collaborative research.

Methods: A fundamental aspect of co-design as a research process was ensuring adequate

representation from all stakeholders to ensure the co-designed output was relevant and met the needs
of end users. We used a stakeholder mapping tool at the project's outset to identify key participants
that could inform the development of a QPS Competency Framework. After obtaining informed
consent, a co-design panel was formed, comprising key stakeholders from healthcare (clinical services,
quality and patient safety and Human Resources leads), patient partners, professional bodies,
academia, and policymakers. The panel (n=88) aimed to contribute to the design of a people-centered
National QPS Framework for Ireland. The Delphi method, known for achieving consensus among
experts, was used with a modified eDelphi (online) survey tool to prioritise key thematic areas.
Simultaneously, a scoping review identified relevant literature, supporting evidence-informed
decisions. Structured qualitative interviews identified additional topics for discussion, and five co-
design sub-groups were formed to refine competencies. These sub-groups engaged iteratively in
facilitated Focus Group Discussions, using liberating structures such as World café, Spiral Journal, etc.
to support the development of the framework.

Results: The tools used maintained a research-based co-design approach throughout the initiation,
design, and processing phases in developing the framework.

Conclusion: The collaborative approach empowered stakeholders to focus on their expertise and
experience, building consensus on essential competencies across all levels in health and social care.
Integrating shared value thinking into a practical environment, especially within coproducing
approaches in health systems, posed unique challenges due to interdisciplinary involvement. A key
outcome of this research project is the successful adaptation of qualitative research tools as various
co-design strategies. This approach effectively engaged relevant stakeholders, prompting them to

261
reflect on the enablers and catalysts of the evidence-based co-production process. The insights
gathered from these efforts have contributed to informing shared governance in the development of
pragmatic and sustainable QPS competencies for the Irish Health Workforce.

References:

1. Steen M. Co-design as a process of joint inquiry and imagination. Design issues. 2013;29(2):16-
28.

2. Messiha K, Chinapaw MJM, Ket HCFF, An Q, Anand-Kumar V, Longworth GR, et al. Systematic
Review of Contemporary Theories Used for Co-creation, Co-design and Co-production in Public Health.
Journal of Public Health. 2023;45(3):723-37.

Disclosure of Interest: None Declared

Optimizing Effective Access to Sexual and Reproductive Services in Primary Healthcare Settings
through joint optimization of technical, human and care culture values in selected facilities in
Ethiopia: (2815) Berhanetsehay Teklewold

ISQUA2024-ABS-2815

T. D. Darebo 1,*, B. Teklewold 1, E. Abate 1, Z. Seife 1, B. Abegaz 1, A. Girum 1, H. Abdi 1, M. Miressa 1, I.

Shemsedin 1 and Dr. Abayneh Kedir and Dr. Bontu Abera are part of this working group. . 1Healthcare
System Impact Syndicate Africa, Addis Ababa, Ethiopia

Introduction: Strengthening primary healthcare for achieving universal health coverage for all has
been part of the global strategy for decades. The interventions to this end focused on expansion of
healthcare infrastructure, production of human resources for health, improving supply of drugs and
technology, increasing financing of healthcare services and information revolution. Ethiopia is one of
the countries with policy and strategic focus on expanding primary healthcare service. As a result, the
country has registered improvement in maternal and child health outcomes over the last three
decades. Despite the achievements, however, utilization of services remains low, and the care provided
lack quality. In this study, we investigate if joint optimization through supplementing the already
available technical value inputs with human value of person centeredness of care and cultural values
of leadership, teamwork, communication, collaboration, improvement and system learning would lead
to improved quality, utilization of services and coproduction.

Methods: A pre-post evaluation was conducted in selected facilities in three major regions of
Ethiopia—Amhara, Oromia, and Afar after implementation of the COPMOV (Contain People Move
Value) bundle project package for improving sexual and reproductive services. The COPMOV bundle
package designed by the Healthcare Systems Impact Syndicate Africa (ACSIS), aims at joint
optimization of technical, human, and care culture values through 1. Revitalization of available
unutilized or underutilized resources 2. Mapping and redesign of care processes around patients and
their families and 3. Providing training and mentorship on leadership, teamwork, communication,

262
collaboration, improvement methodology through a hub and spoke network of learning collaborative
to move value within the system, improve timeliness, person centeredness of care and literacy of
patients for coproduction of sexual and reproductive health. Data on service utilization pattern were
collected for six months before (October 2022-March 2023) and after (April-October 2023) the
intervention. We used a run chart to measure trends in the intermediate outcomes. Six data points
above the median is categorized as statistically significant change. The study employed a robust
evaluation framework aligned with the World Health Organization's health system theory, emphasizing
health system strengthening. The project was approved and registered by the Ethiopian Ministry of
Health.

Results: Within 6 months period, the COPMOV intervention bundle package improved effective access
to sexual and reproductive care in twelve comprehensive SRH centers in rural primary healthcare (PHC)
settings across three regions of Ethiopia. These facilities provided timely cesarean section delivery to
572 women, reducing referrals and minimizing the second and third delays. Furthermore, a statistically
significant changes were observed in the utilization of medical abortion services 191/282 (67.7%),
antenatal care 4524/8162 (55.4%), and delivery services 3723/6041 (61.6%) (Figure 1), including
spontaneous vaginal delivery 3158/5292 (59.7%), due to improvements in the capacity of the PHC
facilities to handle potential complications. However, neonatal intensive care unit admissions have
significantly increased 318/378 (84.1%), primarily due to an increase in total deliveries. In addition,
the collaboration has efficiently mobilized USD 942,992.1 in equipment and supplies and involved 105
different healthcare providers from higher-level facilities to optimize the PHC facilities.

Image:

Conclusion: The joint optimization care bundle package of technical, human, and cultural care values
led to improved access to comprehensive SRH care. It further facilitated mobilization and revitalization
of available frozen material resource and skilled personnel, to improve utilization of care; hence,
coproduction by bridging the gap. The PHC capacity was enhanced to handle potential complications
timely. However, attention is needed for the sustainability and initiation of neonatal care to ensure a
lasting impact.

Disclosure of Interest: None Declared

263
Patient-Centric Progress: Unveiling the Landscape of Shared Decision Making at Shin Kong Medical
Center: (1880) Jui-Ting Chang

ISQUA2024-ABS-1880

J.-Y. Lee 1, P.-S. Lee 2, S.-C. Lai 1, Y.-C. Chang 3, Y.-H. Lin 1 4, S.-M. Hou 3, J.-T. Chang 1 5 6,*
1
Center for Quality Management, 2Department of Planning, 3Superintendent Office, 4Department of
Plastic Surgery, 5Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su
Memorial Hospital, Taipei, 6School of Medicine, College of Medicine, Fu-Jen Catholic University, New
Taipei City, Taiwan

Introduction: The increasing emphasis on patient-centered care and the recognition of patients'
pivotal role in their healthcare decisions prompt the exploration of Shared Decision Making (SDM) as
a strategic initiative1–3. This paper presents the transformative journey of Shin Kong Medical Center
(SKMC) in integrating SDM into its healthcare framework.

Methods: The SDM strategy at SKMC involved a three-tiered approach: institutional, healthcare
professionals, and patients (see Fig. 1). At the institutional level, the hospital was committed to
fostering an SDM-friendly culture with leadership support, policy development, and resource
allocation for seamless integration. The hospital administration was pivotal in creating an environment
that encourages and rewards collaborative decision-making. Healthcare professionals were trained in
SDM theory, effective communication, and practical use of information systems. Workshops and
ongoing professional development were provided to ensure that healthcare providers facilitate
collaborative decision-making. The medical center actively engaged patients and sought their input in
decision-aid development. Information systems were designed to empower patients with accessible
health information. Education sessions were implemented to encourage patients to participate in
medical decisions actively. This comprehensive approach ensures a patient-centered and collaborative
SDM process at SKMC, acknowledging the roles of the institution, healthcare professionals, and
patients in the decision-making process. The evaluation of SDM at SKMC utilized questionnaires,
created by the Joint Commission of Taiwan, for both patients and healthcare professionals.

Results: The patients' responses indicated a significant reduction in anxiety related to medical issues
through SDM. In terms of post-discharge rehabilitation for heart failure patients, the average anxiety
score decreased from 4.3 to 2.6 (p < 0.05) (see Fig. 2). The majority noted substantial assistance from
SDM, ranging from 40-60%. Key promoters of SDM include improving doctor-patient relationships
(71.9%) and ensuring patient understanding of diseases and treatments (75%). However, healthcare
professionals reported time constraints during patient discussions (56.3%) as the most significant
obstacle to SDM implementation. In addition to questionnaire-based insights, we used POWER BI to
monitor and analyze institution-wide SDM usage. From January 2021 to November 2023, 13,853
instances were recorded, with a response rate of 93.5% (see Fig. 3).

Image:

264
Conclusion: The incorporation of SDM at SKMC highlighted the importance of patient empowerment
in modern healthcare practices. The outcomes demonstrated that a patient-centered approach
improved the quality of healthcare delivery and promoted a more inclusive and collaborative
healthcare environment. The study's findings provided valuable insights into the practical
implementation of SDM in medical centers. It emphasized the potential of SDM to revolutionize patient
care and outcomes.

References:

1. ElwynG, FroschD, ThomsonR, Joseph-WilliamsN, LloydA, KinnersleyP, et al. Shared decision making:
A model for clinical practice. J Gen Intern Med. 2012;27(10):1361–7.

2. StiggelboutAM, PieterseAH, DeHaesJCJM. Shared decision making: Concepts, evidence, and

practice. Patient Educ Couns [Internet]. 2015;98(10):1172–9. Available from:
[Link]

3. LégaréF, AdekpedjouR, StaceyD, TurcotteS, KryworuchkoJ, GrahamID, et al. Interventions for

increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst Rev.
2018;7:CD006732.

Disclosure of Interest: None Declared

265
DISCO with Patients, Patient Advocates and Healthcare Teams – A Healthcare Improvement
Collaboration Platform: (1302) Keith Heng

ISQUA2024-ABS-1302

B. Teo 1,*, Y. K. Lim 1, K. Heng 1, K. S. Chew 2, J. Liow 2, P. Naidu 2, Z. Foo 1, K. H. Tan 1

IPSQ, SingHealth Duke-NUS Institute for Patient Safety & Quality, 2SPAN, SingHealth Patient Advocacy
1

Network, Singapore, Singapore

Introduction: The Design. Ideate. Sustain. Change for Healthcare Organisation (DISCO) Café serves as
a platform to encourage collaborations between patients, patient advocates and healthcare teams in
healthcare improvement. The cluster initiative contributes to taking progressive steps in co-production
of care, experience and improving patient safety with patients as Partners in Care.

Methods: DISCO Café, a one-day ideation workshop, is structured with the following key segments:
Identification of Opportunities, Ideation and Solution Sharing. Each segment consists of activities
designed to share perspectives and feedforward for project teams to finetune their improvement
ideas.

A thematic based approach helps garner the interest of projects along similar improvement objective.
Besides the project teams, advocates from the SingHealth Patient Advocacy Network (SPAN-
Advocates), and Technical Expert Facilitators (TEF) were invited to provide meaningful perspectives
and feedforward to help teams identify opportunities to strengthen existing ideas:

Identification of Opportunities – guided by design thinking methodology, teams reflect and identify
opportunities from their improvement projects. Allowing the teams to shortlist focal points for
discussion and a clearer objectives of their project’s intended outcomes.

Ideation – facilitated activities allow the teams to brainstorm ideas collaboratively through an adapted
concept of The World Café1 (TWC), a large group facilitation method that encourages collaborative
dialogue. “In TWC, participants are regarded as experts of their own lived experience and experiential
knowledge2.” As the teams rotate around the tables, TEF and SPAN-Advocates also contribute to the
discussion, allowing teams to understand patients’ perspectives and be aware of the essentials.

Solution Sharing – concludes with teams sharing their improved ideas with further comments and
thoughts from patients, SPAN-Advocates, TEF and team members are encouraged. Cross-institution
collaborations for concerted improvement efforts to be possible, as and when appropriate, is a key
message in the closing of the session.

Results: 62 participants including 2 patient volunteers across 11 SingHealth institutions participated in

the 2 pilot runs held in 2023 (Fig.1). 5 patient advocates from SPAN were invited to share their views
and feedforward on ideas from the patient/caregiver perspectives.

Evaluation collected from the 2 pilots:

1. 94.2% of respondents (49 out of 52) rated that they have benefited from the session.

2. 73.1% of respondents (38 out of 52) find the solution sharing segment the most beneficial to
their project.

266
 3. Evaluation summary: DISCO café allowed participants to peek into and share insights on how
other teams are managing a similar issue and allowing multiple perspectives and ideas to be voiced
out, which helped the team to refocus on the project.

SPAN-Advocates who facilitated, and participated in the sessions, were encouraged by the effort of
DISCO Café:

- As facilitators, they guided teams to shortlist ideas through the idea evaluation matrix.

- In sharing their perspectives with teams, they were heartened to see their views being
considered.

- An excellent platform to bring healthcare teams, patients, and caregivers together to co-produce
healthcare solutions to strengthen patient experience and safety.

Image:

267
Conclusion: DISCO Café is an effective healthcare improvement collaboration platform that provides
an opportunity to collaborate among patients, patient advocates and healthcare teams. Ultimately,
allowing healthcare teams to recognize the importance of understanding the patients’ perspectives
and empowering patients as partners-in-care in co-producing healthcare improvements. Additionally,
seen in pilot 2, where 2 teams attended the session with a similar topic of patient Safe Administration
of Medication. DISCO Café, with its thematic theme approach, potentially enables greater
opportunities for similar projects to be scaled up cluster wide and to promote co-production in
healthcare.

References: 1Brown J, Isaacs D. The World Café: shaping our futures through conversations that
matter. San Francisco: Berrett-Koehler Publishers; 2005

2MacFarlane A, Galvin R, O’Sullivan M, McInerney C, Meagher E, Burke D, et al. Participatory methods

for research prioritization in primary care: an analysis of the World Café approach in Ireland and the
USA. Fam Pract. 2017

Disclosure of Interest: None Declared

Embedding evidence-based professional development tools and quality improvement resources

for General Practitioners to improve patient experience in healthcare: (3581) Tina Janamian

ISQUA2024-ABS-3581

T. Janamian 1,*

CEO, AGPAL, Bowen Hills, Australia

1

Introduction: Evidence shows high-value health care requires active engagement of patients and
carers in co-designing healthcare improvements. Overall patient experience of care are supported by
advanced interpersonal skills by healthcare professionals. Multisource feedback (MSF) is a validated
and robust workplace-based assessment tool that offers 360-degree evaluation of a doctor’s
interpersonal relations and communication skills, professional behaviours, and aspects of patient care.
Obtaining structured feedback about how a doctor is performing (with the ability to compare their
performance in relation to benchmark datasets of similar doctors, fields, and specialism), doctors have
an opportunity to improve their performance towards creating quality patient-centred care.

Methods: MultiSource Feedback (MSF) demonstrates strong alignment with the Medical Board of
Australia’s (MBA) Professional Performance Framework two key domains; measuring outcomes
(patient feedback) and reviewing performance (colleague feedback). Data collected from patients
completing the survey as a part of the MSF measuring patients’ interactions with their general
practitioners over the last five years will be summarised and shared in case studies.

Results: Case studies will illustrate the MSF process including the debriefing and reflective exercise
involved as a professional development tool. Data from 1871 surveys completed by general
practitioners and 804 surveys by registrars (2019-2023) will be shared highlighting key trends and areas

268
for improvement. After data analysis, it is expected to demonstrate that on average general
practitioners’ interactions with their patients have almost returned back to pre-COVID. In addition,
determine if there was any change in doctor to patient interactions as a result of the changes in
services during COVID that potentially impact patients’ health care experience. MSF tools and
resources will be used to illustrate how doctors can maximise patient experience data and the benefits
of undertaking the learning and development process to improve patient care.

Conclusion: Involving patients in quality improvement of heath care through tools such as the MSF,
including self-reflection, patient feedback and colleague feedback, is gaining recognition in the medical
profession. The MSF is a tool to support doctors to reflect on how they engage and work with others,
and identify ways for self-improvement. Using evidence-based facilitated feedback is helpful for
doctors in facilitating their reflection on and use of the feedback. The use of an evidence-based MSF
that aligns with the MBAs new framework facilitates lifelong learning and professional development
ensuring continuous quality improvement and a culture of collegiality, shared experience and peer
support is embedded and sustained.

Disclosure of Interest: None Declared

Utilizing Information Technology in Community Large-Scale Events: Establishing Real-Time Care

Models to Enhance Medical Efficiency: (2093) Chia Hui Chu

ISQUA2024-ABS-2093

C. H. Chu 1,*

Taipei Tzu Chi Hospital, New Taipei City, Taiwan

1

Introduction: In community-based large-scale events, mobilizing significant manpower and resources

is essential, with medical stations playing a pivotal role. The predominant care model in our country
involves collaboration with hospitals, where hospitals provide caregiving personnel and medical
teams. When further treatment is necessary, patients are transferred to their respective medical
facilities. However, these temporary medical missions often rely on paper-based operations, resulting
in slow and incomplete information transmission. Consequently, various medical stations are unable
to support each other effectively, and timely information provision to medical facilities is lacking,
jeopardizing public safety. Therefore, this project aims to establish a care module that can adjust and
collect data in real-time according to care needs. Utilizing encrypted transmission, the collected data
can be promptly provided to other medical facilities for further assessment. This ensures that relevant
information is received by medical facilities upon patient transfer, facilitating more comprehensive
medical services.

Methods: A care model was established, wherein frontline caregivers directly determine the necessary
caregiving information based on the nature of the activity. After configuring personnel at each medical
station and forwarding information to medical facilities, the development of the app is completed.
Before the event, medical personnel use mobile devices to access the app by logging in with assigned

269
credentials, allowing them to perform tasks related to medical care for the event. The app can
immediately adjust and update based on the day's activities, integrate relevant caregiving data in real-
time for reference at each medical station, and facilitate adjustments in medical personnel and
supplies preparation based on admission numbers.

Results: The model was initially implemented in a four-day event comprising seven sessions, with four
medical stations set up. The stations were staffed with five physicians and fifteen nurses. Each session
served between 18,000 to 21,000 attendees, with 445 receiving medical care and 8 requiring referrals.
The average wait time for receiving care decreased from 5 minutes and 32 seconds to 4 minutes and
45 seconds, representing a 14.2% reduction. Based on the symptoms observed in daily patient visits,
medical supplies and medications were estimated and prepared accordingly. For instance, after
identifying muscle pain and mild dehydration as the predominant symptoms on the first day, additional
medications were prepared, and attendees were reminded to stay hydrated, resulting in a subsequent
decrease in patients presenting with dehydration. Similar proactive measures were taken for increased
cold symptoms on the second day and resulted in decreased visits by the fourth day.

Conclusion: Traditionally, post-event data compilation and integration from medical stations were
challenging due to the exhaustive cleanup and lack of time for information organization. Additionally,
the absence of real-time communication hindered mutual support among medical stations. With the
establishment of this care model, aided by information technology, accurate prediction of visitation
trends is possible, allowing for better preparation and maximizing the utilization of manpower through
streamlined information exchange. Our hospital, an affiliate of a religious organization, frequently
hosts similar large-scale events and can leverage this care model to other medical facilities horizontally,
aiming to integrate caregiving resources and provide the public with more comprehensive and timely
medical services.

Disclosure of Interest: None Declared

Empowering Women's Access to Quality Healthcare Through AI-Enabled Virtual Coaching Support:
(3387) Elisabeth Ezekiel

ISQUA2024-ABS-3387

O. O. Ephraim-Emmanuel 1, E. Ezekiel 1, C. Abiakam 1,*, H. Minaye 2, D. Owusu 2, W. Okah 3, M. Moosa 3,

J. Rahman 3, I. Etuk 4, N. Mobisson 5
1
Women's Wellness, 2Research, 3Data, 4Co-Founder & CTO, 5Co-Founder & CEO, mDoc Healthcare,
Lagos, Nigeria

Introduction: The evolution of artificial intelligence (AI) has opened up new possibilities in healthcare,
particularly in aiding women of reproductive age to achieve better health outcomes. This study
explores women's perceptions regarding the utilization of a chatbot named Kem that has been
integrated with a large language model (LLM) in a mobile application aimed at enhancing reproductive

270
health and digital literacy. Understanding these perceptions is crucial for ensuring user acceptance and
the efficacy of such technologies, particularly in medically underserved settings.

Methods: A total of 144 women of reproductive age (18-49 years) participated in the user testing in
Abuja and Lagos, Nigeria. The participants from various demographic backgrounds were recruited to
ensure a comprehensive understanding of the study focus. A mixed-method approach was used in
this study. This approach involved conducting pre- and post-test self-efficacy surveys and semi-
structured focus group discussions, to obtain relevant insights on the study objective.

Data was collected from the participants who interacted with a virtual health coach (Kem) on the
CompleteHealth™ app and examined how Kem assisted their understanding and confidence in using
AI. The quantitative surveys aimed to examine usage patterns, perceived benefits, concerns, and
satisfaction levels, while the focus group discussions provided a deeper exploration of attitudes and
experiences.

Results: The self-efficacy analysis indicated an overall improvement in users' confidence in their ability
to utilize an AI chatbot to obtain valuable health information. The results indicated a baseline
improvement in participants' confidence and comprehension of chatbots and their functionality,
increasing from 41% to 86% before and after using Kem. Similarly, participants' confidence in trusting
the information provided by a chatbot increased from 53% at baseline to 88% after interacting with
Kem. The post-test surveys highlighted 86% of participants' confidence in the chatbot’s ability to
provide adequate and accurate responses.

Additionally, participants also appreciated the availability of Pidgin English on the bot, a Nigerian local
language. However, concerns were raised during focus group discussions about users with limited
traditional or digital literacy being able to type, and the need to include speech-to-text (STT) and text-
to-speech (TTS) capabilities to facilitate their use of Kem.

Conclusion: The findings highlight the potential of LLMs integrated within digital platforms to
empower women of reproductive age to manage their health effectively. Continuous testing and
refinement of the AI chatbot offer promising prospects for enhancing digital health literacy and
supporting women's health. By delivering personalized information, fostering community
engagement, and leveraging generative AI, the app enables women to make informed decisions about
their reproductive health. Collaborative efforts among developers, healthcare professionals, and end-
users are crucial for designing equitable AI technologies to address the diverse needs of women in
reproductive health management.

References: Fahmida, Yesmin & Chowdhury, Fahmida. (2023). Empowering Rural Women's Health
through Online Medical Assistance. International Journal of Innovative Science and Research
Technology. 8. 2091-2093. 10.5281/zenodo.8217210.

Mylavarapu, Raghu & Pokhriyal, Aradhya & Dhargalkar, Risha & Bhati, Neha. (2023). Empowering
Healthcare with AI: Addressing Challenges and Envisioning the Future. 1393-1398.
10.1109/ICESC57686.2023.10193228.

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Tsiouris, K. M., Tsakanikas, V. D., Gatsios, D., & Fotiadis, D. I. (2020). A Review of Virtual Coaching
Systems in Healthcare: Closing the Loop With Real-Time Feedback. Frontiers in digital health, 2,
567502.[Link]

Disclosure of Interest: O. Ephraim-Emmanuel Grant / Research support from: The data used in this
abstract was obtained from the Digital Mom Project. The research/activities in this presentation is
supported by funding from MSD, through its MSD for Mothers initiative. MSD had no role in the design,
collection, analysis, and interpretation of data, in writing of, or in the decision to submit the abstract.
The content of this publication is solely the responsibility of the authors and does not represent the
official views of MSD. MSD for Mothers is an initiative of Merck & Co., Inc., Rahway, NJ, USA., E. Ezekiel
Grant / Research support from: The data used in this abstract was obtained from the Digital Mom
Project. The research/activities in this presentation is supported by funding from MSD, through its MSD
for Mothers initiative. MSD had no role in the design, collection, analysis, and interpretation of data,
in writing of, or in the decision to submit the abstract. The content of this publication is solely the
responsibility of the authors and does not represent the official views of MSD. MSD for Mothers is an
initiative of Merck & Co., Inc., Rahway, NJ, USA., C. Abiakam Grant / Research support from: The data
used in this abstract was obtained from the Digital Mom Project. The research/activities in this
presentation is supported by funding from MSD, through its MSD for Mothers initiative. MSD had no
role in the design, collection, analysis, and interpretation of data, in writing of, or in the decision to
submit the abstract. The content of this publication is solely the responsibility of the authors and does
not represent the official views of MSD. MSD for Mothers is an initiative of Merck & Co., Inc., Rahway,
NJ, USA., H. Minaye Grant / Research support from: The data used in this abstract was obtained from
the Digital Mom Project. The research/activities in this presentation is supported by funding from MSD,
through its MSD for Mothers initiative. MSD had no role in the design, collection, analysis, and
interpretation of data, in writing of, or in the decision to submit the abstract. The content of this
publication is solely the responsibility of the authors and does not represent the official views of MSD.
MSD for Mothers is an initiative of Merck & Co., Inc., Rahway, NJ, USA., D. Owusu Grant / Research
support from: The data used in this abstract was obtained from the Digital Mom Project. The
research/activities in this presentation is supported by funding from MSD, through its MSD for Mothers
initiative. MSD had no role in the design, collection, analysis, and interpretation of data, in writing of,
or in the decision to submit the abstract. The content of this publication is solely the responsibility of
the authors and does not represent the official views of MSD. MSD for Mothers is an initiative of Merck
& Co., Inc., Rahway, NJ, USA., W. Okah Grant / Research support from: The data used in this abstract
was obtained from the Digital Mom Project. The research/activities in this presentation is supported
by funding from MSD, through its MSD for Mothers initiative. MSD had no role in the design, collection,
analysis, and interpretation of data, in writing of, or in the decision to submit the abstract. The content
of this publication is solely the responsibility of the authors and does not represent the official views
of MSD. MSD for Mothers is an initiative of Merck & Co., Inc., Rahway, NJ, USA., M. Moosa Grant /
Research support from: The data used in this abstract was obtained from the Digital Mom Project. The
research/activities in this presentation is supported by funding from MSD, through its MSD for Mothers
initiative. MSD had no role in the design, collection, analysis, and interpretation of data, in writing of,
or in the decision to submit the abstract. The content of this publication is solely the responsibility of

272
the authors and does not represent the official views of MSD. MSD for Mothers is an initiative of Merck
& Co., Inc., Rahway, NJ, USA., J. Rahman Grant / Research support from: The data used in this abstract
was obtained from the Digital Mom Project. The research/activities in this presentation is supported
by funding from MSD, through its MSD for Mothers initiative. MSD had no role in the design, collection,
analysis, and interpretation of data, in writing of, or in the decision to submit the abstract. The content
of this publication is solely the responsibility of the authors and does not represent the official views
of MSD. MSD for Mothers is an initiative of Merck & Co., Inc., Rahway, NJ, USA., I. Etuk Grant / Research
support from: The data used in this abstract was obtained from the Digital Mom Project. The
research/activities in this presentation is supported by funding from MSD, through its MSD for Mothers
initiative. MSD had no role in the design, collection, analysis, and interpretation of data, in writing of,
or in the decision to submit the abstract. The content of this publication is solely the responsibility of
the authors and does not represent the official views of MSD. MSD for Mothers is an initiative of Merck
& Co., Inc., Rahway, NJ, USA., N. Mobisson Grant / Research support from: The data used in this
abstract was obtained from the Digital Mom Project. The research/activities in this presentation is
supported by funding from MSD, through its MSD for Mothers initiative. MSD had no role in the design,
collection, analysis, and interpretation of data, in writing of, or in the decision to submit the abstract.
The content of this publication is solely the responsibility of the authors and does not represent the
official views of MSD. MSD for Mothers is an initiative of Merck & Co., Inc., Rahway, NJ, USA.

Evaluations of the surveyor and the assessed organization related to the remote survey using the
eye tracking and augmented reality technologies: (3137) Keziban AVCI

ISQUA2024-ABS-3137

K. AVCI 1,*, E. Özyurt 1, F. ÇİZMECİ ŞENEL 1

TÜSKA, Ankara, Türkiye

1

Introduction; In recent years, advances in artificial intelligence technologies have accelerated their use
in data collection and analytical studies in health services. Artificial intelligence technologies in health
accreditation surveys have a great impact on instant recording of survey evidence in electronic
environment, creating survey reports simultaneously with the survey, improving evidence collection
opportunities and reducing survey costs. At the same time, in remote surveys, surveyors can conduct
surveys by interacting with the physical space, events, processes and other people in the surveyed
organisation by using technological facilities as if they were physically there. This study was conducted
to develop an innovative Remote Digital Survey Model for health services accreditation in order to test
the usability of eye-tracking and augmented reality technologies and the feasibility of remote
surveying through these systems in order to carry out accreditation surveys in health services more
effectively and efficiently in terms of cost, location and time without compromising quality.

Methods: The Eye Tracking Technology Based Remote Inspection System developed within the scope
of the study was tested with 10 different surveyors in the Laboratory Department of two hospitals
accredited by TUSKA. Each surveyor evaluated 4 standards and 6 evaluation criteria. A hospital
employee wore the eye-tracking based system and the remote inspector connected to the system and
inspected the hospital through the eyes of the navigator. This person was guided by the surveyor with
voice commands. In this way, survey evidence was collected remotely according to the TUSKA survey

273
method. The surveyors who tested the developed system were asked to evaluate this innovative
application in terms of compatibility with evidence collection techniques such as document review,
observation, interview, tracing, etc. used within the scope of the TUSKA survey methodology, as well
as ease of use, communication facilities and overall satisfaction.

Results: In the interviews with the surveyors participating in the testing process, it was observed that
the potential benefit of using Augmented Reality (AR) based systems in enabling the surveyor to focus
on the survey by providing visual feedback where it is needed, was considered important by the
surveyors and met with excitement. Table 1 presents analyses of surveyor evaluations of eye-tracking
technology-based remote surveying systems and Table 2 presents analyses of surveyor evaluations of
AR technology-based remote surveying systems. The nature of AR, which allows the display of
standards and evaluation criteria overlaid on the TUSKAnet, is another area of superiority that is
potentially useful for survey processes with step-by-step instructions and other complementary data.
In addition, the developed system can provide an increase in spatial perception and a reduction in
errors, time and cognitive workload. Thus, the survey process can be optimised. In the detailed
questioning regarding the communication and technology problem, which the surveyors gave a score
of 3, it was observed that the charging time of the device may not allow 8 hours of continuous
surveying, or that it heats up during prolonged use, and that the interference in the sound and
sometimes distant conversations, except for those wearing the microphone, cannot be heard
sufficiently.

Conclusion: With the ability of the systems developed in this study to record the entire survey process,
it will be possible to optimise surveyor decisions, reduce surveyor workload, increase the willingness
to take part in survey processes, reduce objections and complaints and evaluate more objectively.
Moreover, it is considered that remote surveying activities will provide time, place and cost advantages
as well as more objective results. In this context, it is envisaged that both systems developed in this
context can be used in training and quality improvement studies as well as survey activities.

Disclosure of Interest: None Declared

The SEE-IT Trial: Emergency Medical Services Streaming Enabled Evaluation in Trauma. A feasibility
randomised controlled trial: (3174) Lucie Ollis

ISQUA2024-ABS-3174

C. S. Taylor 1, L. Ollis 1,*, R. Lyon 1 2, J. Williams 3, S. Skene 4, K. Bennett 4, M. Glover 5, S. Munro 1, C.

Mortimer 3 and On behalf of the SEE-IT Trial Group also including: Jill Maben, Carin Magnusson,
Heather Gage, Mark Cropley and Janet Holah.
1
School of Health Sciences, University of Surrey, Guildford, 2n/a, Kent, Surrey and Sussex Air Ambulance
Charity, Redhill, 3Research, South East Coast Ambulance Service NHS Foundation Trust, Crawley,
4
Surrey Clinical Trials Unit, 5Surrey Health Economics Centre, University of Surrey, Guildford, United
Kingdom

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Introduction: Accurate and timely dispatch of emergency medical resources (EMS) is vital due to
limited resources and patients’ risk of mortality and morbidity increasing with time. Currently, most
UK Emergency Operations Centres (EOCs) rely on audio calls and accurate descriptions of the incident
and the patients’ injuries from lay 999 callers. If dispatchers in the EOCs could see the scene via live
video streaming from the 999 caller’s smartphone, this may enhance their decision making and enable
quicker and more accurate dispatch of EMS.

There is some limited evidence of the benefits and acceptability of live streaming to aid HEMS dispatch,
but its impact on clinical or economic outcomes has not yet been evaluated.

This study aimed to assess the feasibility of conducting a definitive RCT to assess the clinical and cost
effectiveness of using live streaming in major trauma incidents to improve targeting of EMS.

Objectives were to 1) obtain data required to design a subsequent RCT; 2) test trial processes; 3) embed
a process evaluation.

Methods: A feasibility randomised controlled trial that included an embedded process evaluation and
economic evaluation was conducted in one pre-hospital EMS in South-East England.

Working shifts (0600-1800; 1800-0600) during six trial weeks (one per month for six months), were
randomised 1:1 to video livestreaming (using GoodSAM Instant-On-Scene) or standard care only.

Pre-defined progression criteria were:

(1) ≥70% callers (bystanders) with smartphones agreeing and being able to activate live stream;

(2) ≥50% requests to activate livestreaming resulting in footage being viewed;

(3) Helicopter Emergency Medical Services (HEMS) stand-down rate reducing by ≥10% as a result of
livestreaming;

(4) no evidence of psychological harm in callers or staff/dispatchers.

Observational sub-studies included (i) an inner-city EMS who routinely use video livestreaming to
explore acceptability in a more diverse population; and (ii) staff wellbeing in an EMS not using video
livestreaming for comparison to the trial site.

Results: A total of 62 shifts were randomised, within which they included 240 eligible incidents (132
control; 108 intervention). Livestreaming was successful in 53 incidents in the intervention arm.

Patient recruitment (to access medical records to assess appropriateness of dispatch decisions), and
caller recruitment (to measure potential harm) were low (58/269, 22% of patients; 4/244, 2% of
callers).

Two progression criteria were met: (1) 86% of callers with smartphones agreed and were able to
activate livestreaming; (2) 85% of requests to activate livestreaming resulted in footage being
obtained; and two were indeterminate due to insufficient data: (3) 2/6 (33%) HEMS stand down due
to livestreaming; (4) no evidence of psychological harm from survey, observations or interviews, but

275
insufficient survey data from callers or comparison EMS site to be confident. Language barriers and
older age were reported in interviews as potential challenges to video livestreaming by dispatchers in
the inner-city EMS.

Conclusion: Bystander video livestreaming from scene is feasible to implement, acceptable to both
999 callers and dispatchers, and may aid dispatch decision-making.

Findings support a future multi-centre study that takes account of different triage systems and dispatch
personnel, within which further assessment of unintended consequences, benefits and harm is
required.

Disclosure of Interest: C. Taylor Grant / Research support from: NIHR £459,981, L. Ollis Grant /
Research support from: NIHR £459,981, R. Lyon Grant / Research support from: NIHR £459,981, J.
Williams Grant / Research support from: NIHR £459,981, S. Skene Grant / Research support from: NIHR
£459,981, K. Bennett Grant / Research support from: NIHR £459,981, M. Glover Grant / Research
support from: NIHR £459,981, S. Munro Grant / Research support from: NIHR £459,981, C. Mortimer
Grant / Research support from: NIHR £459,981

Telehealth utilization trends for respiratory conditions in Australian General Practice: A means to
reduce infection risk during the pandemic and beyond: (2829) Mirela Prgomet

ISQUA2024-ABS-2829

M. Prgomet 1,*, G. Kibret 1, J. Thomas 1, A. Georgiou 1

Australian Institute of Health Innovation, Macquarie University, Sydney, Australia

1

Introduction: Public health measures aimed at mitigating transmission of COVID-19, including

restrictions on face-to-face consultations, necessitated shifts to patient care delivery. In Australia, the
government expanded Medicare (Australia’s universal health insurance scheme), in March 2020, to
provide subsidised telehealth (telephone and video) consultations with the intention of supporting
accessibility to care, while protecting patients and health care providers from exposure to COVID-19.
These telehealth benefits also extend to other respiratory infections. Our objective was to examine
longitudinal telehealth use trends for respiratory conditions in general practice during the pandemic
and beyond.

Methods: We undertook a retrospective study using de-identified data from over 860 general practices
across two Australian states (Victoria and New South Wales). Data were accessed via the Population
Level Analysis and Reporting (POLAR) platform [1]. The POLAR platform applies diagnosis grouping
codes to data extracted from the diagnosis section of general practice patient records; which may
include diagnoses (e.g., upper respiratory infection) or symptoms (e.g., cough, sneezing). The
respiratory patient cohort were identified using the grouping codes “Respiratory System Diseases” and
“COVID-19” and linked with service data (Medicare billing codes) to determine consultation modality.
Longitudinal telehealth and face-to-face utilisation trends were analysed using Stata (Version 18) and

276
R (Version 4.3.1). Study approval was granted by the Macquarie University Human Research Ethics
Committee (#5202067517176). This study was supported by Digital Health CRC Limited (DHCRC).
DHCRC is funded under the Commonwealth's Cooperative Research Centres (CRC) Program.

Results: Telehealth use drastically increased in March 2020 following the expansion of Medicare
subsidies (Figure 1). Of all consultations between 1 April 2020 and 30 September 2023, 21%
(17,280,914) were delivered via telehealth. The yearly proportion of telehealth consultations for all
patients showed a gradual decline over time: 24.7% in 2020; 22.0% in 2021; 20.9% in 2022; and 16.8%
in 2023.

For respiratory conditions, 23.4% (4,912,456) of consultations were delivered via telehealth. The
proportion of monthly telehealth consultations for respiratory patients fluctuated (Figure 1), with a
low of 17.1% (in April 2021) and a high of 31.3% (in January 2022). The yearly proportion of telehealth
consultations for respiratory patients showed a gradual decline over time: 25.5% in 2020; 24.7% in
2021; 24.3% in 2022; and 19.0% in 2023.

The proportion of respiratory patients that had a second consultation within 10 days was similar
regardless of initial consultation modality: 54.9% for telehealth and 52.4% for face-to-face. For patients
with an initial telehealth consultation, 44.9% had their second consultation via telehealth. For patients
with an initial face-to-face consultation, 20.1% had their second consultation via telehealth.

Image:

Conclusion: During the pandemic, almost a quarter of consultations for patients with respiratory
conditions were delivered via telehealth. Beyond the pandemic, utilisation rates have slightly declined.
With policies regarding telehealth use and patient eligibility within Australian general practice

277
currently under review, the benefits of telehealth in providing a means to access care while reducing
the risk of spread of respiratory infection to health care providers, and potentially vulnerable patients
in general practice waiting rooms, should be strongly considered.

References: 1. Pearce C, et al. 2019. doi: 10.3233/SHTI190232

Disclosure of Interest: None Declared

Strengthening Patient Safety and Driving Quality Improvement: Healthcare Accreditation and
Information Technology in the Era of Digital Transformation in Thailand: (3370) Piyawan
Limpanyalert

ISQUA2024-ABS-3370

A.-C. Sukkul 1, P. Limpanyalert 1,*, N. Khumloyfa 1, P. Hongboonmee 1, K. Losuwanrak 2, W. Paoin 2 3

1
Healthcare Accreditation Institute, 2Thai Medical Informatics Association - TMI, Nonthaburi, 3Faculty
of Medicine, Thammasat University, Bangkok, Thailand

Introduction: In today's rapidly changing world, digital technology is revolutionizing various industries,
including healthcare. Understanding the significant impact of digital innovation on healthcare services,
it's essential to utilize information technology to improve quality and ensure patient safety in hospitals.
However, focusing solely on the positive aspects of IT isn't enough. There are inherent risks associated
with IT systems, such as clinical errors or service disruptions, that need to be addressed. Given the
financial constraints faced by hospitals, it's crucial to prioritize efficiency in developing IT systems. This
means ensuring quality, value, and careful spending through effective budgeting, avoiding unnecessary
expenses, and strategic planning.

Hospital Digital Transformation involves strategically using digital tools to enhance service quality,
strengthen patient safety measures, and optimize healthcare outcomes. Despite the widespread
adoption of information technology in Thai hospitals, there are still significant gaps, especially in areas
like process redesign and clinical decision support systems. To address these gaps effectively, Thai
Medical Informatics Association (TMI) advocates for comprehensive digital training and capacity-
building within healthcare facilities.

Since 2007, TMI has actively promoted the development of hospital technology systems, notably
through the establishment of the Framework for Improving the Quality of Hospital Information
Technology (HITQIF) certification program. This initiative aims to enhance technology quality and
streamline data management processes within healthcare facilities. Collaborating with the Healthcare
Accreditation Institute (HAI) in 2014 furthered efforts to improve the quality of hospital information

278
technology. Additionally, the introduction of the Hospital IT Maturity Model in 2014 provided a
comprehensive framework for assessing and enhancing technology maturity levels within hospitals.

Methods: Through collaborative efforts and innovative initiatives, TMI is committed to advancing the
quality and effectiveness of hospital information technology. This commitment is evident in the
successful launch of HA-IT certification since 2015, with 50 hospitals achieving certification across
levels 1, 2, and 3, ultimately contributing to optimal patient care delivery.

We will share how to implement HA-IT in hospitals, framework, and the benefits of HA-IT.

Results: In 2023, the Healthcare Accreditation Institute (HAI) conducted a survey assessing the
readiness of 80 public hospitals in Thailand to adopt technology systems aimed at supporting and
enhancing hospital quality. The findings revealed significant challenges, with 78% of hospitals
encountering obstacles hindering the planned development of a digital infrastructure. Among these
challenges, 51% of hospitals reported a lack of readiness in terms of information security.

The identified obstacles encompassed various facets of digital transformation:

1. Digital abilities and skills of hospital staff, accounting for 26%.

2. Issues with providing services through digital systems: 14%

3. Security concerns regarding information technology and data systems: 15%

4. Challenges associated with digital technology implementation and utilization: 14%

5. Policy and practice hurdles in the digital domain: 12%

6. Difficulties in integrating systems and data both internally and externally: 14%.

In response to these findings, the Thai Ministry of Public Health has prioritized initiatives to enhance
quality, particularly in cybersecurity, with a focus on promoting HA-IT certification.

As part of the presentation, experiences from two hospitals in Thailand that ransomware attacks will
be shared, illustrating how HA-IT certification facilitated their response and recovery processes.

Image:

279
Conclusion: In conclusion, the fusion of healthcare accreditation with digital transformation heralds a
significant paradigm shift in healthcare quality management. Embracing digital technologies offers
hospitals the opportunity to not only improve operational efficiency but also revolutionize patient care
delivery. This transformative approach ensures a future characterized, not only in Thailand but also
globally.

In Thailand, hospitals still have room to improve by using digital transformation to make care even
better and safer for everyone.

References: 1. Thai Medical Informatics Association. Hospital IT Quality Improvement Framework

(HITQIF v2). February 2021. Available at: [Link]
content/uploads/2021/12/HospitalIT_QualityImproveFramework_V2.pdf

2. Healthcare Accreditation Institute. Guidelines for self-assessment criteria according to Program and
Disease Specific Certification (PDSC) - Healthcare quality development system using digital technology.
2023. (Thai version).

Disclosure of Interest: None Declared

280
Facilitating a Positive Patient Safety Culture by Learning: (2868) John Fitzsimons

ISQUA2024-ABS-2868

R. Macdonell 1,*, P. Lachman 1, J. Fitzsimons 1 2, E. Fitzgerald 3, O. Woods 4, V. Taylor 1

1
Quality Improvement, Royal College of Physicians of Ireland, 2General Paediatric Consultant, 3General
Paediatrics, Children's Health Ireland, 4Research, Royal College of Physicians of Ireland, Dublin, Ireland

Introduction: RCPI’s Situation Awareness for Everyone (SAFE) collaborative programme improves
communication, builds a safety culture and enhances outcomes for patients in Irish hospitals. It is
aligned with and provides implementation support for the key objectives of the HSE Patient Safety
Strategy, 2019. By providing training and support to clinical teams through SAFE, safety leadership is
developed on the frontline to the benefit of staff, patients and their families, delivering on
Commitment 3 - Anticipating and Responding to Risks to Patient Safety. Frontline clinical teams are
facilitated to implement a bespoke patient Safety Huddle intervention to enhance interdisciplinary
communication and team psychological safety which results in measurable improvements in
perception of safety culture.

Methods: The collaborative methodology is a short-term learning system that brings together teams
from different hospital sites to seek improvement in a specific subject area. The blended learning
course runs over six months with in-person and virtual workshops, facilitated by expert clinical and
quality improvement faculty. Teams have access to Brightspace, RCPI’s online learning environment,
which hosts online learning tools, key resources and a designated SAFE cohort forum. Teams upload
progress reports and ‘homework’ to Brightspace for developmental feedback and bespoke coaching
opportunities.

Team self-assessment of safety culture in their team and organisation is evaluated at the beginning
and end of each SAFE cohort using the validated Manchester Patient Safety Framework (MaPSaF) tool.
MaPSaF was designed to measure perceptions of the importance of safety across a team and in their
organisation. The framework uses ten dimensions of patient safety and each of these describes what
an organisation would look like at five levels of safety culture.

MaPSaF helps teams recognise that patient safety is a complex multidimensional concept by

facilitating reflection on the patient safety culture of a given healthcare organisation and team

stimulating discussion about the strengths and weaknesses of the patient safety culture in the team
and organisation;

highlighting any differences in perception between staff groups

helping teams understand how an organisation with a more mature safety culture might look

helping teams evaluate any specific intervention to change the safety culture of their organisation and
team

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Results: Data will be presented, as run charts and case studies, to demonstrate teams' measurable
improvement in their perception of safety culture at the end of SAFE. Dimensions typically seeing
improvement across all SAFE Teams include the level of priority and transparency given to safety, how
teams engage in learning and effecting change, how teams have developed interdisciplinary
communication about safety issues and perceptions of teamworking.

"Our multidisciplinary safety huddle continues – morning and night 7 days a week, it continues to be
a brief meeting approx. 10 minutes.

It is an efficient and safe way to share departmental activity and (clinical and non-clinical) challenges.
While patient safety is at its core, it does not have an exclusive brief to identify a ‘deteriorating patient’
but rather has a broader remit to support multidisciplinary and multidepartmental engagement and
service planning in the busiest maternity hospital in Ireland."

Conclusion: RCPI's SAFE Collaborative programme facilitates frontline clinical teams to focus on
measurable and targeted safety interventions. Through engaging in this programme, teams experience
realtime improvement in psychological safety and safety culture in their settings. The Situation
Awareness for Everyone collaborative is an intervention that can make a real difference.

Disclosure of Interest: None Declared

Advancing healthcare quality: The Nambian experience in implementing international quality

standards in public hospitals: (1787) Apollo Basenero

ISQUA2024-ABS-1787

A. Basenero 1,*, J. Neidel 1, F. Tjituka 2, H. Kavefi 2, A. Nangolo-Israel 1, A. Erastus 3

1
Quality Assurance, 2Directorate of Special Programmes, Ministry of Health and Social Services,
3
Universal Health Coverage / Life Course Cluster, World Health Organisation, Windhoek, Namibia

Introduction: Ensuring high-quality healthcare services is essential for fulfilling Namibia's healthcare
mission and vision outlined by the Ministry of Health and Social Services (MoHSS). However, the
absence of internationally recognized standards posed a significant challenge in assessing and
benchmarking healthcare quality, particularly in the public sector. In response, the MoHSS embarked
on a comprehensive initiative to develop and implement quality standards for hospitals and primary
healthcare (PHC) facilities. The overarching goal was to ensure continuous improvement in the quality
of healthcare services to enhance patient outcomes and save lives.

Methods: The MoHSS collaborated with a globally recognized health service accreditation body to
spearhead the standards development process. Launched in 2018, the initiative employed a structured
approach, including desk reviews, meetings, interviews, and stakeholder consultations. A five-day
workshop convened key stakeholders to draft comprehensive healthcare standards, criteria, user

282
guides, and an implementation framework. These standards encompassed all hospital and PHC facility
departments, termed service elements, with compliance scores categorized as ≥80% (compliant), 40-
79% (partially compliant), and 0-39% (non-compliant). Piloting occurred at two hospitals and two PHC
facilities, followed by feedback incorporation and final drafting preceding phased implementation.

Results: Internationally recognised healthcare facility standards for hospitals and PHC facilities
respectively were launched in February 2022. Namibia has 36 public hospitals, including 31 district, 4
intermediate, and one national referral hospital. Initially, the implementation targeted four public
hospitals of different levels, comprising two intermediate and two district hospitals. Baseline
assessments revealed partial compliance between 50-62%. Key service elements such as resuscitation
systems, risk management, medical equipment services, and sterile services scored the least. QI
trainings, conducted between August and October 2022, taught QI methodology to enable staff to
address gaps, resulting in the development of QI work plans by each hospital. A four-day learning
session in February 2023 facilitated peer learning, highlighting areas of improvement which included
drafting and publishing hospital organograms, establishing hospital QI coordinating committees,
drafting essential hospital policies to standardise service provision, developing hospital and
department risk registers, ensuring temperature monitoring in medication storage areas, addressing
equipment maintenance issues, and enhancing fire safety measures.

By May 2023, standards were expanded to six more hospitals (1 national referral, 2 intermediate, and
3 district), with baseline assessments ranging from 44-68%. Currently, a total of 10 hospitals implement
the standards, serving 1,193,059 individuals (46% of Namibia's population) with a combined bed
capacity of 4270 (56% of total public hospital bed capacity). In 2024, interim hospital assessments are
planned in preparation for accreditation, along with extending the standards to selected primary
healthcare facilities.

Conclusion: The Namibian experience underscores a dedicated commitment to enhancing healthcare

quality through the implementation of internationally recognized standards. Ongoing efforts, guided
by validated QI methodologies, demonstrate significant progress in addressing identified gaps and
cultivating a culture of continuous improvement.

Disclosure of Interest: None Declared

283
Catalyzing 'Herd Quality in healthcare’: NABH motivating accredited hospitals to mentor smaller
healthcare facilities in rural and urban settings in India - A pilot project: (3079) Atul Mohan
Kochhar

ISQUA2024-ABS-3079

A. M. Kochhar 1,*, E. Antony 1

NABH QCI, New Delhi, India

1

Introduction: The COVID-19 pandemic has reshaped the global healthcare landscape, including India,
prompting a renewed focus on quality in healthcare to fortify the nation's healthcare system. We
would like to propose the term and concept of 'herd quality' focusing on collaborative efforts to
elevate the overall quality of care within a healthcare eco-system. Hub and spoke model has been used
across industries to augment peripheral services by centralising key resources. National Accreditation
Board for Hospitals and Healthcare Providers (NABH) has taken it upon itself to cater to the needs of
the consumers and sets standards and benchmark for the progress of the Indian health industry since
last 19 years. This pilot project explores how NABH acts as a catalyst for implementing 'herd quality'
principles, fostering a collaborative approach to enhance overall healthcare quality in the country.

Methods: This is a pilot study on the hospitals and healthcare facilities accredited and certified by
NABH in India. The accredited facilities were designated as hubs and the non-accredited facilities
around them and in their districts were called as spokes. These hubs were already evolving with
expertise and excellence in quality in healthcare and they were mentored by NABH to adopt at least 4
healthcare facilities surrounding them and in their respective districts. These facilities were also
trained to promote, endorse and spread awareness about the basics of quality and patient safety to
the other adopted facilities. The study covers around 25 accredited hospitals with more than 300 beds,
who have undergone minimum 3 cycles of accreditation and renewal spread across all 5 regions
(North, East, West, South and Central) of India. Training in quality improvement, adoption and
adherence of healthcare quality and patient safety was done using point of care quality improvement
methodology. The modules included various topics like patient safety goals, handwashing techniques,
medication errors, adverse events, patients’ rights and responsibilities, emergency codes, clinical and
medical audits, hospital acquired infections, key performance indicators and others.

Results: Over the years, it was observed that these accredited hospitals were successful in their roles
of mentoring the other adopted facilities and hence elevating the quality in these facilities. As on 31st
December 2023, there were around 72 healthcare organizations which were adopted by the accredited
facilities, have started their journeys in quality under various categories of accreditation and
certification programmes. Around 32 of these healthcare facilities who started their journey in NABH
certification programmes have now been accredited by NABH. While embracing herd quality is
promising, challenges such as resistance to change, resource constraints, and varying levels of
engagement among healthcare professionals need careful consideration. Strategies to address these
challenges include effective communication, leadership support, and providing incentives for
collaborative efforts. The journey towards herd quality in India requires a nuanced and adaptive
approach, acknowledging the country's diversity while striving for universal standards of excellence in
healthcare delivery.

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Conclusion: Going beyond individual excellence and standardized practices, the concept of ‘herd
quality’ should be defined and established in healthcare like the concept of ‘herd immunity’ recognized
after the pandemic. ‘Herd quality’ in healthcare drives beyond individual performance metrics and
emphasizes a collective approach to enhance the overall quality of care delivery. It involves fostering
a culture of collaboration, continuous improvement, and shared responsibility among healthcare
professionals within a system. Incorporating herd quality principles into healthcare practices holds
great potential for elevating the overall quality of care. The evolution towards a herd quality mindset
is essential for creating resilient and patient-centred healthcare systems in the ever-evolving landscape
of medicine and NABH has been successful in this mandate. NABH's commitment to setting and
maintaining high standards for healthcare facilities positions it as a key player in catalysing 'herd
quality' in Indian healthcare.

Disclosure of Interest: None Declared

A Learning Health System initiative to improve MS outcomes: The Multiple Sclerosis Continuous
Quality Improvement Collaborative (MS-CQI) multicenter step-wedge randomized controlled
study: (3519) Brant Oliver

ISQUA2024-ABS-3519

Introduction: Multiple sclerosis (MS) is a complex, chronic, and costly condition that is among the most
common and disabling neurological diseases in adults. We describe the results of the first multicenter
collaborative improvement effort to improve MS population outcomes using a Learning Health System
(LHS) approach, a structured Quality Improvement (QI) intervention, and a prospective step-wedge
randomized design.

Methods: Four MS care centers in the United States participated in the MS-CQI multicenter study from
2018-2021. Clinical data (including MRI imaging, relapses, hospitalizations, ED utilization) and Patient
Reported Outcomes (PRO) data (including depression, anxiety, health confidence, and others) were
collected. A prospective 3:1 (intervention to control) step-wedge randomized design was employed at
the center (system) level to expose participating centers to intervention vs. control states after a one-
year baseline observation period. The experimental condition was professional quality improvement
(QI) team coaching + monthly virtual learning collaborative sessions. The control condition was usual
care. All centers received monthly feedback reports in a visual dashboard which displayed clinical and
PRO outcomes at center and full collaborative levels using Statistical Process Control (SPC)
analyses. This study completed ethics review and was approved as a minimal risk research study by
the Dartmouth Institutional Review Board (IRB). Descriptive statistics and longitudinal mixed-effects
regression analyses were employed. The study was powered for a primary outcome of relapse (MS
exacerbation) reduction, with the hypothesis that intervention would result in a significantly greater
reduction than control. Qualitative assessments were conducted at the close of the study to assess
site experience.

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Results: Baseline characteristics prior to intervention have been previously reported.1 Extending into
the intervention phase of the study, 3,461 adults with MS were followed for a total of 3 years and over
15,000 encounters. Adherence to the intervention was uniform throughout save for the second half
of the third year of the study which coincided with the onset of the COVID-19 pandemic and likely
introduced a confounding effect on access and practice patterns as three of the four participating sites
shifted from predominantly in-person to virtual practice. Relapses, hospitalizations, and emergency
department (ED) utilization reduced in both groups, but reductions were greater in the intervention
group. Significant center-level variation was observed across all 3 years in multiple PRO measures
including fatigue, depression, and work productivity, and also for relapse outcomes. Time in
intervention, patient age, number of comorbidities, female gender, and non-relapsing MS subtypes
were all significantly associated with core outcomes. Qualitative assessments revealed that MS center
teams perceived value in participating in MS-CQI, felt more empowered and more skilled, felt better
informed, reported less burnout, and perceived that the community of practice created by the learning
collaborative contributed to the ability of the MS-CQI study to complete despite major disruptions
introduced secondary to the pandemic.

Image:

Conclusion: MS-CQI demonstrated feasibility, acceptability, and utility in completing the first
randomized multicenter study employing a LHS approach paired with a specified QI intervention. The
study completed despite a major confound introduced by the onset of the COVID pandemic in the
second half of the final year. Intervention was associated with greater relapse reductions and sites
perceived many benefits to participation, including a perceived protective effect against
burnout. Significant between-site variation was observed throughout the study across many clinical
and PRO measures. Time in intervention, age, comorbidities, gender, and MS type were all significantly
associated with core outcomes.

References: 1. Oliver BJ, Walsh K, Messier R, Mehta F, Cabot A, Klawitter E, Pagnotta T, Solomon
A, England SE, for the MS-CQI Investigators (May, 2021). System-level variation in Multiple Sclerosis
care outcomes: Initial findings from the Multiple Sclerosis Continuous Quality Improvement (MS-CQI)
research collaborative. J Pop Health Mgmt; [Link]

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Disclosure of Interest: B. Oliver Grant / Research support from: The MS-CQI was an developed by the
investigators and received research grant support from Biogen, a biotech company which produced
pharmaceutical treatments for MS. MS-CQI did not specifically study or promote any MS treatments.,
K. Walsh: None Declared

The Learning Organization: A New Concept in Lebanese Hospitals: (1366) Jamal Ahmad Yasmine

ISQUA2024-ABS-1366

J. A. Yasmine 1,*

Labib Medical Center, Saida, Lebanon

1

Introduction: The main role of health care organizations is to deliver a safe and effective care.
Hospitals’ strategies to transform into learning organizations are proposed to improve their
effectiveness and efficiency (Singer, Moore, Meterko, & Williams, 2012). Organizational learning
establishes the framework that amalgamates the diverse groups of health care professionals from
various disciplines into a consistent platform to improve patient care (Ratnapalan & Uleryk, 2014).
There is a deficit in the empirical research which studies the concept of the learning organization in
Lebanese hospitals. The purpose of this study is to evaluate the reliability and validity of the
Dimensions of Learning Organization Questionnaire (DLOQ) and to assess the perception of health care
professionals toward its dimensions in Lebanese hospitals. The guiding question for the study was
"How do Lebanese healthcare workers perceive learning organization dimensions?". The need for this
research is based on the necessity for hospitals, as complex organizations, to acquire a profound
realization of the concept of learning organization.

Methods: A quantitative, descriptive cross-sectional research design using the Marsick and Watkins
21-item DLOQ to assess healthcare workers’ perception towards the seven dimensions of the Learning
Organization at 15 Lebanese hospitals. The data collection period was during June - September 2019.
Descriptive Statistics (mean scores and standard deviation for the Learning Organization and
Exploratory Factor Analysis (EFA) and Internal Consistency Testing of the Measure Scales were carried
on. Cronbach's Alpha coefficient for Individual Learning Level (Continuous Learning, Dialogue and
Inquiry) was 0.842 and for Organizational Learning Level (Embedded Systems, Empowerment, Systems
Connection and Strategic Leadership) was 0.905, supporting the appropriateness of the instruments.

Results: A total of 403 valid responses were received corresponding to 59% response rate. Kaiser-
Meyer-Olkin (KMO) measure was 0.938 indicating satisfactory factor analysis to proceed. EFA showed
a seven-factor solution with 18-items to be the most conceptually meaningful representation of the
data, accounting for 77% of the total variance.

Respondents had a mean score of 3.36 (SD 0.869) for the Inquiry and Dialogue dimension which
describes the accrual of creative reasoning skills of people to articulate their views and their capability
to inquire and listen to others. Akhtar, Arif, Rubi, & Naveed, 2011 reported that the Inquiry and
Dialogue dimension significantly affected organizational performance with beta values of 0.455 and t-
statistics of 3.022. Therefore, for better organizational performance a higher score for this dimension

287
is recommended in healthcare as reasoning skill is an indispensable component of medical profession.
Respondents scored 3.39 (SD 0.749) on the Continuous Learning dimension. Scoring high on this
dimension reflects that employees can acquire on the job and are provided opportunities for
continuous education and growth. These findings advise that at the individual level including
Continuous Learning and Inquiry and Dialogue employees are somehow provoked to ask questions and
express their opinions. This also indicates that learning opportunities and self-development are
accessible. The Team Learning dimension mean score was 3.26 (SD 0.786). This dimension is of great
value for health care organizations in adapting and responding strategically and operationally to
continuous change. Peter Senge (1990) stated that organization cannot learn until teams can learn.
Therefore, this dimension is considered as an area for improvement in Lebanese hospitals. The
Embedded System (mean score 3.38, SD 0.77) is one of the organizational learning level dimensions
and it covers the creation of systems that are integrated within the work sphere. Thus, Lebanese
hospitals are supposed to measure the extent to which resources are spent however not to do a gap
analysis to improve their efficiency and to better understand how to improve processes and products.
The highest mean score was reported for the Strategic Leadership dimension (mean score 3.59, SD
0.81). In Lebanon, hospital management somehow delivers strategic leadership for learning where
leaders ensure that the actions of organizations are consistent with their values. Leaders endorse,
support and use learning strategically for business results. This can be ascribed to the level employees
entrust their leaders in a hospital setting which is characterized as being high power distance society.
Senior employees are respected by junior staff not only because of the competence of the former, but
because of their age and long tenancy in the organization. In this study, around 67% of respondents
have six years of experience and more (37% have 11 years or more) with 60% being more than 30 years
old.

Concerning the Empowerment dimension, it scored near to the average (3.31; SD 0.77). Empowering
healthcare workers involves them to set and implement a shared vision. They are motivated and
accountable to learn and make decisions. Although, the Empowerment dimension scored above
average it can reflect the centralized hierarchical structure within hospitals. The healthcare sector is
one of the most progressive sectors in the Lebanese economy, however it remains to be mostly
bureaucratic, ruled by hierarchical structures, rules, and procedures. Healthcare workers need to be
empowered in order to take learning initiatives, however as explained before the healthcare
organizational structure can impede empowering staff and this was reflected by the low ratings on the
empowerment dimension. Finally, the System Connection dimension refers to the link between the
learning organization to its communities; where people can recognize overall environment and use
information to adjust practices in work. Akhtar et al. (2011) reported that the System Connection
dimension affect significantly organizational performance. In the current study, this dimension showed
an average mean score of 3.33, SD 0.808 which is close to the mean score (3.21) as reported by Leufvén
et al. (2015) but lower than the mean score (3.59) reported by Kumar et al. (2016). A cross-sectional
quantitative survey research assessed the perception of nurses of the dimensions of the learning
organization in governmental hospital in KSA. Authors reported a negative perception of the seven
dimensions of learning with a mean score ranging between 2.15 and 2.46 (Alhawsay, Hamouda, &
Mahmoud, 2017). These findings are lower when compared to the findings of the current study.

Conclusion: The first step an organization must take in order to transform into a learning one is to
establish a tool which measures where the organization stands in terms of the seven dimensions of

288
the learning organization. In this study, the psychometric analyses conducted provided overall support
for DLOQ in healthcare. The areas of strength across the sample were the Strategic leadership
dimension followed by promoting Inquiry and dialogue and creating Continuous learning opportunities
dimensions of the individual learning level. However, the somehow positive responses on the
individual level do not pervade the collective level and experience. This can be related to the weakness
of systems to share learning and to use teams as means for learning as reflected by the low score for
team learning. The transformation process of a learning organization builds up from individuals’ skills
and commitment to collectively developing a team learning dynamic which is essential to uphold
organizational learning. A practical implication of this study is that it provides hospital administrators
with an idea of the perception of learning at the individual, team and organizational levels. Moreover,
the results provided additional support for the use of the DLOQ in healthcare mainly in the Lebanese
context as guided by the EFA. Therefore, Lebanese hospitals are encouraged to adopt the DLOQ tool
to assess the learning culture, compare results to this baseline study and look for areas of
improvement based on their findings.

The learning organization approach requires the support of leadership. It is proposed to assess in
future research the impact of leadership theories to enhance adoption of the learning organization
concept.

Disclosure of Interest: None Declared

Patient Safety in Community-based Surgical Centers in Alberta, Canada: a descriptive study of post-
surgical adverse events in accredited non-hospital facilities from 2018 to 2023: (3491) Fizza Israr
Gilani

ISQUA2024-ABS-3491

F. I. Gilani, BSc Pharm, MPH Epidemiology 1,*, A. Maier, RN, CCNc, OHNc 1, J. Beach, MBBS, MD 1

Accreditation, College of Physicians & Surgeons of Alberta, Edmonton, Canada

1

Introduction: As of November 2023, there were over 76, 000 Albertans waiting for scheduled surgery
in Alberta, Canada(1). As a strategy to address the surgical backlog, lower risk surgeries are being
increasingly outsourced to community-based surgical facilities from traditional hospital settings. The
College of Physicians and Surgeons of Alberta (CPSA)(2) is the medical regulatory authority in the
province of Alberta, Canada. In line with its patient safety mandate, CPSA is responsible for setting
standards and accrediting non-hospital facilities across Alberta. Operational oversight of individual
facilities remains under CPSA regulated Medical Director(s). CPSA’s Non-Hospital Surgical Facilities
(NHSF) Accreditation standards support Medical Directors in creating cultures of quality improvement
and strong assurance systems to ensure high quality of services and patient safety. Under these
standards facilities are required to report certain post-surgical adverse events to CPSA for quality
assurance and supportive feedback.

289
The objective of this study was to provide a descriptive overview of reported post-surgical adverse
events in community-based surgical facilities in Alberta between 2018 to 2023.

Methods: A retrospective review of post-surgical incident (Death or hospital admission within 10-days
of surgery; hospital transfers; surgery on wrong-site, wrong-procedure, and wrong-patient; and cluster
of infections) reported to the NHSF Accreditation program was conducted for the study period.
Descriptive statistics and trend analyses were derived using available de-identified patient (age, ASA
class, sex), surgery (type, anatomic category) and facility level (type) data. An analysis of variance test
was used to ascertain between group difference in patient characteristics across reportable incident
types.

Results: Overall, the program received 471 incident reports for the study period. Patient death was
the least frequently reported adverse event type (n=5; 1.1%) while hospital transfers (n= 229; 48.8%)
and admission within 10 days of surgery (n=229; 48.8%) were most frequent among all reported
incidents. Patients ranged from 1 year of age to 87 years, with a mean age of 37.9 (SD±22.4) and
median ASA class of 2 (range 1-4). 32.6% of the incidents (n=310) occurred in female patients. No
significant trend changes were observed in patient severity (based on ASA class) (p= 0.42) or age
(p=0.17) across study years. However, there was a significant between group difference across incident
types for varying patient ages (p=0.002) with patients over 65 years of age experiencing post-surgical
death(n=3; 60%) and infections (n=1; 50%) more frequently and patients 18 to 64 more likely to be
transferred(n=145; 65%) or admitted to hospital (n=140; 61%) within 10 days of surgery. A significant
difference was also found between patient ASA class and incident type (p=0.001). Fewer post-surgical
adverse incidents were reported (n=160; 34.1%) by facilities contracted with the regional health
authority compared with other private surgical facilities.

Conclusion: This study shows that post-surgical adverse events continue to occur in community-based
surgical facilities. As more complex procedures are outsourced to non-hospital settings, proactive
efforts and resources will remain necessary to ensure ongoing safety for surgical patients.
Accreditation of NHSF is an important lever in ensuring learning and proactive patient risk
mitigation. CPSA facility accreditation requirement to report certain post-surgical adverse events is an
important mechanism alerting the Medical Director opportunities quality assurance and improvement
at key intervals.

References: 1. Alberta Health. Alberta Surgical Initiative Dashboard: WaitList. Available from:
[Link]
a3-001d-443c-a395-
9431b63f142b&sectionIndex=0&sso_guest=true&reportViewOnly=true&reportContextBar=false&sa
s-welcome=false. Accessed Feb 9, 2024

2. College of Physicians & Surgeons of Alberta College of Physicians & Surgeons of Alberta | CPSA

Disclosure of Interest: None Declared

290
Experiences of early-career health professionals in the WiSDOM cohort study of their clinical
practice environments in South Africa: (2010) Laetitia Charmaine Rispel

ISQUA2024-ABS-2010

L. C. Rispel 1,*, P. Ditlopo 2, J. White 3, D. Blaauw 2

1
South African Research Chairs Initiative, 2Centre for Health Policy, 3School of Public Health, University
of the Witwatersrand, Johannesburg, South Africa

Introduction: There is global recognition that the health workforce is essential for high-quality
Universal Health Coverage (UHC), with increasing scholarly attention on positive practice
environments. Such environments strive to ensure decent working conditions, and optimal physical
and mental well-being of healthcare providers, thus enabling patient safety and quality health care.
However, knowledge gaps remain on early-career health professionals’ experiences of their clinical
practice environments in sub-Saharan Africa.

The aim of the study was to examine and compare the experiences of early-career health professionals
in the WiSDOM cohort study of their clinical practice environments in South Africa.

Methods: WiSDOM, a prospective longitudinal cohort study that commenced in 2017, consists of eight
health professional groups: clinical associates, dentists, doctors, nurses, occupational therapists, oral
hygienists, pharmacists, and physiotherapists. Since the first follow-up study in 2018, we collect
information annually on perceived workload (5-point Likert scale from very light to very heavy),
availability of medicines and equipment for patients in their care in the month preceding the survey
(Yes or No), and their satisfaction with the clinical practice environment (score out of 10).

Differences between the professional groups were compared using proportions for categorical
variables and means for numerical variables. We used multiple linear regression to investigate factors
associated with the cohort’s experiences of their clinical practice environments.

Results: In 2022, the mean age of the cohort was 28.9 (± 2.1), the majority (77.7%) were less than 30
years old, and female (74.2%). Notwithstanding variations across the eight groups, in 2018, 69.2% of
the cohort members reported a heavy workload, compared to 60.0% in 2022. In 2021, 80.7% of those
cohort members in the public health sector reported that the facility experienced lack of medicines
for their patients in the preceding month, compared to 21.8% of those in the private health sector.
Similarly, 83.8% of those working in rural areas reported lack of medicines, compared to 51.3% in urban
areas.

The trends in the cohort’s satisfaction scores with the clinical practice environment have remained
constant at around 6.85 out of 10. The regression analysis showed that experiences of clinical practice
environments were influenced by professional category, and work setting.

Conclusion: Given the centrality of the workforce for quality care and patient safety, the study findings
underscore the need for positive clinical practice environments for early-career health professionals in
South Africa.

Disclosure of Interest: None Declared

291
Building an authorising environment to enable large-scale change programs: learning from an
Australian statewide initiative: (2188) Janet C Long

ISQUA2024-ABS-2188

J. C. Long 1,*, E. Francis-Auton 1, M. Sarkies 1 2, J. Braithwaite 1

Australian Institute of Health Innovation, Macquarie University, 2Sydney Health Partners, Sydney
1

University, Sydney, Australia

Introduction: Transforming a health system through implementation of interventions across multiple

sites promises rapid and meaningful change but is notoriously hard to do. Between 2017 and 2021 the
Ministry of Health in New South Wales, Australia launched a large-scale improvement initiative called
Leading Better Value Care (LBVC). The goal was to improve patient and clinician experience and
outcomes by increasing the efficiency and effectiveness of care. All of the state’s public hospitals
(n=221) were included and multifaceted interventions across a range of high prevalence conditions
were implemented. Conditions included chronic heart failure, diabetes, osteoporosis and end stage
kidney [Link] aim of our study was to retrospectively examine the implementation of seven of
these interventions using realist methodology, identifying particular contexts that enabled the system
to successfully change. At the conclusion of the project, we identified four principles that we called
“system enablers”. The evidence showed that these principles were key factors that triggered
meaningful change in this whole of system initiative. Here we report on the first principle: build an
authorising environment.

Methods: The realist study set out to show what implementation strategies worked for whom, under
what circumstances. Data was drawn from two literature reviews on implementation of large-scale,
multi-site hospital initiatives, a review of LBVC program documents, and informal discussions with 16
key stakeholders (initiative designers) on how they thought the implementation would work in
practice. Interviews with 56 stakeholders including initiative architects, support officers and
implementers were then undertaken. From this, 42 context-mechanism-outcome statements were
crafted to tease out the circumstances and mechanisms that led to desired or undesired outcomes.
These findings were ratified by three panels of experts (n=51). Finally, this huge body of synthesized
data was interrogated to distil the guiding principles, the “system enablers”. Ethics approval was
granted by University and Local Health Districts. The project was funded by a Medical research Futures
Fund grant (1178554).

Results: We define an authorising environment as the structures, rules, processes, and people who
can grant permission or influence system-wide change. Change is facilitated through top-down and
horizontal pressure created by people at all levels of the system. The authorising environment was
built through: (i) signed formal service level agreements between the Ministry of Health and chief
executives of each district providing certainty of resources, flagging the program as a statewide
priority, defining goals and accountabilities; (ii) statewide clinical support agencies provided officially
sanctioned peer-mentoring activities, including cross site comparisons, as well as tools, advice, and
data; (iii) clearly communicated sponsorship and support from the heads of an organization, unit, or

292
team fostered engagement and commitment to the change from implementers at the hospitals (iv)
permission and support from all levels for use of local adaptations to reach the standardised outcomes.
These elements were seen to mitigate common barriers to change. Examples include: consistent and
clear authoritative messaging around the project mitigated the barrier of uncertainty or cynicism that
the necessary resources for change would be provided. Formal permission encouraging adaptation
assured implementers that their site’s constraints and the clinicians’ local expertise were
acknowledged and it was not a one-size fits all program.

Conclusion: Authorising environments enable large-scale change by formalising issues that can be
perceived as uncertain by the implementers (e.g., funding, staffing, targets and accountabilities). It
also clarifies roles, expectations and acknowledges the expertise of local implementers through
encouraging diverse approaches to reach the agreed targets.

References: Francis-Auton E, Long JC, Sarkies M, et al. Four System Enablers of Large-System
Transformation in Health Care: A Mixed Methods Realist Evaluation. Milbank Q 2023 doi:
10.1111/1468-0009.12684

Disclosure of Interest: None Declared

Polypharmacy measurement in aged care settings: discrepancies between prescribed and

administered polypharmacy rates have implications for quality indicator reporting guidelines:
(1745) Nasir Wabe

ISQUA2024-ABS-1745

R. Urwin 1,*, N. Wabe 1, K. Seaman 1, J. Westbrook 1

Australian Institute of Health Innovation, Macquarie University, Sydney, Australia

1

Introduction: Polypharmacy (the concurrent use of multiple medicines) is prevalent in aged care
homes, where residents are more likely to have several chronic health conditions that are treated with
multiple medicines. Suboptimal prescribing and inappropriate polypharmacy in aged care settings
present significant safety concerns and increase the risk of residents experiencing medicine-related
harms. Polypharmacy is frequently used as a quality of care indicator in aged care settings, despite
being poorly defined. The extent to which the marked variability in reported polypharmacy rates may
be due to different definitions and in particular the use of different data sources, e.g. using records of
prescribed versus administered medicines, is unknown and has implications for monitoring changes in
quality of care and benchmarking between aged care facilities. We aimed to determine polypharmacy
rates under different scenarios, using electronic data records of prescribed and administered
medicines from 30 residential aged care facilities.

Methods: A longitudinal cohort study of 5,662 residents in New South Wales, Australia. Polypharmacy
rates were calculated in 2-weekly intervals from Jan 2019 to Sep 2022, providing 156 assessment time
points. Twelve different polypharmacy rates were computed from prescribing and administration data

293
and polypharmacy definitions that included different combinations of items: medicines and non-
medicinal products, any medicines, and regular medicines and four time frames for data review: one-
day, one-week, two-weeks, and four-weeks. Longitudinal predictors of discrepancies between
prescribed and administered polypharmacy were identified using GEE models.

Results: Polypharmacy rates ranged from 33.9%, for a one-day review of administered regular
medicines, to 63.5% for prescribed medicines and no-medicinal products that included a four-week
review period. At each assessment time point, the differences between polypharmacy rates for
prescribed and administered medicines were consistently more than 10.0%, 4.5%, 3.5%, and 3.0%
respectively with one-day, one-week, two-week, and four-week review period. Residents with
dementia had a reduced likelihood of polypharmacy discrepancies, while residents with diabetes had
twice the likelihood of discrepancies in prescribed and administered polypharmacy compared to those
without.

Conclusion: Polypharmacy rates are highly variable when calculated using either prescribing or
administration data, different time frames for data review, and the inclusion criteria for medicines. We
recommend a more consistent approach to the measurement of polypharmacy in aged care settings
to enable more meaningful reporting and appropriate quality of care benchmarking.

Disclosure of Interest: None Declared

Implementing the National Policy for Quality in Healthcare for Malaysia: Tracking the First-year
Progress: (2051) Samsiah Awang

ISQUA2024-ABS-2051

S. Awang 1,*, I. R. Mohd Ujang 1, N. E. Mohamed 1, N. Hamidi 1, K. Maruan 1, D. N. Narayanan 1, N.

Shaharuddin 1, M. Mohamed 1, R. Supadi 1

Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam ,Selangor, Malaysia
1

Introduction: In October 2021, Malaysia launched its new National Policy for Quality in Healthcare
(NPQH), a country-level document that provides an official, explicit statement of the policy and
strategies required to enhance the quality of Malaysia’s healthcare system. The NPQH delineates seven
Strategic Priorities (SPs) with a total of 47 agreed indicators to monitor the progress of NPQH
implementation over 5 years (2022-2026). Of those indicators, some are continuously tracked
throughout the entire period, while others are specific to a particular year. This paper assesses the
first-year implementation progress of the SPs, identifies implementation challenges and potential
improvement solutions.

Methods: An official request was sent in February 2023 to the quality focal person of various divisions
and programmes within the Ministry of Health Malaysia (MOH) to obtain data for 34 indicators
monitored in 2022. Each indicator, with its unique definition and standard, required numerical values
for numerator and denominator, presented as either number or percentage. The data were captured

294
using REDcap, with the indicator's definition embedded in the application to assist in reporting. User
feedback was obtained intra and post data reporting process to improve data validity. The focal person
was contacted to clarify any query or incomplete data, and cross-verification was applied when
necessary. Data were analysed and presented to the stakeholders during a meeting in June 2023.
Stakeholders' inputs during the facilitated discussion were gathered to identify areas for improvement
in data collection and implementation.

Results: Sixteen divisions/programmes submitted data, yielding a response rate of 89%. Of 34

indicators, 22 successfully met their targets, accounting for a 65% success rate. Indicators under the
SP capacity and capability, and SP communication and engagement of stakeholders showed the highest
achievement, while SP governance and SP monitoring and evaluation need further improvement.
Unclear definitions and accountable divisions/programmes for reporting were among the challenges
identified. A unanimous consensus was reached on the need for a comprehensive indicators dictionary,
serving as a guide for improvement in data collection.

Conclusion: Both data submission and indicators performance show acceptable achievement of more
than 60% in the first year of implementation. Tracking NPQH performance identifies gaps in reporting
and implementation while generating valuable opportunities for peer learning across
divisions/programmes. Areas for further development include a complete dictionary to improve the
quality of reported data. This internal assessment fosters a collaborative spirit that bridges
programmes silos, accelerates improvement, and enhances the quality of healthcare delivered to the
clients.

Disclosure of Interest: None Declared

Lightning Talks

Multiple strategies to improve sarcopenia for nursing home residents: (1209) Chia-Ming Chi

ISQUA2024-ABS-1209

C.-M. Chi 1, Y.-R. Li 2, Y.-T. Wu 3, S.-T. Chuang 4, J.-H. Chien 5 6,*

1
Taichung Tzu Chi Nursing Home, 2Department of nursing, 3Department of Family Medicine, 4Office of
Superintendent, 5 Department of Research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical
Foundation, 6Department of Medical Laboratory Science, Central Taiwan University of Science and
Technology, Taichung, Taiwan

Introduction: Sarcopenia is an acknowledged geriatric condition characterized by aggressive loss of

muscle mass and function. The high prevalence of sarcopenia has been found to affect as many as 25%
to 73.7% of residents at nursing homes.1 Sarcopenia not only impairs physical function but also lowers
the quality of life of the elderly. A number of factors have been associated with sarcopenia, such as
aging, chronic illness, malnutrition, and a lack of physical exercise. We initially scoped this investigation
295
based on the prevalence of sarcopenia among nursing home residents. Our objective was to improve
the sarcopenic condition of nursing home residents by implementing various tactics and interventions.

Methods: The gross motor function categorization system (GMFCS) was used to assess the physical
and muscular state of 346 individuals in total. We also evaluated the inhabitants of nursing homes in
terms of their capacity for training and learning. Participants with physical limitations, those unable to
participate, or those with compromised cognitive ability were not allowed. A total of sixty-one
walkable GMFCS lever 1–3 participants were screened. To assess sarcopenic state, handgrip strength,
5-times chair stand test, and bioelectrical impedance analysis were performed on seven male residents
(41%) and ten female residents (59%) (Figure 1). In this sarcopenia improvement project, we
implemented two main strategies: "Let's eat well-modification in diet and Chinese herbal food" and
"Let's do it-3 weeks exercise training award program."

Results: Participants in the "let's do it-exercise program" were encouraged to work out for an hour,
four days a week. We observed the best-performing muscle strength changes in a 4-month period
follow-up. In the handgrip assessment, it increased from 21.2 ± 2.3 to 22.7 ± 3.7 (p < 0.001) in males,
and for females, it increased from 12.2 ± 3.9 to 12.3 ± 4.7 (p = 0.012). The male movement time
decreased from 15.5 ± 4.6 sec. to 9.3 ± 2.1 sec. (p = 0.005) and the female movement time decreased
from 17.9 ± 1.8 sec. to 15.9 ± 2.5 sec. (p = 0.024) for the five chair stand tests. Nonetheless, there is
no discernible variation in bioelectrical impedance analysis (BIA) between the pre- and post-
intervention values.

Conclusion: Sarcopenia is a complex and multifactorial disease. To date, only a few pharmaceutical
medications have demonstrated promising outcomes in treating or minimizing symptoms. A recent
system review indicated different exercise regimens have differing effects on physical performance in
sarcopenia patients.2 Daily exercise and training considerably improve the handgrip and 5-times chair
stand test scores of the nursing home residents in our study. It is advised that senior citizens should
follow a nutritious diet and regular exercise regimen to increase their muscle power.

References: [Link] J, Zhu Y, Tan JK, Ismail AH, Ibrahim R, Hassan NH. Factors Associated with Sarcopenia
among Elderly Individuals Residing in Community and Nursing Home Settings: A Systematic Review
with a Meta-Analysis. Nutrients. 2023;15(20):4335. doi:10.3390/nu15204335

[Link] L, Mao L, Feng Y, Ainsworth BE, Liu Y, Chen N. Effects of different exercise training modes on muscle
strength and physical performance in older people with sarcopenia: a systematic review and meta-
analysis. BMC Geriatr. 2021;21:708. doi:10.1186/s12877-021-02642-8

Disclosure of Interest: None Declared

296
Towards a digital age: Project Lakshya: (1344) Gaurav Loria

ISQUA2024-ABS-1344

G. Loria 1,*, A. Sharma 1

Quality and Operations, Apollo Hospitals , Hyderabad, India

1

Introduction: Introduction-

Healthcare industry around the world thought they were planning for resilience. But nobody was
prepared for Covid-19. The way healthcare systems around the world suffered shone a spotlight on
processes and systems, revealing vulnerabilities and flaws we overlooked. We, at Apollo hospitals,
decided that there is an immediate need to bring changes in our facilities making us more resilient,
agile and customer-centric. To bring significant systemic changes, improve existing processes, train
staff into engaged caregiver and initiate digital initiative to make our facilities future ready. This
resulted in conceptualization of the initiative ‘Apollo Lakshya’. A 250 bedded hospital was selected.

Objectives-

Since the emergence of Covid-19, health care systems all across the globe were overwhelmed by
the patient volumes they had to handle. With such a situation, patients and their attendants coming
to the hospital wanted smaller queues and lesser crowd in front of various desks, outpatient areas,
pharmacies and diagnostic areas. Less waiting time for various processes in place at the facility were
sought after as well. Patients wanted to keep the touch points to a minimum while they were in the
system. While brainstorming about the possible solution, we were also aware that once the situation
will get under control, patients who adopted to digital healthcare solutions for the convenience and
flexibility, will find it little hesitant to switch to old manual measures and would expect better service.

Methods: Materials & Methods-

Three stages of the projects- Stage 1, stage 2, stage 3.

Stage 1:

a. Digital visitor pass for the patient attendants to control crowd

b. Self-registration kiosks for the patients for contactless registration

c. Staff carrying payment QR codes behind their ID cards for easier and contactless billing

Stage 2:

a. Red button- initiative for OP patients to get our immediate attention

b. Bedside admission and billing to reduce touch points for patients

c. Pharmacy and investigation billing floaters for easier billing and to reduce waiting time

d. OP token system and automated vital checking machine to control crowd and reduce

touch points

297
e. Investigation scheduler for smaller queues

Stage 3:

a. Discharge TAT reduction for both cash and credit patients

b. Live CPOE (Computerised Physician Order Entry) tracker to prevent investigation

revenue leakage

c. OP CSP (Care Suite Persona) for digital prescription by doctors

Results: Results-

Apollo Lakshya is a platform through which we want to showcase that providing exceptional customer
service is the future of healthcare sector and the digital transformation is the way to reach there. In
this pursuit, we surpassed our own expectations on multiple fronts.

- Introduction of bedside admission and billing for patients and current compliance at 100% for single
beds and above.

- Introduction of bedside discharge for patients and current compliance at 100% for single beds and
above.

- Discharge TAT for cash patients brought down from 408 minutes to 89 minutes.

- Discharge TAT for credit patients brought down from 771 minutes to 270 minutes

- Revenue leakages brought down from 65% to 15%.

- Introduction of investigation scheduler for patients and 100% compliance for patients at present.

- Introduction of Pharmacy floaters for easier billing, smaller queues and less waiting time at Pharmacy.

Conclusion: Apollo Lakshya, that started as a pilot project in Apollo Hyderguda, a 250 bedded hospital,
has been a humongous success, which can be evidenced through the hospital’s Google rating which
increased from 3.4 in June 2021 to 4.7 currently. With this success, the project is now being taken up
in 6 more hospitals, with multiple other hospitals under discussion for implementation as well. We
aspire to implement this project on all our units with 100 beds or more in upcoming 5 years, and
ultimately, to all our units.

Disclosure of Interest: None Declared

298
Patient Discharge Journey - An Enigma Decoded!: (1270) Gaurav Loria

ISQUA2024-ABS-1270

N. Nishit 1, G. Loria 2,*, Y. Nayak 1

Apollo Hospitals, Delhi, 2Apollo Hospitals, Hyderabad, India

1

Introduction: The patient discharge process is a crucial aspect of healthcare delivery, as it determines
the quality and
continuity of care for the patient after leaving the hospital. However, the discharge process is often
fraught with
challenges, such as delays, errors, miscommunication, and dissatisfaction among patients and staff.
To address these
issues, our project aims to transform the discharge process from a one-way transaction to a two-way
conversation,
involving the patient and the family as active partners in the discharge planning and education. By
doing so, we hope to
achieve a well-planned, quick and seamless discharge experience that meets the clinical and non-
clinical needs of the
patient and the family, and creates moments of tender loving care.
Our project is based on the following key objectives:
- To achieve a discharge process turn-around time of less than 2 hours (self-pay patients) and 4.5
hours
(credit/insurance patients) respectively
- To ensure a detailed discharge counselling is provided to the patient
- To complete all the discharge related paperwork at the patient’s bedside
- To ensure all paramedical support is planned to facilitate the patient discharge
- To ensure the patient/attendant is appraised on the expected bill
- To ensure the post discharge treatment plan is scheduled and explained
- To bid a fond farewell to the patient/family and create moments of tender loving care

Methods: Methods: Improving Patient Discharge Journey

1.
Experimental Design:
- Conducted gap analysis to identify discharge process inefficiencies.
- Implemented a digital transformation plan with EMR integration.
- Executed a comprehensive training program for all stakeholders.
2.
Analytical Techniques:
- Mandated discharge planning on the day of admission.
- Established interdisciplinary SPOCs for real-time monitoring.
- Introduced mobile billing and insurance counters for efficiency.
3.
Statistics:
- Defined KPIs, including turnaround time and patient satisfaction.
- Monitored compliance across 40 units with statistical tools.

299
- Analyzed data for continuous improvement.
-
4.
Continuous Improvement:
- Implemented a rewards system and weekly huddles for motivation.
- Adapted strategies based on feedback and statistical insights.

Results: This drive helped us improve our patient engagement and helped us establish a sense of
trust. We had received
numerous testimonials from the patients, appreciating the effort. The fond farewell initiative has
been an emotional binder
for the patient with brand “Apollo”.
The following are few numbers at a group level across all the units;
All 40 units of Apollo hospitals group have implemented the initiative with an overall compliance of
76%
Discharges prior to 1pm had increased to an average of 56% (May 23) from a meagre 32% (Apr 22)
All bill related queries at the time of discharge reduced by 53%
Patient satisfaction score (NPS) on discharge experience has increased to 72 (May 23) from 58 (Apr
22)
Patient Loyalty index has increased to 83% (May 23) from 78% (Apr 22)
A reduction in discounts/non-payables by 13% between Apr 2022 and May 2023

Image:

300
Conclusion: In conclusion, the initiative to enhance the patient discharge journey through a
comprehensive and patientcentric
approach has yielded significant and sustainable improvements. The combination of a thorough gap
analysis,
digital transformation, and a disciplined training program has resulted in a cultural shift towards
proactive and
compassionate patient care.
Continuous improvement remains at the forefront, as evidenced by the rewards system, weekly
huddles, and adaptive
strategies based on feedback and statistical insights. This not only sustains the progress made but
also fosters a culture
of ongoing excellence and patient-centered care.
In essence, the initiative to decode the enigma of the patient discharge journey has not only met but
exceeded
expectations. The positive impact on patient engagement, satisfaction, and loyalty reflects the
success of the project in
creating a more efficient, compassionate, and patient-friendly healthcare environment. As we
celebrate these
achievements, we acknowledge that the journey is ongoing, and the commitment to continuous
improvement remains
steadfast.

Disclosure of Interest: None Declared

Towards patient-centred communication in the management of older patients' medications across

transitions of care: A focused ethnographic study: (3004) Guncag Ozavci

ISQUA2024-ABS-3004

G. Ozavci 1 2,*, T. Bucknall 13

, R. Woodward-Kron 4, C. Hughes 5, C. Jorm 6, E. Manias 7 8
1
School of Nursing and Midwifery, Faculty of Health, Deakin University, 2Nursing Research, 3School of
Nursing and Midwifery, Faculty of Health, Alfred Health , 4Department of Medical Education,
Melbourne Medical School, University of Melbourne, Melbourne , Australia, 5School of Pharmacy,
Queen's University Belfast, Belfast, United Kingdom, 6School of Public Health, University of Sydney,
Sydney, 7Faculty of Medicine, Nursing and Health Sciences, Monash University, 8School of Medicine,
Faculty of Health, Deakin University, Deakin University, Melbourne, Australia

Introduction: Communication about managing medications during transitions of care can be

challenging for older patients related to complex medication regimens and multiple medication
changes during hospitalisation. Past work highlighted that links between communication breakdowns
and medication incidents in older patients occur mainly at discharge or in the post-discharge period.
Little attention has been paid to exploring communication strategies facilitating patient-centred

301
medication communication at transitions of care from a discourse-analytic perspective. The objective
of this study was to explore, through a discursive lens, strategies that enable patient-centred
medication communication at transitions of care.

Methods: Interviews, observations and focus groups were analysed utilising Critical Discourse Analysis
and the Medication Communication Model following thematic analysis. Data collection was
undertaken in eight wards across two metropolitan health care settings, including acute and geriatric
rehabilitation hospitals in Australia.

Results: Fifty older patients and 31 family members participated in semi-structured interviews, and
203 hours of observations were conducted. In all, 111 older patients were observed, and 20 older
patients and 13 family members participated in focus groups about medication communication across
transitions of care. Patient preferences and beliefs about medications were identified as important
characteristics of patient-centred communication. Strategies included empathetic talk prioritising
patients' medication needs and preferences for medications; informative talk clarifying patients'
concerns; and encouraging talk for enhancing shared decision-making with older patients. Challenges
relating to use of these strategies included patients' hearing, speech or cognitive impairments,
language barriers and absence of interpreters or family members during transitions of care.

Image:

Conclusion: Missed opportunities existed for health professionals to adopt patient-centredness in

medication communication. Health professionals should explore older patients’ preferences for
involvement in medication decisions, their previous experiences, and beliefs about specific
medications soon after their admissions to the hospital setting so that they can adopt more
individualised communication strategies (which could include informative, empathetic and
encouraging talk) based on patients’ individual needs and characteristics. Communicating about
medications needs to be seen as everyone’s responsibility during patient’s hospital journey.
Additionally, organisational efforts are required to facilitate interpreter and family involvement in the
medication decision-making process for older patients with cognitive declines and different language
backgrounds.

Disclosure of Interest: None Declared

302
The Risks of Patient Safety caused by Information Technology-preliminary results in Taiwan: (1447)
Han-Chi Chung

ISQUA2024-ABS-1447

H.-C. Chung 1,*, S.-H. Hung 2, P.-L. Tang 3, Y.-T. Deng 3, H.-H. Rau 1, C.-C. Fang 2
1
Research and Development, 2CEO Office, 3Quality Improvement, Joint Commission of Taiwan, New
Taipei, Taiwan

Introduction: In recent years, the rapid development of health information technology (HIT) has been
noted widespread implementation of information technology in hospitals to alleviate clinical staff
workload and enhance management and operational efficiency. However, with the integration of HIT
in healthcare, there are a growing number of HIT-related incidents affecting patient safety. The
Emergency Care Research Institute (ECRI) in the United States annually publishes the top 10 health
technology hazards, highlighting the risks associated with medical technology. In Taiwan, the Ministry
of Health and Welfare emphasizes the importance of establishing a system for reporting and managing
HIT-related patient safety incidents as part of the national patient safety goals.

Methods: To raise awareness and the importance of the patient safety risks associated with medical
technology in healthcare, the Joint Commission of Taiwan collaborated with ECRI in 2020 to establish
the nationwide "Information Technology-related Patient Safety (ITPS)” learning platform. Through this
voluntary reporting and learning platform, hospitals can report issues related to information
technology systems, equipment, operations, connectivity, and information security. Reports are
analyzed by healthcare information experts who identify root causes, suggest improvement measures,
and facilitate inter-hospital experience exchange and sharing.

Results: This study analyzed 113 cases reported from 23 hospitals participating in the ITPS platform
from 2021 to 2022. The top three categories of incidents were medication events (43.4%),
laboratory/diagnostic pathology events (23.9%), and clinical treatment and care events (19.5%).
Among medication events, most are related to the physician prescription interface, such as too much
reminder information. Classified by the event-related information systems/technologies, the top three
were information system issues (51.3%), system interface issues (14.2%), and system operation issues
(11.5%). Distinguishing the impact on patient safety caused by the incident based on the degree of
harm, 12.9% were minor injuries, and the rest were mostly no harm (54.7%) and near misses (32.4%).
Among information system issues, most occurred in healthcare information systems such as
computerized provider order entry, pharmacy, and laboratory information systems (59.2%), followed
by clinical documentation systems (28.6%), the possible reasons for the incident are shown in Figure
1. Our platform has announced six systematic learning cases in the past two years, including electronic
signature specifications, medical record consolidation operations, complex prescription issuance (such
as chemotherapy, TPN), interfaces between different systems, interface design, and data transmission
between medical devices and the information system.

Image:

303
Conclusion: Healthcare information technology is complex, and information capacity varies among
hospitals. Successful HIT implementation relies on effective communication and collaboration among
multidisciplinary teams, active user participation in workflow design, and consideration of human
factors and safety issues. Based on the literature, 75% of HIT-related patient safety incidents are
preventable. However, people are not sufficiently aware of the risks associated with HIT in the medical
field. The ITPS platform facilitates the flow of information about common risks and hazards in hospitals.
It allows experts to consult and discuss cases and encourages sharing and learning of best practices
between hospitals. As a result of this collaborative effort, we will develop systematic guidelines to
prevent the recurrence of similar problems and safeguard patient safety.

References: 1. Hsiao-Hsien Rau,Ya-Ting Chuang,Hsun-Hsiang Liao. The Result and Learning from
Develop Healthcare IT Related Patient Safety Information Sharing Platform. Journal of Healthcare
Quality. 2021;15(1):6-11.

2. Jia-Li Huang, Ya-Ting Deng, Sheng-Hui Hung. The Achievements and Future of Information
Technology related Patient Safety. Journal of Healthcare Quality 2022; 16(4):6-11.

3. Taiwan Patient-safety Reporting system (TPRs) Annual Report 2021 ISSN 2518-5223 p.168

4. Guy Martin, Saira Ghafur, Isabella Cingolani, Joshua Symons, Dominic King, Sonal Arora, Ara
Darzi (2019) The effects and preventability of 2627 patient safety incidents related to health
information technology failures: a retrospective analysis of 10 years of incident reporting in England
and Wales. Lancet Digit Health. 1(3):e127-e135.

5. Bipartisan Police Center (2013). An Oversight Framework for Assuring Patient Safety in Health
Information Technology.

Disclosure of Interest: None Declared

304
To Determine Nurses' Attitudes Towards Convicted Patients: (2691) Hanife Cakir

ISQUA2024-ABS-2691

H. Cakir 1,*, A. K. Harmancı Seren 2

1
Prof. Dr. Mazhar Osman Mentaal and Neurogical Diseases Training and Reserach Hospital, İstanbul,
Türkiye, 2Fenerbahçe Üniversitesi, İstanbul, -

Introduction: Quality healthcare service delivery and patient safety are affected by the healthcare
professional's attitude towards the patient. The aim of the study was to examine nurses' attitudes
towards convicted patients and to determine whether they affect nursing care and patient safety.

Methods: This descriptive phenomenological qualitative study aimed to explore nurses'

[Link] study collected data via semi-structured interviews and reached out to 40 nurses via
snowball sampling. MaxQda software program was used for content analyses. After the analysis, the
themes were determined by coding. Ethics approval was obtained. Before the interviews, verbal
consent was requested and recorded.

Results: It has been observed that nurses have negative attitudes towards convicted patients and have
behaviors that threaten patient safety. It has been determined that nurses do not want to care for
patients who are especially guilty of murder, rape, abuse and rape, engage in harmful behavior and do
not want to communicate effectively.

Conclusion: It was determined that the negative attitudes of nurses did not ensure the safety of
patients and that patients had access to low-quality health care. These attitudes cause low-quality
health outcomes, negative patient experience, and failure to ensure patient safety

Disclosure of Interest: None Declared

How we can learn from mistakes - health and social care safety investigation as a fostering patient
and client safety: (3130) Hanna Tiirinki

ISQUA2024-ABS-3130

H. Tiirinki 1 2,*

Health and social care safety investigation, Safety Investigation Authority, Helsinki, 2Social Reseach,
1

University of Turku, Turku, Finland

Introduction: It has been stated that over 1 in 10 patients continue to be harmed due to safety lapses
during their care. There is no available estimate as to how many clients social services are subject to
harm or safety deviation. Safety Investigation Authority, Finland (SIAF) has launched an investigative
branch tasked with investigating health and social care accidents and serious so called never events in
2021. The branch investigates both events with far-reaching consequences and accidents suffered by
individual clients or patients. The purpose of a health and social care safety investigation is to improve

305
patient and client safety as well as general safety of the health and social care system and services.
Recommendations intended to prevent the reoccurrence of similar incidents and decrease the number
of incidence of accidents in general stem from each safety investigation.

Methods: Safety investigations are conducted independently and objectively applying investigation
methods from traditional safety critical fields, such as aviation, railroad or maritime safety. An
investigation team appointed for each specific health and social care investigation determines the
course, causes and consequences of the events. It also determines whether management, supervision
and auditing has been arranged and performed appropriately. An investigation includes investigating
the scene of the accident, interviewing those involved and consulting documents on, for example, the
organization being investigated, its operations, best practices of client and patient safety. The team
also has the right to obtain necessary client and patient records, as well from private health and social
care providers and units as individual health and social care professionals.

Results: Several health and social care safety investigations have been completed by SIAF. The
investigations have focused so far on elderly home care and nursing care, health care information
systems, psychiatric care, drug addiction treatment for young people, and medication errors in
hospitals and pharmacies. The national safety recommendations are based on the results of
investigations. The recommendations have dealt with, among other things, the re-evaluation and
development of instructions, procedures and resources. In addition, some recommendations are
targeted at the level of national legislation.

Conclusion: An independent investigation is an important tool to promote client and patient safety as
well as an excellent way to learn from mistakes. The paramount aspect of a safety investigation is that
it is never done in order to portion blame or seek a culprit. An independent investigation not only
promotes safety, but also creates an open and transparent operating culture. Monitoring the
implementation of the safety recommendations issued in safety investigations is of utmost importance
in order for the safety investigations to have an impact. Sharing the lessons learned from safety
investigations between different countries is very valuable.

References: SIAF (2021) Health and Social Care Accidents. Available in:
[Link]

Disclosure of Interest: None Declared

306
Registration of indicators across ten patient safety themes – The status a decade after the
implementation of the Dutch National Patient Safety program: (2874) Hanneke Merten

ISQUA2024-ABS-2874

H. Merten 1,*, K. van Beekum 2, I. Brugman 2, B. Schouten 1, C. Schlinkert 2, C. Wagner 1 2

Public and Occupational Health, Amsterdam UMC, Amsterdam, 2Nivel, Utrecht, Netherlands
1

Introduction: In 2008 all Dutch hospitals jointly committed to participate in a national patient safety
improvement program. This VMS-Safety Program included the implementation of a safety
management system in each hospital. Also, improvement measures and registration on quality
indicators for ten themes were implemented to support the reduction of unintended preventable
harm in hospitals (1). Examples of themes are reducing the number of wound infections after an
operation and identifying and treating pain at an early stage. However, more than 10 years have
expired since the VMS-program, and scientific knowledge underlying the quality indicators described
in the ten themes has developed. Additionally, registration burden and selection of valuable quality
indicators have become important themes within healthcare. Therefore, the aim of this study was to
gain insight into the considerations, structures and methods used within hospitals to keep registrations
on quality indicators related to the ten themes up to date, relevant and of added value.

Methods: This study consisted of two phases. First, desk research was conducted to study the current
status of evidence underlying the quality indicators for the ten themes. Second, we interviewed quality
advisors within hospitals and private clinics in the Netherlands. Participants gave written and verbal
informed consent to participate in the study and received a summary for member checking. The semi-
structured interviews included topics on the considerations, structures and methods for keeping
registrations on quality indicators related to the ten themes up to date, relevant and of added value.
A thematic analysis with an inductive approach was used. Full data collection and analysis will be
completed in April 2024. The ethics committee of Amsterdam UMC declared that the Medical Research
Involving Human Subjects Act did not apply.

Results: Since the implementation of the ten safety themes and the related indicators, new guidelines
and indicators have been developed related to several themes. Preliminary results show that although
the name VMS-safety is still often used, the extent to which quality indicators are still registered
according to the original description varies widely between themes and hospitals. Several indicators
have been modified in line with new evidence and to make them more useful in daily practice, for
monitoring or external accountability, their status is often tracked in a document management system.
Different strategies were mentioned for keeping these quality indicators up to date, for example by
appointing a specific person with extensive knowledge, forming working groups around themes or
indicators or signal within the quality department whether an indicator should be updated. Quality
advisors recognized that the themes had brought improvement in hospitals in the past ten years, but
that discussion on changing or discontinuing registrations was sometimes difficult because they
provide a sense of control and care providers are familiar with the ten themes. Therefore, quality
advisors emphasized the importance of identifying and prioritizing high-risk processes that may have
become more urgent and to actively redirect attention and registration towards them, going beyond
the scope of the original ten themes outlined in the national patient safety program.

307
Conclusion: The interviews show that the ten themes from the national VMS-safety program and
registrations on the quality indicators within the themes were experienced as a useful national starting
point for safety improvement. Indicators have been modified within hospitals over time to fit with their
specific practice and relevance. Since several of the improvement measures from the ten themes have
been structurally implemented in the care processes, it is important to keep evaluating and discussing
whether continued registration on the related indicators is still of added value. Additionally, hospitals
emphasize the need for a balance between identifying and monitoring high risk processes within care
and minimizing additional registration burden for care providers.

References: [Link]
english/

Disclosure of Interest: None Declared

Adverse events and screening on frailty indicators for older patients in Dutch hospitals: results of a
retrospective record review study: (3347) Hanneke Merten

ISQUA2024-ABS-3347

H. Merten 1,*, B. Schouten 1, C. Wagner 1 2

Public and Occupational Health, Amsterdam UMC, Amsterdam, 2Nivel, Utrecht, Netherlands
1

Introduction: The proportion of older patients admitted to hospital is increasing in the Netherlands.
Previous research has shown that adverse events (AE) occur relatively often in older patients. (1)
Therefore, many improvement initiatives have been implemented in hospitals to reduce the risk of
adverse outcomes in this patient group. One example is the implementation of a bundle of screening
tools for older patients within the national patient safety program (VMS) that ran from 2008-2012 in
the Netherlands. This bundle focused on screening for malnutrition, delirium, fall risk and physical
impairment. A recent evaluation showed that in 2020/2021 74% of admitted older patients was
screened on this bundle. (2) In the current study, we aim to explore the incidence of (preventable) AEs
in older hospital inpatients and how these percentages vary between patients who were screened and
followed up according to the bundle and those who were not.

Methods: In this retrospective record review study, a representative and random sample of 2.998
patients deceased in Dutch hospitals in 2019 was included. The record-review process consisted of two
phases. First, a review on triggers for potential AEs was conducted by trained nurses. Additionally, the
nurses registered whether the VMS-screening had been completed for each of the four indicators and
if appropriate action had been taken in case of identified risks (adherence). Second, a thorough review
was conducted by trained medical specialists for the records in which a trigger was identified. They
determined whether an AE had occurred and if so, to assess its nature, preventability and potential
contribution to the patient’s death. Data were analyzed using STATAMP16. The ethics committee of
VUmc declared that the Medical Research Involving Human Subjects Act did not apply.

308
Results: In total, the sample included 2,188 patients of 70 years and older, of which 291 patients
experienced one or more AEs (13.5%; 95% CI=12.1%-15.2%). For 93 of these patients the AE was
potentially preventable (4.1%; 95% CI=3.3%-5.1%) and for 69 patients the potentially preventable AE
contributed significantly to their death (3.1%; 95% CI=2.4%-4.0%). For each indicator, more than half
of the patients of 70 years and older was screened and appropriate action was taken when necessary
(adherence). Figure 1 shows the percentages of AEs and preventable AEs for each indicator. The
percentages were consistently higher in the groups where screening had been conducted and
appropriate follow-up measures were taken (difference 4.8-9.8% for AEs and 2.5-4.6% for preventable
AEs).

Image:

Conclusion: The results show that, in line with the previously mentioned study, the VMS-screening is
registered and appropriate follow-up actions are taken for a substantial percentage of older patients.
The majority of patients in the no adherence groups was not screened at all on the indicator(s) from
the bundle. A potential explanation for the higher percentages of AEs and preventable AEs in the
adherence groups may be that nurses make a substantiated decision not to screen, or register the
results of the screening, when they assess a patient as low-risk. Further research is needed to
investigate the potential relationship between screening and safety outcomes and the reasons
underlying the decision whether or not to screen a patient.

References: 1 Long, SJ., Brown, KF., Ames, D., Vincent, C. What is known about adverse events in older
medical hospital inpatients? A systematic review of the literature. Int J Qual Health Care. 2013(5):542-
45.

2 Meulman, M., Merten, H., Wagner, C. Screening of vulnerable older patients: research from a Safety-
I and Safety-II perspective: evaluation of the VMS-theme vulnerable older patients. [report in Dutch].
Utrecht, Nivel, 2021.

Disclosure of Interest: None Declared

309
Using Quality Control Circle to Optimise Hospital Pharmacy Inventory Management Processes-A
Case Study of a Medical Center in Taiwan: (1207) Jing-Ying Huang

ISQUA2024-ABS-1207

J.-Y. Huang 1,*, S.-M. Kao 1, C.-L. Cheng 1 2, Y.-H. Yang-Kao 2 and PharmaSmart Team, National Cheng Kung
University Hospital, College of Medicine, National Cheng Kung University
1
Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung
University, 2Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National
Cheng Kung University, Tainan, Taiwan

Introduction: Efficient management of medicines in a medical centre's pharmaceutical warehouse is

crucial. This is why the use of modern logistics management techniques is essential. This QC circle
brings together pharmacists, pharmacy clerks and IT professionals to achieve significant improvements
in management standards and operational efficiency through a task-oriented QC story approach.

Methods: After analysing the current situation, the team identified six key areas for improvement.
They analysed potential discrepancies, challenges, and strategies, eventually selecting eight core
strategies for improvement. Based on current performance metrics, the daily time consumption for
activities such as checking, accepting, shelving, and picking is measured at 1200 minutes. The team
aims to improve operational efficiency by 10%.

The team used the PDCA (Plan-Do-Check-Act) cycle to implement successful scenarios for the eight
improvement strategies.

Establishment of Fixed Open Shelves: Replacing mobile shelving with fixed shelving reduces
occupational injury.

Electronicisation of shipping data: Suppliers are required to upload shipping data in the format
provided, facilitating data integration.

Establish a system to track batch numbers, expiry dates and quantities: Implement a system to track
batch numbers, expiry dates and inventory quantities. Improve management of expired and
backordered products, improve inventory utilisation and digitise inventory information.

Introduction of electronic labels and a lighthouse system: Introduction of electronic labels and a
lighthouse system linked to PDAs displaying electronic maps. Guide staff during picking, shelving and
ad hoc requests.

Establish a closed-loop feedback system for checking, receiving, shelving and picking: introduce a step-
by-step verification mechanism to ensure interlinked operations. PDAs identify picking lot numbers
and expiry dates, ensuring first-in-first-out compliance.

Schedule picking tasks in the information system: Distribute tasks evenly based on the average number
of workers for the day. The system interacts with PDAs to display tasks.

Placement of fixed shelves within the cold store: Create a cold store with fixed shelving to increase the
storage capacity for refrigerated medicines and simplify cold store management.

310
Design training according to job roles: Plan training based on trainees' specific roles. Conduct Direct
Observation of Procedural Skills (DOPS) assessments for operational skills.

Results: Primary goals:

Reduce daily work time from 1200 minutes to 705 minutes, achieving a 40% decrease.

The new system enables meticulous tracking and auditing of drug flow, reducing manual intervention
and establishing an information closed-loop.

Improvement Benefits:

1. Reduction in labor operation time and paperless operations result in annual savings of
approximately NT$ 405,000.

Six Additional Benefits:

Reduction in drug search time from 115.0 seconds per transaction to 47.5 seconds per transaction
(59% reduction).

The time taken to search for expired products per month has been reduced from 12 hours to 0 hours
(100% reduction).

The time taken to enter the half-yearly inventory data was reduced from 4 hours to 0 hours (a reduction
of 100%).

The production time for medication labels was reduced from 130.9 seconds per label to 10.0 seconds
per label (a reduction of 92%).

The accuracy of the acceptance data increased from 96.0% to 99.9% (an increase of 4%).

Picking accuracy increased from 88.0% to 99.7% (12.5% increase).

Intangible Outcomes:

Average employee satisfaction score greater than 4.

Use human factors engineering to reduce the physical and cognitive strain on staff.

Real-time batch number and expiry date checks enhance patient medication safety.

Conclusion: Processes are standardised and incorporated into the pharmacy management operations
manual. This improvement initiative can be extended to internal sub-warehouses within the hospital,
ensuring accurate management of medicines throughout the hospital.

Disclosure of Interest: None Declared

311
Point of Care Quality Improvement (POCQI) Model Implementation in Jordan: (3466) Heba Mezeyd

ISQUA2024-ABS-3466

H. Mezeyd 1,* and I am part of QI team who worked hard in training , coaching and reviewing QI
initiatives, who are : the lead : Dr. Haitham Al-dowiri , coworker: Ms. Rozalien Ayed

Training & Consultation , HSQA, Amman , Jordan

1

Introduction:

The demographic comprising women of childbearing age, pregnant mothers, postpartum women, and
children constitutes one of the largest segments within Jordanian community, necessitating sustained
and consistent healthcare services. Health centers serve as crucial role in delivering these services.
Consequently, our ongoing effort is to enhance the quality of care provided and enhance the
proficiency of healthcare providers comprehensively and continuously. We aim to achieve this by
empowering and building capacity the service providers with the expertise in quality methodologies,
models and tools for data, indicators, and monthly reports on service provision. This approach allows
for the identification of improvement opportunities and the subsequent implementation of scientific
and straightforward quality improvement methodologies to enhance and refine service delivery

Methods: The Activity team closely collaborated with the Ministry of Health (MOH) and Rpyal Medical
Services (RMS) to finalize the review of the current Quality Improvement (QI) structures, processes,
data use, and quality tools, focusing on RMNCH services. The review highlighted the main challenges,
identified areas for improvement, and determined priorities. The key recommendations were to
establish Quality Assurance and Patient Safety (QAPS) teams and build their capacity for QI. in
collaboration with the MOH/ Institutional Development and Quality Control (IDQCD) and the RMS
Quality and Inspection Division, established 140 QAPS teams with 867 nominated members at the
Activity’s 140 health facilities from the MOH and RMS. The Activity aims to empower the QAPS teams
to use health facilities’ RMNCH data to find quality gaps, undertake root-cause analyses in their own
contexts, and implement the solution(s) to address the identified quality problems by utilizing the
POCQI model. The established QAPS teams consist of 153 midwives, 178 nurses, 262 physicians, 118
quality coordinators and 155 others. The Activity engaged MOH staff from the IDQCD and Woman and
Child Health Directorate (WCHD) as facilitators for the training sessions to enhance their role in
supporting QAPS teams at health facilities. In close collaboration with the MOH/IDQCD and the RMS
Quality and Inspection Division, the Activity team developed QI training materials for both HCs and
hospitals. The Activity adapted WHO materials and the POCQI training materials to Jordan’s health
care context, translated the materials into Arabic,

The POCQI model enables QAPS teams to use facility RMNCH data to identify quality gaps (problems
or issues), undertake root-cause analyses in their own contexts, and identify and implement the
solution(s) to address the identified quality problem related to RMNCH.

Point-of-care quality improvement (POCQI) is a systematic approach to identifying and solving

problems and improving practices. It was developed by the World Health Organization (WHO), USAID,
and the All-India Institute of Medical Sciences (AIIMS). It is a tested, commonsense approach to
achieving incremental improvement in a short time using available resources. POCQI relies on the
following four steps to address gaps between current practices and desired standards: (1) Identify a

312
problem and define the aim. (2) Analyze and measure the quality of care. (3) Develop and test changes
to improve quality. (4) Sustain improvements.

Results: Results:

Throughout the period spanning 2022 to 2023, QAPS teams underwent rigorous training in the POCQI)
model, facilitated through a series of 40 workshops. Additionally, these teams received advanced
training sessions focused on various quality dimensions, patient safety, and Lean management
encompassing 45 workshops. Following the completion of these comprehensive training programs,
QAPS teams were further supported by conducting four coaching field visits to each health institution,
aimed at facilitating the development and implementation of quality improvement initiatives geared
towards enhancing service delivery. This concerted effort culminated in the formulation and execution
of a total of 303 distinct quality improvement initiatives, ultimately contributing to the enhancement
of the quality of healthcare services rendered, as table 1, some of these QI initiatives presented in the
fiest QAPS- Talks event

Table 1: Quality improvement Initiatives

QI Titles Specifications Number

Include all child services provided:

-Growth and development compliance

Child health care 88
-Vaccination compliance

-Anemia screening compliance

Include all maternal services:

Reproductive & -Antenatal care

194
maternal -Postnatal care

-Implementation Golden hour activities

Include all services provided to

Neonatal care 21
newborns in NICU

Total 303

Image:

313
Conclusion: It is not a study; it is activity to improve the quality of provided RMNCH services in Jordan
by build the capacity of health care providers

References: Implementation experience of the WHO SEARO model of point-of-care quality

improvement (POCQI). [Link]

Disclosure of Interest: None Declared

Using ultrasound guidance to reduce the rate of venous catheter repositioning: (2730) Hsieh Shih
Wei

ISQUA2024-ABS-2730

H. Shih Wei 1,*, W. Botang 1, L. wan-chen 1, W. Pei-jhen 1, W. han-ni 1 1, K. Shu-Chen 1, M. Tsai-He 1 and
no

intensive care unit, An Nan Hospital, China Medical University, Tainan, Taiwan
1

Introduction: Using ultrasound guidance to assist in the placement of venous catheters not only makes
medical procedures faster and more accurate, but also reduces patient fear and pain, enhancing the
quality of patient care.

314
Methods: In May 2021, our unit established the IV TEAM and conducted root cause analysis using
fishbone diagram and verified the true causes using the Pareto 80/20 rule. According to literature,
utilizing ultrasound-guided insertion for difficult venous catheterization can achieve a success rate of
up to 92%. Analysis of our unit's data from March 2021 to April 2021 showed a catheter reinsertion
rate of 61.2%, with 70% of patients having vascular fragility (37.5%) and severe edema (32.5%) as
predominant factors. Therefore, strategies were formulated to address these issues, including the
establishment of a dedicated intravenous catheterization team and the introduction of ultrasound
equipment to assist with catheter insertion. It is anticipated that the reinsertion rate of venous
catheters under ultrasound guidance will decrease to 27%.

Results: From March 2021 to April 2021, the catheter reinsertion rate in our unit was 61%. After
establishing the IV TEAM in May, the reinsertion rate decreased from 61% to 14.9% from November
to December, utilizing ultrasound guidance. The achievement rate was 135.38%, with a progress rate
of 75.6%. Monitoring of effectiveness was maintained from December 2021 to May 2022, with a
reinsertion rate of 13%, meeting the target value of 27%.

Conclusion: After establishing the IV TEAM, the average number of needle insertions for difficult
venous catheterization decreased from 4 to 1. This resulted in a reduction of nursing hours spent on
needle insertion by 1,752 hours per year and a saving of approximately 1,065,216 yuan in medical
material costs annually. Not only did this alleviate patient anxiety and fear caused by catheter
reinsertions, but it also addressed the challenges of inserting intravenous catheters in COVID-19
patients wearing level 3 protective equipment during the pandemic. Limited visibility and multiple
layers of gloves made the procedure more difficult, but IV TEAM intervention reduced contact time
with patients and improved needle insertion efficiency. Subsequently, efforts were made to enhance
the capabilities of IV TEAM members through horizontal dissemination, making intravenous catheter
insertion a distinctive feature of our hospital. This has led to quicker medical procedures, reduced
patient fear and pain associated with needle insertion, and an overall improvement in the quality of
patient care.

References: 1.

Brass, P., Hellmich, M., Kolodziej, L., Schick, G., & Smith, A. F. (2015). Ultrasound guidance versus
anatomical landmarks for internal jugular vein catheterization. The Cochrane database of systematic
reviews, 1(1), CD006962

2. Randolph, A. G., Cook, D. J., Gonzales, C. A., Andrew, M., & Canadian Critical Care Trials Group.
(1996). Ultrasound guidance for placement of central venous catheters: a meta-analysis of the
literature. Critical care medicine, 24(12), 2053-2058.

3. Troianos, C. A., Hartman, G. S., Glas, K. E., Skubas, N. J., Eberhardt, R. T., Walker, J. D., ... &
Reeves, S. T. (2012). Guidelines for performing ultrasound guided vascular cannulation:
recommendations of the American Society of Echocardiography and the Society of Cardiovascular
Anesthesiologists. Anesthesia & Analgesia, 114(1), 46-72.

Disclosure of Interest: None Declared

315
Improving Medication Safety for New Healthcare Staff with HFACS Human Factors Analysis and
Experiential Activity Teaching: (1998) HsiuHsia Weng

ISQUA2024-ABS-1998

H. Weng 1,*, Y.--.-C. liu 1, P.-H. Chiang 1, H.-J. Fang 1, H.-C. Chen 2, Y.-C. Su 1

ED, 2ND, Ditmanson Medical Foundation Chiayi Christian Hospital, CHIAYI, Taiwan
1

Introduction: During the COVID-19 pandemic, a global health disaster, new nursing staff experienced
significant workplace stress and obstacles to professional progress. Restrictions on in-person nursing
education and clinical internships have a negative impact on their clinical skills, communication, and
decision-making ability. Using the Human Factors Analysis and Classification System (HFACS), we
discovered unsafe medication administration behaviors among these new employees, such as skill-
based and decision-making errors, which were exacerbated by psychological stress, insufficient
supervision, and organizational culture issues. These considerations compromised patient safety while
also highlighting communication and psychological adaptation issues. We discovered key issues
through qualitative interviews, including communication hurdles, information reception difficulties,
fear, and difficulty with autonomous problem-solving and requesting support. In response, we offer
support and training measures aimed at strengthening new nursing staff's clinical skills and confidence,
increasing communication channels, and providing psychological support to increase their
occupational adaptation and overall medical quality.

Methods: To address challenges faced by new nursing staff, our improvement plan identifies core
issues: lack of operational skills, communication barriers, fear of the clinical environment, and
insufficient clinical guidance and organizational support. The most critical issues identified were the
lack of effective clinical guidance and support, followed by insufficient operational skills.

To tackle these issues, we propose the following improvement measures:

- Conducting consensus meetings for mentors to enhance their understanding and support for
new staff.

- Joint medical team support for new staff through welcome ceremonies.

- Promoting teamwork and communication skills through team communication games.

- Implementing gamified teaching, such as medication administration games,.

- Introducing a dual mentor system for targeted guidance through assessment and the
involvement of assistant mentors.

- Implementing a comprehensive mentorship mechanism and arranging "little angels" to provide

constant support and guidance for new staff.

Results: This study implemented improvement measures to address new nursing staff challenges,
aiming to boost their clinical skills, communication, and patient safety. Results showed high
engagement in team activities (92.43% attendance, 100% satisfaction) and counselor meetings
(83.72% attendance, 95% satisfaction), indicating the effectiveness of these measures. Over half of the

316
new staff (57.14%) benefited from a dual counselor system, enhancing foundational and
communication skills.

Significantly, communication self-efficacy among new staff increased from 36.26% to 73.46%, and
medication safety events caused by communication issues dropped to zero, markedly improving
patient safety.

Conclusion: These outcomes demonstrate that through organizational support, targeted training, and
team-building activities, it is possible to effectively improve the communication skills and clinical
abilities of new nursing staff, thereby enhancing patient safety and the quality of care. The successful
implementation of this improvement plan provides strong evidence on how to effectively support new
nursing staff and improve the quality of healthcare services, offering a viable model and reference for
similar future projects.

References: Yu-Hsun, Cheng., Sheng-Hui, Hung., Tung-Wen, Ko., Pa-Chun, Wang. (2020). Human
Factors Underlying Adverse Medical Events: Revisit Root Cause Analysis Cases Using the HFACS. doi:
10.3966/181020932020091803002

Khalafalla, F. G., & Alqaysi, R. (2021). Blending team-based learning and game-based learning in
pharmacy education. Currents in pharmacy teaching & learning, 13(8), 992–997.
[Link]

Disclosure of Interest: None Declared

Measuring Health system performance; a new approach to accountability and quality

improvement in Jordan: A qualitative study: (2797) Ibrahim Aqel

ISQUA2024-ABS-2797

S. A. Aitan 1, I. Aqel 1,*

Health, The Institute for Family Health/King Hussein Foundation, Amman, Jordan
1

Introduction: Accountability refers to the relationship through which an agent's behaviour is

evaluated against the predetermined standards. As described by (Emanuel and Emanuel, 1996a),
accountability initiatives seek to ensure that all patients receive care that is aligned with established
standards. In September 2020, the Jordan Strategy Forum published a report highlighting the various
challenges faced by the country's healthcare system. challenges included: The lack of transparency and
poor accountability, inadequate mechanisms for collecting data and publishing it, and the weak ability
of local communities to call for accountability and determine priorities based on actual need. The
report also indicated that performance and appraisal systems in the public health sector do not link
performance to incentives, and there is a lack of systems that are designed to monitor and improve
the performance of health sector employees. Based on the above data, there is a need for more
investigation into the currently available accountability mechanisms, tools, and systems in the
healthcare sector in Jordan. The primary purpose of this research is to explore and describe current

317
performance accountability mechanisms, systems, frameworks, and tools available in the health sector
in Jordan, identify gaps, and guide health policy leaders during the process of reforming accountability
in the healthcare sector in Jordan.

Methods: This study is trying to unfold and shed light on issues related to accountability in the health
sector in Jordan, identify gaps, and guide health policy leaders during the process of reforming
accountability. The researcher believes that the best choice of philosophy for this research is
pragmatism. Qualitative research methods were employed to capture the rich experiences, and
perspectives of various stakeholders, including healthcare professionals, administrators, service
providers, and health policymakers. This research study utilized a qualitative research design,
specifically employing in-depth interviews and focus group discussions. Approval to conduct the
research was obtained from the Research Ethical Committee. The analytical techniques used included:
Thematic Analysis which includes the identification of recurring patterns and themes in the data, and
triangulation where regular meetings were conducted with professionals to discuss emerging themes,
resolve discrepancies, and ensure intercoder agreement.

Results: What are the key factors that influence accountability in healthcare institutions in Jordan?

The in-depth interviews and focus group discussion analysis revealed several key factors including:

Legal and Regulatory Frameworks

Governance and Leadership

Transparency and Information Sharing

Patient Rights and Involvement

Quality Assurance and Performance Monitoring

Professional Ethics and Conduct

Stakeholder Engagement and Collaboration

Adequate Resources and Infrastructure

Continuous Learning and Improvement

Licensing and Certification.

Supervision and Peer Review

Complaint and Feedback Mechanisms

Peer Pressure and Professional Reputation

External Oversight

Clinical Governance

318
What are the current accountability systems, mechanisms, and tools available in the healthcare
sector in Jordan?

Laws, bylaws, and regulatory legislations: such as the Jordan Public Health Law No. 47 of 2008, and
the Medical and Health Liability Law No. 25 of 2018.

Healthcare Regulatory Bodies such as the Jordanian Ministry of Health, the Jordan Medical Council
(JMC), and the Health Care Accreditation Council (HCAC).

Licensing and Certification

Health Care Accreditation

Clinical Practice Guidelines

Incident Reporting Systems

Patient Complaint Mechanisms to address grievances and concerns.

Performance Indicators and Quality Metrics: include patient satisfaction surveys, clinical outcome
measures, infection rates, and adherence to best practices.

Electronic Health Records (EHR)

What are the gaps and challenges facing the current accountability systems available in the
healthcare sector in Jordan?

The in-depth interviews and focus group discussion analysis identified the following Accountability
System gaps:

- At the central ministry level: the gaps related to systems, policies, laws, legislation, regulations, and
structures due to the absence of a national accountability framework, for clinical governance, and the
lack of performance-based regulations for incentives, penalties, and benefits and the unavailability of
unified Clinical guidelines at a national level and outdated job descriptions.

- At the facility level: the a lack of equal distribution of human and financial resources, a lack of
adequate capacity-building and training, a lack of a structured performance-based supervision system,
and a lack of mechanisms for linking performance to outcomes.

- At the service providers' level: the lack of updated Job descriptions and performance indicators based
on competencies, inadequate work environment, the lack of incentive schemes, lack of needs-based
capacity building, and absence of structured clinical/technical supervision.

- At the community level: the lack of effective Communication Channels and the absence of Public
Performance Reporting.

What strategies, frameworks, and mechanisms can be proposed to enhance accountability in the
healthcare sector in Jordan?

319
Based on the findings from the interviews and focus group discussion; a multi-level bottom-up and
top-down framework for healthcare accountability in Jordan is suggested to be implemented. The
framework suggests using specific accountability mechanisms at the following different levels:

Legislature Level (Parliament & Senate councils)

Central Government Level

Ministry of Health Central Level

Regulatory and Quality Agencies Level

Governorate (District) Level

Facility Level

Service providers Level

Service Recipients Level

Community Level

Conclusion:

In conclusion, this qualitative research study aimed to explore the concept of accountability in the
health sector in Jordan. Accountability is a complex and multifaceted concept. The research revealed
that accountability mechanisms in the Jordanian health sector face several challenges such as a lack
of multilevel accountability mechanisms, and the presence of bureaucratic barriers. The study
identified gaps at different levels in the central ministry, facility, service provider, and community. It
also emphasized the role of different stakeholders in promoting accountability in the health sector.
Recommendations stemming from this research include strengthening the capacity of healthcare
professionals to understand and implement accountability principles, allocating sufficient resources,
and fostering a culture of transparency and integrity within healthcare organizations. Overall, this
qualitative research study sheds light on the challenges and opportunities surrounding accountability,
it offers a foundation for further discussions and actions to enhance accountability practices and
improve the overall quality of healthcare services in the country.

Disclosure of Interest: None Declared

320
Care Behavior Impact and Acceptability of Scope-Based Structured Point of care obstetric
ultrasound (SPOUS) provided at Point of practice in Selected Rural Primary care setups in Ethiopia:
(2816) Ishmael Shemsedin

ISQUA2024-ABS-2816

E. Abate 1,*, T. D. Darebo 1, Z. Seife 1, A. Kedir 1, B. Abera 1, A. Girum 1, B. Teklewold 1, I. Shemsedin 1 and
Dr. Bethelihem Abegaz, Dr. Tsion Hiwot, Dr. Merry Miressa and Dr. Hayat Abdi are part of this working
group.

Healthcare System Impact Syndicate Africa, Addis Ababa, Ethiopia

1

Introduction: The world health organization recommend at least one ultrasound assessment for all
pregnant women before 24th week of gestation for better maternal and neonatal outcome. Resource
limited settings however struggle to provide such care due to lack of adequate obstetricians and
radiologist to preform the procedure. There have been successful reports of skill retentions after
training midlevel professionals including midwives and primary care physicians to perform limited
scope obstetric ultrasound. The successful skill acquisition, however, has not translated into effective
ultrasound care access as a result of failure of the care system to learn to initiate and sustain the
service. In this study, we evaluate the acceptability and Care behavior impact of a training package,
SPOUS, that includes joint optimization of Intensive skill transfer at point of practice, Service
management coaching, and Skill retention decision support design in selected rural primary care
settings in Ethiopia.

Methods: The SPOUS training program consists of two main components: intensive training for 1 week,
on-site training for 5 weeks, and finally competency measurement, which was determined using an
objective, structured assessment of ultrasound skill (OSAUS) and a written exam. The curriculum
integrates 1. Focused scope with structured intensive skill transfer at the setting of subsequent practice
to ensure contextual fidelity 2. Ultrasound service management/improvement training and in-person
coaching to initiate system learning 3. 25 videos in the two major languages in the country of Amharic
and Oromifa to provide opportunity for continuous self-learning and decision support for skill
retention and augmentation. We utilized the Kirkpatric Four Level Training Evaluation Model to analyze
reaction, learning, behavior, and result of the SPOUS training during, at the end, three and six months
after completion. A pre-post evaluation was performed among 10 selected out of 54 im[lementation
facilities in three regions of Ethiopia. Data were collected retrospectively for six months before
(January 2023-June 2023) and six months after (July 2023-December 2023) the implementation. We
conducted Kirkpatrick level three and level four assessments to measure changes in trainees'
application of E-SPOUS, R-SPOUS, and D-SPOUS protocols; and measured intermediate maternal and
fetal health outcomes. We analyzed the average change in the level of utilization and overall trend
improvements using a run chart. Six data points above the median after the implementation of the
intervention will be categorized as a statistically significant change. The SPOUS is a registered and
accredited obstetric ultrasound course in Ethiopia.

Results: Over a period of six months, 9341 pregnant rural women underwent SPOUS scans. Among
them, 214 cases of retained products of conception, 9 ectopic pregnancies, and 25 adnexal masses
were diagnosed by employing E-SPOUS protocol for emergency personations; R-SPOUS protocol
performed for routine antenatal assessment identified 24 cases of anencephaly and 20 cases of

321
hydrocephalus. D-SPOUS protocol utilized for decision making near term detected 97 cases of
oligohydramnios, 53 cases of polyhydramnios, and 194 cases of non-reassuring fetal heart rate status.
A significant increase was observed in the utilization of antenatal care, deliveries, and medical abortion
services, whereas maternal referrals for ultrasound services decreased significantly. However,
challenges related to the lack of supplies and maintenance of instruments were found to be obstacles
to the sustainability of the observed improvements.

Image:

Conclusion: Implementation of the SPOUS curriculum that include focused and scope based structured
skill transfer, system learning, skill retention and decision support design is acceptable to mid-level
professionals; can be retained and improve care behaviour to diagnose and timely manage critical
obstetric conditions. The introduction of SPOUS in PHC settings also led to increased utilization of safe
maternal health services. Issues related to continuous supply of inputs and maintenance capacity need
to be addressed. Further investigation are required to analyse the long term impact and sustainability
of the SPOUS intervention.

References:

Disclosure of Interest: None Declared

322
NON-CLINICAL SPECIFIC INTERVENTIONS TO IMPROVE PATIENT SAFETY IN PERIOPERATIVE CARE
PROCESS: AN UMBRELLA REVIEW: (2007) Janne Kommusaar

ISQUA2024-ABS-2007

J. Kommusaar 1,*, J. Pühvel 1, M. Kangasniemi 1, Y. Emond 2, A. Heideveld-Chevalking 2, H. Calsbeek 2, K.

Põlluste 1

University of Tartu, Tartu, Estonia, 2Radboud university medical center, Nijmegen, Netherlands
1

Introduction: In Europe around 10% of patients admitted to hospitals experience adverse events, and
perioperative care is one of the most reported fields. Adverse events have been found to cause patient
harm and increase costs, highlighting the need for tailored interventions. Non-clinical specific patient-
safety interventions refer to interventions related to patient safety beyond direct patient care. This
umbrella review aims to identify effective non-clinical specific interventions to improve patient safety
in the perioperative care process in adult patients and to describe the quality of evidence of these
interventions.

Methods: We carried out an umbrella review1 with registration in PROSPERO (CRD42023397419).

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram was
followed. We carried out both electronic and manual searches for systematic reviews and meta-
analyses on interventions to improve adult patients' safety across the perioperative care process.
Electronic searches were made in PubMed, Scopus, CINAHL, PsycINFO, and Cochrane databases.
Manual searches were carried out in the reference lists of the included studies to identify additional
relevant studies. Our inclusion and exclusion criteria were based on PICO. Reviews were included when
published between 2012 and 2022, clearly described the used methodology, and involved more than
one surgical subspecialty. The selection was done by two researchers’ independent assessment and by
a third reviewer if consensus was not reached.

Results: Based on the electronic searches, 4,609 publications were identified. After title and abstract
screening, 133 publications were selected for full-text screening, out of which 32 met our inclusion
criteria. After hand-searching the reference lists of included reviews, 30 studies were added.
Altogether 62 systematic reviews and meta-analysis were included in the umbrella review. The overall
methodological quality of the studies was moderate to high. Three types of non-clinical-specific
effective interventions were identified: enhanced recovery after surgery (ERAS) or fast-track surgery
(FTS), the use of checklists, and patient-related interventions. The first two are effective in improving
general patient safety outcomes such as complications, infections, and length of hospital stay. While
patient-related interventions such as music, aromatherapy, massage, educational interventions,
mental simulation practices, psychosocial techniques, and psychological preparation have a positive
impact mainly on patient-reported outcomes like pain and anxiety.

Conclusion: Several effective non-clinical specific interventions focusing on different patient safety
outcomes can be deployed to improve perioperative care. The moderate to strong methodological
quality of the included studies is in favor of the findings of this umbrella review. Most evidence for
effective interventions was found for ERAS / FTS, the use of checklists and patient-related
interventions. There is limited hard evidence to state which part(s) of the interventions have led to
certain, specific improvements. Therefore, more studies are needed.

323
This research is funded by the European Union’s Horizon Europe research and innovation programme
under grant agreement No 101057825 (SAFEST project).

References: 1. Aromataris, E., Fernandez, R., Godfrey, C. M., Holly, C., Khalil, H., & Tungpunkom, P.
(2015). Summarizing systematic reviews: methodological development, conduct and reporting of an
umbrella review approach. International journal of evidence-based healthcare, 13(3), 132–140.
[Link]

Disclosure of Interest: None Declared

Determinants of Inpatient Satisfaction in a Post-Acute Care Rehabilitation Hospital in the US:

(1988) Jing Xu

ISQUA2024-ABS-1988

J. Xu 1,*, S. Park 1

Health Administration, University of North Florida, Jacksonville, United States

1

Introduction: Patient satisfaction has been a significant factor in determining individual hospitals'
quality of care and a metric to help patients choose the right healthcare provider and facility. While
ample research examines the factors affecting patients' experience of care in acute care hospitals,
there is limited information on determinants of inpatient satisfaction for post-acute care facilities,
especially in freestanding rehabilitation hospitals. This study aimed to examine how specific hospital
service domains influence final Press Ganey (PG) scores, patient rating on the overall quality of care,
and willingness to recommend the hospital to others in a rehabilitation hospital in the state of Florida,
United States.

Methods: We utilized discharge data and PG patient satisfaction data from 2010 through 2019. The
independent variables included the patient satisfaction ratings for each hospital service domain.
Dependent variables were the final mean PG Score, overall rating of care, and the likelihood of
recommending the hospital to others. Multivariate logistic regression was conducted to model the
probability of "1" (extremely satisfied) versus 0 (good, fair, poor, and very poor), adjusting survey year,
diagnosis program, discharge location, length of stay, average therapy minutes per day, age, and
gender. No patient identification in the dataset, so the study was issued a Waiver of IRB review at the
University of North Florida.

Results: The results of this study contribute to our knowledge of the major hospital service domain
determinants of positive patient experience in a rehabilitation hospital setting. This study found the
personal issues domain to be the most important factor in determining the final mean PG Score, overall
rating of care, and likelihood to recommend the hospital to others, followed by physical therapist,
nurse, discharge, and food domains. Within the personal domain score, pain control, staff promptness,
and explanation upon arrival were areas identified as opportunities to make improvements that would

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result in the greatest positive effect. Other areas identified for maximizing effect within the nursing
care domain included nurse instruction for home care and satisfaction with the night nursing staff.

Image:

Conclusion: The results of this study contribute to our knowledge of the major hospital service domain
determinants of positive patient experience in a rehabilitation hospital setting. The findings presented
here may result in providing actionable insights that can be used to improve the patient experience.
Focused strategic improvements based on survey results at individual healthcare facilities can improve
patient experience scores, which may lead to better patient health outcomes.

References: Elliott, M. N., Lehrman, W. G., Goldstein, E., Hambarsoomian, K., Beckett, M. K., &
Giordano, L. A. (2010). Do hospitals rank differently on HCAHPS for different patient
subgroups? Medical care research and review: MCRR, 67(1), 56–73.
[Link]

Park, S., Xu, J., Smith, F. S., & Otani, K. (2020). What Factors Affect Patient Perceptions on Their Hospital
Experience?. Hospital topics, 98(3), 127–134. [Link]

Otani, K., Waterman, B., Faulkner, K. M., Boslaugh, S., & Dunagan, W. C. (2010). How patient reactions
to hospital care attributes affect the evaluation of overall quality of care, willingness to recommend,
and willingness to return. Journal of healthcare management / American College of Healthcare
Executives, 55(1), 25–38.

Hush, J. M., Cameron, K., & Mackey, M. (2011). Patient satisfaction with musculoskeletal physical
therapy care: a systematic review. Physical therapy, 91(1), 25–36.
[Link]

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O'Keeffe, M., Cullinane, P., Hurley, J., Leahy, I., Bunzli, S., O'Sullivan, P. B., & O'Sullivan, K. (2016). What
Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic
Review and Meta-Synthesis. Physical therapy, 96(5), 609–622. [Link]

Xu, J., Park, S., Xu, J., Hamadi, H., Zhao, M., & Otani, K. (2022). Factors Impacting Patients' Willingness
to Recommend: A Structural Equation Modeling Approach. Journal of patient experience, 9,
23743735221077538. [Link]

Disclosure of Interest: None Declared

Facilitators and barriers of critical care nurses’ alarm customization on the physiologic monitor: An
interpretive descriptive study: (3300) Liqing Yue

ISQUA2024-ABS-3300

H. Nie 1,*, B. Li 1, L. Yue 1. 1Xiangya Hospital of Central South University, Changsha, China

Introduction: Physiologic monitor alarms are frequent in the ICU and dominated by clinically irrelevant
alarms, leading to severe alarm fatigue of critical care nurses and threatening patient safety. Alarm
customization means that parameters are personalized and dynamically adjusted according to the
patient's condition, which reduces clinically irrelevant alarms. Thus, customization may help solve the
dilemma of alarm fatigue. However, little is known about the factors influencing the alarm
customization of critical care nurses. This study was conducted to explore the facilitators and barriers
of alarm customization by critical care nurses.

Methods: This descriptive qualitative study was conducted in 2023 using video-call interviews.
Eighteen nurses were purposively sampled from nine intensive care units in a tertiary academic
hospital in China. Topic guides for the interviews were developed based on the COM-B model. The six-
step approach to thematic analysis recommended by Braun and Clarke (2006) was used to guide the
process of data analysis.

Results: Facilitators for alarm customization in the ICU included initial and ongoing training, standards,
inspection, positive alarm culture, duty and goals, and incentives. Barriers for alarm customization
included conflict of nursing tasks, lack of specific standards of alarm settings for specific diseases or
special conditions, aging equipment and inconsistent branding, and alarm fatigue. Knowledge and
skills were found to be conditional factors of alarm customization.

Conclusion: Comprehensive strategies such as standards, training and inspections are necessary to
improve adherence and safety of alarm customization in the ICU, and quality improvement projects
are an effective way to achieve this goal. More attention should be paid to critical care manpower
allocation, intelligent alarm setting solutions, and group standards for the alarm customization for
specific diseases. Our findings provide information for a better understanding of critical care nurses’
alarm customization in Chinese context and offer a reference for developing more specific strategies
to facilitate alarm safety.

Disclosure of Interest: None Declared

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Day 3 – Friday 27th September

Morning

Short Orals

What are the key patient experiences driving overall rating of cancer care? Insights from the Swiss
Cancer Patient Experiences (SCAPE-2) study: (3417) Chantal Arditi

ISQUA2024-ABS-3417

C. Arditi 1,*, V. Jolidon 1, M. Eicher 2 3, I. Peytremann-Bridevaux 1

1
Department of Epidemiology and Health Systems, Center for Primary Care and Public Health
(Unisanté), University of Lausanne, 2Institute of Higher Education and Research in Healthcare (IUFRS),
Faculty of Biology and Medicine, University of Lausanne, 3Department of Oncology, Lausanne
University Hospital (CHUV), Lausanne, Switzerland

Introduction: Collecting patients’ experiences with care provision is essential to evaluate the quality
of care in general, and patient-centeredness in particular, one of the core dimensions of high-quality
care. These experiences are typically gathered through patient experience surveys with multiple
questions designed to capture experiences throughout the entire care pathway. Determining which
specific aspects of patient experience are the most crucial and require prioritization to enhance quality
of care is challenging. The objective of this secondary analysis of a patient experience survey in cancer
care was to identify the main drivers of patients' overall cancer care rating among various patient
experience items.

Methods: Data from 2750 patients diagnosed with cancer from the Swiss Cancer Patient Experiences-
2 (SCAPE-2) study were included in the analyses. This cross-sectional survey, conducted in eight Swiss
hospitals from September 2021 to February 2022, collected data with a self-administered
questionnaire, including questions on experiences of care, as well as socio-demographic and clinical
characteristics. Two patient partners were involved in various activities throughout the study, such as
pre-testing the questionnaire, developing the patient study materials, preparing lay summaries of
findings for respondents, and disseminating results. The study was approved by the Cantonal Research
Ethics Committee, Vaud (CER-VD). We used stepwise logistic regressions to analyze the relationship
between the overall rating of cancer care and 29 patient experience items, adjusting for sex, age, self-
rated health, financial hardship, and health literacy.

Results: The average rating for patients’ overall cancer care experience was 8.9 on a 0-10 scale. In
separate regression models, every patient experience item was significantly associated with overall
care rating. Adjusted stepwise regressions indicated that seven drivers, covering six of the eight
dimensions of patient-centered care, contributed significantly to overall care rating in the final model.
The most influential drivers related to the coordination and integration dimension (“professionals
working well together” and “tests and exams not repeated unnecessarily”) and physical comfort
dimension (“being offered advice and support to deal with symptoms”). Additional drivers included
“Hospital staff ensuring availability of support/equipment at home”, “Being offered to see health
professional for emotional support at diagnosis”, “Treatment options being explained” and “Being
involved in treatment decisions”.

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Conclusion: Among the 29 patient experience items of the multidimensional SCAPE questionnaire,
seven were associated with overall rating of cancer care. By directing attention to these particular
areas, hospitals can improve the overall patient experience, as well as effectively allocate resources for
initiatives aimed at enhancing patient experience.

Disclosure of Interest: None Declared

Improving patient participation in value improvement teams: An action research study: (1392) Jet
Jeltje Westerink

ISQUA2024-ABS-1392

J. J. Westerink 1 2,*, M. Garvelink 1, N. van Uden 3, H. Bart 4, P. van der Wees 2, P. van der Nat 1 2
1
Value Improvement, St. Antonius hospital, Nieuwegein, 2IQ Health, RadboudUMC, Nijmegen,
3
Santeon, Utrecht, 4Independent patient advocate, Kortenhoef, Netherlands

Introduction: The concept of Value Based Health Care (VBHC) has emerged as a prominent movement
in healthcare over the past decade. It entails organizing care with a primary focus on increasing value
for patients, where value is defined as patient relevant outcomes relative to the costs for achieving
these outcomes. Within a VBHC system, actively involving patients is crucial for understanding their
perspectives on relevant outcomes and value. Despite the pivotal role of patients in VBHC, studies
consistently highlight a concerning lack of patient participation in VBHC initiatives. Therefore, we
aimed to improve patient participation within VBHC teams. This study evaluates the impact of our
efforts to improve patient participation and provides insight into the overall lessons learned.

Methods: This study is currently conducted in the seven Dutch Santeon hospitals (March 2023 –
September 2024). These hospitals have implemented VBHC via Value Improvement (VI) teams. Each
hospital has multidisciplinary VI teams for 15 medical conditions. More details on the Santeon
approach can be found in the article of Engels et al [1].

This study is designed according to the principles of action research (AR). Seven different VI teams (one
team in each hospital) were selected for this study via purposive sampling based on differences in
health conditions and level of patient participation at the start (Table 1). Within these 7 teams, the
cyclical steps of AR are followed to improve patient participation, i.e. the orientation phase, planning
phase, action phase, and evaluation phase. The first step was to clearly define the goals for patient
participation for each team (orientation phase). Based on these goals, different actions to improve
patient participation were selected (planning phase) and are currently being implemented (action
phase).

To evaluate improvements in patient participation, qualitative observations and minutes of meetings

with the VI teams are being collected. Furthermore, data collection includes quantitative observations
and responses to the Public and Patient Engagement Evaluation Tool (PPEET) questionnaire (which is
sent out every 6 months to all VI teams) [2]. The response choices for the PPEET comprise a 5-point

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Likert-type scale, ranging from total disagreement to total agreement. Qualitative data is thematically
analyzed and quantitative data of the first PPEET measurement is presented with descriptive statistics.

This study has been approved by the Medical Ethics Committee (W23.022). Participants gave informed
consent to use their data for the study.

Results: So far, we found that patient participation is often seen as a separate ‘project’ for a VI team,
instead of standard practice within the team. Secondly, we found that it is important to assign
responsibility for patient participation both on team-level as on organization-level. At the team-level,
this responsibility includes supporting patient VI team members and creating awareness for
opportunities for patient participation. At the organizational level, it should be made clear who is
responsible for and available to support patient participation activities. Thirdly, we found that VI teams
that have formal responsibility for the value of care of the entire patient journey seem to be more
open towards input from patients compared to project teams with more limited responsibility for value
of care.

The first PPEET results showed that AR contributes to setting up goals for patient participation (%
(total) agreement AR teams= 67%; other teams=29%) and making action plans for patient participation
(% (total) agreement AR teams= 60%; other teams=25%). Furthermore, 80% of the VI team members
that participate in the AR would like to participate in a training on patient participation, compared to
40% of the other team members. Lastly, only 29% of the VI team members indicate having sufficient
resources to plan and execute patient participation.

Image:

Conclusion: This is the first study that is actively working on improving and evaluating patient
participation within a VBHC context. Our preliminary results indicate that our efforts to improve
patient participation have contributed to improved goals for patient participation, setting up action
plans for patient participation, and gaining insight into facilitators for implementation of patient
participation. In the upcoming eight months, the VI teams will continue with the action phase, and

329
data will be analyzed to determine the impact of our efforts to improve patient participation and
overall lessons learned for successful implementation of patient participation. Based on these insights,
we will develop a good practice model for patient participation within VI teams, which will be finalized
and presented at the conference in September.

References: [1] [Link]

[2] [Link]

Disclosure of Interest: None Declared

Patient/Family Advisors Co-designing Healthcare Quality & Safety Improvement - From Planting
Seeds to Driving Transformation: (1412) Dr. Katharina Kovacs Burns

ISQUA2024-ABS-1412

K. D. Kovacs Burns 1 2 3,*, M. George 4

1
Clinical Quality Metrics/Data & Analytics, Alberta Health Services, 2Patients for Patient Safety Canada,
3
School of Public Health, University of Alberta, 4Provincial Patient & Family Advisor Council, Alberta
Health Services, Edmonton, Canada

Introduction: Transforming or “making a difference” in healthcare quality and safety requires active
involvement of those affected in delivery as well as receiving care. Over the past decade, more efforts
by healthcare services or organizations include co-production or co-design where care providers
partner with patients and families in different ways to improve the delivery of safe and quality care
experience, and where patients and families are more then recipients of care and supports. The
challenge is to ensure that those involved are comfortable and ready to co-design. Readiness comes
with capacity building of those involved. To clearly understand the barriers and challenges around co-
design readiness for quality and safety improvement or sustained transformation, there needs to be
real-time co-design orientation, implementation and evaluation. The objective of our work was to (1)
bring together key stakeholders of patients, families, care providers, and leaders in quality, safety and
policy to explore and map out the essential components of co-design as related to quality and safety
improvements in care; (2) co-develop a co-design approach that could be implemented in different
care settings; and (3) evaluate the outcomes of the co-design process as well as resulting
improvements in patient experiences with the quality and safety of their care.

Methods: It was proposed that a 'Co-design Orientation 101' framework be developed to guide
understanding, readiness of all involved, implementation and evaluation of effectiveness, process and
other outcomes related to the co-design approach itself, as well as the quality and safety improvement
initiatives. Different care setttings were approached (i.e. acute, home care, continuing care, long term
care and others). Sites in agreement to apply co-design recruited staff, care providers, leaders and
patient/family advisors to be actively involved as care setting teams throughout the process. Each care
setting team participated in identifying what they needed to understand the reality of quality and

330
safety in their settings (e.g. existing patient safety and care experience data; safety issues, etc.), and
what they felt they needed to implement their co-designed plans and activities with the intent of
improvng or transforming their quality and safety outcomes. Developmental evaluation was
embedded throughout the co-design process to gather the experiences and perceptions of all
stakeholders involved. Real-time patient/family experiences were gathered via interviews/survey pre
and post quality/safety improvement iniatives for each care setting. Quality and safety metrics were
reviewed at team meetings to inform any further actions needed.

Results: Over three years excluding during the COVID pandemic, the co-design approach was
implemented and evaluated specifically as applied to quality and safety improvement in 22 care
settings, involving 69 staff/care providers and 17 patient/family advisors. As the co-design process
unfolded in each care setting there was confirmation of what an appropriate co-design approach was.
Experience data gathered from care setting team members determined that an orientation and four-
phased co-design implementation approach for quality and safety improvement worked best.
Experiences overall were positive and affirming for the co-design approach and outcomes achieved.
Themes emerged for each of the four phases of the co-designed work - for example, "having clear
direction for work planned/proposed", :engaging in quality improvement decisions" and "making a
difference". Real-time patient/family experiences gathered also indicated improvements in various
quality and safety areas - e.g. reduction in noise levels enhanced patients' much needed rest/sleep
and reduced stress levels.

Conclusion: The evaluation of the four-phased co-design implementation approach was determined
to be the best approach for care settings to improve and transform their efforts around quality and
safety in their care delivery. More so, care setting teams learned to co-design and experienced the
benefits of co-designing quality and safety improvement for their care settings. They felt they made a
difference in the overall experiences of patients and families. The resulting Kovacs Burns & Geoge co-
design orientation guide for healthcare quality and safety improvement has been published and is
available for teams to explore and apply.

Disclosure of Interest: None Declared

Understanding the influence of co-design on distress, clinical decision making and disease self-
management of cancer patients-as-partners: a quasi-experimental study: (2015) Zahraa Al
Raychouni

ISQUA2024-ABS-2015

A. Dayekh 1,*, Z. AlRaychouni 2

331
1
Doctoral school of health sciences, University of Pécs , Pécs , Hungary, 2Patients Affairs Department ,
Saint Georges Hospital Hadath , BeirutureB, Lebanon

Introduction: Cancer is regarded as a major worldwide burden. Patients diagnosed with cancer are at
risk of multi-system complications despite the availability of cancer treatment options. Cancer patient
distress has been linked to disease progression. Studies show that patient engagement strategies affect
clinical decision making process and disease self-management; therefore, alleviate patient’s clinical
outcomes. The optimal engagement method is the patient partnership model of care that integrates
patient’s expertise into comprehensive co-design of healthcare system.

Methods: This is the first study to investigate the impact of partnership with cancer patients on distress
level. It also evaluates the cancer patient-as-partner experience, and assesses the influence of
partnership model of care on clinical decision making process and disease self-management. It is a
quantitative and quasi-experimental study that adopted partnership committee at a Lebanese
hospital. A stratified random sampling approach was used, and data was collected by self-administered
structured questionnaires. We utilized the standardized distress thermometer and Public and Patient
Engagement Evaluation Tool.

Results: We recruited 100 Patient partners. PP characteristics had no significant association with
partnership experience. Cancer patients as partners had optimal engagement experience in quality
improvement project (Mean = 4; SD = 0.4). Participants ‘agreed’ to ‘strongly agreed’ (3.9 ± 0.5) (85.6%
response frequency) that were satisfied with this engagement initiative and found it a good use of
their time. The main partnership benefits were improved hospitalization experience and patient
satisfaction (49%), patients’ ability to express their opinion (39%), distress relief (21%), hospital
reputation enhancement and patient loyalty (21%). Almost half of PP reported no challenges faced
(49%). Recommendations for improvement were training (19%), team dynamics management (12%),
and proper time allocation (7%). Distress level post the implementation of partnership approach was
significantly reduced (t = 12.57, p < 0.0001). This study highlights the importance of patient partnership
and its ability to influence shared decision making preference [χ2(2) = 13.81, p = 0.025] and self-
management practices index [F(3, 11.87) = 7.294, p = 0.005].

Conclusion: Research findings suggest that partnership model of care can shape the healthcare system
into people-oriented culture that drive better patient clinical outcomes and high quality care. Further
research is needed to explore diverse PP engagement methodologies and their effect on organizational
growth and development.

Disclosure of Interest: None Declared

332
Building bridges between people, systems and organisations: transformative system and practice
improvement through in Touch Residential Aged Care Facility Pathway: (2157) David Greenfield

ISQUA2024-ABS-2157

D. Greenfield 1,*, J. Ellis 2, K. Eljiz 1, J. Medlin 2, A. Derrett 2, G. Loy 2

Faculty of Medicine and Health, School of Population Health, University of New South Wales,
1

Western Sydney Local Health District, Sydney, Australia

2

Introduction: Person-centred care with enhanced care co-ordination promotes high quality, safe
health services, organisational resilience and meets community expectations. Intention to reality,
however, remains a challenge; there is a need to overcome fragmentation and integrate services within
the health sector – between acute, primary and aged care - and across the health and community care
sectors. The study aim was to identify changes for patient-centric care with enhanced care co-
ordination across health and community care sectors.

Methods: The case study uses document analysis (n=10 documents; n=15 websites) and discussions
with key informants (n=9). The study focuses upon the inTouch Residential Aged Care Facility Pathway
(RACFP) implemented by Western Sydney Local Health District across 2022-23.

Results: inTouch RACFP – one of four redesign pathways within a broader innovation program - is a
holistic, system approach to reconceptualising service delivery. inTouch RACFP was necessitated due
to three contextual drivers for improved integration between acute, primary and aged care sectors:
service demand, state contextual policy directions and a national judicial commission. Together these
instigated organisational cultural changes to how care was governed. Changes were achieved through
three mechanisms: redesigned community care pathways; a dedicated access point for acute services;
and, enhancements to virtual care capacity, decision making tools, and quality and safety
measurements. To realise, and sustain, integration and improvements changes occurred at four levels:
cultural – governance and attitudinal approaches to delivering care; system – incentives and models
directing how care is planned, monitored and evaluated; technical – sharing of information and
knowledge; and, practice – decision making and care coordinating on a daily basis.

Conclusion: Collaborative strategies, across services and sectors, simultaneously at multiple levels are
required for successful redesign outcomes. The inTouch RACFP approach is a demonstration of
improved health planning and system improvement. The outcome being patient centred integrated,
flexible, timely and optimised care for individuals and populations.

Disclosure of Interest: D. Greenfield: None Declared, J. Ellis Employee of: Works in WSLHD which is
the study site, K. Eljiz: None Declared, J. Medlin Employee of: Works in WSLHD, which is the study site,
A. Derrett Employee of: Works in WSLHD, which is the study site, G. Loy Employee of: Works in WSLHD,
which is the study site

333
Medication Review in Patients on Polypharmacy: Insights from Integrated Care Data: (3371) Derryn
Lovett

ISQUA2024-ABS-3371

T. Woodcock 1,*, D. Lovett 2, G. Ihenetu 1, P. Aylin 1 on behalf of NIHR ARC Northwest London
Polypharmacy Steering Group, L. Li 1, V. Novov 1, G. Greenfield 1 and NIHR ARC Northwest London
Polypharmacy Steering Group

School of Public Health, Imperial College London, 2NIHR ARC Northwest London, Chelsea and
1

Westminster Hospital NHS Foundation Trust, London, United Kingdom

Introduction: Polypharmacy, where patients are prescribed of multiple medications, is a major

challenge for health systems internationally (1-3). Polypharmacy is associated with increased rates of
adverse drug events (4), reduced medication adherence (5), and higher drug costs (6). As such
medication reviews are an important element of care for patients on polypharmacy. There have been
no studies of polypharmacy prevalence, medication cost, and provision of medication reviews at a
population level in England.

Aim: To determine prevalence and medication cost of polypharmacy, and understand potential health
inequalities in provision of medication reviews, by patient characteristics.

Methods: Retrospective cohort study of North West London integrated health and care records. We
used SNOMED dispositions to classify and count regular medications, and defined polypharmacy to be
more than five regular medications prescribed during the study period (2022). We quantified
prevalence and medication cost of polypharmacy, by demographics and frailty. We fitted mixed-effects
logistic regression models for polypharmacy, and for medication reviews. We created a funnel plot to
show variation by GP practice in provision of medication reviews. A patient representative contributed
to all stages of the project through the steering group.

Results: 1.7 million adults were included, of which 167,665 (9.4%) were on polypharmacy.
Polypharmacy was associated with age and socio-economic deprivation (OR 9.24 95% CI 8.99 to 9.50,
age 65-74 compared with 18-44; OR 0.68 95% CI 0.65 to 0.71, least deprived compared with most), as
was frailty (OR 1.53 95% CI 1.53 to 1.54 per frailty component, for White women). Black people had
lower odds of polypharmacy for average frailty (OR 0.82 95% CI 0.79 to 0.85, compared with White),
but had greater odds increases with increases in frailty (OR 1.02 95% CI 1.01 to 1.03). Annual
medication costs were 8.2 times higher among those on polypharmacy compared with not (£370.89
vs £45.31). Early findings suggest there is variation in provision of medication reviews by demographics
and by GP practice.

334
Conclusion: Overall, one in ten adults are on polypharmacy, and prevalence varies by age, socio-
economic deprivation, frailty, gender and ethnicity. Patterns in polypharmacy recorded in the literature
were broadly consistent with our findings (7,8) Polypharmacy is associated with high cost of
medication, with average costs per regular medication higher for those on polypharmacy than those
who are not. Furthermore, there is variation in provision of structured medication reviews. Further
research should explore why, to reduce health inequities, improve quality of care, and optimise cost
associated with polypharmacy.

References: 1. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A

systematic review of definitions. BMC Geriatr. 2017 Dec;17(1):230.

2. Abolhassani N, Marques-Vidal P. Polypharmacy, defined as taking five or more drugs, is

inadequate in the cardiovascular setting. Journal of Clinical Epidemiology. 2018 Sep;101:1

3. World Health Organisation. [Link] Safety in [Link]. 2019.

4. Fattinger K, Roos M, Vergères P, Holenstein C, Kind B, Masche U, et al. Epidemiology of drug

exposure and adverse drug reactions in two Swiss departments of internal medicine: Drug exposure
and adverse drug reactions in inpatients. British Journal of Clinical Pharmacology. 2000 Feb;49(2):158–
67.

5. Tsai KT, Chen JH, Wen CJ, Kuo HK, Lu IS, Chiu LS, et al. Medication Adherence Among Geriatric
Outpatients Prescribed Multiple Medications. The American Journal of Geriatric Pharmacotherapy.
2012 Feb 1;10(1):61–8.

6. Bradley MC, Fahey T, Cahir C, Bennett K, O’Reilly D, Parsons C, et al. Potentially inappropriate
prescribing and cost outcomes for older people: a cross-sectional study using the Northern Ireland
Enhanced Prescribing Database. Eur J Clin Pharmacol. 2012 Oct;68(10):1425–33.

7. Payne RA, Avery AJ, Duerden M, Saunders CL, Simpson CR, Abel GA. Prevalence of
polypharmacy in a Scottish primary care population. Eur J Clin Pharmacol. 2014 May;70(5):575–81.

8. Guthrie B, Makubate B, Hernandez-Santiago V, Dreischulte T. The rising tide of polypharmacy

and drug-drug interactions: population database analysis 1995–2010. BMC Med. 2015 Dec;13(1):74.

Disclosure of Interest: None Declared

335
Improving Systems of Care for ST Elevation Myocardial Infarction patients through Public-Private
integration for Pre-Hospital Care activation of Primary Percutaneous Coronary Intervention: (1944)
Farina Mohd Salleh

ISQUA2024-ABS-1944

F. Mohd Salleh 1,*, A. S. Mohamed 1, S. A. Yahaya 2, I. S. Sabian 3, U. K. Mohamad 4, S. Shaikh Abdul Karim
5

1
Emergency Department, 2Cardiology Department, 3Clinical Research Department, National Heart
Institute, 4Emergency and Trauma Department, Kuala Lumpur Hospital, 5Emergency and Trauma
Department, Sungai Buloh Hospital, Kuala Lumpur, Malaysia

Introduction: The first ST Elevation Myocardial Infarction (STEMI) Network for Primary Percutaneous
Coronary Intervention (PPCI) in Malaysia was established in 2014 between National Heart Institute
(NHI), a private cardiovascular hospital and Hospital Kuala Lumpur, the largest public hospital in Kuala
Lumpur. NHI initially collaborated with a private ambulance service for Pre-Hospital (PHC) STEMI
activation in 2019 and established the first PHC STEMI service with ECG transmission in Malaysia. This
was made possible by availability of ECG transmission capabilities by portable defibrillator machines
from ambulance to hospital. However, it was found that from 2019-2022, only 3% (3/97) of PHC ECGs
were STEMI that required intervention as majority of patients utilized government instead of private
ambulances. Plans to commence PHC STEMI Network with government ambulances were delayed due
to COVID-19 pandemic. Efforts were resumed post-pandemic and Klang Valley Ambulance Services
(KVAS), the government ambulance services network within the nation’s capital, commenced PHC
STEMI Network with NHI in May 2023. This study aims to demonstrate good patient outcomes for the
new integrated initiative.

Methods: In establishing the PHC STEMI Network with KVAS, processes were developed for on-site
ECG assessment of patients with chest pain retrieved by ambulance. As there is no doctor in the
ambulance, a brief and targeted history is obtained by trained Medical Assistants and vital signs are
taken. Information of the patient’s clinical condition and ECG is relayed to the Emergency Physician on
duty. Diagnosis of STEMI is made and patients are diverted to NHI Emergency Department (ED) based
on selected inclusion criteria, including patient age, medical background and clinical stability. The NHI
ED doctor will activate the Cardiologist and catheterization laboratory to prepare for PPCI prior to
patient arrival. On arrival to NHI ED, the patient will be assessed briefly before going for PPCI. Data on
ECG time, arrival time, reperfusion time as well as outcome measures including length of stay (LOS)
and survival to discharge was collected and analyzed. Regular meetings were held to address issues
and ensure quality of services.

Results: There was a total of 45 PHC STEMI cases sent from KVAS to NHI from 1st May 2023 to 31st
December 2023. 51% (n=23) of patients were retrieved from home while the remainder were from
clinics. 93% (n=42) of patients were male. Median age of patients was 48 years and ranged from 30 to
79 years. Median time from first ECG to NHI was 43 minutes. Out of 45 patients, only 1 patient did not
have a diagnosis of STEMI after assessment at NHI. 60% (n=27) of patients presented with Inferior
Myocardial infarction and 76% (n=34) were classified as Killip I. 89% (n=44) proceeded with angiogram
and PPCI was performed in 91% (n=41) of patients. Acute occlusion of Right Coronary Artery was the
main angiographic finding in 51% (n=23) of patients. Out of the patients who had angiogram, 2 had

336
normal coronary arteries. 1 patient had severe 3 vessel disease but did not agree to PPCI or Coronary
Artery Bypass Graft (CABG) surgery. Median door-to-reperfusion time was 57 minutes while median
ECG to reperfusion time was 107 minutes. This was despite half (49%) of the patients arrived in NHI
after office hours. With regards to outcome measures, 100% of patients survived to discharge with
median LOS of 5 days. 1 patient had CABG during the same admission. In terms of risk factors for
Ischaemic Heart Disease (IHD), the majority or 47% (n=21) had more than 1 risk factor. Smoking was
the most common risk factor, present in 62% (n=28) followed by Hypertension in 47% (n=21) of
patients. Out of those with single risk factor, smoking was the most common. 5 patients had no risk
factors for IHD.

Conclusion: PHC STEMI activation is an efficient way to manage STEMI patients who are retrieved by
ambulance. Median door-to-reperfusion time of 57 minutes is within the standard of 90 minutes
according to Malaysian Clinical Practice Guidelines for STEMI. With good patient selection, all patients
survived to discharge with a short LOS. This outcome is extremely relevant for local systems of care to
promote effectiveness of PHC STEMI Networks with potential for expansion in Malaysia. The study
demonstrated that integrated patient care through public-private collaboration had excellent patient
outcomes.

Disclosure of Interest: None Declared

Comprehensive and integrated Geriatric Care Program in a model regional teaching hospital in
Taiwan: (1493) Meng-Chih Lee

ISQUA2024-ABS-1493

M.-C. Lee 1,*, H.-C. Chen 1, M.-Y. Liao 1, Y.-D. Huang 2 and Study Group on Taiwan Longitudinal Study in
Aging (TLSA), Hospital and Social Welfare Organizations Administration Commission, Ministry of Health
and Welfare, Taiwan
1
Department of Family Medicine, 2Department of Obstetrics and Gynecology, Taichung Hospital,
Taichung City, Taiwan

Introduction: Taiwan has become an aged society since 1993. Currently there are more than one-third
of all patients in our hospital who are over 65 years of age, and this figure is increasing year by year.
As a model Age-friendly hospital as well as Health promotion Hospital in Taiwan, we are trying to
establish a comprehensive and integrated geriatric care program from health promotion/disease
prevention to acute, postacute and long term care in both our hospital and surrounding community
settings.

Methods: To create a quality, safe and friendly care, we have integrated the principles of Universal
Design and Integrated Care to provide comprehensive care ranged from community care, acute care,
postacute care, and long term care and palliative care. In addition, we have established a multi-
disciplinary team to perform comprehensive geriatric assessments and interprofessional practice (IPP)
for better care of the elderly. This team is comprised of doctors, nurses, case managers, social workers,

337
dieticians, clinical pharmacists, physical and occupational therapists, and always including patients
themselves and their families. Hospital has been well connected with community settings including
primary care clinics and long-term care facilities through the Discharge Planning Office and electronic
referral information system.

Results: We have 24- bed postacute Care Ward where 80% elderly patients with stroke or hip fracture
can go home and live independently at discharge, 36-bed acute geriatric ward where 100% of patients
will receive comprehensive geriatric assessment and interprofessional acre, and 190-bed nursing
home with more than 95% satisfaction rate from patients and their families for our full-range
rehabilitation program. In addition, in our hospital, Integrated Geriatric Clinic, Customer Center, and
Education and Health Case Center together provide a one-stop and full-range services for our elderly
patients.

Conclusion: In conclusion, a barrier-free environment, interprofessional teamwork and comprehensive

services are all important to provide optimal care for the elderly. Our dedicated efforts resulted in
being awarded as Distinguished Age friendly Hospital , Health Promotion Hospital as well as
Distinguished Friendly Environment Hospital for the Elderly in the past 10 years. We will continually
improve our Comprehensive Geriatric Care program through total quality management (TQM) and
total resources management (TRM) to tailor to the specific needs of our elderly patients.

References: 1. Lee, M.C., Hsu, Y.N. Quality and Medicine-Taichung Hospital as An Example. J Med and
Health 2015; 4:105-15.

2. Lee, M.C., Kuo, T.C., Ueng, W.N. Perspectives on Long-Term Care in Taiwan-Integration of Health
Care and Welfare services. Hospital 2019; 52:1-5.

3. Tai, C. J., Tseng, T. G., Hsiao, Y. H., Kuo, T. A., Huang, C. Y., Yang, Y. H., & Lee, M. C.* Effects of hearing
impairment and hearing aid use on the incidence of cognitive impairment among community-dwelling
older adults: evidence from the Taiwan Longitudinal Study on Aging (TLSA). BMC Geriatr 2021; 21: 76.

4. Lee, S. H., Yeh, C. J., Yang, C. Y., Wang, C. Y., & Lee, M. C.* Factors Associated with Attitudes toward
Aging among Taiwanese Middle-Aged and Older Adults: Based on Population-Representative National
Data. Int J Environ Res Public Health 2022; 19:2654.

5. Ho, H. E., Yeh, C. J., Cheng-Chung Wei, J., Chu, W. M., & Lee, M. C.* Association between
multimorbidity patterns and incident depression among older adults in Taiwan: the role of social
participation. BMC Geriatr 2023; 23:177.

6. Hung, Y. C., Lao, W. L., Yeh, C. J., & Lee, M. C.* The mediating effect of leisure activities in the
relationship between depression and cognitive decline in middle age and older adults in Taiwan. BMC
Geriatr 2023; 23:315.

Disclosure of Interest: None Declared

338
Enhancing Early Discharge after Elective Caesarean Section: Implementing a Fast-Track Approach
(ERAS) for Improved Patient Outcomes: (2923) Afnan Tawfiq Ahanfish

ISQUA2024-ABS-2923

E. S. Alradwan 1,* and 3Dr. Afnan Tawfiq Hanfish (Champion of ERAS), Ms. Laila Alrasi (QM)

pmo, Jubail Health Network, Jubail, Saudi Arabia

1

Introduction: Cesarean sections, a common global surgery, pose challenges in patient recovery and
postnatal care. Increasing rates impact recovery times and length of stay. Enhanced Recovery After
Surgery (ERAS) proves effective, with guidelines improving maternal and neonatal outcomes,
encouraging early ambulation, and reducing admission days.

Methods: The project executed in Jubail City from July 2022 to July 2023, adopts a multimodal,
evidence-based approach to surgical care for scheduled and arranged cesarean sections. uses the
Eastern Health Cluster pathway and guidelines. Measures through a platform, and ensures regular
communication within the team. Patient satisfaction surveys are conducted for continuous
improvement and assessment.

Results: The program, exceeded the target enrollment by 119%. 76.6% were discharged on the second
day, reducing the Average Length of Stay from 4 to 2.3 days. Overall morbidities decreased by 0.60%
and readmission rates and from 9% to 6%. Nonsurgical complications decreased by 0.40%, and the
average return of bowel activity was 1.7 days. Surgical site infections dropped from 2.8% to 1.6%, with
no reported cases of venous thromboembolism or paralytic ileus. Additionally, 307 home care visits
were conducted post-discharge (postpartum care). Patient satisfaction showed a 96% overall
satisfaction, with 88% experiencing a better cesarean section experience compared to previous
procedures. The project has also demonstrated cost savings, with a minimum of 237,894 SR per year.

Image:

339
Conclusion: A study in KSA supports Enhanced Recovery After Surgery (ERAC) effectiveness, citing
improved symptom control, pain management, early ambulation, higher satisfaction, and reduced
admission days.

The ultimate goal of ERAS is to enhance perioperative care, hasten recovery, improve maternal and
neonatal outcomes, shorten the length of stay LOS, and reduce readmission rate and postoperative
complications coupled with improved patient satisfaction.

References: Health Care Model - Eastern Health Cluster. (2023, March 6). Eastern Health Cluster.
[Link]

Home Page: American Journal of Obstetrics & Gynecology. (2019). [Link]. [Link]

Patel, K., & Zakowski, M. (2021). Enhanced Recovery After Cesarean: Current and Emerging
Trends. Current Anesthesiology Reports, 11(2), 136–144. [Link]
9

Disclosure of Interest: None Declared

Variations in diagnostic guideline compliance for COPD: Observational study of primary care in
England: (2895) Alex Bottle

ISQUA2024-ABS-2895

A. Bottle 1,*, A. Adamson 1, B. Hayhoe 1, J. Quint 1

Imperial College London, London, United Kingdom

1

Introduction: Chronic obstructive pulmonary disease (COPD) affects over a million people in the UK
and nearly 400 million worldwide. Acute exacerbations (AECOPDs) cause much of the progressive
decline in lung function and reduce patients’ quality and quantity of life. A reduction in AECOPDs
through more timely diagnosis and intervention could significantly reduce the burden borne by
patients and the health system. Using a nationally representative sample of linked primary care
electronic health records, we assessed variations by family doctor practice in the use of spirometry
and national guideline-recommended measures for diagnosis. We compared guideline compliance in
two cohorts, ten years apart, and an early COVID-era group to see what had changed.

Methods: The Clinical Practice Research Datalink collects anonymised patient electronic health records
from participating family doctor (general practitioner, GP) practices. Data are linked to death
registrations, hospital admissions and other datasets. We included all patients aged over 35 with COPD
diagnosed between 1 April 2005 and 31 March 2007 (Cohort 1), between 1 April 2015 and 31 March
2017 (Cohort 2) and between March 1 and August 30 2020 (Cohort 3). For each patient, the diagnosis

340
date was defined as the first record of COPD, either in the primary care record or in hospital admissions
data. We assessed variation in spirometry rates by GP practice using multilevel models adjusting for
patient factors such as age, sex and comorbidities; variation in the other four measures were quantified
descriptively.

Results: Cohort 1 had 40,577 patients (47.3% female, mean age 68.3 [SD 11.7]), with 78.1% diagnosed
in primary care. Cohort 2 had 48,249 patients (47.2% female, mean age 68.2 [SD 12.2]), with 77.5%
diagnosed in primary care. Cohort 3 had 4,752 patients (70.9% diagnosed in primary care) and similar
demographics. Hypertension, asthma, cancer, anxiety, depression and diabetes were common (>10%)
in all cohorts. The following results all relate only to those diagnosed in primary care. Table 1 shows
the median and IQR rates of guideline compliance by practice for the two main cohorts.

Measure Cohort 1 median (IQR) % Cohort 2 median (IQR) %

Spirometry (pre-diagnosis) 76.9 (61.2 to 86.6) 86.4 (78.6 to 93.3)

Chest X-ray (CXR) 50.0 (27.3 to 71.0) 73.1 (50.0 to 85.7)

Full blood count (FBC) 80.0 (66.7 to 89.3) 94.4 (86.7 to 100.0)

Body mass index (BMI)

95.0 (87.5 to 100.0) 100.0 (96.7 to 100.0)
measurement

All of spirometry, FBC, CXR, and

BMI measurement before COPD 27.8 (11.8 to 44.4) 54.9 (33.3 to 69.0)
diagnosis

From the modelling, median odds ratios for spirometry were 1.95 (95% CI 1.89 to 1.98), 1.62 (1.59 to
1.65) and 1.72 (1.68 to 1.76) for cohorts 1-3, respectively, showing moderate variation by GP practice.
These median odds ratios estimate the median increase in the odds of spirometry when a patient
hypothetically moves from a low spirometry use practice to a high spirometry use one.

Conclusion: The majority of patients receive their COPD diagnosis via primary care, but only a minority
receive all the guideline-recommended measures for diagnosis, with notable variations by GP practice.
There is an urgent need for greater support for primary care in timely identification of individuals with
COPD.

Acknowledgment: this work was funded by NIHR HSDR programme, grant 17/99/72. The views
expressed are those of the authors and not necessarily those of the NIHR or the Department of Health
and Social Care.

Disclosure of Interest: None Declared

341
An European Consensus on Core Measures Set for Patient Safety in Perioperative Care (SAFEST
project): (1926) Carola Orrego

ISQUA2024-ABS-1926

A. B. Nunes 1 2 on behalf of SAFEST Project, A. Leite 1 2 3, J. P. Teixeira 1, C. Valli 4, A. Seyfulayeva 1, P. Casaca

Carvalho 1 2, I. Martinez-Nicolas 5 6 7, D. Arnal-Velasco 5 8, C. Orrego 4, P. Sousa 1 2,* and SAFEST Project
1
NOVA National School of Public Health, NOVA University Lisbon., 2NOVA National School of Public
Health, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, 3Departamento de
Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal, 4Avedis
Donabedian Research Institute, Universitat Autònoma de Barcelona, Barcelona, 5Sistema Español de
Notificacion en Seguridad en Anestesia y Reanimacion (SENSAR), 6Hospital Universitario Fundación
Alcorcon, Alcorcon, Spain, 7National Institute of Public Health, Cuernavaca, Mexico, 8Anaesthesia and
Reanimation Unit, Hospital Universitario Fundacion Alcorcon, Alcorcon, Spain

Introduction: Although surgical-related adverse effects are among the most common in-hospital
adverse events, no set of measures has yet been defined for a comprehensive and patient-centred
analysis of this phenomenon at healthcare services level. Thus, it is crucial to standardise a minimum
set of measures, a Core Measure Set (CMS), that encompasses structure and process measures while
emphasizing outcome measures through a Core Outcome Set (COS), to allow for monitoring and
evaluation of patient safety best practices in perioperative care in healthcare services. This study aims
to reach a European Union-wide consensus on relevant and feasible core measures, including patient-
reported measures, to assess patient safety in perioperative care.

Methods: An initial list of measures was developed following a multimethod approach. First, an
umbrella review on measures of patient safety in perioperative care in adult patients was conducted.
This umbrella review was complemented by measures identified through a systematic review of
Clinical Practice Guidelines and an umbrella review of non-clinical interventions to improve
perioperative patient safety. Second, the full list of measures underwent further refinement, including
deduplication, rewording, and merging, facilitated by the research team. Third, 67 experts, including
patients, were invited to participate in a two-round Modified eDelphi survey to rate the list of
measures on the importance and feasibility of each measure on a 9-points Likert scale. The rated
measures were grouped by the perioperative period and subgrouped by Donabedian's quality of care
conceptual model. Consensus was defined as 75% of experts scoring a measure as 7 to 9, and 15% or
less scoring 1 to 3. Fourth, a subsequent CMS consensus conference was held, where participating
experts explored the challenges of measuring specific measures highly valued by patients. Finally, the
resulting preliminary final list of measures underwent further synthesis and refinement by the research
team, leading to the CMS and COS. Ethical approval for SAFEST was given by IDIAP Jordi Gol’s Research
and Ethics Committee (CEIm code 22/146-P). For this study, all expert panel participants were required
to provide informed consent.

Results: The 3 reviews yielded a total of 9530 records, out of which 315 records met the inclusion
criteria. From these included studies, a total of 1305 measures were extracted, resulting in a
consolidated list of 247 measures after duplicate removal, merging and further refinement. The expert
panel comprised a diverse composition of stakeholders, consisting of 52.2% females, 9.6% patients
and patient representatives, 83.6% patient safety/perioperative experts, and 6.0% healthcare

342
evaluation experts. From the initial list of measures included in rounds 1 and 2, 85 (34.1%) reached
consensus regarding importance and feasibility. One-hundred and sixty-four measures failed to reach
a consensus simultaneously for importance and feasibility. At the Consensus Conference, 25 measures
were discussed (19 outcome measures, 5 process and 1 structure measures), with most measures
related to the postoperative period. From the preliminary final list of measures consisting of 91
measures that successfully met the consensus criteria during the eDelphi process, the CMS resulted in
77 measures including 23 outcome measures, 18 process measures and 36 structure measures.

Conclusion: A consensus among a diverse panel of experts was reached for core measures in reporting
perioperative patient safety, successfully reducing measures from 247 to 77. While the experts
emphasized the importance of these indicators, further exploration of their feasibility is essential for
the effective implementation of monitoring and evaluation in surgical-related patient safety systems
in clinical practice. It's crucial to acknowledge that the resulting CMS still presents a considerable
number of measures, posing implementation challenges.

This CMS contributes to enhancing standardised reporting in perioperative patient safety, allowing for
benchmarking across EU countries and studies. As such, this CMS holds promise for enhancing the
monitoring and evaluation of patient safety practices in perioperative care, thereby contributing to the
overall quality of care and informed healthcare decision-making.

Disclosure of Interest: None Declared

Navigating the information source landscape: a mixed methods study to assess the use of
information sources by Dutch medical specialists: (2206) Floris Weller

ISQUA2024-ABS-2206

F. Weller 1,*, L. van Bodegom-Vos 1, S. Repping 2, J. Hamming 1

Leiden University Medical Centre, Leiden, 2Amsterdam University Medical Centers, Amsterdam,
1

Netherlands

Introduction: Evidence-based medicine (EBM) is widely recognized as the standard in informed

medical decision-making. It consists of three cornerstones; the best available evidence, patient
preferences and the clinical expertise of medical specialists. To efficiently use the first pillar, best
available evidence, medical specialists need to use a wide variety of information sources. The
landscape of these available information sources to inform medical specialists about the latest
evidence has evolved significantly over the past decades. Some studies describe a general overview of
what information sources could be used in clinical practice. It is unknown however, which information
sources Dutch medical specialist actually use most frequently to inform their daily medical decision
making and to update their general knowledge. Insight in the practical use of different information
sources could aid policy makers in providing medical specialists with an accessible way of utilizing the

343
best available evidence tailored to their specific needs. This will promote true EBM and therefore
improve healthcare quality throughout.

Therefore, this study aims to assess the extent to which Dutch medical specialists use different types
of information sources in their daily practice to inform medical decisions and to update their general
knowledge.

Methods: - An exploratory sequential mixed methods design was used. An interview study with
medical specialists was performed to explore the wide variety of information sources used in daily
practice in the Netherlands to answer point-of-care clinical questions and for updating general
knowledge. We defined direct information sources (directly used to answer a clinical question) and
indirect information sources (used to update general knowledge without a specific question) within
the interview topic guide. This was followed by a cross-sectional web-based survey to quantify the
used information sources to answer clinical questions. We also asked what information sources they
found the most useful in keeping their knowledge up to date. Descriptive statistics were used in
analyzing the results. Informed consent and the acceptance of our privacy policy, which was in line
with the GDPR, was obtained for all respondents prior to participation. This study was exempted for
further ethical appraisal by the medical ethical committee of Leiden University Medical Center.

Results: The qualitative study consisted of semi structured interviews with ten surgeons and ten
internal medicine specialists. Within the predetermined direct and indirect information sources three
main groups of information sources were defined as made visual in figure 1. To consult a colleague was
stated to be the most preferred information source due to its accessible nature. These individual
information sources were fitted into an online survey. In total 296 medical specialists replied to our
survey. More than 90% of respondents actively used information sources in less than 10% of their
patients. Most used direct information sources were direct colleagues (85% often), followed by the
use of CPG’s (64% often). For indirect information sources respondents most frequently visited medical
conferences (99%), followed by reading (updated) CPG’s (84%). Although near all respondents
reported medical conferences as the most ‘used’ information source for updating their knowledge,
only 12% of respondents rated medical conferences as most useful to keep their knowledge up-to-
date.

Image:

344
Conclusion: Our study shows that medical specialists actively use direct information sources in less
than 10% of their patient interactions and emphasizes the importance of direct colleagues in clinical
decision making. Although two medical specialists will know more than one, a direct colleague is not
necessarily a substitute for the best available medical evidence. For indirect information sources
‘medical conferences and courses’ were used most frequently but not considered the most useful to
stay up-to-date. Respondents stated that medical conferences are more important for promoting
research collaborations and the social aspects rather than to update knowledge.
In order to promote true EBM and make it easier for medical specialists to utilize the best available
evidence in their medical decision making information sources should be presented in an accessible
manner. This could improve healthcare quality as it will reduce sub-optimal treatment and diagnostic
decisions.

References: Abbreviations

CGP: Clinical practice guideline

EBM: Evidence-based medicine
GDPR: General Data Protection Regulation

Disclosure of Interest: None Declared

345
Importance of Effective Hospital Stock Analysis for Healthcare Quality: ABC and VED Analysis
Pharmaceutical Stock Analysis with AHP Method: A Private Hospital Example: (2958) İbrahim Halil
Kayral

ISQUA2024-ABS-2958

I. H. Kayral 1,*, D. Incegil 1, S. Boz 2, F. Çizmeci Şenel 1

International Programs, TÜSKA, Ankara, 2Bakırçay University, İzmir, Türkiye

1

Introduction: Medicines are among the most important materials that hospitals have to stock in order
to provide uninterrupted and quality service. For this reason, planning when and where medicines
should be procured, creating demands according to the situation and preparing them are all possible
through well-managed stock management. Due to the specific and diverse nature of the services they
offer,, hospitals manage the process of drug purchases according to many criteria. Among the criteria
subject to our study; price, demand and supplier reliability. The purpose of this study; The aim is to
analyze all drugs used in a 100-bed private hospital in Istanbul with ABC-VED and ABC-VED matrix
management and to establish the order of consumption cost and vital importance. With the AHP
method, it is aimed to find out which of the experts subjectively prioritize the criteria of price, demand
and supplier reliability. Effective stock control provides positive results both financially and in the
quality of the service to be provided. In this context, this study aims to evaluate ABC, VED and ABC-
VED matrix analyzes from the perspective of community pharmacies.

Methods: The drug data subject to the research was obtained from the private hospital and divided
into unit numbers on a monthly and annual basis through Excel according to the ABC-VED analysis
method, and the total expenditure amounts allocated from the balance sheet were calculated.
Pharmaceutical items are financially categorized into three classes: Group A, B and C. For VED analysis,
the hospital staff were asked for their opinions and drug lists were given to them and they were asked
to categorize them as V, E, D. Total amounts of categorized drug items were calculated on an annual
basis via Excel. Grouping was performed by making ABC-VED matrix, and the research findings were
revealed by calculating the number of drugs, their percentages in the total number of drugs, total
expenditure amounts and percentages in the total expenditure amounts of the grouped drugs. With
the AHP method, 6 experts were asked to score the criteria determined according to their importance
against each other, using Saaty's 1-9 scale. The scored survey forms were analyzed and their
importance was ranked according to the weight of the criteria.

Results: The drug stocks used in a private hospital were analyzed by the ABC, VED and ABC-VED stock
control method and the matrix method of the stocks in terms of financial and vital importance of the
drugs. As a result of three analyses, it was observed that a total of 3,187,954.16 Turkish Lira (TL) was
spent on a total of 545 drugs. There are 50 drugs in group A and the total expenditure is 2,240,127.33
TL, 79 drugs in group B and the total expenditure is 641,442.01 TL, and 416 drugs in group C and the
total expenditure is 306,384.82 TL. It was observed that group A included 70.30% of the total cost,
20.10% of group B and 9.60% of group C. In the VED analysis, the total expenditure of drugs in group
V is 958,195.33 TL, the total expenditure of group E drugs is 1,049,012.10 TL, and the total expenditure
of group D drugs is 1,180,746.73 TL. The percentages of VED drug groups in the total cost are 30.06%
in group V, 32.91% in group E and 37.04% in group D, respectively. When the ABC-VED matrix is
examined in terms of both financial and vital importance, it is observed that there are 20 drugs of the

346
A-V drug group and the total expenditure is 821,221.72 TL, and the percentage of this expenditure
amount in the total cost is 25.76%. The weights of the answers given by 6 experts were calculated
using the AHP method. The geometric averages of the weights were taken and their consistency was
calculated, the importance ranking was created with the weights of the criteria, and by ranking among
the three criteria, it was observed that the price was more important.

Image:

Conclusion: While group A drugs are financially high-priced but have fewer drugs, group C drugs are
drugs with a high drug variety but a high financial share. According to the findings, group A and group
C achieved the expected results. VED group drug stock values are expected to be close to each other.
The analysis result obtained satisfied this condition. Stock items were evaluated in terms of cost and
criticality with the ABC-VED matrix, and according to the data obtained based on expert opinion in the
AHP method of pharmaceutical stocks, it was concluded that price was the first among the three
criteria in the stock process. Thus, stock management can be improved through cost analysis by taking
into account the price policy of pharmaceutical stocks during the purchasing process.

Disclosure of Interest: None Declared

Engaging Stakeholders to Enhance patient safety by Ensuring standards in instrument Sterilisation:

A National level Quality Improvement Journey in India: (3047) Jayalakshmi Jayarajan

ISQUA2024-ABS-3047

J. -.- Jayarajan 1,*, L. Joseph 2, V. Agarwal 2, M. Murugesan 3

KMCH Institute of Health Sciences & Research, Coimbatore, 2Consortium of Accredited Healthcare
1

Organization, New Delhi, 3Meenakshi Mission Hospital and Research Centre, Madurai, India

Introduction: The Central Sterile Supply Department (CSSD) plays a critical role in ensuring that the
medical devices are sterilized and delivered to various users in the hospital in a quality-assured
environment for safer patient care. Poor handling is associated with damaged instruments and
improper sterilization is associated with increased risk of healthcare associated infections. It is
essential to have appropriate infrastructure, adequate equipment and skilled and knowledgeable

347
personnel for efficient functioning of CSSD. However, CSSD represents the most neglected area of
infection prevention control in most of the hospitals.

Considering the significance and recognizing these gaps , Consortium of accredited Healthcare
Organization (CAHO), a Not-For-Profit Organization in India along with 3M launched CAHO-3M
Awareness-Compliance-Excellence (ACE) CSSD program. The primary objective of the program is to
facilitate capacity building amongst CSSD professionals, share best practices, and provide
benchmarking, while promoting and continuously improving the quality and safety of healthcare
services as per the latest guidelines.

Methods: A multidisciplinary team developed basic and advanced CSSD course modules and designed
an audit tool with 135 questions for auditing various aspects of CSSD in Health care organization
(HCOs) across India. The audit tool was adopted from Asia pacific Society of infection control Self-
Assessment Framework, CDC, APSIC & AAMI-ST79 guidelines and validated by key experts across
India. An auditor course with an assessment pass score of >80% was mandated for all ACE auditors to
standardise the audit process in order to avoid bias.

HCO were invited for voluntary enrolment in the ACE CSSD programme. Following readiness, an initial
baseline virtual audit was conducted followed by a physical audit using the same audit tool by a
different empanelled auditor and final scores assigned. Those HCOs with ≥80% scores were recognized
as CSSD centres of excellence (COE) with a validity of 3 years. Feedbacks were collected using a
structured survey questionnaire to understand the challenges faced & benefits for the end users.

Results: About 93 hospitals in 2021, 93 hospitals in 2022 and 85 hospitals in 2023 enrolled in the
program. Out of this, 70 (75.2%) hospitals in 2021, 62 (66.6%) hospitals in 2022 and 73 (89%) in 2023
were eligible for physical audit. Among those, 64 (91.4%) in 2021, 54 (87%) in 2022 and 66 (90.4%) in
2023 were awarded as COE (Figure 1). Those hospitals that were not able to achieve in 2021 within
the stipulated time were handheld and guided by CAHO-3M team to raise their standards. Among
those who was not able to complete or achieve through the audit have reapplied in 2023 showing their
commitment towards excellence. In 2023, around 80% of reapplied hospitals are selected as COE.

About 84 hospitals responded to the feedback survey. In those, 67 (79.8%) felt the audit was very
useful. The most common challenges faced by the hospitals in implementing best CSSD practices were
knowledge, time constraints and resources. The top benefits perceived by the hospitals were pride in
recognition as COE, confidence in quality among the users and cost effectiveness of the process.

Image:

348
Conclusion: The audit finding has given a promising result that a QIP for CSSD provides comprehensive
handholding support to enhance their practices, ensuring adherence to stringent sterilization
protocols. This initiative by CAHO & 3M is not merely an audit program, it is a commitment to foster a
culture of continuous improvement in healthcare facilities across India, ensuring that every step of the
medical device sterilization process is elevated and aligned with the international standards thereby
enhancing better patient outcomes with safer procedures. The impact created by this program on
quality and patient safety is a positive ripple and ongoing.

References:

Asia Pacific Society of Infection control (APSIC) for disinfection & sterilization of instruments in health
care facilities , 2017

Lallu Joseph ,B Rabindranath ,Florence Ponnie , Premila lee, Achieving Continuous Improvement in
CSSD Management through Performance Measurements using User Satisfaction Surveys and
Interventions Glob J Qual Saf Healthcare. 2021 Jul 12;4(4):123-30.

Disclosure of Interest: None Declared

Postgraduate Education in Patient Safety/Quality Improvement: Setting Expectations to Optimize

Clinical Learning Environments: (2595) Robin Wagner

ISQUA2024-ABS-2595

R. Wagner 1,*, N. Koh 1, J. Arrighi 2, K. Weiss 1

ACGME, 2ACGME International, IL, United States

1

Introduction: Clinical sites that host post graduate education (PGE) of resident and fellow physicians
have a dual responsibility to simultaneously optimize both learning and patient care. Yet many clinical
sites lack optimal infrastructure, processes, and monitoring to fully integrate learners into their
systems for addressing patient safety and health care quality. In 2019, the Accreditation Council for
Graduate Medical Education (ACGME) released version 2.0 of the CLER Pathways to Excellence1
document—a set of guidelines for optimizing the clinical learning environment (CLE) in 6 cross-cutting
areas of focus, including patient safety, health care quality, teaming, supervision, well-being, and
professionalism. The purpose of the document is to assist executive leaders responsible for patient
safety and health care quality in understanding the infrastructure and actions needed to optimize the
CLE. In 2023, the ACGME partnered with ACGME International (ACGME-I) to adapt the Pathways
document for international use.

Methods: In 2023, international PGE leaders currently sponsoring or in the process of sponsoring
ACGME-I accredited residency and fellowship programs were invited to join a working group to review
and adapt the Pathways document for international use. These leaders were also asked to invite the
executive leaders responsible for patient safety and quality at their clinical site. The working group
included over 40 participants from over 20 organizations/sponsoring institutions and located across
over 10 different countries. Twenty-six of the participants responded to an initial survey review of the

349
Pathways document (i.e., pathways and properties). In the survey, the participants reviewed each
pathway and property in the Pathways document and marked it “keep as is”, “modify”, or “delete”.
The results of the initial review were then collated and used to inform small and large group discussions
held both in-person and online via videoconference.

Results: The discussions focused on any property in the Pathways document where less than 80% of
the participants indicated to “keep as written” or where more than 11% indicated “modify” or “delete”.
The entire group of 40+ participants reviewed and modified as needed the language of 10 properties
for Patient Safety; 9 for Health Care Quality; 7 for Teaming; 2 for Supervision; and 1 for Professionalism.
None of the Well-being properties were flagged for modification or deletion. After several rounds of
iterative discussions and revisions, the group reached consensus on a final version that each
participant committed to disseminating to promote conversations with the executive leaders of their
clinical sites.

Conclusion: The resulting CLE International Pathways to Excellence is a resource that emphasizes the
importance of the interface between PGE and the hospitals, medical centers, and clinical sites that
serve as CLEs. The document frames each of the pathways and properties from the health system’s
perspective, recognizing that health care organizations and their clinical sites create and are therefore
primarily responsible for the CLE. This new document provides a tool that can resonate across the
international community of leaders dedicated to optimizing the environment for both learners and
patient care.

References: CLER Evaluation Committee. CLER Pathways to Excellence: Expectations for an Optimal
Clinical Learning Environment to Achieve Safe and High-Quality Patient Care, Version 2.0. Chicago, IL:
Accreditation Council for Graduate Medical Education; 2019. doi:10.35425/ACGME.0003

Disclosure of Interest: None Declared

Systematic Review on the Frequency and Quality of Reporting Patient and Public Involvement in
Patient Safety: (1496) Sahar Hammoud

ISQUA2024-ABS-1496

S. Hammoud 1,*, L. Alsabek 1 2, L. Rogers 1, E. McAuliffe 1

1
UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS),
School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin,
Dublin, 2Department of Oral and Maxillofacial Surgery, University Hospital Galway, Galway, Ireland

Introduction: In recent years, patient and public involvement (PPI) in research has significantly
increased; however, the reporting of PPI remains poor (1). The Guidance for Reporting Involvement of
Patients and the Public (GRIPP2) was developed to enhance the quality and consistency of PPI

350
reporting (1). The objective of this systematic review is to identify the frequency and quality of PPI
reporting in patient safety (PS) research using the GRIPP2 checklist.

Methods: Searches were performed in Ovid MEDLINE, EMBASE, PsycINFO, and CINAHL from 2018 to
December, 2023. Studies on PPI in PS research were included. We included empirical qualitative,
quantitative, mixed methods, and case studies. Only articles published in peer-reviewed journals in
English were included. The quality of PPI reporting was assessed using the short form of the (GRIPP2-
SF) checklist. As this is a systematic review, no ethical approval was required. The review protocol was
registered with PROSPERO (CRD42023450715).

Results: A total of 8561 studies were retrieved from database searches, updates, and reference checks,
of which 82 met the eligibility criteria and were included in this review. Major PS topics were related
to medication safety, general PS, and fall prevention. Patient representatives, advocates, patient
advisory groups, patients, service users, and health consumers were the most involved. The main
involvement across the studies was in commenting on or developing research materials. Only 6.1% (n=
5) of the studies reported PPI as per the GRIPP2 checklist. Regarding the quality of reporting following
the GRIPP2-SF criteria, our findings show sub-optimal reporting mainly due to failures in: critically
reflecting on PPI in the study; reporting the aim of PPI in the study; and reporting the extent to which
PPI influenced the study overall.

Conclusion: Our review shows a low frequency and sub-optimal quality in PPI reporting in PS research
using the GRIPP2 checklist. Researchers, funders, publishers, and journals need to promote consistent
and transparent PPI reporting following internationally developed reporting guidelines such as the
GRIPP2. Evidence-based guidelines for reporting PPI should be supported to help future researchers
plan and report PPI more effectively.

References: Staniszewska S, Brett J, Simera I, Seers K, Mockford C, Goodlad S, et al. GRIPP2 reporting
checklists: tools to improve reporting of patient and public involvement in research. Bmj-Brit Med J.
2017;358.

Disclosure of Interest: None Declared

Using resilience in healthcare (RiH) theory to generate reflective learning from safe care delivered
to deteriorating patients: a mixed methods study : (1965) Shalini Ganasan-Ryan

ISQUA2024-ABS-1965

S. Ganasan-Ryan 1,*, M. Kumar 1, J. Morris 2, P. Frost 2 3, A. Carson-Stevens 3

Cardiff Business School, Cardiff University, 2Cardiff and Vale University Health Board, 3School of
1

Medicine, Cardiff University, Wales, United Kingdom

Introduction: Timely intervention is needed for deteriorating patients to mitigate harmful outcomes,
intensive care admissions and preventable cardiac arrests. Rapid response systems (RRS) have been

351
established internationally to tackle delayed recognition and treatment of deteriorating patients,
through coordinated care delivered by intensive care consultants (ICUC) and nurse practitioners (NP).
Evidence about RRS effectiveness is mixed, requiring further research on staff-reported outcomes.
Whilst implementing a new RRS programme at the largest Health Board in Wales, we used resilience
in healthcare (RiH) theory to identify and structure learning arising from everyday care delivery to
understand how optimal, sub-optimal and unsafe outcomes were achieved through learning from the
different outcomes, to inform and sustain future performance and safety improvement.

Methods: This predominantly qualitative, mixed-methods, case study involved document analysis and
non-participant observations (NPOs), followed by informal interviews to clarify findings from the
NPOs. A structured, empirical data collection form adopting a human factors lens was used, to describe
the work system, processes, and outcomes. This enabled understanding of how staff interacted with
work system factors (environment, workload, demand, tools, technology, design, and variable tasks)
to deliver care. The NP and ICUC classified patient outcomes generated from each encounter as safe
(optimal, sub-optimal) or unsafe, considering the context. Learning activities from each encounter was
recorded and analysed to explore how learning from safe and unsafe care outcomes could inform
safety improvement. Demographic data was analysed descriptively, and qualitative data analysed using
reflexive thematic analysis. Ethical approval was obtained from Cardiff University (CARBS SREC ID
1235).

Results: Fifty-six NPOs took place involving 30 participants who provide care via the RRS (17 NP and
13 ICUC), alongside 130 hours of NPOs (November 2022-May 2023). Seventeen male and 13 female
participants were observed. Mean number of years in clinical practice was 17 years (NP) and 21 years
(ICUC). Care episodes which resulted in 91 (96%) optimal outcomes, 4 (4%) sub-optimal outcomes and
no unsafe outcomes were observed. Proactive initiatives (person-centred care, risk assessment,
coaching and mentoring, quality improvement) and reactive learning (protocol updates, missed or
poor care) around ways to sustain safe care or areas for improvement for sub-optimal care transpired
in 53/56 NPOs (95%). This fed forwards into formal and informal learning activities (governance
meetings, audit, planned study days, bedside teaching) aligned to RiH theory ‘resilience potentials’
such as responding to challenges, monitoring the environment, anticipating disruption, and learning
from everyday care.

Conclusion: Reviewing care delivery through the lens of RiH theory contributed valuable insights into
what worked well and could be sustained, as well as what did not work and could be improved upon,
whilst introducing a new initiative at a large healthcare organisation. Our evidence strengthens the
case that understanding systems resilience, and related human factors, whilst implementing new
improvement initiatives can yield important insights from safe care delivery and outcomes.

Disclosure of Interest: None Declared

352
Development of key principles for stakeholder involvement in resilient healthcare: a multi-phase,
multi-method empirical study: (3281) Veslemøy Guise

ISQUA2024-ABS-3281

V. Guise 1,*, H. Bø Lyng 1, C. Haraldseid-Driftland 1, S. Wiig 1 and The RiH Project Team

SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway

1

Introduction: Resilience in healthcare is the capacity to adapt to challenges and changes to maintain
the safety and quality of care across all levels of the healthcare system. Multiple healthcare system
stakeholders, including patients, informal carers, healthcare professionals, service managers and
policy makers, are acknowledged to be important contributors to the enactment of resilient
healthcare, largely due to their involvement in adaptations necessary for high quality healthcare
services. To expand our knowledge of how to facilitate and support resilient healthcare systems, we
need a better understanding of adaptive capacity and the characteristics and contexts of adaptations.
This includes insight into which healthcare system stakeholders are involved in adaptations and how
and in what circumstances the different stakeholders contribute to the adaptations necessary for
resilience at all system levels. We therefore sought to establish key principles for stakeholder
involvement in resilience in healthcare, to aid facilitation of much needed knowledge and
understanding. The aim of the study is to describe the conceptual development of a broad set of
principles for stakeholder involvement in resilient healthcare.

Methods: Principles for stakeholder involvement in resilient healthcare were developed using a multi-
phased, multi-method empirical study design. The initial exploratory phase incorporated such
methods of data collection and analysis as case-study, scoping review, stakeholder analysis, and meta-
synthesis of empirical studies. The subsequent phase entailed workshops and focus groups with a
variety of stakeholders from the Norwegian healthcare system.

Results: A set of interconnected principles for stakeholder involvement in resilience in healthcare were
established to account for their diverse roles in adaptations and the resilient performance of the
system. The principles are to 1) Map patient factors; 2) Consider capacity for family involvement; 3)
Assess the care setting; 4) Consider healthcare staff factors; 5) Assess degree of contact and
collaboration; 6) Consider influence of leadership; and 7) Evaluate applicable laws, policies and
guidelines. See Figure 1 for an illustration of the seven principles and how they relate to each other.
The presentation will expand upon the development process and will describe the content of the
principles in more detail.

Image:

353
Conclusion: Empirically grounded principles for stakeholder involvement in resilient healthcare can aid
understanding of and facilitate an increase in adaptative capacity and resilient performance across all
levels of the healthcare system.

Disclosure of Interest: None Declared

Integration of Team Resource Management with Simulation Training to Promote Obstetric and
Neonatal Safety: (2469) Wei-Ting Hsu

ISQUA2024-ABS-2469

W.-T. Hsu 1,*, S.-C. Wang 2, T.-C. Wu 3, H.-C. Chang 4, J.-Y. Chung 5, Y.-F. Lei 1, P.-C. Wang 1

Department of Quality Management, 2Nursing Department, 3Obstetrics And Gynecology, 4Pediatrics,

1

Division of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan

5

Introduction: Obstetric and neonatal safety has become one of the key priorities promoted by the
World Health Organization in recent years. Early identification, prevention, and response to potential
risks during pregnancy, childbirth, and the postpartum period can reduce the occurrence of adverse
[Link] teams often face emergency or high-risk delivery situations that require
interdisciplinary collaboration. The ability of personnel to recognize emergencies, provide clinical
interventions, communicate effectively, and collaborate as a team is crucial. Incorporating the concept
of Team Resource Management(TRM) and utilizing scenario-based simulations can enhance the clinical

354
skills and situational awareness of healthcare professionals, ensuring they can identify emergencies
and provide appropriate clinical interventions.

Methods: [Link] Support and Participation

Both supervisors and staff in obstetrics and pediatrics undergo training in TRM. The training utilizes
theoretical frameworks, scenario videos, and practical case studies to enhance participants' clinical
application experience.

[Link] of Scenario Simulation Training

Based on reported adverse events during deliveries, high-risk scenarios are designed, including
postpartum hemorrhage, severe preeclampsia with complications, emergency delivery and neonatal
resuscitation, uterine rupture, emergency cesarean section for suspected placental abruption, home
quarantine or confirmed COVID-19 cases, transfer of patients with fetal distress and pulmonary edema,
and premature infant resuscitation. Simulations take place in obstetric simulation rooms using
simulation models and standardized patients. Each session involves five participants and lasts for two
hours, including scenario-based role assignments, familiarization with the environment and
equipment, simulation exercises, debriefing, feedback from instructors, and participant discussions.
Knowledge sharing occurs after each session.

[Link] of Instructors

Healthcare personnel from obstetrics and pediatrics with experience in team resource management
training and simulation participate as instructors. They are responsible for curriculum design,
structured assessment of clinical interventions and teamwork, scenario setup, and standardized
patient portrayal. Through accumulated experience, they ensure the sustainability and continuity of
training.

Results: During the implementation period from 2022 to 2023, all participants (N=101) completed the
basic course in TRM, designed eight scenario-based teaching cases, conducted 16 simulation sessions
with an average of 15 participants per session, and trained four instructors. Statistical analysis of pre-
and post-training assessments revealed an improvement in overall team performance from an average
of 3.6 to 4.1 (out of 5) and in individual performance from an average of 2.9 to 3.5 (out of 5). The most
significant improvements were observed in leadership and situational awareness. Through the
implementation of simulation training, the Taiwan Safety Attitude Questionnaire (SAQ) survey1 shows
that, TRM proved to promote positive patient safety culture among obstetric and neonatal teams
(Figure 1).

Image:

355
Conclusion: Introducing TRM and scenario-based imulation training helps personnel to cultivate a
spirit of cross-team collaboration, enhance their ability to deal with high-risk situations, and
contributes positively to the culture of organization safety.

References: [Link], W.-C & Chien, S.-F & Chen, Yit Chung & Huang, T.-P & Lee, C.-H & Lee, S.-D. (2008).
Validation study of the Chinese safety attitude questionnaire in Taiwan. 27. 214-222.

Disclosure of Interest: None Declared

Lightning Talks

Patient Electronic Health Record Accessibility Optimization with root-cause analysis in a Medical
Center of Taiwan--A Digital ECGs Uploading study: (2546) Chung Chieh Wen

ISQUA2024-ABS-2546

C. C. Wen 1 on behalf of Project Supervisor of patient EHR uploading team , Y.-F. Chang 1,* on behalf of
Team Leader of Patient EHR Uploading Project , W.-T. Liu 2 on behalf of Clinical representative of patient
EHR uploading project, C.-M. Chu 3 on behalf of Consultant of Biostatistics and Methodology and Ya-
Lin Chen , Health Insurance Declaration Department Administrator ;Chung-Chi Huang, Leader of
Medical IT Department ; Guei-Rung Chen, Medical IT Programmer,TSGH

356
1
Medical Information Management, 2Cardiology Department , Tri-Service General Hospital , 3Public
Health Department , National Defense Medical Center, Taipei, Taiwan

Introduction: Patient-Accessible Electronic Health Records(PAEHRs) are digital versions of a patient's

medical records which containing laboratory test reports, medical images, outpatient medical records
and discharge summaries etc. The goal is to empower patients easliy access to their own health
information and actively participate in healthcare decisions. Taiwan Ministry of Health and
Welfare(MOHW) White paper 2025 points out one of key objectives is to optimize EMR Interoperability
and PAEHRs Accessibility for better healthcare. However, different hospital information systems,
incompatible equipments and human factors make uploading data to public cloud more difficult. We
would like take Digital ECGs data for example to evaluate uploading workflow with root-cause analysis
for optimizing Patient Electronic Health Record Accessibility.

Methods: To strengthen the disclosure of real-time medical information to patients on Taiwan National
Health Insurance(NHI) public cloud, we establish PAEHR Uploading Project Team to monitor the
uploading rate and optimize the workflow in October 2021.

We collected digital electrocardiograms (ECGs) report upload data from 2022 Q1 to 2023 Q4 and
employed Root Cause Analysis (RCA) to pinpoint causative factors with Ishikawa [Link] we
applied Plan-Do-Check-Act (PDCA) management techniques for Standard Operating Procedures (SOPs)
rolling adjustment and continuous uploading [Link] 5 SOPs of ECGs Uploading are shown
as below: [Link] Medical Order [Link] Room(ECG Room) check-in [Link] Exam and Medical
Imaging Checkup Execution [Link] Report Completion [Link] Uploading.

Results: The quarterly average upload rate of ECGs report increased from 38%(2022 Q1) to 85%(2023
Q4) and ECGs Report Completion Time shortened from 45 days(2023 Q1) to 5 days(2023 Q4). It means
more patients could access to their EHR in a shorter period of time.

The RCA analysis results(Shown as Ishikawa Diagram)found four major factors: Human
Behavior,Hospital Information System(HIS) Revision, ECGs Machine,Interface [Link] total
annual amount of failed ECGs upload case is dropped from 26,994 to 21,085 [Link] percentage of
Human Behavior factor is reduced from 48.9%(13,204/26,994) in 2022 to 15.7%(3,178/21,085) in 2023
after PDCA and SOP execution. However,compared to 2022(21.1%),HIS Revision factor rised to 54.3%
in 2023 .We inferred from our ER HIS2 system implementation in Nov. 2022. It’s affected by
programming errors, but got improved after [Link] ECGs Machine, Interface Compatibility
factors remained almost the same (14.5%& 15.5%)for both year.

Image:

357
Conclusion: The impact of upload data to the public cloud is [Link] lessen-learnt from this study
is Early Intervention Monitoring and Preparation,such as Cross-Functional Team Building,HIS revision
response and EHR Accessibility Indicator set up(Upload Rate,ECGs Report Completion Time).Our team
covers Health Information Manager,[Link] ECGs Technician,IT Programmer,Insurance Declarer and
Contractors for problem solving.

By statistics,Human Behavior is the main factor to stop uploading data in 2022(Repeated Medical
Orders,Order Execution without issuing,Delayed ECGs Report Completion),thus we did PDCA and
adjusted our step to have on-site clinical survey in the beginning of [Link] doctors and ECGs
Technician follow 5 [Link],our IT professionals set up a dashboard with PowerBI for whole
members’ [Link] those actions,we found 2023Q3 upload rate is 84% which exceeded 80% for
the first time and ECGs report could be reached within 5 days after 2023Q3 for better Patient EHR
Accessibility.

References: [Link] HS, Lie AK, Moen K. Patient Rationales Against the Use of Patient-Accessible
Electronic Health Records: Qualitative Study. J Med Internet Res. 2021 May 28;23(5):e24090.

[Link] R, Slade C, Burton-Jones A, Sullivan C, Staib A, Janda M. Patient Portals Facilitating

Engagement With Inpatient Electronic Medical Records: A Systematic Review. J Med Internet Res. 2019
Apr 11;21(4):e12779.

358
[Link] HC, Chang WP, Hsu MH, Ho CH, Chu CM. An Assessment of the Interoperability of Electronic
Health Record Exchanges Among Hospitals and Clinics in Taiwan. JMIR Med Inform. 2019 Mar
28;7(1):e12630.

[Link] PC, Kao FY, Liang FW, Lee YC, Li ST, Lu TH. Existing Data Sources in Clinical Epidemiology: The
Taiwan National Health Insurance Laboratory Databases. Clin Epidemiol. 2021 Mar 1;13:175-181.

Disclosure of Interest: None Declared

EVALUATION OF HOSPITAL MANAGEMENT STRATEGIES RELATED TO PANDEMIC: (3212) Keziban

AVCI

ISQUA2024-ABS-3212

K. AVCI 1,*, E. Özyurt 1, S. DEMİRCİ 1, F. ÇİZMECİ ŞENEL 1

TÜSKA, Ankara, Türkiye

1

Introduction: Health institutions are faced with mass applications in periods when diseases spread
rapidly, regional disasters and epidemics affect large masses due to urbanisation, and intense
migration movements are experienced due to reasons such as war-disaster-epidemic. Hospitals
operate through coordinated processes that require effective management and uninterrupted supply
lines. In this respect, pandemic periods are crisis periods where the importance of proper management
of human resources, equipment, materials and information comes to the fore. Especially considering
the uncertainty of the therapeutic, economic and managerial effects on hospitals, there is a need to
examine the preparedness of hospitals for these unexpected pandemics. In this context, this study
aims to examine pandemic management strategies in tertiary education and research hospitals in
Turkey and to evaluate the organisational competencies of these hospitals.

Methods: The population of the study consists of a total of 167 hospitals of all ownership types, public-
university and private, which have the competencies to conduct education and research operating in
Turkey. No sample selection was made in the study and the quality directors of the hospitals in the
universe were invited to participate in the study. A total of 58 training and research hospitals that
responded completely to all questions were included in the study. This study is a cross-sectional and
descriptive study conducted between January 2022 and May 2022. Hospital management strategies
were evaluated according to the standards given in the "COVID-19 Hospital Readiness Assessment
Tool" published by the Institute for Healthcare Improvement (IHI). The data were analysed using SPSS
version 26. Descriptive statistics related to the data are given.

Results: In nearly 91% (n=53) of hospitals related to the Planning, Decision Making and
Communication Structure dimension, the task team reported coordinating across the health system to
share supplies, coordinate testing, standardise communication and processes, and manage capacity
expansion. For the Monitoring and Improvement Processes dimension, almost all hospitals (89%)

359
reported that management frequently visits service areas to listen to and learn from staff, and that a
communication process is managed with a continuous flow of information to disseminate learning
among clinical and operational staff. Similarly, in a large proportion of hospitals, it is reported that
training to prepare, support and improve all staff against uncertainties is routinely provided, and new
practices are quickly tested and used to improve processes. In this study, it can be said that the
functional readiness of training and research hospitals in Turkey is at an adequate level.

Conclusion: Hospitals should be prepared for possible pandemics to provide timely, effective, rapid
and reliable healthcare services to patients and to reduce mortality. In this respect, health managers
should be fully aware of the risks and work to improve their ability to cope with them.

Disclosure of Interest: None Declared

Identifying the prevalence and distribution of adverse drug events in children within community
settings: A scoping review: (1832) Kim Sears

ISQUA2024-ABS-1832

S. Belbin 1, K. Sears 1,*

School of Nursing, Queen's University, Kingston, Canada

1

Introduction: Overview: Children present unique medication prescribing and monitoring

considerations as weight-based dosing calculations are often required, a situation further complicated
by a lack of standardized paediatric easy-to-use dosage formulations. [1] An estimated 75% of licensed
pharmaceuticals in North America have never been tested in children, yet they are routinely utilized
in this population without adequate evidence on their safety and efficacy. [2] The Canadian Medication
Incident Reporting and Prevention System (CMIRPS) defines a medication incident as “a medication
incident is a mistake with medicine, or a problem that could cause a mistake with
medicine”.[3] Paediatric medication related events or adverse drug events (ADEs) are the most
frequent type of medical error involving children. [4,5] Despite this common occurrence there is
limited data describing the frequency and epidemiology of their occurrence, particularly in the non-
inpatient setting.

Methods: The search strategy will aim to locate both published and unpublished studies. An initial
limited search of MEDLINE was undertaken on April 19, 2023 to identify articles on the topic. An update
will be completed in February 2024. The text words contained in the titles and abstracts of relevant
articles, and the index terms used to describe the articles were used to develop a full search strategy
for Medline, Embase, CINAHL with Full Text, and Web of Science.

Results: The extracted data will be presented in diagrammatic or tabular form in a manner that aligns
with the objectives of this scoping review. A narrative summary of findings table will describe how
included studies relate to the research objective and questions.

360
Conclusion: By creating a summary from this scoping review of the current prevelance and distribution
of ADEs in children aged 19 or under, pharmacies will have increased knowledge of areas needing
improvement to decrease these errors. This scoping review will provide stakeholders with insight so
they can effectively implement practices to better address emerging challenges.

References: 1. Malkawi W, AlRafayah E, AlHazabreh M, AbuLaila S, Al-Ghananeem A. Formulation

challenges and strategies to develop pediatric dosage forms. Children. 2022;9(4):488.
doi:10.3390/children9040488

2. Greener M. Bitter medicine. EMBO reports. 2008;9(6):505-508. doi:10.1038/embor.2008.95

3. Canadian Medication Incident Reporting and Prevention System. (2023). How does it work?
Canadian Medication Incident Reporting and Prevention System. Retrieved from [Link]
[Link]/?p=12&lang=en

4. Kaushal R. Medication errors and adverse drug events in pediatric inpatients. JAMA.
2001;285(16):2114. doi:10.1001/jama.285.16.2114

5. Wong IC, Ghaleb MA, Franklin BD, Barber N. Incidence and nature of dosing errors in paediatric
medications. Drug Safety. 2004;27(9):661-670. doi:10.2165/00002018-200427090-00004

Disclosure of Interest: None Declared

The impact of a consensus process on implementation of interventions into healthcare settings: A

qualitative study: (1997) Lisa Pagano

ISQUA2024-ABS-1997

L. Pagano 1,*, J. Long 1, E. Francis-Auton 1, J. Braithwaite 1 2, A. Hirschhorn 3, G. Arnolda 1, M. Sarkies 1 4

1
Australian Institute of Health Innovation, Macquarie University, Sydney, Australia, 2ISQua -
International Society for Quality in Healthcare, Dublin, Ireland, 3MQ Health, Faculty of Medicine and
Health, Macquarie University, 4Sydney School of Health Sciences, Faculty of Medicine and Health,
University of Sydney, Sydney, Australia

Introduction: Ensuring patient care is in line with evidence-based guidelines is fundamental for
improving global healthcare systems. Care pathways, such as perioperative pathways for elective
surgeries, can play a key role in reducing variation from guidelines and, in doing so, enhance patient
outcomes1. Clinicians practice a diverse array of care pathways based on evidence-based practice,
experience and training, and professional preference. The challenge, therefore, lies in choosing a
strategy to develop and implement these interventions that can achieve agreement and buy-in
amongst clinicians. Using consensus discussions could address this challenge however, little is known
about how these discussions work in practice2. This study sought to: (i) examine how different
consensus processes influence the implementation of standardised care pathways and; (ii) develop a
practical model for facilitating local consensus discussions within healthcare settings, ultimately
improving the implementation of interventions for better patient care.

361
Methods: A qualitative study was conducted in a private hospital in metropolitan Sydney, Australia
using modified grounded theory methodology, where concepts are built from the ground up3. Twenty-
five participants from clinical and non-clinical disciplines were recruited by convenience sampling. Data
were collected using semi-structured interviews and participant observations of meetings related to
consensus development amongst clinicians or implementing the agreed upon pathways. Data
collection and analysis occurred concurrently and continued until theoretical saturation was achieved.
Interviews and field notes were recorded and transcribed verbatim. Data were analysed in NVivo using
coding, constant comparison, detailed memo writing and data interpretation.

Results: The hospital approached consensus-building in two different ways: i) multidisciplinary team-
based discussions or ii) a leadership driven approach. Both approaches achieved consensus between
clinicians within similar time frames however, influenced implementation of the intervention in
different ways. A model was constructed from these findings, involving four key steps integral to
achieving consensus and ultimately leading to effective implementation. To conduct informal
consensus discussions, organisations had to establish a consensus group with key expertise, determine
the appropriate methods to achieve consensus, coordinate consensus meetings and reach consensus.
Causal mechanisms were identified demonstrating that achieving consensus through one method
triggered distinct implementation responses. For example, the inclusion of staff on the ground in the
consensus process resulted in greater clinician engagement and buy-in, leading to greater adherence
to the pathways. Conversely, when only leadership and management were involved in initial
discussions, slower responses from on the ground staff were reported. Findings suggest that
multidisciplinary engagement, streamlining workflows, highlighting the value of what is being
implemented and using targeted behaviour change methods promote adoption and successful
implementation. Additional considerations for implementing interventions using consensus
discussions included the concepts of; surgeons valuing their autonomy, effective communication
between staff and how patients understand the new processes.

Conclusion: This model provides a valuable blueprint for healthcare organisations seeking to
understand and optimise the informal consensus process for developing and implementing
interventions, such as care pathways, into clinical practice. An in-depth understanding of these
processes can empower clinicians to employ this strategy more effectively and is essential for
policymakers aiming to maximise implementation efforts to bring about tangible improvements in
healthcare systems.

References: [Link] KM et al., Improving the cost, quality, and safety of perioperative care: A systematic
review of the literature on implementation of the perioperative surgical home. J Clin Anesth. 2020

[Link] N et al., Consensus development methods:considerations for national and global

frameworks and policy development. Research in Social and Administrative Pharmacy. 2022

[Link] L et al., Implementation of consensus-based perioperative care pathways to reduce clinical

variation for elective surgery in an Australian private hospital: a mixed-methods pre–post study
protocol. BMJ open. 2023

Disclosure of Interest: L. Pagano: None Declared, J. Long: None Declared, E. Francis-Auton: None
Declared, J. Braithwaite Grant / Research support from: Holds multiple grants funded by the European

362
Union, and the Australian National Health and Medical Research Council and Medical Research Future
Fund, A. Hirschhorn: None Declared, G. Arnolda: None Declared, M. Sarkies: None Declared

Health for People and Planet: Building Bridges to a Sustainable Future: (2421) Lisa Pagano

ISQUA2024-ABS-2421

L. Pagano 1,*, S. Spanos 1, G. Dammery 1, L. A. Ellis 1, C. L. Smith 1, G. Fisher 1, D. Foo 1 2, J. Braithwaite 1 3

1
Australian Institute of Health Innovation, Macquarie University, 2Healthdirect Australia, Sydney,
Australia, 3ISQua - The International Society for Quality in Health Care, Dublin, Ireland

Introduction: A key component of building sustainable health systems is strengthening the front lines
of care, especially emergency departments and primary care settings. Globally, these settings are
challenged, amongst other factors, by ageing populations, a burnt-out workforce, future pandemics,
and worsening climate change effects. Learning Health Systems (LHSs) have been advocated as a
solution to improve care quality and patient safety by continuously embedding research and data into
routine practice, thereby enabling the front lines to learn and improve on-the-go1,2. So: how far have
the front lines of care progressed in adopting LHSs principles? Many experts think progress is critical in
delivering better care and being prepared for looming threats to the system. This rapid literature
review investigated the breadth of LHS approaches adopted in primary care and emergency settings
and the factors influencing their adoption.

Methods: To comprehensively consider this question, three databases (Embase, Scopus, PubMed)
were searched from January 2018 to March 2023 for literature reporting on LHSs in primary care or
emergency settings. Articles with a key focus on LHSs in primary care (general practice, allied health,
multidisciplinary primary care, and community-based care) and/or emergency settings were screened
to assess their eligibility. Data from included articles were extracted into a purpose-designed Excel
spreadsheet and catalogued according to the five components of the Zurynski-Braithwaite 2020 LHS
model3: science and informatics, patient-clinician partnerships, incentives, continuous learning culture
and structure and governance.

Results: Of the 37 articles included and analysed, the vast majority (86%) were focussed on primary
care and conducted in North America (68%). Science and informatics was the most commonly
employed LHS component, in which 92% of articles examined technological tools, systems, or
measures that had been implemented to improve care quality (e.g., electronic health records to
improve adherence to guideline-directed care). Continuous learning culture was a focus of 84% of
articles, most frequently centred on the creation of teams or collaboratives to share quality
improvement learnings. Structure and governance, the third most common component (76%), focused
primarily on partnership structures to strengthen research and leadership engagement. Less of a focus
were incentives (e.g., compensation to encourage staff training) and patient-clinician relationships
(e.g., intervention co-design). Further, patient satisfaction and health outcomes in the context of LHSs
were rarely explored. Barriers to adopting LHSs at the front lines of care included data infrastructure

363
that was too complex, communication challenges between healthcare professionals, and limited
resources to support improvement. Facilitators included stakeholder buy-in, positive relationships, and
forward-planning for interventions.

Conclusion: This study found a breadth and range of LHS approaches adopted in primary care and
emergency settings, internationally. Many care settings are providing clinicians with actionable data
and tools to learn from patient encounters; are facilitating a culture of continual quality improvement;
and are effectively managing their learning environment. Less progress than we would prefer is being
made along LHS lines to provide incentives and take patient preferences into account in decision-
making processes. Becoming an LHS requires good policy to support resource commitment, and
funding models that enable partnerships within and across organisations. Multidisciplinary learning
and patient co-design must be a core focus to facilitate empowered, informed, and enabled individuals
and teams at the front lines of care.

References: 1. Braithwaite J, Glasziou P, Westbrook J. The three numbers you need to know about
healthcare: the 60-30-10 challenge. BMC medicine 2020;18:1-8.

2. Pomare C, Mahmoud Z, Vedovi A, et al. Learning health systems: a review of key topic areas and
bibliometric trends. Learning Health Systems 2022;6(1):e10265.

3. Zurynski Y, Smith CL, Vedovi A, et al. Mapping the learning health system: a scoping review of current
evidence. A white paper. 2020

Disclosure of Interest: L. Pagano: None Declared, S. Spanos: None Declared, G. Dammery: None
Declared, L. A. Ellis: None Declared, C. L. Smith: None Declared, G. Fisher: None Declared, D. Foo: None
Declared, J. Braithwaite Grant / Research support from: Holds multiple grants funded by the European
Union, and the Australian National Health and Medical Research Council and Medical Research Future
Fund

Student Nurse Retention – identifying risks and best practices for retention via retrospective data
analysis: (2921) Robert M. Cook

ISQUA2024-ABS-2921

R. M. Cook 1,*, S. Jones 1, E. Crisp 1

Staffordshire University, Stafford, United Kingdom

1

Introduction: Retaining pre-registration student nurses to improve the supply of registered nurses in
the healthcare workforce is important for ensuring adequate care in the face of growing demand.
Attrition for pre-registration student nurses in the UK is approximately 24% (Health Education, 2019);
efforts to retain students could make a significant contribution to the supply of registered nurses in
England, where there were 43,619 nurse vacancies in the quarter ending in December 2022 (NHS

364
Digital). In 2020, the global shortage of nurses was estimated at 5.7 million (International Council of
Nurses, 2020).

Student retention programmes have employed qualitative methods to characterize the needs of the
cohort and, while these lessons are key, each study represents a static snap shot of a historical student
cohort. The challenge is to understand to what extent we can perform a low resource evaluation of
recent nursing cohorts to aid intervention, either as overarching lessons or as identification of at risk
individuals. The operational imperative to capture information about students, customers and service
users offers a wealth of data which, in combination with the disciplines of statistical learning, pattern
recognition and predictive analytics, presents an easy to implement analysis.

This study aims to examine the feasibility of implementing a quantitative approach to student nurse
retention. It explores the steps needed to identify, extract and analyse existing retrospective
operational data from a higher education institute, with the expectation of disseminating the model
both as key inferential patterns and a predictive algorithm.

Methods: Three outcomes were defined:

Likelihood for a student to leave a nursing course within a year of enrolment (Y1 Model).

Likelihood for a student to leave a nursing course within a year of enrolment, given they have not left
in their first year (Y2 Model)

Likelihood a student fails to complete a nursing course given they have not left in their first two years
(Y3 Model)

Following initial stakeholder events, a variable pool was defined including demographics, module
scores, incidents of intermission and discipline. Data sets were extracted from the universities business
intelligence warehouses, applying a random hash function to minimize identifiability risks. Analysis
was performed via bi-directional stepwise binary logistic regression, with data divided into training and
validation sets in a 3:1 ratio. Model quality was measured via the ROC-AUC method.

Results: Preliminary results suggest that in the 1st year of study of a nursing course, young students
(aged 18-21) and those that identify as male have the greatest risk of being lost from the course. In
later years, the predominant factors were if the student had previously taken a period of intermission
and their module scores. The data suggests the period after returning from intermission, and the first
clinical placement are critical to the student journey.

On applying the model to the data of current students, individual risk scores were calculated and
converted to an early warning score. Interventions focused on the highest risk for attrition are
currently ongoing.

Conclusion: This work demonstrates the viability of pairing existing qualitative student retention
programmes with predictive analytics. The triangulation of acute voiced issues with chronic signals
offers an opportunity to better focus HE resources to ensure lower attrition rates and better meet the
staffing demands of modern healthcare.

365
References: Health Foundation (2019) How many nursing students are leaving or suspending their
degrees before graduation? [Link]
infographics/how-many-nursing-students-are-leaving-or-suspending-their-degrees accessed
25/06/2023

International Council of Nurses (2020) COVID-19 and the international supply of nurses.
[Link]
07/COVID19_internationalsupplyofnurses_Report_FINAL.pdf accessed 25/06/2023

NHS Digital (2020) NHS Vacancy Statistics, England, April 2015 - December 2022, Experimental
Statistics [Link]
survey/april-2015---december-2022-experimental-statistics accessed 25/06/2023

Disclosure of Interest: None Declared

Promoting & Encouraging Exception Reporting (PEER) Quality Improvement Project: (1709) Schnell
D'sa

ISQUA2024-ABS-1709

S. D'sa 1,*, O. Ali 1, O. Sonola 1

NHS, Peterborough, United Kingdom

1

Introduction: In 2016, NHS England introduced Exception Reporting in the 'Junior Doctors and Dentists
in Training’ contract. This is a process whereby doctors inform their employer when “their day-to-day
work varies significantly and/or regularly from the agreed work schedule”1 and can receive pay and
other resolutions. Understaffing concerns may also be highlighted to aid the trust with appropriate
resource allocation.

Our aim is to improve the proportion of junior doctors in North West Anglia Foundation Trust (NWAFT)
who understand how to Exception Report and complete the practice. Additionally, we aim to
understand the rationale behind why doctors choose not to Exception Report, and the impact of
overtime working on staff and perceived patient safety.

Methods: A quality improvement project was completed using PDSA cycles to assess the effects of
changes implemented. Data collection occurred via surveys distributed in February 2023 (first cycle)
and November 2023 (second cycle). NWAFT’s junior doctors, in all grades and specialties, were invited
to complete a digital (Microsoft Forms) or paper version of the same survey. This data was analysed
using Microsoft Excel. Root-cause-analysis was performed with Ishikawa diagrams and theory testing
with driver diagrams. Initial findings were presented at the trust's Board of Directors meeting with the
Chief Medical Officer (CMO) and Guardian of Safe-Working (GoSW) present. Here, we sought to
directly include leadership members at the trust in our aim to improve Exception Reporting. Further
presentations of PEER occurred at local and regional QIP conferences.

366
Working closely with NWAFT’s CMO and GoSW, survey results were shared with all junior doctors.
Barriers to Exception Reporting were identified from the survey responses, and targeted changes were
discussed then enacted. This was done in several ways. We implemented instructional posters in every
doctors’ office across Peterborough City Hospital and circulated informational, purpose-designed
videos and posters to doctors. These resources were also shared at departmental inductions.
Additionally, with the help of rota coordinators and departmental leads, emails were sent to all
supervising consultants supported by the CMO emphasising the importance of encouraging Exception
Reporting. Moreover, we facilitated the resolution of junior doctors’ technical difficulties related to
accessing the Exception Reporting portal.

Following implementation of interventions, data collection amongst NWAFT’s junior doctors was
repeated in November 2023 with the same survey as the first cycle. We sought to compare results and
assess the impact of the interventions.

Results: There were 80 junior doctors who responded to the survey in our first cycle, compared with
the 104 respondents of our second cycle. Both surveys had respondents ranging across most grades
and specialties. There was an increase in the proportion of doctors who were aware of how-to
Exception Report from 56.25% in the first cycle to 61.54% in the second cycle. More doctors reported
that they had Exception Reporting explained to them during their departmental inductions rising from
22.5% to 29.81% in the first and second cycle respectively. However, 35.58% of respondents remained
unsure of when it was appropriate to Exception Report in the second cycle compared to 38.75% in the
first cycle. The median frequency of junior doctors who Exception Reported their overtime hours
shifted from 'Never to 'Rarely' in the second cycle. There was also a rise in respondents who found the
process of Exception Reporting ‘Very Easy’ from 6.25% to 13.46% in the second cycle. Amongst the
barriers to Exception Reporting identified in Figure 1, there was a reduction in junior doctors who
shared that Exception Reporting was discouraged by their department from 8.75% to 3.85% in the
second cycle. Of the respondents, 7.69% of doctors reported working approximately >15 hours of
overtime each month in the second cycle compared to 10% in the first cycle. Overtime work was
reported to have a detrimental impact on staff. The second cycle data shows that 73.08% reported
burnout/fatigue, 49.04% expressed reduced morale and lack of work/life balance was noted by
73.08%. Critically, overtime working was perceived by 33.65% to result in suboptimal patient care.

Image:

367
Conclusion: The PEER quality improvement project has shown a rise in the proportion of junior doctors
who know how to exception report and complete the practice, amongst other measures. Thus,
suggesting the interventions have been making a positive impact. However, there were multiple
barriers to Exception Reporting identified that require further interventions in future PDSA cycles. To
promote sustainability of our changes, we aim to appoint junior doctor and consultant Exception
Reporting champions roles in every department, who can continue to promote and encourage
Exception Reporting practices. This quality improvement project is pivotal to promote safe working
practices in junior doctors, prevent burnout and ensure optimal patient care.

References: 1. Terms and Conditions of Service for NHS Doctors and Dentists in Training (England)
2016 Version 3 21 April 2017

Disclosure of Interest: None Declared

368
Distilling implementation and policy strategies for sustainable healthcare innovation using policy
labs: A Hospital at Home case study: (1852) Yi Feng Lai

ISQUA2024-ABS-1852

Y. F. Lai 1 2 3,*, S. D. Goh 2, T. Y. Tan 2, C. Chua 1. 1MOH Office for Healthcare Transformation, 2National
University of Singapore, Singapore, Singapore, 3School of Public Health, University of Illinois Chicago,
Chicago, United States

Introduction: The evolution of hospital care is witnessing a remarkable shift with the recent expansion
of Hospital at Home (HaH) programmes. Many have emerged in the last five years in response to the
acute shortage of hospital beds triggered by the COVID-19 pandemic and challenges posed by ageing
populations. However, lack of effective scale-up strategies strongly suggest that evidence gap in
implementation and policy research to identify and test strategies to increase adoption and
sustainability across different healthcare systems. This study aims to use policy labs to bring together
stakeholders to generate and prioritise strategic recommendations to facilitate nationwide scaling-up
of HaH in Singapore.

Methods: Using three policy lab sessions (Hinrichs-Krapels, 2020), we gathered data from 23 key
stakeholders including HaH programme leads, programme implementers, and health ministry’s
policymakers. Each of the session consisted of two parts- (1) Review of barriers and facilitators: open
for discussion for participants to clarify issues and opportunities relevant to HaH scaling-up; and (2)
Strategy prioritisation and co-creation, where participants outlined strategies and determine measures
of success. Field notes were taken in each session. Data were compiled, compared, and triangulated
with discussion materials generated for actionable insights, which were then used for sensemaking
and generating strategy recommendations.

Results: Our research provides comprehensive insights into the readiness of Singapore's health system
for implementing HaH and illuminates effective multi-level strategies for scaling up this model,
including (1) supportive regulatory policy redesign, (2) sustainable healthcare financing, (3) deliberate
evidence-to-policy translation, (4) effective policy-to-operations communication, and (4) enhanced
programme awareness among target patient and provider populations. Specific strategy
recommendations were plotted on an action time scale, and accountable parties were identified along
with key landing spots for each strategy.

Conclusion: The collaborative and iterative policy lab approach to strategy development involving
multi-level health system partners allowed for the exploration of implementation and policy strategies
for the engagement of referrers, patients and caregivers, and recommendations for process
optimisation and sustainability. The actionable insights generated are critical for HaH to be a core part
of every acute hospital’s care strategy and extend its impact to transform patient care on a larger scale.
Beyond the tangible output generated from the policy lab sessions, the study also provided a platform
for implementers to be involved in the policymaking process; including creating new networks,
collaborations and partnerships.

References: 1) Hinrichs-Krapels, S., Bailey, J., Boulding, H. et al. Using Policy Labs as a process to bring
evidence closer to public policymaking: a guide to one approach. Palgrave Commun 6, 101 (2020).
[Link] Disclosure of Interest: None Declared

369
Setting Standards in Long Term Care: Identifying Achievable Benchmarks of Care for Long Term
Care Facilities: (1505) Maria Carolina Inacio

ISQUA2024-ABS-1505

J. Schwabe 1, R. Jorissen 1, G. Caughey 1, T. Comans 2, O. Ryan 1, M. C. Inacio 1,* and the Australian
Consortium for Aged Care Quality Measurement and Evaluation Toolbox (ACAC-QMET) Research
Collaborators
1
Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute,
Adelaide, 2The Centre for Health Services Research, The University of Queensland, Brisbane, Australia

Introduction: Benchmarks are an important aspect of quality measurement and evaluation of long-
term care facilities (LTCF) performance. While benchmarks can be set using different approaches, data
driven benchmarks focus on achievability and highlight real work examples. This study’s objectives
were to estimate achievable benchmarks of care for twelve quality indicators across Australian LTCFs
and identify LTCFs characteristics associated with benchmark attainment.

Methods: Study Design: A cross-sectional study was conducted, using integrated population-based
datasets from the aged care, health care, and social welfare sectors contained within the National
Historical Cohort of the Registry of Senior Australians (ROSA). All LTCFs residents in 2019 were
included. Twelve risk-adjusted quality indicators, including exposure to high sedative load,
antipsychotic use, chronic opioid use, antibiotic use, premature mortality, fall-related hospitalisations,
fractures, hospitalisations for medication-related adverse events, hospitalisations with weight loss and
malnutrition, delirium and/or dementia related hospitalisations, emergency department
presentations, and hospitalisations with pressure injuries were examined using the ROSA datasets.
Achievable benchmarks were defined as the average performance of top-ranked facilities providing
care for at least 10% of all residents nationally, and indicator-specific achievable benchmarks for 2019
were estimated using the Bayesian adjusted performance fraction ranking, as per the Achievable
Benchmarks of Care (ABC) approach. Logistic regression models estimated facility characteristics
associated with achievable benchmarks of care attainment. Population Studied: 2746 LTCFs and
244,419 older (≥65 years) residents between 01/01/2019 and 31/12/2019 were studied. Overall, the
cohort was mostly female (65%), with a mean age of 85 years (standard deviation=7.9), and 56% had
dementia.

Results: The achievable benchmarks of care for medication-related adverse events (0%), premature
mortality (0.07%), weight loss hospitalisations (0.1%), pressure injuries (0.2%), and delirium and
dementia hospitalisations (0.3%) were very low and 21-69% of LTCFs met these benchmarks. The
achievable benchmarks of care for fractures (1.3%), falls (4.0%), and emergency department
presentations (5.1%) were low and between 7-11% of facilities met these benchmarks. The achievable
benchmarks of care for antipsychotic use (10.7%), opioid use (23.6%), high sedative load exposure
(27.4%), and antibiotic use (47.8%) were met by 6-7% of LTCFs. Generally, smaller (<60 residents) LTCFs
compared to medium (60-149 residents) and larger (>=150), and government owned LTCFs compared
to private and not-for-profit LTCF, were more likely to achieve the estimated achievable benchmarks of
care.

Conclusion: This is the first national estimation of achievable benchmarks of care for Australian LTCFs
and has identified real world examples of LTCFs with relatively better national performance. The

370
estimated benchmarks are realistic starting goals for LTCFs working towards performance
improvement. Smaller and government owned LTCFs have consistently been identified in the
Australian literature to be associated with higher quality of care and should be further investigated to
identify aspects of their care models contributing to better resident outcomes.

Implications for Policy or Practice: The findings suggest that facility size and ownership are important
factors facilitating achievement of high-quality care. They highlight the need for tailored policy
interventions and practical strategies to improve care quality in diverse facility types. This includes
targeting the factors likely underpinning these associations such as service access, care models, and
workforce availability.

Disclosure of Interest: J. Schwabe: None Declared, R. Jorissen: None Declared, G. Caughey: None
Declared, T. Comans Consultant for: the Australian Government Department of Health and Aged Care
and sits on an Advisory Board for Star Ratings for Residential Aged Care., O. Ryan: None Declared, M.
Inacio Consultant for: the Australian Government Department of Health and Aged Care and sits on an
Advisory Board for Star Ratings for Residential Aged Care.

Measures or mitigating the negative effects of patient participation in patient safety: a qualitative
study: (1444) Michael Van Der Voorden

ISQUA2024-ABS-1444

M. Van Der Voorden 1,*, A. Franx 1, K. Ahaus 2

Obstetrics & Gynaecology, Erasmus MC, 2Health Services Management & Organisation, Erasmus
1

University, Rotterdam, Netherlands

Introduction: Patient participation is a strategy to improve patient safety. Indeed, recent research
shows the added value in hospitals of patient participation in patient safety. Furthermore, to the
improvements and positive effects that have been observed, there are also studies that identify
negative effects. This study focuses on bringing together the separate negative effects that have been
previously reported in the literature. In addition, the aim of this study is to generate an overview of
measures that can mitigate the negative effects of patient participation in patient safety.

Methods: This study was conducted in the obstetrics department of a tertiary academic center in the
Netherlands. An explorative single case study included sixteen interviews with professionals (N=8) and
patients (N=8). The negative effects of patient participation in patient safety and the measures that
could mitigate the negative effects of patient participation in patient safety were both deductively
identified and analyzed.

Results: Four negative effects of patient participation in patient safety were identified. These can be
summarised as follows: patients’ confidence decreases, the patient–professional relationship can be
371
negatively affected, more responsibility can be demanded of the patient than they wish to accept and
the professional has to spend additional time on a patient. Eighteen measures were identified that
mitigated the negative effects of patient participation in patient safety. These measures were
categorized into five themes: ‘structure’, ‘culture’, ‘education’, ‘emotional’, and ‘physical and
technology’. These five categories reflect the current approach to improving patient safety which is
primarily from the perspective of professionals rather than of patients.

Image:

Conclusion: This study identifies and brings together four negative effects of patient participation in
patient safety that have previously been individually identified elsewhere. In our interviews, there was
a consensus among patients and professionals on five different forms of participation that would allow
patients to positively participate in patient safety. Besides, most of the identified measures are linked
to changing the culture to generate more patient-centered care and change the current reality, which
looks predominantly from the perspective of the professionals and too little from that of the patients.
Furthermore, none of the suggested measures fit within a sixth anticipated category, namely, ‘politics’.
Future research should explore ways to implement a patient-centered care approach based on these
measures. By doing so, space and time are created to elaborate on these measures and integrate them
into the organizations’ structure, culture and practices.

Disclosure of Interest: None Declared

372
Longitudinal relationship between Vitamin D supplementation and falls incidents in residential
aged care: Implications for Falls Prevention Programs: (3010) Nasir Nasir

ISQUA2024-ABS-3010

N. Nasir 1,*, I. Meulenbroeks 1, D. C. Firempong 1, M. Raban 1, A. Nguyen 1, J. Close 2 3, S. Lord 2 4, J.

Westbrook 1
1
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie
University, 2Neuroscience Research Australia, 3Prince of Wales Clinical School, 4School of Population
Health, University of New South Wales, Sydney, Australia

Introduction: Vitamin D plays an essential role in supporting musculoskeletal health, and

supplementation may lower the risk of falls. Vitamin D supplementation may be particularly beneficial
in residential aged care (RAC) settings, given the high prevalence of Vitamin D deficiency within this
population. However, past research on the effects of vitamin D supplementation on falls in RAC has
reported inconclusive findings, partly due to study design limitations. We utilised a longitudinal study
design to assess the association between the use of vitamin D and falls over 36 months in RAC.

Methods: A longitudinal cohort study was conducted using routinely collected electronic data
extracted from 27 RAC facilities in Sydney, New South Wales, Australia. Study inclusion criteria were
residents who: were permanent residents aged 65 years or older; admitted for the first time on or after
the study start period of July 1, 2014, and were long-term residents (>30 days admission). We
identified daily vitamin D usage over 36 months, and measured adherence using the Proportion of
Days Covered (PDC) metric. PDC represents the proportion of days that residents were covered by
vitamin D supplements with a value of ≥80% signifying optimal adherence. Primary outcomes were
the number of all falls and injurious falls. We employed Generalized Estimating Equations (GEE) to
investigate the longitudinal association between the use of vitamin D supplements and the subsequent
risk of falls. This study was reviewed and approved by the Macquarie University Human Research Ethics
Committee (ref: 52019614412614).

Results: A total of 4,520 participants were included, with over two-thirds of residents (67.8%; n=3,063)
receiving vitamin D supplements during their stay. The median PDC was 74.8%, signifying that
approximately half of the residents received daily vitamin D supplements for three-quarters of their
total time spent in the RAC facilities. The proportion of residents achieving optimal adherence was
44.6% (n=1,365). Increasing age, osteoporosis or fracture history, and dementia were associated with
a greater likelihood of achieving optimal adherence. After accounting for relevant demographics (e.g.,
age) and health conditions (e.g., dementia status), no significant relationship was observed between
vitamin D supplement usage and fall outcomes: all falls (Incident Rate Ratio [IRR] 1.01; 95% CI 1.00-
1.02; P=0.237) and injurious falls (IRR 1.01; 95% CI 1.00-1.02; P=0.091).

Conclusion: Vitamin D supplementation was prevalent in RAC settings; however, it did not
demonstrate an association with a reduced risk of falls. This suggests that it may not be an effective
standalone intervention for preventing falls in RAC. While clinicians should prioritise ensuring
adequate vitamin D intake for residents' musculoskeletal health, other comprehensive measures may
be necessary for falls prevention in RAC populations.

Disclosure of Interest: None Declared

373
Impact of Early detection and Management of colorectal cancer to improve patient outcomes and
Reducing the healthcare cost in AL-HADA Armed Forces Hospital -TAIF Region - KSA: (1738) Neda
MAZEED Althkafai

ISQUA2024-ABS-1738

N. M. Althkafai 1,*, M. ALGAMDI 1 2, J. Alnofeye 1

CQI&PS, 2Endoscopy , ALHADA ARMED FORCES HOSPITAL, TAIF, Saudi Arabia

1

Introduction: World Health Orgnaziation reported colorectal cancer is the third most common cancer
worldwide, accounting for approximately 10% of all cancer cases and is the second leading cause of
cancer-related deaths worldwide and Colon cancer is the second leading cause of cancer-related
deaths worldwide. In 2020, more than 1.9 million new cases of colorectal cancer and more than 930
000 deaths due to colorectal cancer were estimated to have occurred worldwide.

Many people will not have symptoms in the early stages of the disease, and colorectal cancer is often
diagnosed at advanced stages when treatment options are limited.

Additionally, given the predominance of colorectal cancer compared with other cancers in Saudi
Arabia, Colorectal cancer is the most common cancer among Saudi men and the third commonest
among Saudi women also is a significant public health concern worldwide. Early detection through
effective screening tools plays a vital role in reducing mortality rated and improving our customers'
outcome.

Methods: The methodology is the Plan-Do-Check-Act cycle with best evidence-based practices
specifically applied to enhance and streamline the repetitive workflow involved in the early detection
and management of colorectal cancer in AL-HADA Armed Forces Hospital by focusing on Collaboration
among the primary health care in community to enhancing patient awareness and facilitating access
to Increase screening cases, enhanced the compliance of our Gastroenterology healthcare providers
with the national guidelines for colorectal cancer screening in Saudi Arabia with strength of
recommendation and quality of evidence. Additionally streamlining the patient journey in the
endoscopy department, ensuring early appointments within two weeks and improving patient
prioritization and integration immediately with the general surgery department to management
precancerous stage. This was done parallel to motivation our GIT consultant to compline with
international measurement of Adenoma Detection Rate (ADR) aiming to improve the overall
accessibility, and comprehensive care for early detection and management of pre-cancerous lesions.

Results: Our results demonstrate a significant improvement in primary outcome of the percentage of
early-stage cases with detected lesions has shown a substantial increase, rising from 4% prior to the
intervention to 17%. Moreover, the secondary outcomes of the percentage of referred patients to the
general surgery department has increase, escalating from 3.4% before the intervention to 11% after
its implementation.

Finally, Financial implication was crucial in evaluation the success of our intervention with highly cost
saving about SR 741,298.38 till the end of October 2023.

374
Conclusion: Improving the early detection and management of colorectal cancer has markedly
improved the overall of the positive case that were detection in early stage and management with
general surgery that impact on reduce cost in health care system and patient outcome.

References: Alyabsi M, Algarni M, Alshammari K. Trends in colorectal cancer incidence rates in Saudi
Arabia (2001–2016) using Saudi National Registry: early- versus late-onset disease. Front Oncol 2021;
11: 3392.

Wolf A, Fontham ET, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018
guideline update from the American Cancer Society. CA Cancer J Clin 2018; 68: 250-81.

Karsenti D, Tharsis G, Burtin P, et al. Adenoma and advanced neoplasia detection rates increase from
45 years of age. World J Gastroenterol 2019; 25: 447-56.

Disclosure of Interest: None Declared

Analysis of Factors Causing Low Doctor Verification Compliance based on Hospital Accreditation
Standard: (3459) Nungky Nurkasih Kendrastuti

ISQUA2024-ABS-3459

N. N. Kendrastuti 1,*, I. Octaviani 2. 1Management , KARS, 2Medical Record, Esa Unggul University,
Jakarta, Indonesia

Introduction: This study aimed to analyze the factors associated with low of verification by doctors at
hospital. According the hospital accreditation standard, the doctor responsible for the patient carried
out verification to ensure that all health actions carried out on the patient by other health workers are
known to the doctor responsible for the patient. The verification process is a process where a
responsible doctor signs at the side of the care professional's writing on the Integrated Patient Progress
Record form. Initial studies show that the level of verification compliance by the doctor in charge of
the patient was quite low. The average level of compliance with filling out doctor's verification in
medical records was 9.26% (0-60%).

Methods: This research method used a quantitative analytical approach with the research population
consisting of doctors and inpatient medical record documents. A total of 31 doctors took part in this
research. This research was carried out in November 2022 – February 2023 at RSUP dr. Sitanala
Tangerang Indonesia. Relationship testing was carried out using the Chi-Square test with p>0.05. The
variables age, length of service, gender and doctor's knowledge were tested to see whether they had
a relationship with verification compliance

Results: The results of the study showed that there was no relationship between the age factor (p=
0.922), the length of work factor (p= 1.101), and the gender factor (p= 0.360) on the percentage of
doctor verification compliance (95% CI, p<0.05 ). However, there is a significant relationship between
the knowledge factor (p= 0,015) and the percentage of compliance with doctor verification

375
Conclusion: Conclusion:

There is no significant relationship between age, length of work, and gender on the low percentage of
doctor verification compliance. But, there is a significant relationship between the knowledge factor
and the percentage of doctor verification compliance

References: 1.

1. Tandy DY. Analysis of Compliance in Filling Out Medical Record Files at Kalisat Jember Regional
Hospital (Rsd) in 2017. Digit Repos Univ Jember [Internet]. 2021;(September 2019):2019–22. Available
from: [Link]

2. Anisafitri A. The Relationship between the Characteristics of the Doctor Responsible for Services
(Dpjp) and Compliance with Filling Out the Medical Resume of Patients at the Social Security
Administering Agency for Health (BPJS) (Study at Installation 46. Inpatient at Jemursari Islamic Hospital,
Surabaya). Https://MediumCom/ [Internet]. 2016;(July):1. Available from:
[Link]

1. Rusdianawati I, Usman S, Biidznillah GG, Rohman T. Evaluation of Compliance with Initial Medical
and Nursing Assessments. J Hosp Accredit. 2021;03(1):27–33.

1. Tosepu Y. Pareto's Law: The 80:20 formula which can be applied in all aspects of life. IssuuCom
[Internet]. 2018; Available from: [Link]
Hukum_pareto_yang_dapat_diterangkat13. Fauzil F, Yusuf Y, Astiena AK. Analysis of Dpjp Compliance
in Completeness of Filling in Medical Records and Factors That Influence It at Dr Rasidin Hospital,
Padang. Hum Care J [Internet]. 2022;7(2):359. Available from: [Link]

Disclosure of Interest: None Declared

Improving the quality of hospital care for mothers and children in Kyrgyzstan: (2884) Nurshaim
Tilenbaeva

ISQUA2024-ABS-2884

N. Tilenbaeva 1,*, D. Beglitse 2, K. Lomouri 3, Z. Ospanova 4, I. Stepanova 5, O. Kuzmenko 6, A.

Kuttumuratova 7, S. Jullien 8, M. Weber 8
1
World Health Organization , Bishkek, Kyrgyzstan, 2Municipal maternity hospital 1, Krasnodar, Russian
Federation, 3Tbilisi State Medical University, Tbilisi, Georgia, 4City polyclinic 7, Astana, Kazakhstan,
5
Maternity hospital 21 , Perm, Russian Federation, 6World Health Organization , Copenhagen,
Denmark, 7World Health Organization , Almaty, Kazakhstan, 8World Health Organization , Athens,
Greece

Introduction: Maternal, newborn and child mortality are still unnecessarily high in the Kyrgyz Republic.
Despite certain progress over the past decades, mortality rates are still very high compared to the
average in the WHO European Region. Suboptimal quality of care largely results to poor health
outcomes. National quality improvement approaches are often person-focused concentrating on

376
supposed ‘correction of mistakes and errors’ by individual care [Link] hospital quality
improvement project for mother, newborn and child health in 11 hospitals of the Kyrgyz Republic was
implemented from 2021 to 2023. Targeted facilities were primary, secondary and tertiary level
hospitals across the country. The study was conducted to assess the progress of quality of care for
mothers, newborn and children after implementation of the complex improvement process for two
years.

Methods: The quality of care in 11 hospitals was assessed in October 2021, using adapted WHO
assessment tools on hospital care for children (2015) and hospital care for mothers and newborn
babies (2014). The tools evaluated availability and appropriate use of resources, case management,
and key hospital policies. Assessment teams included obstetricians, midwives, neonatologists,
paediatricians and nurses who were prior trained on assessment tools, Effective perinatal care and
Pocket book of hospital care for children. The baseline assessment was followed by a complex
improvement process for two years including updating clinical guidelines, selected training sessions in
technical areas and quality improvement methods, supportive supervision and semi-annual
collaborative improvement meetings between hospitals. Core technical training sessions focused on
on-job training on Effective perinatal care and Pocket book of hospital care for children. Moreover, five
rounds of supportive supervision to pilot hospitals by National and peer supervisors, four semi-annual
quality improvement workshops, including for hospital quality committees, were conducted. Hospitals
have been developing their quality improvement plans based on the baseline assessment results which
were updated after each supportive supervision and semi-annual quality improvement workshops.

Results: Most hospitals showed considerable improvement in many case management indicators;
however, the standard of care achieved after two years of interventions was largely still not according
to international standards in most cases. From little to no changes were observed in hospital support
services as well as policies and organization of services. Hospitals with frequent change in leadership
and less support for the process showed generally less improvement.

Conclusion: Quality improvement emerges from the interactions of all functions of the health system.
Well-trained health care workers are enabled to provide quality of care when they are well-
remunerated and have access to well-equipped health infrastructure with required diagnostic tests,
medicines, devices and technologies. Support and leadership from hospital management encourages
the quality of care. Quality improvement in a setting with a 'person-focused approach' to quality is
challenging. Changes take time and the quality improvement process will need to be continued. This
requires deliberate efforts and continuity. Improving maternal, newborn and child health requires the
health-systems lenses where efforts are made to address challenges in all of it functions.

Disclosure of Interest: None Declared

377
Addressing patient flow issues reducing risks to patient safety and improving the quality of care:
(1879) Pieter Jan Van Dam

ISQUA2024-ABS-1879

P. J. Van Dam 1,*, M. Dwyer 2, J. Montgomery 3, S. Prior 4, M. O'Reilly 5, R. Turner 2

1
School of Nursing, 2Tasmanian School of Medicine , 3School of ICT, University of Tasmania, Hobart,
4
Tasmanian School of Medicine , University of Tasmania, Burnie, 5School of Natural Sciences, University
of Tasmania, Hobart, Australia

Introduction: Emergency Department (ED) crowding, bed access block, and increased length of stay,
pose substantial risks to patient safety. The risk of inpatient mortality for patients admitted via the ED
during crowding periods can be up to 34% higher compared to those admitted during non-crowded
periods. Poor patient flow also impacts hospitals more broadly, in the form of decreased quality of
inpatient care and reduced financial performance. Several of these issues are present in a tertiary care
centre in Tasmania, Australia, potentially causing sub-optimal patient and organisational outcomes.
The current study was conducted with a view to understanding the root causes of these contextual
issues, and also to explore and understand the factors that influence patient flow management in
general. With such information, the authors could develop solutions aimed at addressing these issues.

Methods: A pragmatic qualitative approach was employed, whereby in-depth consultations were
conducted with 13 clinicians whose positions in the hospital heavily involved the maintenance of
patient flow, to determine the most valuable key factors involved in the management of patient flow.
The data was analysed using Attride – Stirling’s thematic networks tool. In addition, tag- a-longs were
caried out to examine and measure patient flow process.

Results: Four global themes were developed: Managing Patient Flow – multiple paper-based lists and
software programmes were used to make decisions regarding the most appropriate bed for patients.
The wide variety of conflicting information led to confusion. Communicating for Decisions - admission
processes whereby the same patient in the ED is assessed by three different medical teams led to
lengthy delays. Tools as Enablers and Barriers – there were instances where staff members did not
document the correct information in the various systems and there was also evidence that staff
members were not aware of the capabilities of these systems, which caused delays and confusion.
Increasing Complexity – participants noted that efforts to maintain patient flow were hampered by
factors such as inappropriate patient stays, high demand for beds, and a workforce not agile enough
to care for a wide variety of patients. Participants were asked what would help them to manage patient
flow better and a predictive tool was suggested.

Conclusion: Based on the results several potential solutions have been identified and are currently
addressed. An overarching tool (software) incorporating all information required to aid patient flow
decisions was regarded as a priority. This tool includes prediction of how many admissions the hospital
can expect every day, based on statistical modelling. It is anticipated that this will lead to more
sophisticated resource management. Linking forecasts of arrivals with upstream (ambulance call-outs)
and downstream (length of stay) analytics could lead to more personcentred decision-making and
increase patient safety.

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Disclosure of Interest: None Declared

The burden of potential drug-drug interactions in a large tertiary care teaching hospital in rural
India and suggested interventions: (2417) Pratheesh Ravindran

ISQUA2024-ABS-2417

P. Ravindran 1,*, K. Arumugam 1, H. Kandeeban 1, J. Pandian 2, P. Kulanchiappan 1, E. G 3

1
Quality Management Services, 2Pharmacology, Mahatma Gandhi Medical College and Research
Institute, Sri Balaji Vidyapeeth University, 3Biostatistics, Sri Balaji Vidyapeeth University, Pondicherry,
India

Introduction: Drug-drug interactions (DDIs) are a significant contributor to preventable adverse drug
events (ADEs), and may cause severe harm(1,2). They also lead to avoidable hospital admissions and
additional expenditure. Most previous studies have focused on the incidence of potential DDIs (pDDIs)
in cardiac and internal medicine wards. This study was undertaken at a 1200 bedded multispecialty
teaching hospital in rural India, across all departments, to:

1. Estimate the burden of pDDIs and identify the predictors

2. Formulate interventions to reduce the same

Methods: In this retrospective study, 724 cases were randomly selected from all department
admissions during July-October 2023 at Mahatma Gandhi Medical College and Research Institute,
Pondicherry. The oral drugs were checked for pDDIs using the Medscape drug-drug interaction checker.
The interactions were classified into “Contraindicated”,” Serious”,” Monitor closely” and” Minor”.
Pearson Chi Square test was used to check association between patient characteristics and pDDIs, and
logistic regression was used to estimate the Odd's Ratio. The results were analysed and appropriate
interventions were formulated. There were no ethical considerations except that the patients who had
been discharged on drugs with potential of serious reaction, were called back to the hospital and the
medications were changed/stopped.

Results: A total of 724 prescriptions were evaluated. There were 407 males and 317 females. In the
study population, 387 patients belonged to surgical departments and 337 patients belonged to medical
departments. pDDIs occured in 133(18.4%) patients. Two hundred and five (28.3%) patients were on
eight or more drugs. The number of pDDIs per patient ranged from 1 to 11. Two patients were on a
pair of drugs which were in the "Contraindicated" category, and 19 patients were on drugs with
potential of "Serious" reaction. The number of potential "Serious" reactions per patient ranged from
1 to 4. One hundred and sixteen (16%) patients had potential durg interactions, which required close
monitoring. Thirty four (4.7%) patients had potential minor drug interactions. No adverse drug reaction
had been reported for any of these patients during their hospital stay. The contraindicated drugs had
been stopped for both patients at discharge. Four out of the 19 patients with potential serious drug
interactions had been discharged on at least one pair of interacting drugs.

379
Higher Age (p 0.001), admission in a medical specialty (p 0.033), and number of prescribed drugs (p
0.001) were associated with pDDIs based on Pearson's Chi Square test results. Binary logistic regression
analysis was performed to assess Odds ratio for developing pDDIs for selected independent variables.
As the age of the patient increased, they were more likely to develop pDDIs (OR 1.02), and it was
significant (p=0.001). Female gender afforded protection from pDDIs (OR 0.86) as compared to male
patients but the difference was statistically insignificant. Higher number of prescribed drugs was also
significantly associated with pDDIs( OR 3.5, p 0.001).

Interventions: The four patients who had been discharged on drugs with potential of serious reaction
were called back and the drugs were stopped/changed. The two Clinical Pharmacists of the hospital
presented the data to individual departments, and doctors/nurses were educated about pDDIs. The
list of contraindicated and serious drug intreactions were dislpayed in all wards. Based on the results
of this study and literature, the clinical pharmacists started focusing on patients aged 50 years and
above, with multiple co-morbidities and who had been prescribed more than 5 drugs; to ensure higher
pickup rate of serious category pDDIs for timely intervention. A repeat audit is planned after 3 months
of implemention of the interventions.

Conclusion: There is a high incidence of pDDIs at our hospital which may in turn lead to serious side
effects.

A program spearheaded by Clinical Pharmacists, which includes medication safety education

intervention for doctors and nurses, highlighting the common drug interactions, and a screening tool
for patients based on risk factors for pDDIs, may help reduce the possible complications.

It is not feasible to have enough Clinical pharmacists to evaluate all prescriptions daily in a hospital. In
such a scenario, a computerised physician order entry (CPOE) for electronic prescribing, with Clinical
decision support system (CDSS) and alert system, would be the gold standard to recognize pDDIs.
However, such technologies should be affordable for developing countries, and also address associated
alert fatigue.

References: 1. Cruciol-Souza JM, Thomson JC. Prevalence of potential drug-drug interactions and its
associated factors in a Brazilian teaching hospital. J Pharm Pharm Sci. 2006;9(3):427-433.

2. Bethi Y, Shewade DG, Dutta TK, Gitanjali B. Prevalence and predictors of potential drug-drug
interactions in patients of internal medicine wards of a tertiary care hospital in India. Eur J Hosp Pharm.
2018;25(6):317-321.

Disclosure of Interest: None Declared

380
Lunchtime

Lightning Talks

The effect of Joint Commission International accreditation on patient safety culture and outcomes:
(2154) SIDIKA KAYA

ISQUA2024-ABS-2154

S. KAYA 1,*, B. METE 2, Z. ASILKAN 3, A. H. METE 4, S. AKTURAN 5, N. TUNCER 6, F. YUKSELIR ALASIRT 7, O.

TOKA 8
1
Department of Health Management, Faculty of Economics and Administrative Sciences, Hacettepe
University, Ankara, 2Department of Health Management, Faculty of Health Sciences, Sakarya University
of Applied Sciences, Sakarya, 3Department of Medical Services and Techniques, Vocational School of
Health Services, İzmir University of Economics, İzmir, 4Department of Health Management, Faculty of
Health Sciences, Istanbul University-Cerrahpasa, Istanbul, 5Department of General Surgery, Yıldırım
Beyazıt University Yenimahalle Training and Research Hospital, Ankara, 6Department of Health
Management, Faculty of Health Sciences, Hitit University, Corum, 7Department of Health
Management, Faculty of Health Sciences, Kırklareli University, Kırklareli, 8Department of Statistics,
Faculty of Science, Hacettepe University, Ankara, Türkiye

Introduction: Although accreditation is believed to have a positive impact on quality and safety in
healthcare, there is limited literature about the effect of accreditation on patient safety culture and
outcomes in Türkiye. The objective of this study is to determine the effects of Joint Commission
International (JCI) accreditation on patient safety culture and 4 outcomes (self-reported errors,
witnessing errors, incident reporting, and patient safety grade).

Methods: The data were collected using the Turkish version of the Safety Attitudes Questionnaire
(SAQ)1, which consists of 6 dimensions (teamwork climate, safety climate, job satisfaction, stress
recognition, perceptions of management, and working conditions). Of 1679 personnel working in three
accredited and three non-accredited hospitals in Ankara, 860 were randomly selected. The data were
analyzed using binary logistic regression analyses. The responses given to the SAQ and outcome
variables were categorized into two groups: agree (“agree slightly” and “agree strongly”) and others
(“disagree slightly,” “disagree strongly” and neutral). All regression models were adjusted for
characteristics of respondents (position, age, gender, duration of work in hospital and in clinic) and size
of the hospital.

Results: The response rate was 62.7%. The means of overall patient safety culture, job satisfaction and
working conditions were higher in accredited hospitals compared to non-accredited hospitals (p<0.05).
Among the outcomes, only the incident reporting mean was significantly higher (see Figure). When
adjusted for employee characteristics and hospital size, the probability of the overall SAQ score being
positive was 1.8 times higher in accredited hospitals compared to non-accredited hospitals. The
probability of job satisfaction scores being positive was 1.8 times higher in accredited hospitals and
the probability of positive working conditions scores was 1.7 times higher. In accredited hospitals, the
probability of agreeing with the statement 'In this clinical area, when an error is made that had the
potential to harm patients, this is reported (an incident reporting form is filled)' was 2 times higher
(p<0.05).

381
Image:

Conclusion: JCI accreditation was associated with a more favorable overall patient safety culture, job
satisfaction and working conditions in hospitals. Additionally, it was concluded that accreditation
increased incident reporting. Therefore, hospital managers who want to improve patient safety culture
and incident reporting can benefit from accreditation.

References: 1Kaya, S. et al. (2023). Patient Safety Culture: Effects on Errors, Incident Reporting, and
Patient Safety Grade. Journal of patient safety, 19(7), 439–446.
[Link]

Disclosure of Interest: None Declared

Prevention of Lower Limb Deep Venous Thromboembolism and Pulmonary Embolism: Early
Ambulation 24 Hours Post-Cesarean Section: (2063) Wei An Chen

ISQUA2024-ABS-2063

W. A. Chen 1,*, S. C. Wang 2

OBGYN, 2Nursing, Cathay General Hospital, Taipei, Taiwan

1

Introduction: According to the analysis of the Taiwan Annual Report on Obstetric Accidents, venous
thromboembolism (VTE) accounted for 16.1% of all maternal deaths in 2020, making it the fourth
leading cause of death related to pregnancy (Ministry of Health and Welfare, 2021). Middleton et al
reported a higher risk of VTE in cesarean sections in 2021. Soon after, the Taiwan Society of Obstetrics
and Gynecology newly classified prolonged postoperative bed rest in cesarean section patients in 2022
as a general risk for VTE, recommending early ambulation within 24 hours post-surgery. However,
delays in ambulation often occur due to factors such as pregnancy-related lower limb swelling,
postoperative discomfort and pain, and inconvenience caused by catheterization, leading to an
increased risk of VTE. A review of our hospital's practice for cesarean section patients revealed in

382
February 2023, the average time for the first ambulation post-surgery was 28.6 hours, with an
ambulation rate within 24 hours of 17.4%.

Methods: The proposed intervention plan outlines strategies to enhance venous thromboembolism
(VTE) prevention in post-cesarean section patients through educational training and evidence-based
practices. The educational training component involves continuing education courses for nursing staff
to improve their ability to identify and respond to emergencies promptly. Additionally, staff is educated
on performing Homan's test and assessing the symmetry of lower limb circumference and dorsalis
pedis pulse. The evidence-based obstetric risk prevention measures include searching relevant
literature for VTE prevention strategies and introducing intermittent pneumatic compression systems.
Obstetricians are informed to revise routine orders to encourage early ambulation, adjust
postoperative analgesics based on patient conditions, and teach joint exercises for bedridden patients.
For high-risk individuals, the recommendation includes wearing elastic stockings or using elastic
bandages, emphasized during shift handovers. Maternal information is addressed through group
health education sessions, comprehensive informed consent for intermittent pneumatic compression
systems, and nursing guidance on preventing lower limb VTE through exercise in postpartum education
handbooks. This multifaceted approach aims to improve early ambulation rates and reduce VTE risks
in post-cesarean section patients.

Results: From April 2023 to December 2023, 137 cases of cesarean section were collected after the
implementation of the new protocol. We noted a decrease in average time for the first ambulation
from 28.6 hours to 17.5 hours and an early ambulation rate increase from 17.6% to 94.9%.

Conclusion: Prioritizing VTE prevention requires educating healthcare personnel on factors and
strategies to prevent venous thrombosis, educating patients and families to protect themselves, and
encouraging post-cesarean section patients to ambulate early to effectively mitigate the risk of VTE.

References: Shalhoub, J., Lawton, R., Hudson, J., Baker, C., Bradbury, A., Dhillon, K., Everington, T.,
Gohel, M. S., Hamady, Z., Hunt, B. J., Stansby, G., Warwick, D., Norrie, J., & Davies, A. H. (2020).
Compression stockings in addition to low-molecular-weight heparin to prevent venous
thromboembolism in surgical inpatients requiring pharmacoprophylaxis: the GAPS non-inferiority RCT.
Health technology assessment (Winchester, England), 24(69), 1–80. [Link]
[Link]/10.3310/hta24690

Koo, K. H., Choi, J. S., Ahn, J. H., Kwon, J. H., & Cho, K. T. (2014). Comparison of clinical and physiological
efficacies of different intermittent sequential pneumatic compression devices in preventing deep vein
thrombosis: a prospective randomized study. Clinics in orthopedic surgery, 6(4), 468–475. [Link]
[Link]/10.4055/cios.2014.6.4.468

Disclosure of Interest: None Declared

383
Assessment of Antimicrobial Stewardship Program Implementation in Hermina Hospital Group,
Indonesia: A Survey-Based Study: (3199) Wenny Retno SarieLestari

ISQUA2024-ABS-3199

W. R. S. Lestari 1,*, S. D. Marlina 1, P. Muliarini 2, D. Darmajaja 2

Hermina Tangkubanprahu Hospital, Malang, 2KARS, Jakarta, Indonesia

1

Introduction: In May 2015, the World Health Assembly endorsed a global action plan on antimicrobial
resistance, delineating five key objectives:

Enhancing awareness and comprehension of antimicrobial resistance through effective

communication, education, and training.

Strengthening the knowledge and evidence base via surveillance and research.

Decreasing infection incidence through effective sanitation, hygiene, and infection prevention
measures.

Optimizing the use of antimicrobial medicines in both human and animal health.

Developing the economic case for sustainable investment, considering the needs of all nations, and
increasing investment in new medicines, diagnostic tools, vaccines, and other interventions.

In Indonesia, Antimicrobial Stewardship (AMS) was initiated following its launch by the World Health
Organization (WHO). However, the implementation of AMS at the hospital level has not been
thoroughly systematized, and national reporting has not been consistently conducted. Within the
Hermina Hospital Group, AMS has been extensively implemented since 2019, albeit with challenges in
standardizing reporting across individual hospitals and with broader corporate implications. Although
AMS has been integrated into a nationally accredited program since 2019, operational activities have
not been fully incorporated into routine practice. Antimicrobial vigilance commenced in 2021,
coinciding with an increase in antibiotic usage as part of Covid-19 therapeutic protocols at that time.

Methods: We surveyed hospitals under the Hermina Group during 2023. We used WHO Health-Care
Facility Assessment Tools for the questionnaire. The tool has 28 items within six domains including
leadership commitment, accountability and responsibility, AMS actions, education and training,
monitoring and surveillance, and reporting feedback within the health-care facility. Hospitals were
asked to select responses for each item with “No”, “No, but a priority”, “Planned but not started”,
“Partially implemented”, or “Fully implemented” options. Data were analyzed descriptively and
presented in graphic (bar and spider web diagram).

Results: Most of the hospitals involved in the study had fully integrated the Antimicrobial Stewardship
Program (AMS) as per the questionnaire. All hospitals had implemented six itmes of the AMS, which
included the hospital management/leadership prioritizing AMS, establishing a mechanism for regular
monitoring and measurement of AMS activities, appointing a person in charge of AMS, maintaining a
formulary/list of approved antibiotics based on the national formulary, and consistently monitoring
the quantity and types of antibiotic use (purchased/prescribed/distributed). The remaining 22 items
showed variability across hospitals. Regarding the development, collection, and regular updating of

384
antibiograms, 53.3% of hospitals had fully implemented this aspect, 40% had partially implemented it,
and the remaining items were not given priority.

Establishment of Antimicrobial Resistance Prevention Committee of Medikaloka Hermina were in June

2022. Hermina Group's Antibiotic Utilization Guide refers to culture data from Hermina Jatinegara
Hospital (Hermina group's reference center for microbiological examinations) published in April 2023,
last revision in Sept 2023. The E-Raspro application began to be tested in 24 Hermina hospitals as of
September 2023 and coordinated supervision and control of interprofessional collaboration carried
out, becoming part of the performance of medical support managers. With systematization in the
management and use of E-Raspro, monitoring of PPRA supervision and control as of January 2023,
which has never been achieved finally December 2023 achieved all PPRA targets. That is, the use of
anti-microba reserve 74.82, watch 22.62 and reserve only 2.72% this is in accordance with WHO
standards.

Conclusion: The findings revealed that while the majority of hospitals had fully integrated the AMS,
there were variations in the implementation of specific AMS components. The study highlights the
need for further systematization and standardization of AMS activities, especially in areas such as the
development of antibiograms and regular updating of antibiotic guidelines. The results provide
valuable insights for the ongoing improvement of antimicrobial resistance management in the
Indonesian healthcare setting.

Disclosure of Interest: None Declared

The role of KARS surveyors in accelerating the reduction of maternal mortalityin Indonesia: (2888)
Yessy Rachmawati

ISQUA2024-ABS-2888

Y. Rachmawati 1,*
, M. Hussein 1, H. P. Putra 1, P. Muliarini 1. 1KARS, Jakarta, Indonesia

Introduction: Comprehensive MPDSR is instrumental in generating high-quality information on the

primary causes of maternal and perinatal deaths, as well as the significant contributing factors to these
fatalities. However, the systematic implementation and monitoring of responses, as well as the analysis
of their effectiveness, are often lacking in MPDSR. Countries, such as Indonesia, advance in establishing
a comprehensive approach to support the quality of care for maternal, newborn, and child health, new
areas of inquiry pertaining to the linkages between MPDSR and quality of care implementation will
arise. There are initial questions to consider and test, particularly in contexts where both quality of
care and MPDSR committees/teams are operational. This includes identifying best practices for
enhancing communication and harmonizing processes. Furthermore, it is essential to explore whether
hospital accreditation, particularly through the surveyors of the Hospital Accreditation Commission /
KARS, can effectively implement and monitor MPDSR activities at the hospital, sub-national, and
national levels. The Indonesian government has mandated a national regulation that requires all
hospitals to report maternal and perinatal deaths and conduct AMPSR, with these activities being
included as an element in hospital accreditation by 2022. In the implementation of this regulation,

385
hospital accreditation surveyors must be vigilant in observing its execution, considering that not all
MPDSR activities are documented as elements in assessing hospital accreditation standards.

Methods: This study observed the activities of KARS surveyors in mapping the implementation of
MPDSR applications in accredited hospitals as compared to data in national MPDSR digital applications.
The researchers modified the facility-level monitoring indicators of MPDSR implementation from the
WHO Maternal and Perinatal Death Surveillance and Response: Materials to Support Implementation.
Responses were gathered based on information provided by KARS surveyors from hospitals in various
regions of Indonesia.

Results: Most surveyors followed the study were female (53,3%) and have served as surveyors more
than five years (80%). The most referred were Class C hospitals (66,7%). Achievement of MPDSR
indicators were varied across hospitals. A maximum of two weeks medical audit after death were
partially implemented among 60% of hospitals referred. More than half of hospitals (53,3%) partially
conducted clinical audit within a maximum of three months after a case fatality. Maternal perinatal
death meeting were followed by QI committee only among 46,7% hospitals.

Conclusion: The detailed mapping of MPDSR activities carried out by KARS surveyors can serve as a
comparison and supplement to data for sub-national reporting at the hospital and regional levels. This
will enhance the knowledge and skills of surveyors in evaluating the quality of maternal services, while
also providing more detailed insight to improve the quality of maternal services and fulfil the elements
of national program assessment standards in hospital accreditation, thus contributing to the success
of the WHO program. The challenges encountered in the implementation of this research underscore
the significance of understanding the national health system in accordance with the WHO action plan
in every hospital accreditation survey implementation.

Disclosure of Interest: None Declared

An attempt to make 5S-KAIZEN a managerial foundationforpatient safety at government hospitals

in Uganda; Needs ofparallel application ofIHI-GTT and Tracer Method to accelerate the
improvement: (1118) Yujiro Handa

ISQUA2024-ABS-1118

Y. Handa 1 2,* on behalf of Japan International Cooperation Agency (JICA) Project on Patient Safety
Establishment through 5S-KAIZEN-TQM, E. Ouma 3, J. H. Obonyo 3, J. Atepo 3, N. Take 4, S. Takahashi 5,
E. Onosaka 6, B. Ntegeka 3, H. Tasei 6 and Japan International Cooperation Agency (JICA) Project on
Patient Safety Establishment through 5S-KAIZEN-TQM in collaboration with Ugandan Ministry of
Health
1
Derpt. of Development Consultancy, International-Techno Center, Tokyo, Japan, 2Global Health &
Health Security, Taipei Medical University, Taipei, Taiwan, 3Dept. of Development Consultancy,
International-Techno Center, Kampala, Uganda, 4Dept. of Development Consultancy, Kaihatsu
Management Inc., Tokyo, Japan, 5JICA Project on Patient Safety Establishment through 5S-KAIZEN-
TQM, Kampala, Uganda, 6Dept. of Development Consultancy, International-Techno Center, Tokyo,
Japan

Introduction: Patient Safety is an important target in developing countries in Africa. Timely

investments to government hospitals are not always easy. Project on Patient Safety Establishment

386
through 5S-KAIZEN-TQM (the Project) has been in operation since 2021 with collaboration among the
Ugandan Ministry of Health, 18 public Referral Hospitals (RFs) and the Japan International Cooperation
Agency. As basic managerial tools, 5S Principles and KAIZEN are used at the targeted hospitals to
improve the working environment and processes. The 18 RFs are tackling patient safety using their
experiences in 5S-KAIZEN. In this presentation, the authors discuss the effectiveness of this approach.
A question is whether the medical teams develop pro-safety mindsets using their experiences in 5S-
KAIZEN.

Methods: Assessment of the managerial improvement in the selected RFs was conducted using (1) the
5S Achievement Scale (5AS), and (2) the review of inpatient medical records (MRs) by the IHI-Global
Trigger Test (GTT) in 2022. The 5AS is the assessment tool which was a structured tool by the Project.
Two-day group training for work unit leaders followed by quarterly technical supervision to the
Quality/Safety Management Offices of the hospitals were conducted prior to the assessment. For GTT,
IHI's original format was utilized on the ca. 300 inpatients' medical records. The detected triggers and
the adverse events (AEs) were recorded by the calibrated hospital-based assessment teams.

Results: The result in 5AS ranged from 32 to 90 (100; full marks). The two RFs, which marked over 90
were selected for GTT. AEs recorded at RF-K and RF-M were 11.6 and 11.5 per 100 admissions
respectively. On the severity of the AEs, 54.6% (RF-K) and 56.2%(RF-M) were found to be under
category E (AE contributed to temporary harm and required intervention) out of 5 categories of AEs
(IHI-GTT). Regarding category I (AE contributed to patient death), 3% of 33 AEs out of 285 cases (RF-K)
and 18.1% of 31AEs out of 286 cases (RF-M) were noted respectively. Medical record (MR)
documentation at the RF-K and RF-M was not perfect indicated by the fact that the discharge
summaries were completed only in 67.4 % and 66.7 % (Medicine), 59.2% and 76.8% (General Surgery),
46.7% and 22.7% (Obstetrics) respectively. The data of AEs must have appeared lower than the reality.

Conclusion: Achievement in working environment improvement using 5S-KAIZEN fluctuated among

the targeted 18 hospitals in one year. The attitude seeking the betterment of the routine care processes
could not be well formulated among the medical staff only by the 5S-KAIZEN even at the selected two
hospitals which achieved high marks over 90. The completeness of MR documentation should be an
indicator of the additional need for intervention. The rate of AEs under category I (AE-contributed
patient death) should be analyzed on the root causes by the medical team to implement the
countermeasures. In addition to IHI-GTT, a proactive measure, such as the tracer method, to the
routine care process should be added as an intervention to the medical teams. The combined
interventions by the IHI-GTT, tracer method and 5S-KAIZEN could be a triad to encourage the hospital
staff in government hospitals in developing countries such as Uganda.

References: Handa Y, Denekew G, Taka K, et al.; Your path to success in quality and safety, A trainer’s
guidebook on 5S principles and practice, Second Edition, 2023; Japan International Cooperation
Agency (JICA), ISBN 978-8-6766-3176-6, ONWARD Communication, Addis Ababa, Ethiopia

Ikeda, S, Kobayashi M, Kaneko T, et al.: Identification of adverse events in inpatients: Results of a

preliminary survey in Japan, Asian Pacific Journal of Disease Management, 2010; 4(2), 49-53

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 Kurutkan MN, Usta E, Orhan F, et al.: Application of IHI Global Trigger tool in measuring the adverse
event rate in a Turkish healthcare setting, International Journal of Risk & Safety in Medicine, 2015; 27,
11-21

Siewert B, The Joint Commission ever-readiness: Understanding tracer methodology, Current

Problems in Diagnostic Radiology, 2018; 3, 131-135,

Disclosure of Interest: None Declared

Effectiveness of PRIDE program in the restraint Patient care: (1676) YUMEI LEE

ISQUA2024-ABS-1676

Y. LEE 1,*

CHIMEI MEDICAL HOSPITAL, TAINAN, Taiwan

1

Introduction: The average restraint rate for clinical patients is 1.18%, higher than the national medical
center average rate of 0.6%. However, clinical care nurses currently lack evidence-based restraint
strategies. This quality project aims to develop a program combining different strategies and to
evaluate the effectiveness of restrain patient care

Methods: Using a PRIDE program is combined with the nursing practices , healthcare team
collaboration and caregiver’s participation. The PRIDE program includes the following five key
points:Professional, Responsibility, Innovation, Decision making, Empathy. It’s major elements are
Professional assessment of restraint necessity, Responsible care teamwork, Innovative restraint tools,
Decision-making involving caregivers, and Empathy towards patients' stress and discomfort.
Implemented in 28 units of medical and surgical wards and intensive care units and used on 108
patients Following the implementation of the developed restraint strategies, a nine-month audit of
the physical restraint rate in clinical care patients was conducted to assess the effectiveness of the
strategies.

Results: The innovative design of restraint tools by this project have obtained invention patents in
Taiwan and Japan. After completing the education and training of 45 nurses, the restraint accuracy rate
in the audit was 92.6%. The post-implementation review indicated that the physical restraint rate has
decreased from 1.18% to 0.80%.

Image:

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Conclusion: Patient-centered care means that the team joins hands with the patient's
family/caregivers to provide empathy and informed consent to the care process when performing
treatment and care, and to provide physical comfort and psychological support through integrated
care. This is our continuous promotion of friendly restraint [Link] implementation of
innovative restraint strategies can effectively reduce the rate of physical restraint in clinical patients.
Therefore, we plan to promote this strategy in our [Link] the goal of "zero-constraint" care
and create the goal of three good things.#Patient/Family Good: Patients can be safe, comfortable and
dignified, and their families can feel more at ease #CareTeamGood: Feel the professional significance
and value, enhance work identity and sense of accomplishment

References: YL Lin, CC Liao, WP Yu, TL Chu, LH Ho (2018). A Multidisciplinary Program Reduces Over
24 Hours of Physical Restraint in Neurological Intensive Care [Link] Journal of Nursing Research.
26(4) , 288-296

吳美玉、金淑儀、連如玉（2023）。照顧急性呼吸窘迫症候群患者及其家屬的照護體會。榮
總護理，40 (1)，89-95。[Link]

賴美玉（2013）。在職教育加護病房護理人員實行身體約束之相關成果探討[碩士論文，中山
醫學大學]。華藝線上圖書館。[Link]

Disclosure of Interest: None Declared

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Optimizing Inpatient Care: Implementing an Evidence-Based Hospitalist Program: (2692) Zainab
Abdullah Alzaki

ISQUA2024-ABS-2692

Z. A. Alzaki 1,* on behalf of Dr. Ali Alsaeed and Dr. Ali Alsaeed

Internal Medicine , Dammam Health Network , Dammam , Saudi Arabia

1

Introduction: Dammam Medical Complex launched the Hospitalist Program to improve patient care
and satisfaction. Key performance indicators identified factors contributing to prolonged average stays,
such as ineffective work strategies, poor communication, delayed diagnoses, and difficult transitions
between care levels. The program aimed to reduce hospital stays and increase bed availability by
optimizing bed utilization through efficient patient management. This improved patient satisfaction
and increased the hospital's capacity to accommodate more patients and respond effectively to
emergencies. Cost savings and resource utilization were also crucial, as they measured by
hospitalization durations and readmission rates, aiming to make more efficient clinical decisions.

Methods: The Hospitalist Program Enhancement project at DMC was developed through a phased
implementation strategy, starting with a five-member team in March 2022. This team provided full-
day coverage for inpatients, focusing on general internal medicine, infectious disease, pulmonary,
hematology, and rheumatology. In October 2022, the team expanded to eight members, covering a
maximum of 15 active patients daily. The scope of practice expanded to include all medical
subspecialties except infectious disease, allowing for comprehensive care coordination. In May 2023,
four hospitalists worked 12-hour shifts seven days a week, ensuring continuous care for patients. The
team remained dedicated to managing a maximum of 15 patients per day. In July 2023, the team
incorporated infectious disease cases, excluding HIV and TB, into their scope of practice, further
enhancing their ability to address various medical conditions. The program design included key
performance indicators to measure the program's success.

Results: The project has significantly improved healthcare quality by serving over 60% of inpatients
within the organization, demonstrating the hospitalist program's capacity to meet growing demand.
The project aimed to reduce the length of stay (LOS) to an average of 5.5 days, resulting in more
efficient care delivery and streamlined processes. The project also reduced transfers to the intensive
care unit by 50 patients, demonstrating improved management of critical patients and the program's
ability to handle complex medical cases.
Improving weekend discharge rates was a key focus, ensuring timely and seamless patient transitions.
The project addressed the issue of long-stay patients by improving care coordination, transitions, and
optimized processes, decreasing long-stay patients.
Patient access was enhanced by increasing clinical capacity, maximizing facility and resource utilization,
and increasing bed turnover.

Image:

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Conclusion: The Hospitalist Program Enhancement project revealed significant improvements in
patient care and satisfaction through a hospitalist-based approach. The program focused on
comprehensive care coordination, improved communication, and shorter hospital stays, emphasizing
the importance of a dedicated hospitalist team in optimizing patient outcomes. The average length of
stay (LOS) in medical specialty units was reduced to an average of 5.5 days, demonstrating the
program's effectiveness in facilitating efficient care delivery and resource utilization. The number of
transfers to the intensive care unit decreased, indicating improved handling of critical patients. The
project also improved weekend discharge rates by addressing staffing and resource challenges,
ensuring timely and seamless patient transitions. Long-stay patients were reduced, indicating
improved efficiency and resource utilization. These findings underscore the potential of a hospitalist-
based approach in managing patient flow and optimizing bed availability.

References: Our Hospitalist Program is based on evidence-based best practices and aims to provide
high-quality, patient-centered care to improve patient outcomes. We have utilized clinical guidelines,
expert input, teamwork, ongoing professional development, and quality improvement initiatives We
benchmarked at JAHA and Houston Methodist healthcare institutions to identify effective strategies,
allowing us to develop a comprehensive Hospitalist Policy and Procedure that provides the best
possible care to our patients. Additionally We referenced publications from the Society of Hospital
Medicine, the International Journal of General Medicine, and the Journal of Hospital Medicine.

Disclosure of Interest: None Declared

Patient and family engagement in patient safety in the Eastern Mediterranean Region: A scoping
review: (3255) Zhaleh Abdi

ISQUA2024-ABS-3255

Z. Abdi 1,*, H. Ravaghi 2, M. Letaief 2. 1Tehran Yniversity of Medical Sciences, Tehran, Iran, Islamic
Republic Of, 2Regional Office for the Eastern Mediterranean, Cairo, Egypt

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Introduction: Patients can play a key role in delivering safe care by becoming actively involved in their
health [Link] suggests that most patients are willing and able to participate and engage in their
safety and their participation has been associated with enhancing patient safety. Engaging patients in
promoting safety and reducing adverse events has become an international policy priority. Despite
growing research on patient participation in patient safety globally, there is a lack of information on
this topic among EMR member states This study aimed at reviewing the literature for evidence of
patients’ and families’ engagement in patient safety in the Eastern Mediterranean Region (EMR).

Methods: We conducted a scoping review of the literature published in English using PubMed,
EMBASE, CINAHL, Scopus, ISI Web of Science, and Global Index Medicos until June 2023 among 22
countries of EMR (Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya,
Morocco, Occupied Palestinian Territory, Oman, Pakistan, Qatar, Saudi Arabia, Somalia, Sudan, Syrian
Arab Republic, Tunisia, United Arab Emirates, and Yemen).

Results: A total of 9019 studies were screened, with 22 meeting the inclusion [Link] review found
few published studies of patient and family engagement in patient safety research in the EMR. Thirteen
studies explored the attitudes, perceptions, and/or experiences/ preferences of patients, families, and
healthcare providers (HCPs) regarding patient engagement in patient safety. Nine publications
reported patient engagement in patient safety activities with different levels of engagement. Three
categories of factors were identified that may affect patient involvement: Patient-related (e.g., lack of
awareness on their role in preventing harms, unwillingness to challenge HCPs’ authority and cultural
barriers) HCP-related (e.g., negative attitudes towards patient engagement, poor patient-provider
communication and high workload) and healthcare setting-related (e.g., lack of relevant policies and
guidelines, lack of training for patients and HCPs, and lack of patient-centered approach).

Conclusion: Despite the international movement to increase patient involvement in safety, there is a
dearth of research evidence from the EMR on the acceptability to patients, families, and HCPs as well
as the potential impact of such involvement on enhancing safety. The available evidence indicates that
patients are willing and able to be involved in patient safety practices. There is a need to understand
how patients, families, and caregivers can actively be involved and how they can contribute as
knowledgeable partners in patient safety activities. Further evidence is required to understand
patients’, caregivers’, and HCPs’ preferences and experiences of the involvement process and whether
such involvement translates into improved safety in practice. Future studies should expand our
understanding of which strategies work best in different contexts and their impact on patient safety.
There is a need, especially for implementation studies showing how to implement the concept in
clinical settings given the diversity of the EMR countries.

Disclosure of Interest: None Declared

AN EVALUATION OF ACCREDITATION STANDARDS IN HEALTH SERVICES FROM THE PERSPECTIVE OF

INTERNATIONAL ACCREDITATION ORGANIZATIONS: (3534) Ayşe Sibel GÜLTÜRK

ISQUA2024-ABS-3534

A. S. GÜLTÜRK 1,*, D. GÖKMEN KAVAK 2, M. E. ÇELİK 3, B. İNCEOĞLU 4, H. I. KAYRAL 2, F. ÇİZMECİ ŞENEL 2

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1
Provincial Directorate of Health, Sivas, 2Türkiye Health Care Quality and Accreditation Institute,
3
Department of Autism, Mental Special Needs and Rare Diseases, 4General Directorate of Health
Services Oral and Dental Health Department, Ankara, Türkiye

Introduction: Accreditation standards in healthcare inherently require a dynamic working process.

Both the working principles of The International Society for Quality in Health Care (ISQua) and the fact
that the standards are always open to renewal make it necessary for the standards to be updated,
developed and improved over time. In this context, organizations carrying out accreditation activities
periodically review their standards and make improvements when necessary. The purpose of this
study; To make an evaluation from the perspective of international accreditation organizations
regarding the use of accreditation standards in health services. As a result of the research, it is aimed
to provide accreditation bodies with a perspective on the use of accreditation standards in health
services.

Methods: The study was conducted using the survey method. The survey used within the scope of the
study was prepared by the researchers. The survey was sent electronically to approximately 100
different healthcare accreditation organizations that are members of ISQua and provide services in 70
different countries. 14 organizations that are members of ISQua, already have a standard set, and
agreed to participate in the research were included in the research. Descriptive statistics (frequency
and percentage) were used to evaluate the research data, and Microsoft Excel program was used for
descriptive statistics.

Results: Accreditation is mandatory in 71.4% of organizations.

In most of the organizations (35.7%), the number of accredited institutions varies between 11 and 100.

57.1% of the organizations do not have a support mechanism for accredited institutions, and none of
them provide financial support. However, in 28.6%, accredited institutions are supported through
methods such as continuing education on standards, donor support and coaching training.

Almost all of the organizations (85.7%) provide services such as training and consultancy to institutions
implementing accreditation programs. Additionally, in 71.4% of the cases, these services are provided
by public or private organizations.

Most organizations (42.9%) have a number of standards sets ranging from 1-5.

35.7% of the standard sets used were not accredited by ISQua due to reasons such as use for a small
number of facilities and small market share.

When determining the content of standard sets, areas such as hospitals, oral and dental health
services, and dialysis services are mostly taken into account (71.4%). While service status such as
public, private, university is not taken into consideration; 21.4% according to the tier system; 24.3%
according to the size of the institutions; 28.6% are related to leadership, research activities, etc. The
subsection topic is determined by other topics, such as the implementation of the quality management
system.

More than half of the institutions (57.1%) do not have accreditation programs specific to clinical service
areas such as cardiology, intensive care, operating room, emergency health and sterilization.

393
35.7% of organizations use a single set of standards for all accreditation programs. 44.4% of
organizations do not experience any problems with the use of a single set of standards for all
accreditation programs. However, in most organizations (55.6%), problems may be experienced such
as exclusion of many standards depending on the type of the field inspected, difficulties in determining
standards for a particular field, and difficulties in the use of practitioners.

44.4% of organizations prefer to use different sets of standards for different accreditation programs.
While half of the organizations (50%) do not experience any problems with the use of different
standards sets; The other half is that creating a new standard set for each health field causes an extra
workload (28.6%), repetitions occur in standard sets (28.6%), and the application of revisions made in
one set to the other set is time-consuming and delays occur ( 14.3%), the development of standards is
a very long process that is costly and time-consuming (7.1%).

Most organizations (78.6%) do not prefer to use a single set of standards for different accreditation
programs.

Nearly half of the organizations (42.9%) have not made any changes in the structure or design of their
standards sets since their establishment. More than half of the organizations (57.1%); Taking into
account issues such as the need to update standards every 4 years, patient surveys, auditor and
practitioner feedback, legislation updates, adding new evidence-based requirements, strengthening
standards and clinical governance related to care, reviewing, developing and strengthening the scoring
and rewarding system, classification of standards and They have made changes in the structure or
design of their standards sets for reasons such as adding guidance notes.

Half of the organizations More than 50,000 (57.1%) plan to make changes to the structure or design
of the standards sets they currently use.

Almost all of the organizations (92.9%) provide a guide prepared for the use of institutions and
auditors, providing information about the sets they use in their accreditation programs.

While the standard sets of 64.4% of the organizations can be accessed from their web pages, 42.9%
can be accessed as a hard copy or through an electronic method such as a phone application. In 14.3%
of the organizations, it can be obtained by sending an e-mail or making a payment to the relevant
organization.

Access to standards sets is free in 64.3% of organizations.

Conclusion: The use of accreditation standards in health services varies according to international
accreditation organizations. There may be various opportunities and difficulties in the use of standards.
The perspective put forward by this research may provide useful guidance for accreditation bodies.

Disclosure of Interest: None Declared

Assessing The Implementation of The World Health Organization (WHO) Building Blocks in The
Maternal Health System in Indonesia: (1251) Prita Muliarini

ISQUA2024-ABS-1251

P. Muliarini 1 1,*, E. Sumarsono 2, D. Darmajaja 1

394
KARS, Jakarta, 2Mulia Berkarya Indonesia, Malang, Indonesia
1

Introduction: Maternal mortality in Indonesia remains a significant concern, and it is crucial to

evaluate the effectiveness of the maternal health system in addressing this issue. By focusing on the
WHO building blocks, which encompass service delivery, health workforce, health information
systems, access to essential medicines, financing, and leadership/governance, this study seeks to
understand the strengths and weaknesses of the Indonesian maternal health system. Specifically, the
study aims to identify gaps and areas for improvement in order to enhance maternal health services.

Through this assessment, the study seeks to provide insights into the challenges faced by the
Indonesian maternal health system and recommend strategies for enhancing its effectiveness. By
identifying gaps in the implementation of the WHO building blocks, policymakers, healthcare
professionals, and stakeholders can work towards tailored interventions and reforms that address
these gaps. The ultimate goal is to improve the quality and accessibility of maternal health services in
Indonesia, leading to a reduction in maternal mortality rates.

Methods: The research methodology employed in this study involved observing the Maternal and
Child Health Book (MCHB) as a "reflection" to the journey of maternal health. The MCHB was analyzed
to determine if it aligns with the key characteristics of well-functioning health service delivery, as
outlined by the WHO. Additionally, the study examined the linkages between the different building
blocks of the health system in the context of maternal care in hospitals. The national health policies
relevant to maternal care were also monitored to understand their influence on service delivery.

Results: The study found several areas that require attention and improvement. Firstly, there is a lack
of compliance with maternal death notification reporting, hindering efforts to address maternal
mortality. Secondly, access to standardized maternal services is limited due to the diversity of clinical
practice guidelines in various health facilities. Thirdly, the referral systems for maternal care have not
been adequately established. Fourthly, the distribution of health human resources is uneven, affecting
the quality of maternal health services. Lastly, the process of achieving universal health coverage for
maternal financing is still ongoing.

To address these challenges, Indonesia is embarking on a comprehensive health transformation

initiative that encompasses six core pillars: Primary Service Transformation, Referral Service
Transformation, Health Security System Transformation, Health Financing System Transformation,
Health HR Transformation, and Health Technology Transformation. The updated hospital accreditation
standards, enacted by the Indonesian Ministry of Health, aim to expedite the transformation of the
health system. By aligning with the WHO framework for health system performance assessment and
focusing on the building blocks, Indonesia can enhance the resilience of its maternal services in the
post-pandemic era.

Conclusion: The findings of this study highlight the need for comprehensive reforms in the Indonesian
maternal health system. The transformation of the health system, as outlined in the six pillars of Health
Transformation, presents an opportunity to address the challenges identified. By aligning with the
WHO framework for health system performance assessment and focusing on the building blocks, such
as service delivery, health workforce, health information systems, access to essential medicines,
financing, and leadership/governance, Indonesia can enhance the resilience of its maternal services in

395
the post-pandemic era. It is crucial to prioritize policy success indicators, such as appropriate client
input and effective access to healthcare. Furthermore, improving the quality of health service delivery,
person-centered care, patient safety, and public health literacy are essential for accelerating the
decline in maternal mortality rates.

References: Kementerian Kesehatan. Standar Akreditasi Rumah Sakit Kementerian Kesehatan.

Kementerian Kesehatan; Jakarta: 2022.

World Health Organization (WHO). Everybody's business - strengthening health systems to improve
health outcomes: WHO's framework for action.

WHO; Geneva: 2007. [Link]

World Health Organization (WHO). Monitoring the building blocks of health systems: a handbook of
indicators and their measurement strategies. Geneva, Switzerland: WHO;2010.

Disclosure of Interest: None Declared

Gastro-Intestinal Anaesthesia Safety Checklist Audit in improving patient care at a tertiary care
cancer centre (CARE): (1323) Reshma Ambulkar

ISQUA2024-ABS-1323

R. Ambulkar 1,*, S. Solanki 2, M. Joshi 1, V. Agarwal 2 and HPB Anaesthesia Group

1
Anaesthesia Critical Care and Pain, ACTREC, Tata Memorial Centre, 2Anaesthesia Critical Care and Pain,
Tata Memorial Centre, Mumbai, India

Introduction: Though a seemingly simple intervention, checklist has played a leading role in the most
significant successes of the patient safety movement. Safety Checklists are increasingly being used as
tools to improve care processes and outcomes by reducing patient harm and eliminating medical
errors. This safety program was implemented at our tertiary care cancer hospital, as a part of multi-
component quality improvement initiatives in patients undergoing major gastro-intestinal (GI)
surgeries.

Aim: Implementation of the Checklist and monitoring the compliance with five safety measures would
improve patient safety.

Methods: A preoperative safety checklist consisting of five safety measures based on current available
best evidence was introduced by our team of GI anaesthetists. We monitored compliance to five safety
measures (Ultrasound use during insertion of central venous catheter, VTE prophylaxis
(pharmacological and/or TEDs), Timing of LMWH and epidural insertion, Preoperative carbohydrate
drink in non-diabetics and Allen’s test prior to radial arterial line cannulation)1-5. Data was collected at

396
two timepoints, baseline and five years after implementation of the Safety checklist by our research
nurse. Baseline data collection (over one year) was followed up by continuous education of all resident
anaesthetists at our hospital regarding the five safety measures. After five years, we reaudited and
data which was collected (over one year) and compared to the baseline data. Proportion count was
used to summarise the data of safety checklist parameters.

Results: Results: Total 760 patients were included in the analysis in the baseline data in the year 2017
and 720 patients were included in 2022. The compliance to the five safety measures is mentioned in
Table 1.

Table 1: Compliance to five safety parameters

Preoperative
USG Guided VTE LMWH &
Carbohydrate Allen’s Test
Year CVC Prophylaxis Epidural
Drink N (%)
N (%) N (%) N (%)
N (%)

2017 79 (74%) 758 (99.8%) 584 (97%) 586 (78%) 227 (93%)

2022 18 (100%) 715 (99.3%) 464 (100%) 624 (100%) 371 (100%)

Conclusion: The initial results achieved with implementation of the safety checklist in major GI
surgeries are encouraging. Strict adherence to safety measures is possible, with regular teaching and
awareness of safety measures in improving patient care.

References: 1). Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus
anatomical landmarks for internal jugular vein catheterization. Cochrane Database of Systematic
Reviews 2015

2) Kohonen M, Teerenhovi O, Terho T, Laurikka J, Tarkka M. Is the Allen test reliable enough? Eur J
Cardiothorac Surg. 2007 Dec;32(6):902-5

3) Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis
or pulmonary embolism. NICE Clinical Guideline [NG89] March 2018.

4) Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional anesthesia in
the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional
Anaesthesia and Pain Medicine evidence-based guidelines (fourth edition). Reg Anesth Pain Med.
2018;43(3):263–309.

5) Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk
of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated
report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the use of
pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017;126:376–393.

397
Disclosure of Interest: None Declared

Reduction and Control of Surgical Site Infections: A multidisciplinary approach to enhance patient
safety: (3036) Saadia Pervaiz

ISQUA2024-ABS-3036

S. Pervaiz 1,*, S. Asim 2, P. Amirali 3, A. Imtiaz 3

Quality Improvement, 2Family Medicine, 3Nursing, Evercare Hospital Lahore, Lahore, Pakistan
1

Introduction: Surgical site infections (SSI) are extremely serious post-surgical complications that can
lead to extended hospital stays, reinterventions, readmissions, and the possibility of lasting
impairment or even death for the patient. Since January 2023, Evercare Hospital Lahore was faced with
the challenge of high rates of SSIs which needed urgent intervention. A multidisciplinary team was
activated to take effective measures.

The main objective was to identify the root causes of rise in SSIs, determine the common factors,
collect detailed information about each case and to reduce the SSI rate with continuous monitoring.

Methods: The project initiated from January 2023 and is an ongoing process uptil now.

PDSA model was used:

Plan:

Following steps were involved for our planning phase:

1. Defining the problem i.e. Rise in SSI rate in the Hospital

2. Formation of a multidisciplinary team with Quality and clinical representatives.

3. Analyzing the existing data for thorough investigation. Determining the frequent surgeries with
SSIs, observing the hand hygiene and scrubbing practices of the staff, the type of organisms with each
SSI, review of antibiogram, patient risk factors etc.

4. Designing SSI protocols and flyers for staff awareness and implementation.

DO:

1. Frequent team meetings were conducted. Issue was highlighted in the infection control and
Quality committee meetings.

2. Meetings with the surgeons were held to discuss the way forward with their consensus.

3. SSI protocols were developed in line with CDC guidelines including detailed information
regarding the pre-op, intra-op and post-op instructions.

4. Staff trainings were conducted to create awareness.

5. Strict monitoring of hand hygiene and scrubbing practices.

398
 6. Review of disinfection protocols for high touch surfaces in ICU and OR.

7. Strict traffic control in OR and Surgical ICU was ensured.

8. Deployment of Infection Control Nurse in OR to monitor the Infection Control practices.

9. Patient Education material was handed over to all the post-op patients including instructions
regarding proper wound-care.

10. SSI module was developed in HIMS to prompt about any reported SSI for immediate
interventions.

Study:

After taking all the measures to control SSIs, the infection control practices and adherence to SSI
protocols was checked through random audits. The data was analyzed which was in declining trend
and proving the interventions were working.

Act:

All the initiatives taken were continued. Staff was continuously being evaluated for their practices in
accordance with the developed SSI protocols. Continuous trainings regarding SSIs are being done. SSI
reporting has been made more efficient with the development of SSI module in HIMS. The measures
taken are part of an ongoing process and is not limited to a one-time activity.

Results: Declining trend in the rate of SSIs was observed based on our quarterly trend analysis for
2023. In the month of October, there were no SSIs reported.

Image:

399
Conclusion: This project produced significant results due to the unparalleled efforts and commitment
of the entire team. Hand hygiene and scrubbing practices are being done as per the standardized
procedures and in case any SSI is reported, thorough investigation is done to prevent future SSIs.

Disclosure of Interest: None Declared

Engaging and encouraging staff for incident reporting: Leading towards improved patient and
workplace safety: (3033) Saadia Pervaiz

ISQUA2024-ABS-3033

S. Pervaiz 1,*, U. Shaikh 2, S. Asim 3

Quality Improvement, 2Operations, 3Family Medicine, Evercare Hospital Lahore, Lahore, Pakistan
1

Introduction: Effective and transparent incident reporting is crucial in identifying gaps and prevention
of future errors that can result in patient and employee harm.

Evercare Hospital Lahore had manual incident reporting system since its inception in 2019. Online
mode of incident reporting was introduced in mid Sep-2022.

The problems identified were:

1. Incidents were not being reported due to lack of staff awareness, fear of consequences and a
hassle to fill out the manual forms.

2. Risk of confidentiality breach initially since the forms were manually transported by the staff
or porter.

3. Chances of sensitive information being misplaced was higher.

The main objective was to address the issues of underreporting, gain staff’s trust about incident
reporting and to take immediate actions to streamline the process.

Methods: PDSA:

Plan:

The problems with the existing reporting mechanism were identified. Following steps were involved in
plan phase:

1. Assessment of staff knowledge through a baseline survey.

2. Development of online incident management portal.

3. Designing incident reporting flyers in English and Urdu languages.

4. Formation of Incident management committee to review all the incidents, their investigation
and closure status and to propose action plans.

Do:

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 1. Online incident management portal was launched.

2. Weekly email circulation containing the awareness flyer. Flyers were also placed on all
workstations.

3. Activation of incident management committee on monthly basis.

Study:

With the launch of online portal, there was an extremely low number of incidents reported initially.
Through the frequency analysis and random staff interviews, it was identified that still there are a lot
of employees who are unaware about incident reporting especially the new staff as the numbers
improved to some extent but still seemed to be under reported.

Act:

Formalized staff trainings were needed. The Area leads were also advised to continue training the staff
on the ground.

1. Daily staff briefing of incident reporting was done.

2. Formal trainings were conducted more frequently.

3. Flyer content was revised to include more information on type of incidents.

4. Clear communication about the importance of reporting incidents in patient safety, defining
near-miss, adverse events and Sentinel events, with the message that this whole process is not to
name or blame anyone, rather is for improved patient and workplace safety practices.

5. Automation of Incident management system underway through a module in HIMS.

Results: Significant improvement in the number of reported incidents was observed showing a clear
rise in the number of incidents reported not because there were more incidents happening but
because the staff was aware of the incident reporting mechanism and its importance to reduce errors
and ensure patient and workplace safety. The highest number of incidents were reported in December
with contribution from all areas of the hospital.

Image:

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Conclusion: Our project highlights the importance of incident reporting and the staff’s understanding
of how reporting can lead to prevention of serious safety events from occurring in future. It is clearly
indicated that the interventions and efforts to encourage staff proved to be fruitful and hence the
number of reported incidents increased significantly.

Disclosure of Interest: None Declared

Language Services for Limited English Proficient Patient Quality and Safety - Dashboard and Data
Driven Process Improvement: (3477) Samuel Verkhovsky

ISQUA2024-ABS-3477

S. Verkhovsky 1,*. 1Quality, Safety and The Value Institute, Dartmouth Health, Lebanon, United States

Introduction: Professional Interpreter Services are critical to ensuring patients with Limited English
Proficiency (LEP) receive safe and effective care in settings and geographies where English is the
predodominant language. Without professional interpreters, LEP patients encounter numerous
barriers in accessing healthcare and experience higher risk in healthcare outcomes. Without
documentation and measurement of LEP patient encounters and interpreter utilization, improvement
efforts are challenged.

402
Methods: We implemented changes in the way that we identify patients primary language needs from
simply asking whether an interperter is needed to asking which language they prefer to discuss their
health information in. We implemented electronic medical record documentation of interpreter
utilization and we started using a dashboard to track encounters where LEP patients are seen and how
interpreter services are utilized, whether in person, video or telephonic.

Results: Early results indicate that we have an improved grasp of understanding the volume, rate and
distribution of instances where and when Limited English Proficient patients are seen. We have started
to build a data infrastructure which allows us to monitor and track whether interpreter services are
used, and their modality.

This work allows us to stratify health outcomes by LEP status. We have found statistically significant
differences in important primary care metrics between LEP patients and English speaking patients.

Conclusion: This data driven work allows us to target professional language services in areas where
they are needed. We are able to see where LEP patients are seen, understand their language barriers
and intervene with needed services. Published literature has shown that Limited English Proficiency
is an independent driver of health disparities. There are numerous care associated outcomes that LEP
patients are at an increased risk of suffering. By understanding these risks and measuring where
patients are seen, we can target needed services to make sure that they are able to communicate with
their care providers using qualified medical interpreters.

References: 1) American Commmunity Survey 2021,

2) US Census Bureau 2020 Decennial

3) Dartmouth Health Informatics

4) Overcoming the challenges of providing care to LEP patients. The Joint Commission Quick Safety
Issue 12 May 2015

Disclosure of Interest: None Declared

Evaluation of the Use of Quality Improvement Tools by Quality Managers of Hospitals in Turkey:
(2973) Şenol DEMİRCİ

ISQUA2024-ABS-2973

S. DEMİRCİ 1,*, D. GÖKMEN KAVAK 1, M. E. ÇELİK 2, F. ÇİZMECİ ŞENEL 1

1
Türkiye Health Care Quality and Accreditation Institute, Health Institutes of Türkiye (TUSEB), 2Republic
of Türkiye Ministry of Health, Ankara, Türkiye

Introduction: Healthcare organizations use various techniques, methods and tools while working on
quality and quality improvement. These tools are frequently used to identify and assess problems,
address errors and increased costs, change practices, generate/develop new ideas, obtain data,

403
visualize problems or solutions, make decisions and conduct analyses. It is known that there are many
quality improvement tools in health services. This study aims to investigate the frequency and reasons
for the use of quality improvement tools by quality managers of hospitals.

Methods: This study is descriptive and cross-sectional. The population of the study consisted of 1329
quality managers of group A, B, C and D hospitals in Turkey. No sample selection was made in the study
and it was tried to reach the quality managers of the hospitals in the universe. A total of 248 hospital
quality managers who volunteered and willing to participate in the study and answered all questions
completely were included in the study.

In the study, quality managers were asked how often and for what purpose they use the identified
quality improvement tools. The answer options related to frequency of use were as follows: I use them
frequently, sometimes, rarely, I know but I never use them and I don't know. The answer options for
the reasons for use are identifying the problem, developing/generating new ideas, obtaining data,
visualizing the problem/solution/process and making decisions.

Descriptive statistics (frequency and percentage) were used to evaluate the study data. Microsoft Excel
program was used for descriptive statistics.

Results: When the individual characteristics of the participants were examined, it was found that
81.5% of the participants were female, 76.2% were aged between 31 and 50, 64.1% had a bachelor's
degree, 52% had 15 years or more of professional experience, 45.2% had 3 to 10 years of experience
in quality, and 66.1% worked in a public hospital.

When the frequency of use of quality improvement tools was analyzed, it was found that the rate of
those who selected the answer option "I use it frequently" was 54.0% for Brainstorming, 37.1% for the
Five Why's Analysis, 32.3% for PDCA Cycle, 28.2% for Cause and Effect Diagram, 23.4% for Failure Mode
and Effects Analysis, 23.0% for Control Charts, 21.0% for Flow Diagram, 16% for House of Quality,
14.5% for Tracer Method, 12.9% for Histogram, 10.9% for Process Mapping, 9.7% for Tree Diagram,
9.3% for Pareto Diagram, 8.1% for Spaghetti Diagram, 7.3% for Scatter Diagram, 7.3% for Mapping the
Last Ten Patients, 5% for Interrelationship Diagram, 5.2% for Six Thinking Hats and 4.8% for Swiss
Cheese Model. The most common purposes of using these tools were to identify the problem,
develop/generate new ideas and visualize the problem/solution/process.

Conclusion: Through the use of quality improvement tools, the underlying causes of the problem or
problem in the health institution can be better understood, an idea can be gained on how to make the
best improvement and an effective strategy can be developed for the completion of the activities.

Disclosure of Interest: None Declared

What role does compassion have on quality care ratings? A regression analysis and validation of
the Sinclair Compassion Questionnaire: (1066) Shane Sinclair

ISQUA2024-ABS-1066

404
S. Sinclair 1,*, H. Boss 2, C. MacInnis 3, R. Simon 4, J. Jackson 4, M. Lahtinen 4
1
Nursing, 2Psychology, University of Calgary, Calgary, 3Psychology, Acadia University, Wolfville, 4Health
System Analytics, Health Quality Council of Alberta, Calgary, Canada

Introduction: Despite being prominently featured in medical codes of ethics, best practice guidelines,
organizational visions statements, and anecdotal patient reports, the impact of compassion on quality
care ratings has not been rigorously studied. Recently, a valid and reliable patient reported compassion
measure-the Sinclair Compassion Questionnaire (SCQ)- was developed for Long Term Care, Hospice,
and Acute Care settings, providing the opportunity to investigate the impact of compassion in diverse
healthcare settings.

In the current study, we verified the validity of the SCQ in the emergency department (ED), primary
care (PC), and residential care (RC) settings with confirmatory factor Analyses (CFA). A subsequent
regression analyses also confirmed that patients’ experiences of compassion were a significant
predictor of their overall quality care ratings, and varied based on certain sociodemographic factors,
particularly amongst emergency department patients.

Methods: We employed a cross-sectional survey design; derived from 3 different patient populations.
Specifically, data were collected from patients in fourteen urban and regional hospital emergency
departments (N = 4501), primary care patients (N = 2291), and long term care residents (N = 2683).
Confirmatory factor analyses (CFA) were conducted to validate the factor structure of the compassion
measure across diverse healthcare contexts. Specifically, factor loadings, internal consistency
reliability, and indicators of global fit are reported.

Hierarchical stepwise linear multiple regression was used to assess the unique variance of compassion
on quality care ratings during patients’ more recent emergency department visit, beyond
demographics and measures of patient information (e.g., patient perceptions of health), and patient
experience (e.g., physician communication).

One-Way Analysis of Variance (ANOVA) was used to assess whether patients’ mean compassion scores
differed based on demographic factors.

This study was approved the Research Ethics Board (CHREB) at the University of Calgary (REB21-1938).

Results: Results from the 3 CFAs demonstrated excellent internal reliabilities across care settings
(emergency department α = .98, primary care α = .98, residential care α = .91). Furthermore, most
global fit indicators demonstrated good to excellent model fit (Factor Loading <.75, CFI ≤ .97, RMSEA
≥ .09, SRMR ≤ .02). These results affirmed the robustness of the measure of compassion in diverse
healthcare settings.

Compassion was a predictor of quality care rating in each setting. In the emergency department
setting specifically, stepwise hierarchical multiple regression revealed compassion as significant
predictor, explaining 19% additional variance in patients’ quality care ratings. Additionally, one-way
ANOVAs were utilized to examine the influence of demographic factors on mean compassion scores.
Importantly, women reported significantly lower levels of compassion compared to men. Additionally,
indigenous patients also reported significantly lower levels of compassion compared to white patients.

405
Conclusion: We demonstrated strong evidence for validity of the Sinclair Compassion Questionnaire
across a diversity of healthcare settings, with excellent internal reliability. While highlighting the
emergency department, compassion was identified as key contributor to patients’ quality care ratings
across settings. Patients’ experiences of compassion were found to vary based on demographic factors.

Disclosure of Interest: None Declared

Comparative Analysis of Patient Safety Incidents: Identifying Disparities between Units with
Frequent and Sporadic Recurrence in Hospital: (2347) Shih-Chiang Hung

ISQUA2024-ABS-2347

S.-C. Hung 1,*, C.-P. Han 2, T. T.-Y. Chiou 3

Emergency Medicine, 2Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, 3Internal
1

Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Introduction: Patient safety incidents, posing unintentional harm to patients, persist as a pervasive
concern in hospital settings. Despite considerable efforts to enhance patient safety, still certain units
experience frequent recurrences of similar incidents, while others do not. This study aims to explore
the disparities between units characterized by frequent and sporadic recurrence of patient safety
incidents. By identifying and understanding the contributing factors to such variations, this study
enhances our knowledge of underlying issues and propose targeted interventions to improve overall
patient safety outcomes in hospital settings.

Methods: This retrospective study focused on patient safety incidents reported at Kaohsiung Chang
Gung Memorial Hospital in 2023, specifically targeting recurring instances of similar incidents with a
severity level above mild. Units that experienced these incidents more than twice were categorized as
the "frequent recurrence" group.

Subsequently, we integrated the results of a hospital-wide safety culture survey conducted in the same
year. The patient safety culture questionnaire assesses several dimensions such as teamwork, safety
climate, job satisfaction, stress perception, resilience, work conditions, perception of management,
and work-life balance. Comparative statistical analysis employed a two-tailed Wilcoxon rank-sum test
to assess disparities between the frequent and sporadic recurrence groups.

Results: Kaohsiung Chang Gung Memorial Hospital is a medical center located in southern Taiwan. In
2023, a total of 291 patient safety incidents were reported. Categorizing these incidents by severity:
128 (44%) as no-harm or near-miss events, 79 (27.1%) as mild harm events, 77 (26.5%) as moderate
harm events, and 7 (2.4%) as severe harm events. Frequent recurrence units identified were
Nephrology Ward, Orthopedics Ward, Rehabilitation Ward, Outpatient Department, Orthopedics
Division, Administration Division, and Pharmacy Department. Comparative analysis of safety culture
survey results revealed significant disparities in three dimensions: teamwork, safety climate, and
perceptions of management.

406
Conclusion: By identifying frequent and sporadic recurrence units and uncovering safety culture gaps,
this study enables hospital leadership to develop tailored interventions targeting specific areas in need
of reinforcement.

Disclosure of Interest: None Declared

HOW CAN WE ENSURE PATIENT SAFETY ON NOVEL AND RISKY SURGERY?-6-YEAR EXPERIENCE OF
STATUTORY INTERNAL REVIEW SYSTEM: (1802) Shin Ushiro

ISQUA2024-ABS-1802

S. Ushiro 1 2,*, S. Hamai 2 3 and Committee on public affairs and scientific research, Japan National
University Hospital Alliance on Patient Safety (JANUHA-PS)
1
Japan Council for Quality Health Care, Tokyo, 2Division of Patient Safety, Kyushu University Hospital,
3
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyushu University, Fukuoka, Japan

Introduction: In the year 2014 and 2015, Japanese society was stunned at the series of media publicity
on high mortality rate in patients who underwent novel and risky laparoscopic surgery conducted by
a single surgeon in a prestigious university hospital. The investigation committee was swiftly launched
and published in-depth report that demonstrated that there was little or no review process before
implementing the surgery which was not well established in terms of evidence on safety. Therefore,
the procedures provided was not covered by the public healthcare insurance which has a scope of
wide range of cares evidenced as safe and effective through body of research. The central government
subsequently revised the ministerial ordinance to mandate university hospitals to install with internal
review system for novel and risky surgeries and procedures. We have run the review system in Kyushu
University Hospital (KUH) since 2016. Here, in this study, type of surgeries, review comments in
implementing novel and risky procedure, challenges and opportunities are analyzed and presented.

Methods: The internal review and follow-up system was embedded in KUH in 2016. Division of patient
safety requested all the clinical departments to submit implementation plan of novel and risky
procedure according to definition generated by the Ministry of Health (MoH). It is defined “Surgery or
procedure that has never been conducted in the institution and could possibly cause devastating
consequences such as death or serious conditions”. Records on the review during 2017-2022 including
submitted documents and comments made by the committee were analyzed. In order to assess status
quo of the review system of KUH, it underwent peer-review through on-site visit program of the
National University Hospital Alliance on Patient Safety (JANUHA-PS). Concurrently, it was also a subject
to hospital accreditation survey in 2023 provided by the Japan Council for Quality Health Care (JQ).
Therefore, assessment by those external evaluations were also incorporated in the analysis.

Results: i) The number of procedures approved by year;

7 procedures(Year 2017), 11(2018), 4(2019), 9(2020), 0(2021), 9( 2022).

ii) Type of procedures;

407
A) Robotic surgeries dominated in the review system. B) Other surgical procedures are also included
in the review list

with C) small number of procedures by internal medicine department.

Example of A); Robot-assisted-thoracoscopic mitral valvoplasty, thoracoscopic atrial septal defect

closure, thoracoscopic esophageal cancer resection, lung cancer resection, mediastinum cancer
resection, pantreatoduodenectomy, etc.

Example of B); Non-robotic procedures were also reviewed such as pediatric heart transplantation,
implantation of left ventricular assist device for pediatric patient etc.

Example of C); Endoscopic bronchial thermoplasty, and ultrasonography- guided biliary drainage (EUS-
BD).

iii) Clinical follow-up timetable;

The MoH presented a framework of the review system in which tracing of appropriate number of cases
i.g. five cases in a row and time points for follow-up such as the time of the surgery/procedure
conducted and patient discharge from the institution

are recommended. KUH adopted follow-up of five consecutive cases to assess in short term and time
of discharge, 3-months and 1-year after discharge in middle and long-term follow-up timetable. No
cases of adverse outcome related to the surgery/procedure were observed.

iv) Comments made by the review committee;

Most comments were made on informed consent or consent form. They were made for suggestion or
recommendation in such a way of “Additional staff is included in in informed consent process.”, “The
number of cases treated at the institution with the same surgery/procedure is clearly displayed in the
consent form.”, “Elevated risk which the patient inherently bears when he/she undergoes the
surgery/procedure is described in the consent form.”.

v) Peer-review and hospital accreditation survey;

KUH underwent two different external evaluations such as JANUHA-PS's peer-review and JQ's hospital
accreditation survey. Experts and surveyors of those programs assessed positively the KUH's progress
of the review system except that JQ's survey suggested that follow-up need to reach out to patient
who cease to visit KUH by being referred to affiliated institutions.

vi) Challenges;

We identified great number of challenges related to the review process such as,

- Failure to submit the plan.

408
 - Failure to identify surgery/procedure to put in agenda due to broad leeway of the chair and
ambiguous definition of the “Novel and risky surgery/procedure”. Accordingly, there was no review in
2021, while new chair took up nine petitions in agenda in 2021.

- Review committee and sub-committee "timetable" i.e. held on monthly basis does not meet
physician’s request for expeditious reviewing due for patient in rapidly deteriorating condition.

- Review committee "follow-up timetable" does not meet physician’s request for expeditious
reviewing on surgery/procedure to be provided for mounting number of patients.

- Careful informed consent must be carried out by multi-professional team i.e. not by “only
physician”.

- The surgery/procedure is well reviewed among university hospital through assessment of the
university hospital alliance, while no review system is currently in place on mandatory basis in other
institutions such as community-hub hospitals where similar surgery/procedure is conducted.

vi) Opportunities;

The review and follow-up system seemed well ingrained in university hospitals not only revision of the
government ordinance but by private programs such as external evaluation of the JQ and JANUHA-PS.
The programs will continue to maintain quality of the system and hopefully encourage community hub
hospitals to install with the same system in such a way to it settings of them.

Image:

Conclusion: In the wake of high mortality rate of series of novel and risky surgery provided in a single
hospital, university hospitals which provide highly advanced care have been under strict review ,

409
monitoring and assessment by the JANUHA-PS and the JQ. It serves as a catalyst in bringing cross-
sectional vigilant system at institutional level to address siloed healthcare delivery on departmental
basis that potentially put it at risk. There has been no remarkable publicity like the one observed in
2014-2015 hinting no sunning accidents on novel and risky surgery/procedure took plce in university
hospitals, while similar incidents allegedly occur in community-hub hospitals where no such system is
in place. It is hoped that the review system is embedded in those hospitals in a way that fits local
settings.

References: 1) 2017-2022 Peer Review Reports by Permanent Steering Committee, Hospital Director
Council of National University
([Link] last accessed on Jan
26, 2024, available only in Japanese.

Disclosure of Interest: None Declared

Afternoon

Short Orals

Health justice and equity of access to digital mental health services for Indigenous and ethnic
minority youth – The Human Rights Framework and Obligations: (3259) Solveig Hodne Riska

ISQUA2024-ABS-3259

S. H. Riska 1,*, P. Viksveen 1

1Faculty of Health Sciences, University of Stavanger, Stavanger, Norway

Introduction: The objective of this presentation is to explore the human right to health for
indigenous and ethnic minority youth. Moreover, we present the implications this has on states
to ensure indigenous and ethnic minority youth equity of access to mental digital health
services, treatment and health outcomes. The presentation is a part of the InvolveMENT
collaborative research project that aims to improve the quality, equity, and efficiency of digital
mental health services for groups of minority youth in Norway. The project will assess their use
of, experiences with, and perspectives on digital services. The ambition is for digital services to
be adapted so they are culturally sensitive, meet the needs of indigenous and ethnic minority
youth and fulfil the state's obligations.

Methods: This presentation applies legal method as the methodology which involves
interpreting and establishing the content of the human right to health care for indigenous and
ethnic minority youth. Furthermore what obligations this imposes on the states to ensure equity
of access to mental digital health services, treatment and health outcomes. The legal point of
departure is the United Nation (UN) Convention on the Rights of the Child (CRC), article 24 on
the right to health (1). To explore and determine the content of this right, in this context, the right
is interpreted in light of the best interests of the child in article 3, the right to non-discrimination

410
in article 2, and the child´s right to be heard in article 12. Relevant sources of law to interpret
these rights are the UN's underlying General Comments on the rights arising from the CRC
(5,6,7). The interpretation of indigenous and ethnic minority youths’ right to health also includes
the UN’s International Covenant on Economic, Social and Cultural Rights (ESCR) and the UN
Declaration on the Rights of Indigenous Peoples (2,3).

Results: Our preliminary results indicates that the human right is not to be understood as a
right to be healthy, but the right to a system of health which provides equality of opportunity for
people to enjoy the highest attainable level of health. To secure equal opportunities as an
outcome, the access to the health services must be adaptable and culturally sensitive to youth
with indigenous and ethnic minority background (1,2,4). This implies firstly that digital services
should be available in different languages to fulfil the right (4,6). Secondly, to secure equal
access, the services should provide resources for youth with indigenous and ethnic minority
backgrounds to design, deliver and control the services so that they may enjoy equality of
opportunity as a health outcome (3,4). Thirdly, it should consider traditional preventive care,
healing practices and medicine. The right to health for youth with indigenous or ethnic minority
backgrounds will not be equal without considering such forms of treatment (4,5). Lastly, the
youth´s best interest implies that the digital services should facilitate individual assessment of
the young person´s situation of vulnerability. It will not be the same as those of all the youth´s
in the same vulnerable situation. Each youth is unique and the digital health services must take
into consideration the individual´s uniqueness to provide equity of services (7).

Conclusion: Further conclusions will be available and presented in time for the conference
proceedings.

References:

1. United Nations Convention on the Rights of the Child (CRC), 1989

2. Unites Nations Covenant on Economic, Social and Cultural Rights (ESCR), 1966

3. UN Declaration on the Rights of Indigenous Peoples, 2007

4. Committee on the Economic, Social and Cultural Rights, General Comment No. 14: The Right
to the Highest Attainable Standard of Health (Art. 12), 2000

5. Committee on the Rights of the Child, General Comment no. 11, Indigenous children and
their rights under the Convention, 2009

6. Committee on the Rights of the Child, General comment No. 15 on the right of the child to the
enjoyment of the highest attainable standard of health (art. 24), 2013

7. Committee on the Rights of the Child, General comment No. 14 on the right of the child to
have his or her best interests taken as a primary consideration (art. 3, para. 1), 2013

Disclosure of Interest: None Declared

411
Health Worker Safety Indicators during Pandemics, lessons from the COVID-19 Pandemic: (2513)
Alaa A. Sayed

ISQUA2024-ABS-2513

A. A. Sayed 1,*, A. Alboksomaty 1, J. Tabrizi 2, S. ElQsos 1, A. Asery 3, G. AlKayyali 1, M. Letaif 1

WHO-EMRO, Cairo, Egypt, 2Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Republic
1

Of, 3Saudi Patient Safety Center, Riyadh, Saudi Arabia

Introduction: Health workers (HWs) are the frontline enablers to achieve quality and patient
safety. Ensuring HWs are safe, physically and mentally, is a foremost global health priority. The
World Health Organization (WHO) priorities HWs safety especially during global pandemics, this
was evident during the COVID-19 pandemic. WHO Eastern Mediterranean Regional Office
(WHO-EMRO) has taken the initiative to develop a set of safety indicators to assess the standard
of HW safety in the EMR as an avenue to identify the gaps and challenges to drive improvement.
The aim is to institutionalize HW safety indicators with the existing health systems in the region
to ensure ownership by the Member States.

Methods: Published literature and existing WHO publications were initially screened to develop
a primary set of HWs safety indicators. More than 120 regional and international experts in
quality, patient safety, and health emergencies were consulted in two stages to filter these
potential indicators through an e-Delphi survey. The assessment was based on three criteria,
feasibility, importance, and amenability. A pilot test was advanced in 4 EMR countries to shape
regional learning and assess applicability.

Results: The literature review yielded 40 indicators. The initial list was then circulated for expert
input. A final set of 22 indicators were concluded and advanced to the pilot test stage. Four
countries, including countries in emergency settings, Iran, Palestine, Saudi Arabia, and Jordan
agreed to contribute in 2021. WHO-EMRO led the initiative in collaboration with WHO Country
Offices and Collaborating Centers. Ministries of Health and local authorities were involved at
different levels to ensure accountability. The pilot test ensued in eight primary care centers and
six hospitals, including public and private. Meta-data files and data collection resources were
developed to support the implementation and enhance uptake.

Image:

412
Conclusion: The literature review yielded 40 indicators. The initial list was then circulated for
expert input. A final set of 22 indicators were concluded and advanced to the pilot test stage.
Four countries, including countries in emergency settings, Iran, Palestine, Saudi Arabia, and
Jordan agreed to contribute in 2021. WHO-EMRO led the initiative in collaboration with WHO
Country Offices and Collaborating Centers. Ministries of Health and local authorities were
involved at different levels to ensure accountability. The pilot test ensued in eight primary care
centers and six hospitals, including public and private. Meta-data files and data collection
resources were developed to support the implementation and enhance uptake. Health workers'
safety is a cornerstone for any prosperous and resilient healthcare system. The developed
indicators cover but are not restricted to COVID-19-related safety measures and can be used in
a multitude of healthcare setting.

Disclosure of Interest: None Declared

413
Mobilising staff, data, and AI to improve equity in a large UK hospital to improve quality and
patient outcomes: (2778) Esther Kwong

ISQUA2024-ABS-2778

E. Kwong 1 2,*, H. Fontana 3, M. Martin 3, H. Franklin 3, S. Poon 3, D. Allwood 2 3

1NIHR Applied Research Collaboration North West London, 2Dept of Primary Care and Public
Health, Imperial College London, 3Imperial College Healthcare NHS Trust, London, United
Kingdom

Introduction: Healthcare services across the UK and globally have faced unprecedented
challenges in managing rising demand from the impact of the Covid-19 pandemic and pre-
existing health challenges. Globally we are facing widening disparities in health outcomes
disproportionately affecting people living in poorer areas and those from Black, Asian and
minority ethnic communities. There is an urgent need for more deliberate efforts to address
equity, a core dimension of quality, through the delivery of our health services.

Objectives: This project explores approaches of a large hospital provider in the UK to develop a
pathway of measuring and addressing health inequalities, to understand staff perceptions, and
to stimulate staff involvement in direct patient solutions and interventions to address inequities
in our hospitals e.g., outpatient attendances.

Methods: We set out to explore an approach to address equity through the dimensions of
access, experience, and outcomes of care. The project focused on a mixed-method approach
with several elements. 1) We conducted a series of qualitative interviews with a range of front-
line staff to explore insights and experience of equity issues, and undertook thematic data
analysis, 2) We used improvement approaches including process mapping and root cause
analysis to understand some of the systemic organisational level issues, and 3) We examined
routinely collected Trust data drawn from our hospital's electronic records system to
understand what data we had to support equity measurement to highlight equity issues and
inform the subsequent development of a subset of indicators for equity using datasets.

Results: The qualitative results demonstrate that many staff have an awareness of inequality
and inequity and observed the effects of how wider determinants of health, housing, education,
and social deprivation directly affect outcomes of care. Staff highlighted issues of accessing
care relating to the ‘inverse care law’ and ‘postcode lottery’. The qualitative data and the
process mapping and root cause analysis highlighted the impact of language and lack of
culturally sensitive care in some instances, which was seen as a major barrier to equitable care,
affecting patient and staff communication, and the ability for shared decision-making. Staff
also highlighted a desire for greater involvement in monitoring health inequalities, the need for
routine data and dashboards and a proactive approach to addressing equity. Our quantitative
analysis clearly showed that patients from more deprived backgrounds and those in the most
deprived quintile were almost 50% more likely to not attend their outpatient appointments.
Subsequently, an improvement project was initiated, piloting the use of AI to predict, identify
and support patients who would be most likely to miss appointments and a co-production

414
approach with patients and staff on interventions to improve equity of access to outpatient
appointments.

Image:

Conclusion: The equity of access project continues to progress against its aim to reduce the
gap between the highest and lowest outpatient attendances. The hospital has now begun using
routine equity data to support the development of a dashboard and continues to develop
feedback channels for staff to provide qualitative insights to understand equity issues. The
project has combined quantitative and qualitative approaches to understand the problem and
techno-social approaches in the form of AI and digital solutions alongside patient co-
production and staff education to address equity of outpatient attendance. Our work highlights
the role of hospital providers in addressing health inequities to improve the health of their
patients and populations. Mobilising staff and through greater use of digital and technological
solutions embedded as a routine and sustainable culture for busy acute providers to address
inequalities has been key. This is a crucial foundation to improve healthcare providers’ ability to
improve equitable healthcare outcomes for patients and populations.

Disclosure of Interest: None Declared

415
Towards Improving the sexual reproductive health (SRH) and gender equity of Women Survivors of
Intimate Partner in a Sample of Syrian Refugees in Jordan, a cross-sectional Study: (1788) Sarah
Ahmad Aitan

ISQUA2024-ABS-1788

S. A. Aitan 1,*, I. Aqel 1, O. Samawi 1

1
Health, The Institute for Family Health/King Hussein Foundation, Amman, Jordan

Introduction:

The United Nations defines violence against women as "any act of violence that results in, or is
likely to result in, physical, sexual, or mental harm or suffering to women, including threats of
such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life".
Gender-based violence (GBV) is a global pandemic and healthcare emergency, happening in all
societies, classes, races, religions, and ethnicities and does not have boundaries related to
place or time. According to the World Health Organization (WH0), 1 in 3 women will experience
physical or sexual abuse in their lifetime. Gender-based violence is a phenomenon deeply
rooted in gender inequality and continues to be one of the most notable human rights violations
and significantly impacts women's health. The primary purpose of this research is to study the
negative sexual reproduction health consequences as a result to identify and address yet
improve the SRHR needs of the women who are survivors of violence in displacement settings.

Methods:

This research used a cross-sectional research design; specialists executed direct interviews
with the survivors of violence. The inclusion criteria were married women who are survivors of
recent violence. The number of study sample participants was (102) females mostly from Syrian
refugees. Informed consent was signed before initiating the interviews and after explaining the
aim of the study. Approval to conduct the research was obtained from the Research Ethical
Committee in the Institute for Family Health after reviewing the questionnaire and data were
collected from Jan 1st, 2021, until July 7th, 2022. All data were analyzed using the
SPSS software. The Pearson correlation coefficient was used to measure internal item
consistency and Item discriminative validity. Cronbach's alpha coefficients determined the
whole scale. A t-test was performed to examine the existence of statistical significance
between the means to test the first question. A level of p < 0.05 was considered statistically
significant. Finally, the frequencies and percentages were calculated and supported by graphs
to answer the second question.

Results: The results were as follows according to the research questions:

What are the predictors of unintended Pregnancy and the prevalence of unmet needs in
the sample population?

416
Results showed that 67,6% of the study sample had unintended Pregnancy, with the highest
percentage in the age group less than 18 representing 43%.

The percentage of unmet needs for contraception was 55 % among the study sample
compared to Fourteen per cent of married women aged 15-49 according to the 2017-18
Population and Family Health Survey Key Findings in Jordan

What is the prevalence of maternal health care conditions/complications in the study

sample?

Antenatal care, delivery, and postnatal care:

This study showed that almost all recent Intimate partner survivors married women (98%) aged
15-49 received at least one antenatal care (ANC) visit from a skilled provider (doctor or
nurse/midwife). (73.5%) women aged 15-49 made 4+ ANC visits, and 16.6% had the
recommended 7+ visits. 26% received inadequate visits (defined as less than four, mostly due
to financial reasons).

Almost all (96%) of births in the study sample were delivered in a health facility. Fifty-two per
cent of women aged 15-49 did not receive a postnatal checkup.

C-sections: 26% of births were by C-section, where cesarian section births are most common
in the marriage age group below 15, with the most common indication being the previous
cesarian section.

Breastfeeding

only 67% were breastfed in the first hour of life.

Current Use and Trends of Family Planning:

(78.1%) currently use a modern method of family planning, and (21.9%) use a traditional
method. Intrauterine devices are the most popular modern method (50.0%), followed by oral
pills (15%).

Women’s Nutritional Status:

The researchers took weight and height measurements of survivors of recent (Intimate partner
violence (IPV ); results showed that 49% of the study sample were obese, having a body mass
index of 30.

Source of sexual information:

40% had no source of sexual information

30% received from a social circle (as friends, mother, sister, teacher)

Common sexual reproductive health conditions:

- Recurrent vaginitis: 54%

- Infertility (male, female, unexplained): 28%

- Dyspareunia (37%)

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- Low sexual drive (42%)

Conclusion: Little research has been conducted on the consequences of violence in low or
middle-income countries on sexual reproductive health especially in conflict - post-conflict
settings. The current study extends the existing state of knowledge by assessing associations
between violence and unintended Pregnancy, unmet needs for contraception, and the
prevalence of common sexual and reproductive health conditions. This study showed that child
marriage was significantly associated with unintended Pregnancy. In addition, it showed the
prevalence of negative health consequences such as inadequate postnatal contacts, recurrent
vaginitis, dyspareunia, and lack of resources for sexual health information. The need of the hour
is to take specific measures to reduce the incidence of unintended pregnancy and to design
quality improvement methodologies focused at improving the sexual reproductive health and
well-being of women survivors of intimate partner violence, especially in displacement and
post-conflict settings, in addition to addressing the root cause of the issue lying in gender
inequality. the measures can include advocating for sexual reproductive health and rights and
inclusion of men in the awareness activities. A second phase of a study will be conducted to
evaluate the improvement measures.

Disclosure of Interest: None Declared

Hospital Transition from Paper Towels to Hand Dryers: A Smart Solution: (3042) Mr. Uzair Ali
Shaikh

ISQUA2024-ABS-3042

S. Pervaiz 1,*, M. Khan 2, A. Shahid 2, U. Shaikh 3

1
Quality Improvement, 2Facility Management, 3Operations, Evercare Hospital Lahore, Lahore,
Pakistan

Introduction: Pakistan is one of the largest paper production country with 700,000 tons
production reported in 2019. Among paper production, tissue products show a significant
growth of 4% every year. This is because tissue and hygiene products are essential to everyday
life, and their demand is increasing in commercial sectors due to a greater awareness about
personal health and hygiene among consumers. In various commercial sectors, hospitals
utilized highest proportion of tissue/ hygiene paper towel because staff, patients, and visitors
are encouraged to frequently wash and dry their hands to prevent the spread of infections
ultimately leads to higher tissue consumption. Pandemic COVID-19 also encouraged more
widespread global consumption of single-use products- tissues for drying. However, excessive
use of tissues/ hygiene paper towels for drying has several implications.

Problems with using of paper hand towels are listed below:

- Increased Costs: Excessive use of tissues leads to increased burden on purchasing and
disposal of higher volume of tissue products.

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 - Environmental Impact: The production of tissues utilizes natural resources like water,
energy, and trees as raw materials. Cutting trees for production of paper causes deforestation
which leads to many other environmental issues e.g. global warming.

- Increased waste production: Overuse of tissues contributes to increased waste and

environmental burden due to the production and disposal of the tissues

- Sustainability Concerns: Overuse of tissues contradicts efforts toward sustainability and

responsible resource utilization within the healthcare sector.

- Carbon Emissions: High environmental impact with 13.9g CO2 per dry

Methods: Evercare Hospital Lahore is a 270 Bedded hospital with 4 types of room categories all
with attached bathrooms. A total of 112 toiles are there in the hospital with 33 toilets in access
to the public. Baseline data regarding hygiene paper towel consumption in the hospital and
associated cost was collected. The Project was initiated in the month of April -23 with the
installation of hand dryers in all the non-clinical/public toilets and data collection for the impact
was also done at the same time.

Results: From the data collected, it was found that total hygiene consumption per month in the
toilets were 4,000 and the cost per month per toilet was 5,536 PKR. Overall, the trend showed
that the consumption was increasing with increasing cost and additional burden on waste
disposal. On the basis of data collected an alternative strategy electric hand dryer was
proposed. Electric hand dryers involve low running cost and environmental impact as compared
to paper towels. Multiple options were explored, based on price comparison and energy
efficiency IZONE I303 1500W hand dryers were finalized.

Cost benefit analysis was done and it was found to be beneficial.

Image:

419
Conclusion: After installation of hand dryers, quantity of consumption of paper towels was
signifcantly reduced. This caused reduction in operational cost of Hospital by 100,000 PKR in
total per month. Return on investment has successfully been achieved within 3.3 months.

A significant reduction of waste has been noted after the installation of hand dryers in public
areas. A decreasing trend depicts reduction in general waste generation and disposal thus
reducing harmful impact on environment.

Disclosure of Interest: None Declared

Evaluation of Measures That Can Be Taken for Public Health within Framework of Climate Change
Adaptation and Action Plan: Türkiye 2010-2023 Climate Change Adaptation and Action Plan
Example: (1914) Didem Incegil

ISQUA2024-ABS-1914

D. Incegil 1,*, I. H. Kayral 1, F. Çizmeci Şenel 1

1
International Programs, TÜSKA, Ankara, Türkiye

Introduction: Today, researchers state that global climate change is a multifaceted and
complex problem that can lead to serious environmental and socioeconomic consequences
and even threaten the security of countries, and its effects will become one of the most
important problems that threaten the lives of future generations. Countries are creating
strategies to fight climate change and preparing long-term adaptation and action plans. In this
study, the measures taken to protect public health within the scope of the Türkiye Climate
Change Adaptation and Action Plan 2010-2023 were examined and the benefit of creating a
country policy and strategy to prevent climate change damages was emphasized.

Methods: Türkiye is also aware of the importance of international cooperation within the scope
of reducing greenhouse gas emissions that cause climate change and combating climate
change. In this context, Türkiye sets as a goal to contribute to efforts to combat global climate
change within the framework of "common but differentiated responsibilities", which is one of
the basic principles of United Nations Framework Convention on Climate Change (UNFC-CC); It
reveals national mitigation, adaptation, technology, financing and capacity building policies.
Türkiye has prepared the "National Climate Change Strategy 2010-2023" in order to contribute
to global efforts to reduce effects of climate change within the framework of its own special
conditions and opportunities. In this study, measures taken to protect public health within the
scope of Türkiye Climate Change Adaptation and Action Plan 2010-2023 were examined.

420
Results: Climate change has direct or indirect effects on health. Direct effects; temperature
extremes, heat/cold waves, hurricanes, storms, floods and fires; indirect effects are; vector
diseases, infections, epidemics, water and foodborne diseases, air pollution and respiratory
diseases, stratospheric ozone depletion and UV Radiation, allergic diseases and field dust.
Within the scope of Türkiye National Climate Change Strategy 2010-2023, priority targets and
sub-targets under the title " Public Health" are given in Table.1. National targets within the scope
of this strategy are stated below;

Reducing the impact of natural disasters resulting from extreme weather events on public
health and social life

Strengthening the institutional infrastructure to monitor increasing diseases and increasing

internal and external cooperation

Ensuring water and food security, combating water- and food-borne diseases,

Carrying out necessary work to ensure that sensitive groups are not affected by negative effects
of climate change.

Reducing the negative contributions of health institutions to climate change.

Raising public awareness for more effective protection from the negative effects of climate
change on health.

Conducting monitoring and evaluation studies.

Image:

421
Conclusion: Today where effects of global warming are felt more and more every day, World
Health Organization (WHO) estimates that there are more than 150 thousand deaths annually
due to climate changes. According to United Nations report titled The State of Food Security
and Nutrition in the World, the number of people suffering from hunger reached 690 million in
2019. Many diseases or causes of diseases caused by climate change are of great concern to
public health. Large budgets are spent every year to eliminate the negative effects of climate
change. Measures and adaptation practices to be taken within the framework of adaptation to
climate change will minimize losses or health risks. Countries should create long-term policies
regarding climate change and prepare strategies and action plans accordingly. Prepared action
plans must be sustainable and followable. In order to strengthen and implement climate
change policies, international collaborations should be used as well as national initiatives.

Disclosure of Interest: None Declared.

422
Reduce Paper Usage in Hospitals– A Step Towards Environmental Sustainability and Digitalization:
(3444) Huma Naz

ISQUA2024-ABS-3444

H. Naz 1,*, U. Pardhan 1

1
Outpatient, Aga Khan University, Karachi, Pakistan

Introduction: There is a growing need to implement effective strategies for reducing paper
consumption. This imperative arises from various factors, including environmental concerns,
cost efficiency, and the transition towards a more digitally oriented healthcare landscape. The
project focuses on digitalization and streamlining paper-based procedures to boost operational
efficiency, optimize resource utilization, and ultimately reduce costs with overall positive
environmental impact in a tertiary care hospital in LMIC.

Methods: Data collection and analysis was carried out in 2022. Utilization of different type of
papers along with the purpose, pattern and cost impact was studied. The project was divided
into phases based on types of utilization; 1) Papers used for administrative purposes (Common
office use, log sheets, confirmation lists, appointment lists, schedules, rota, assignments etc.),
2) Paper used for clinical purposes (Patient Education material, prescriptions, ordering sheets,
letter heads, medical certificate, other forms etc.).

Possible alternatives for each type of paper usage were brainstormed and several small pilot
testing were carried out to assess the implications from end of year 2022 onwards. Several
strategies were deployed to rationalize paper usage including Process Reengineering,
Behavioral Transformation, Digitalization, Monitoring & Control and Innovation.

Results: Paper consumption for administrative purposes reduced to up to 17% in just first 6
months after the implementation of the project strategies and without any major
investment. The second important targeted category was education material, which was
digitalized with the help of QR code leading to 14% reduction in paper consumption during this
time. As the paper quality in education material is much higher than other papers, the cost
savings are also higher. The estimated cost saving through this project is around 27% and
expected to improve further as we gradually expand our scope within and outside the
department. The concomitant environmental impact is also significant for e.g., the number of
trees saved so far (10 trees) along with other environmental impact indices of total energy
savings (equivalent to 13.6 residential refrigerators operated/year), water savings (10,030
gallons of water), greenhouse gases emission reduction (8,320 pounds of carbon dioxide,
equivalent to 0.8 cars/year etc.).

Image:

423
Conclusion: Our proactive approach to paper reduction in hospital setting through various
process reengineering and technology driven strategies have a positive impact underscoring our
commitment to environmental sustainability as well as operational efficiency. Monthly
consumption patterns for each category of item are now part of the unit performance indicator
to ensure sustainability of actions and encourage teams to do more.

References: Estimated environmental impacts were calculated using the Environmental Paper
Network's Paper. [Link]

Disclosure of Interest: None Declared.

424
Environmental Impact of extensive use of Personal Protective Equipment in health care during
COVID-19: (3536) Tilotma Jamwal

ISQUA2024-ABS-3536

T. Jamwal 1,*, P. Khanna 2, K. Jain 1

Hospital Administration, 2Anaesthesiology, Pain Medicine & Critical Care, All India Institute of
1

Medical Sciences, New Delhi, India

Introduction: Covid-19 pandemic has caused health crisis and concerns worldwide. The use of
Personal Protective Equipment (PPE) has been the primary behavioural and policy response to
avert the infection of coronavirus. (1) In health care, single-use PPE are commonly used, which
are made up of synthetic fibers such as polypropylene and polyester and are preferred due to
their low-cost, hydrophobic nature and better barrier properties. (2) This study aims to provide
an overview of the environmental challenges associated with Covid-19 pandemic faced in the
Public Institute of National Importance (INI), India. The study determines carbon footprint in
terms of carbon emission equivalent associated with PPEs.

Methods: Retrospective cross-sectional study was carried out in a public sector Institute of
National importanc India. The data was collected for pre COVID-19 (January 2019 - December
2019), First wave COVID-19 (January 2020- December 2020), Second wave COVID-19 (January
2021- December 2021), Third wave COVID-19 (Jan 2022- December 2022) as well as post
COVID-19 (January 2023-December 2023). Life cycle assessment approach was used to
estimate emissions and resulting environmental impact from the most common PPE items
prescribed and used in India: masks, gloves, gowns, and face shield. Data of use of these PPE
items was retrieved from records maintained at the Stores section for the duration during the
pandemic, before pandemic as well as after the pandemic. Monthly utilization average will be
ascertained for each PPE item to nullify the effect of skewed data (if any) and enable
comparison about the use during, before and after [Link] data on the volumes of these
PPE distributed for use by health and social care services in the INI was summated, to estimate
the overall environmental impact of PPE during the said period.

Results: Our results show a significant difference in consumption of PPE during COVID-19
(p<0.05) in comparison to pre COVID-19 and post COVID-19 phase (Image: Table 1). The data
shows that PPE were extensively used during COVID-19. Carbon emission during COVID-19
was 2566 tonns eq CO2 whereas pre pandemic it was 321 and post pandemic it came down to
974 tonns eq CO2 (Table 2). The average carbon footprint generated by each type of PPE in
KgCO2 is (1): N95 mask - 0.05/single use, Surgical Mask - 0.059/single use, Disposable sterile
surgical gowns (3) - 0.5/piece, Face Shield - 0.35/piece, Nitrile gloves (4) - 0.028/use .

425
Image:

Conclusion: In view of the highly contagious COVID-19, there has been an unprecedented
need, consumption, and release of single-use plastic products. Our study reveals a staggering
carbon footprint of 2566 tons equivalent of CO2 attributed to the extensive use of Personal
Protective Equipment (PPE) during the COVID-19 pandemic. Addressing this issue requires a
multifaceted approach, innovations to enhance economic and environmental efficiency,
governmental support and contingency plans, the development of advanced methods for
plastic waste treatment, and stringent enforcement of regulations.

426
References:

Monolina P, Md MHC, Md NH. The use of Personal Protective Equipment (PPE) and associated
environmental challenges: A study on Dhaka, Bangladesh [Internet]. Heliyon: Cell Press; 2022
[cited 2024 Feb 12]. Available from: [Link]

A. Uddin, S. Afroj, T. Hasan, C. Carr, K. S. Novoselov, N. Karim, Environmental Impacts of

Personal Protective Clothing Used to Combat COVID-19. Adv. Sustainable Syst. 2022, 6,
2100176. [Link]

Quintana-Gallardo A, del Rey R, González-Conca S, Guillén-Guillamón I. The Environmental

Impacts of Disposable Nonwoven Fabrics during the COVID-19 Pandemic: Case Study on the
Francesc de Borja Hospital. Polymers. 2023; 15(5):1130.
[Link]

Nortz S, Eckelman M, Nuberg S, Sutton Nitrile, latex & cotton gloves: Comparing the
Environmental Impacts [Internet]. 2022 [cited 2024 Feb 12]. Available from:
[Link]

Disclosure of Interest: None Declared

The healthcare provider views on the implementation of the national guidelines of patient safety
incident reporting in a selected hospital in North West province, South Africa: (2599) Sabelile Tenza

ISQUA2024-ABS-2599

S. Tenza 1,*, A. A. Abuosi 2, N. Scheepers 1, S. K. Coetzee 1

1
School of Nursing Science, North-West University, Potchefstroom, South Africa, 2Department
of Public Administration and Health Services Management, University of Ghana Business
School, Legon, Ghana

Introduction:

The World health Organisation (WHO) Global patient safety action plan 2021-2030, urges
countries worldwide to set and adhere to national level policy guidelines that direct patient
safety in hospitals. In South Africa the national guidelines for patient safety incident (PSI)
reporting guides the management of PSI’s in hospitals. Since its implementation in 2017 there
has not been studies in the North West Province examining the implementation of these
guidelines. This study explored the views of healthcare providers in the implementation of PSI
guidelines.

Methods: This was a qualitative exploratory study design. Following ethics approval (N W U - 0
0 0 5 9 - 2 3 - A 1), nine focus group discussions consisting of 6-10 participants per group were
conducted with heath care providers including doctors, physiotherapists, occupational
therapists, pharmacists, nurses, and patient safety committee leaders. The data collection tool

427
focused on the context, process and challenges of implementing the guidelines. Data was
collected between August and December 2023. Data was transcribed verbatim and thematic
data analysis was done; principles of trustworthiness were adhered to in conducting the study.

Results: We found that the context of implementing guidelines is influenced by the need to
learn from existing incidents, and the need to provide structure in reporting. The process of
reporting is impeded by the insufficient knowledge of the implementers, lack of feedback from
reported incidences lead to demotivation, fear of reporting, insufficient human resources
constrained time available for reporting. Duplicated approaches in reporting, and lack of
collaboration across healthcare providers impeded implementation.

Conclusion:

Innovative training approaches catering for all group of healthcare providers, frequent updates
on reported incidences, promotion of just culture and simplification of the reporting process
could improve the implementation.

Disclosure of Interest: None Declared

Improving care for respiratory conditions, including Covid 19 in the public primary care system in
Mendoza, Argentina: (2801) Ezequiel Garcia Elorrio

ISQUA2024-ABS-2801

E. Garcia Elorrio 1,* on behalf of Collaborative Group to Improve Primary Care Respiratory Care
in the Province of Mendoza, A. Falaschi 2, F. Jorro Baron 1, M. B. Peralta Roca 2
1
Quality and Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires,
2
Epidemiology and Quality of Care, Minister of Health, Mendoza, Argentina

Introduction: During the recent pandemic, healthcare systems have had to adopt various
strategies to mitigate the negative impact of COVID-19. The primary level of care played a
crucial role in ensuring continuity in the provision of health services, both for COVID-19 patients
and those with other conditions. What is particularly also now also important with the surge in
cases observed in the LAC region.

The primary goal or our work now is to increase the adoption of evidence-based interventions
for timely identification of deterioration in adult patients with confirmed or suspected
respiratory COVID-19 at the primary level of care in the province of Mendoza, Argentina.
Secondary objectives include assessing the frequency of unexpected events during visits to
Hospital Emergency Services, the rate of hospitalizations related to respiratory COVID-19 and
other acute respiratory infections in adults, evaluating the experience with the patient care
process and healthcare providers, and determining the 30-day mortality rate.

428
Methods: We developed a Quality Improvement Collaborative in 9 Primary Health Centers
(PHCs) from the public sector of the Province of Mendoza, over a 12-month period under the
design of an uncontrolled interrupted time series. We implemented specific interventions
supported by an implementation science based multimodal model to achieve the project
objectives, with components such as leadership commitment, teamwork improvement tools,
visual and digital reminders, audit and feedback and direct observation among others. The
study had two phases: Formative phase: during baseline data collection we developed a
qualitative evaluation based on in-depth interviews in each of the participating PHCs.
Intervention phase: local study coordinators was trained on a) Audit and feedback, b) facility-
specific treatment guidelines or clinical pathways to enhance the effectiveness focused on the
most common circumstances associated with respiratory syndromes in adults, c) Usage of a
bundle of specific tools to improve care of Covid-19 in the ambulatory primary care setting
consisting of: triage of adult patient with acute respiratory symptoms tool, usage of a National
Early Warning Score 2 deterioration scale, portable home oximeters usage and appropriate use
of telehealth, d) education to improve detect and treat acute respiratory infections through
posters, flyers and newsletters, or electronic communication to staff groups. The learning
sessions and action periods are meant to test and implement changes in the CAPS, and data is
being collected to measure the impact of the changes using an interactive database.
Subsequently, an analysis will be conducted on the results, lessons learned, the applicability of
interventions, and modifications to the work plan following the PDSA cycles.

Results: We plan to share findings on the main and secondary otucomes using a Control Charts
as well describe predictve factors that had influenced trends of results.

Conclusion: Results from this work will be of use to understand how primary care based
interventions will support the health system during times of need. Will also contribute to proper
use of resources as well improve clinical outcomes as well patient/provider experience.

References: Garcia-Elorrio E, Rowe SY, Teijeiro ME, Ciapponi A, Rowe AK. The effectiveness of
the quality improvement collaborative strategy in low- and middle-income countries: A
systematic review and meta-analysis. PLoS One. 2019 Oct 3;14(10):e0221919.

Disclosure of Interest: None Declared

Prescribing error patterns among junior medical officers in paediatrics: (1256) Johanna Westbrook

ISQUA2024-ABS-1256

J. I. Westbrook 1,*, T. Badgery-Parker 1, L. Li 1, E. Fitzpatrick 1, M. Raban 1

1
Australian Institute of Health Innovation, Macquarie University, Sydney, Australia

Introduction: Medication errors in hospitals continue as one of the most significant patient
safety risks worldwide. In paediatrics the consequences of such errors can be particularly
acute given this vulnerable population. Understanding the epidemiology of medication errors in
hospitals has relied heavily on review of incident report data and small-scale audits.

429
Understanding the distribution and nature of medication errors is central to devising effective
interventions. Patterns of medication errors have most often used patients as the denominator.
Studies of the distribution of medication among prescribers are rare.

Our aim in this study was to examine variation in the rates of prescribing errors among junior
medical officers (JMO) working in the two major paediatric referral hospitals in Sydney,
Australia.

Methods: This is a secondary analysis of medication chart review data from two paediatric
referral hospitals. All medication orders for a random sample of patients (stratified by ward) in 9
wards at Hospital A (N = 10596 orders) and 5 wards at Hospital B (N = 8356 orders) over a 3
month period in 2020 were assessed for errors. For this analysis, orders entered by junior
medical officers (JMOs) were analysed. We calculated error rates per prescriber by error type
and severity for all orders and for orders involving high-risk medicines. Each estimate was
restricted to prescribers with at least 10 orders in the denominator.

Results: Of 645 JMO prescribers in the dataset, 453 entered at least 10 orders (total 17097
orders) and 139 entered at least 10 orders for high-risk medicines (total 2611 orders). The
overall error rate was 16.6 (95% CI 16.0–17.2) errors per 100 orders for all medicines and 20.0
(95% 18.5–21.6) errors per 100 orders for high-risk medicines. The error rate was higher at
Hospital B (18.7; 95%CI 17.8–19.5) than Hospital A (14.8 errors/100 orders; 95%CI 14.1–15.6).

The prescriber-specific error rates ranged from 0 to 69.2 errors per 100 orders (median 14.9).
Rates of potentially serious errors ranged from 0 to 46.2 errors per 100 orders (median 0). Fig 1
shows the individual prescriber-specific error rates with 95% and 99.8% binomial control limits
around the mean (16.4 errors per 100 orders). Each dot represents a JMO prescriber. Twenty-two
prescribers (4.9%) had error rates above the 99.8% upper control limit while one had an error
rate below the 99.8% lower control limit.

For high-risk medicines, the prescriber-specific error rate ranged from 0 to 75.0 errors per 100
orders (median 16.7) for all medicines and from 0 to 60.0 for potentially serious errors (median
0). Five prescribers (3.6%) had error rates for high-risk medicines above the 99.8% upper control
limit.

Among 346 prescribers with ≥10 orders for oral medicines, the median error rate was 13.6 errors
per 100 oral orders and ranged from 0 to 80.0. Among 173 prescribers with ≥10 orders for IV
medicines, the median error rate was 10.0 errors per 100 IV orders, ranging from 0 to 100.0
orders per 100 IV orders. There was no correlation between the prescriber-specific oral and IV
error rates (Pearson ρ = −0.02; 95%CI −0.17 to 0.14).

Image:

430
Conclusion: This study provides a rare insight into the prescribing error patterns of a large
sample of junior doctors. This is a first step in exploring both the types and frequencies of errors
occurring and hence where strategies to provide user feedback and interventions should be
focussed for junior medical officers.

Disclosure of Interest: None Declared

Identifying actual harm from prescribing errors in acute paediatric care: (2373) Magdalena Z Raban

ISQUA2024-ABS-2373

V. Mumford 1,*, M. Z. Raban 1, E. Fitzpatrick 1, L. Li 1, T. Badgery-Parker 1, J. I. Westbrook 1

1
Australian Institute of Health Innovation, Macquarie University , Sydney, Australia

Introduction: Medication errors in paediatrics can be difficult to identify as doses need to be

adjusted for patient age and weight, and off-label use is necessary where medications have not
been specifically approved for this patient group. Identifying actual harm from medication
errors can also be difficult to quantify due to age related changes in vital signs and the challenge
of eliciting symptoms in younger and non-verbal patients. This has resulted in little data on
actual harm from medication errors in children. Despite these challenges, our aim was to
identify the actual harm resulting from prescribing errors in a paediatric hospital.

431
Methods: Prescribing data were collected from a retrospective record review in an Australian
tertiary paediatric hospital.1 Pharmacists reviewed 26,369 orders and identified 19,692 errors
which were classified according to their potential harm severity: 1) no harm or temporary harm
requiring monitoring, and 2) serious potential harm comprising; temporary harm requiring
intervention, permanent harm, and potential death. Case studies were prepared for patients
where errors were: a) categorised as having serious potential harm; and b) there was evidence
that the error reached the patient. A multi-disciplinary panel reviewed these cases studies to
determine whether patients had experienced actual harm from the error(s).

Results: The panels reviewed 173 case studies (378 errors) and identified actual harm in 22
cases (comprising 42 errors) with actual harm severity ratings of minor (n=8), moderate (n=13)
and serious (n=1) harm, with none designated as severe harm (i.e resulting in permanent life-
threatening harm or death). No harm was found in 330 errors and six errors were rated un-
assessable due to a lack of information in the medical record. Patients were significantly
(p<0.05) younger in the harm group (median 5.1 years) than the non-harm group (median 9.7
years). There was some evidence that errors were detected during admission (n=11/22 cases)
but only one case resulted in an incident report. The main error types resulting in harm were
dose errors comprising overdoses (n=10/22 cases) and underdoses (=9/22). However wrong
route was the most common error type when analysed on an error rather than case basis
(n=18/42 errors) due to patients being prescribed multiple drugs orally when they had a feeding
tube. The most common medication groups involved in actual harm were antibiotics
(n=7/22cases), and hypnotics and sedatives (n=6/22cases).

Image:

Conclusion: The difference in potential and actual harm, and the significant age difference
between patients identified as harmed or not harmed by a prescribing error, are critical findings
in terms of ensuring that error mitigation efforts accurately target the populations most at risk of
actual harm.

References: 1. J Westbrook, et al. Short- and long-term effects of an electronic medication

management system on paediatric prescribing errors. npj Digital Medicine 2022;5(1):179 doi:
10.1038/s41746-022-00739-x

Disclosure of Interest: None Declared

432
Electronic Health Record Transition: Clinician Perspective and Patient Safety: (3565) Ozlem Eskil
Cicek

ISQUA2024-ABS-3565

O. Eskil Cicek 1,*, Z. Akgun Cihnioglu 1, F. Aytekin 2, G. Kanturk 2, M. Erkiran 3

1
Quality Management, 2Hospital Management, 3Hospital Management, Psychiatry Clinic,
Bakırköy Mental Health, Neurology and Neurosurgery Hospital,, İstanbul, Türkiye

Introduction: Although there is a growing body of literature in terms of patient and physician
satisfaction regarding the transition to electronic medical record, there are few studies in the
field of psychiatry clinic. Patient safety and the impact of patient-physician relationship is one of
the main concerns about the transition to electronic medical record transition.

Methods: In our hospital, the transition to electronic medical records in the child psychiatry
clinic was carried out together with child psychiatry clinicians, the informational technology
department and technical services in the outpatient clinic, emergency and health board
procedures under the coordination of hospital management. .Due to the concern that the
electronic medical record might affect the patient-physician relationship, computer screens
were embedded in the tables with a special design so that eye contact between the patient and
the doctor is not prevented. The information that should be on the screen was determined after
the meetings with the physicians, and the forms were integrated into the Hospital Information
Management System (HIMS). 16 scales, 10 physician information forms and all nursing forms
used by child and adolescent psychiatry during the transition to practice were integrated into
[Link] scales filled in by psychologists were defined as HIMS and they could be viewed on
physician screens. The transition to the electronic registration system was evaluated with the
questionnaire obtained through the literature review. A questionnaire was shared with 48
resident physicians and 12 child and adolescent psychiatrists. The questionnaire was filled out
by 21 (43.75%) resident physicians and 7 (58.33%) child and adolescent psychiatrists.

Results: It has been determined that 86% of the physicians participating in the survey are
satisfied with the transition to the electronic medical record. 89% of clinicians reported that the
electronic medical record system effectively enhanced communication among healthcare
professionals. According to a survey, 57% of clinicians report that the electronic medical record
system offers a more comprehensive record of the patient's psychiatric history and examination
findings, whereas 36% only provide a partial record.

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Conclusion: This study is one of the few studies available in the existing literature in the field of
psychiatry. While electronic medical records are a cause for many concerns, affecting patient-
physician relationship, is one of the main barriers. The burial of the screens on the table has
reduced the effect of the computer screen, which is believed to impede the patient's
communication with the doctor. It is believed that the study and the electronic medical record
transition project are important in this context, and that it could be the basis for advanced
studies in electronic medical record transition in psychiatric clinics.

References: (1) Stewart et al. Do electronic health records affect the patient-psychiatrist
relationship? A before & after study of psychiatric outpatients BMC Psychiatry 2010,
doi: 1186/1471-244X-10-3

(2) Patel et al. Clinician Perspectives on Electronic Health Records, Communication, and
Patient Safety Across Diverse Medical Oncology Practices Journal of Oncology Practice Volume
15, Issue 6 335 DOI [Link]

Disclosure of Interest: None Declared

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Implementation of patient flow-based electronic clinical pathways (ECP) for patients presenting
with HIP fractures in emergency departments: (2809) Ricardo Sampaio Paco

ISQUA2024-ABS-2809

R. S. Paco 1,*, M. Mehmood 2

1
Lean Transformation Office, 2Emergency, St James Hospital, Dublin, Ireland

Introduction: St. James's Hospital is involved in the Irish Hip Fracture Database (IHFD) Audit,
which is overseen by the National Office of Clinical Audit (NOCA). This audit helps to prioritize
and define quality improvement strategies for patients with hip fractures in accordance with the
IHFD Standards set by NOCA. A team called the Hip Fracture Multidisciplinary Clinical
Governance oversees patient care and provides guidance to enhance compliance with the IHFD
standards. Compliance with the IHFD standards was within the national average, except for
Standard 1 (Admission to an orthopaedic ward within 4 hours of presentation to ED). To improve
outcomes and increase compliance with the IHFD standards, the team launched a project
called "Code Hip". During phase 1 of the "Code Hip" project in 2018, compliance with Standard
1 increased from 4% to 50%. However, due to Covid-19, the ability to maintain the implemented
changes was affected, leading to decreased compliance with the Irish Hip Fracture Standards
back to 4%. Therefore, a need for another improvement cycle became imperative, and thus,
"Code Hip 2.0" was designed.

Methods: We combined design thinking and agile methodologies to create a structured and
patient-centred framework for refining electronic care pathways for hip fracture patients. We
use Whiteboard, a patient flow management software, to manage care pathways. We extended
the current E.D. Whiteboard by incorporating the new Code Hip electronic pathway. We shaped
the prototype artefact during the Alpha phase and refined it through feedback given during
weekly meetings. We released a more polished version of the prototype to all users during the
Beta phase.

Our core design principles for the IT solution are:

1. Data integration with care pathway identifiers

2. Customized interface for a defined number of care pathways (initially hip fractures)

3. Real-time triggers for orders and actions related to the patient journey

Results: The implementation of Code Hip 2.0 at St. James's Hospital has significantly improved
compliance with Standard 1 for hip fracture management. In July 2023, the hospital achieved
100% compliance, and the high sustainability of this success has been maintained since then.
Several key developments have led to this success:

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1. Standard 1 Compliance and Sustainability: Data shows that compliance with Standard 1 has
been continuously improving from January 2023 (30%) to January 2024 (91%). The overall
duration of patients' stay in the Emergency Department (ED) has notably reduced.

2. Pre-Configured Order and Process Completion Triggers: A new system with both automated
and manual inputs has been introduced. This system enhances the patient's journey from
arrival to admission by triggering appropriate care pathways and enabling real-time updates
between departments.

3. User-Friendly Electronic Interface: The development of an easy-to-use interface for managing

hip fracture patients streamlines task completion and provides organization-wide insights into
the patient's progress.

4. Real-Time Monitoring and Discussion of Non-Compliances: The system allows for immediate
monitoring and discussion of any process non-compliance, facilitating quicker adjustments and
continuous improvement.

5. Active Management of Care Pathway Tasks: The system supports a "pull" mechanism from
the ward to expedite patient transfer from the ED. This enhances efficiency and patient
experience.

6. Ease of Reporting and Reduced Audit Workload: Real-time access to data reduces the effort
required to prepare reports and enhances the ability to monitor compliance and manage the
patient care pathway effectively.

Overall, Code Hip 2.0 has transformed hip fracture care at St. James's Hospital by integrating
digital solutions to streamline processes, improve compliance, and enhance patient care
outcomes.

Image:

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Conclusion: Despite global health improvement efforts, inefficiencies still adversely affect
health outcomes and quality of life, a situation expected to deteriorate with demographic shifts.
Recognizing the importance of enhanced information through investment in ICT for healthcare
strategies, the CodeHip project was initiated at St. James's Hospital. It aimed to enhance
outcomes for hip fracture patients by increasing compliance with the Irish Hip Fracture
Standards. Initially, Code Hip improved compliance with Standard 1 from 4% to 50%, but faced
setbacks due to COVID-19, leading to reduced compliance. Code Hip 2.0 focused on improving
process resilience and utilized an agile methodology to adapt to changes and feedback,
achieving 91% compliance at one point and aiming to maintain at least 90% compliance.

This success was attributed to exceptional leadership, team engagement, and the use of
advanced digitization, providing a comprehensive view of the patient journey and facilitating
quick, informed decision-making. The initiative demonstrates the potential for digital
transformation in healthcare, with aspirations to expand this approach to other clinical
pathways in the emergency department, suggesting a scalable model for broader healthcare
system improvements.

Disclosure of Interest: None Declared

Ambulatory Medication Reconciliation: A tool to improve patient safety and minimize medication
errors: (2027) Salma Al Khani

ISQUA2024-ABS-2027

S. Al Khani 1,* and Dr. Abdullah Al-Turki, Martin Heppenheimer

1
Medical Affairs, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia

Introduction: Ambulatory Medication Reconciliation: The process of creating and ensuring

the most accurate and up to date list possible of all medications the patient is taking, including
drug name, dosage, frequency, and route. then and comparing that list against the previous
physician’s discharge orders, and/ or previously prescribed medications in the ambulatory care
setting as applicable with the goal of ensuring correct medications to the patient.

In King Faisal Specialist Hospital & Research Center, the Medication Reconciliation Process
policy is mainly related to the inpatient setting. Admission & Discharge and does not include
ambulatory medication reconciliation

Significant number of medication prescribing errors were reported in the hospital safety
reporting system. Investigating these errors revealed that these errors are mainly related to a
failure in reviewing and reconciling the ambulatory active medication list in the patients’
electronic medical record profile

Several studies were discussing the ambulatory medication reconciliation impact; Turchin et al,
in 2018 concluded that a higher fraction of reconciled outpatient diabetes medications was

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associated with a lower frequency of ED visits and hospitalization, they concluded that a higher
fraction of reconciled outpatient diabetes medications was associated with a lower frequency
of ED visits and hospitalization.

In addition, The Joint Commission recognized the importance of this and included this as a
National Patient Safety Goal

Ambulatory medication reconciliation will help in achieving the following: 1- Systematic view
and review for active patient’s medication list, 2- Minimize duplication of therapy.

Under this project, Medication reconciliation in the ambulatory care setting were added as
mandatory requirement to the hospital policy and to the Physicians’ medication prescribing
training module

Our project is aiming to establish the ambulatory medication reconciliation with the following
objectives:

1- Increase the overall hospital compliance with ambulatory medication reconciliation from the
project bassline by at least 10 folds in 12 months from starting the project; i.e. to reach a
compliance rate of 40%

2- Deliver at least 20 educational sessions to the different hospital medical departments

3- Present the compliance data in the hospital medical affairs quality directors meeting on a
monthly basis

Methods: The project implementation went into three phases:

Phase I

1- Formulate the project multidiscplnary team

2- Review the current hospital policy for medication reconciliation to include and ambulatory
medication reconciliation,

3- Identify and implement possible system enhancement

4- Develop physician’s education material

Phase II

1- Develop implementation compliance indicators, design compliance report

2- Conduct a training campaign

Phase III

1- Monitor compliance with continuous support

2- Provide periodic report to the hospital leaders and departments chairpersons and quality
directors

First Year Project target: is 40% compliance rate

Results: Over the first five months

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1- Around 21 training session were delivered to different medical departments, these included
big medical departments and some session provided specifically to sections under bigger
departments

2- The Data were presented in the medical quality directors meeting on a monthly basis, five
presentations were starting August – December 2023, this will continue until August 2024

3- Overall hospital monthly compliance were improved in the first five months from 4% - 24%
between August to December 2023. Project team will continue to monitor till July 2024

4- Some departments had a significant compliance improvement example, Heart Center, and
Medical Genomics.

Conclusion: Medication reconciliation in the ambulatory care setting is an effective tool to

improve medication safety and minimize medication errors, well-structured training program,
empowered by leadership support and ongoing compliance monitoring is key for a successful
implementation.

References: Turchin et al, Ambulatory Medication Reconciliation and Frequency of

Hospitalizations and Emergency Department Visits in Patients With Diabetes, Diabetis
Care. 2018 Aug;41(8):1639-1645.

Meghan J. Hession University of Massachusetts Amherst, Best Practice Medication

Reconciliation in the Outpatient Setting 2018,

Disclosure of Interest: None Declared

Insights from Adjudicated Complaints: Identifying Hot Spots and Blind Spots with HCAT: (2731)
Søren Fryd Birkeland

ISQUA2024-ABS-2731

S. B. Bogh 1,*, S. M.-B. Hansen 1, M. Kring Clausen 2, L. Morsø 1, S. F. Birkeland 3

1
OPEN, University of Southern Denmark, 2OPEN, Odense University Hospital, 3Department of
Regional Health Research, University of Southern Denmark, Odense, Denmark

Introduction: Systematic analysis of patient complaints has the potential to improve

healthcare quality by pinpointing prevalent issues or situations linked to dissatisfaction. The
Healthcare Complaints Analysis Tool (HCAT) offers a structured approach to characterize
patient complaints. HCAT has identified both hot spots and blind spots from the patient's
perspective, irrespective of healthcare providers' decisions, providing valuable insights for
enhancing care quality. A patient complaint requires a settlement, but HCAT has not been used
to explore complaint patterns between cases resulting in criticism and those without criticism.
This study aims to fill this gap by investigating disparities in the most notable "hot spots"
concerning harm between these two groups. Understanding such discrepancies can shed light
on potential areas for improvement in healthcare delivery.

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Aim:
To examine disparities in the most notable "hot spots" concerning harm between cases
resulting in criticism and those without criticism.

Methods: The HCAT taxonomy organizes data into seven problem categories, and 38 sub-
categories, assessing severity, overall harm and stage of care. Applying the HCAT on all patient
complaints and compensation cases from a Danish University hospital (approx. 9.800 cases) in
a period of five years and subsequently comparing areas of hot spots (harm and near misses)
for accepted and non-accepted cases. Harm hot spots denote complaints categorized as major
or catastrophic harm, while Near-miss hot spots encompass cases of high severity with
minimal or minor harm. We used proportional reporting ratios (PRRs) to measure the
disproportionality of the problem. For a signal to be relevant in an area of interest, the following
criteria should be met: the lower limit of the 95%CI of the PRR should be >1, and a number of
observed cases should be ≥20. The signals were ranked according to excess reporting
(expected-observed complaints), and only the top three are presented.

Results: We have applied for access to the data regarding case decisions, which has been
granted; however, we are still awaiting its receipt. In the interim, we have included data from a
smaller, nationally representative sample of patient complaints to provide an initial insight into
our study's scope and potential outcomes.
In this national sample, we analyzed 1,933 hospital patient complaints, with 18% (n=350)
resulting in criticism toward either the provided healthcare services or specific health
professionals. These complaints encompassed 4,899 distinct problems, with a higher
proportion of quality or safety issues evident in criticism cases than non-criticism cases. Please
see table 1 for the distribution within the HCAT categories. Notably, within the non-criticism
sample, the most notable excess reporting occurred in quality problems during the procedure
stage (PRR 1.52, 68 cases more than expected), followed by safety problems during
examination (PRR 1.44, 60 cases more than expected), and institution-related issues during
discharge (PRR 3.0, 20 cases more than expected). Conversely, in the criticism sample, only two
categories met the criteria: safety problems during examination (PRR 1.36, 20 cases more than
expected) and quality issues related to ward procedures (PRR 1.41, 13 cases more than
expected).

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Conclusion: Though, it is not possible to conclude on the material not received yet, we can
conclude, based on the material analyzed, that analyzing patient complaints using a data-
driven approach can help identify areas for improvement. Criticism cases primarily highlighted
quality issues related to ward procedures and safety problems during examination. The latter
was also a hot spot for non-criticism cases, suggesting a need for targeted interventions to
address this area of concern.
We want to emphasize that should our application be accepted, the conference presentation
will feature additional material, including compensation claim cases, which may yield different
results and further enrich the discussion and findings of our study.

Disclosure of Interest: None Declared

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