Simple signage and targeted education can lead to process improvement in acute appendicitis care

IntroductionAn institution-wide protocol for uncomplicated acute appendicitis was created to improve compliance with best practices between the emergency department (ED), radiology and surgery. Awareness of the protocol was spread with the publication of a smartphone application and communication to...

Full description

Saved in:
Bibliographic Details
Published in:BMJ open quality 2023-10, Vol.12 (4), p.e002327
Main Authors: Atwood, Rex, Benoit, Patrick, Hennrikus, William, Kraemer, Laura, Gunasingha, Rathnayaka Mudiyanselage, Kindvall, Angela, Jessie, Elliot, Gosztyla, Carolyn, Bradley, Matthew
Format: Article
Language:English
Subjects:
Antibiotics
Antimicrobial agents
Appendectomy
Appendicitis
Clinical medicine
Compliance
Disease prevention
Education
Emergency medical care
Health professions education
Healthcare quality improvement
Initiatives
Intervention
Laparoscopy
Medical records
Medicine
Original Research
Patients
Signs
Smartphones
Surgery
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by
cites cdi_FETCH-LOGICAL-b461t-7785e75ff634086bfa2dd35a2a2b224d4b224436246f8beddd49d7689e2f61523
container_end_page
container_issue 4
container_start_page e002327
container_title BMJ open quality
container_volume 12
creator Atwood, Rex
Benoit, Patrick
Hennrikus, William
Kraemer, Laura
Gunasingha, Rathnayaka Mudiyanselage
Kindvall, Angela
Jessie, Elliot
Gosztyla, Carolyn
Bradley, Matthew
description IntroductionAn institution-wide protocol for uncomplicated acute appendicitis was created to improve compliance with best practices between the emergency department (ED), radiology and surgery. Awareness of the protocol was spread with the publication of a smartphone application and communication to clinical leadership. On interim review of quality metrics, poor protocol adherence in diagnostic imaging and antimicrobial stewardship was observed. The authors hypothesised that two further simple interventions would result in more efficient radiographic diagnosis and antimicrobial administration.Materials and methodsSurgery residents received targeted in-person education on the appropriate antibiotic choices and diagnostic imaging in the protocol. Signs were placed in the emergency and radiology work areas, immediately adjacent to provider workstations highlighting the preferred imaging for patients with suspected appendicitis and the preferred antibiotic choices for those with proven appendicitis. Protocol adherence was compared before and after each intervention.ResultsTargeted education was associated with improved antibiotic stewardship within the surgical department from 30% to 91% protocol adherence before/after intervention (p
doi_str_mv 10.1136/bmjoq-2023-002327
format article
fullrecord <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_005490771ddc4fedb0442a12a810ab2e</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><doaj_id>oai_doaj_org_article_005490771ddc4fedb0442a12a810ab2e</doaj_id><sourcerecordid>2881122175</sourcerecordid><originalsourceid>FETCH-LOGICAL-b461t-7785e75ff634086bfa2dd35a2a2b224d4b224436246f8beddd49d7689e2f61523</originalsourceid><addsrcrecordid>eNp1klFv1iAUhhujccvcD_COxBtvqnBKgV4Zs6hbssQL9RopnFa-tNBBu2T_Xr51mc7EmwPhvO-TA7xV9ZrRd4w14n0_H-JNDRSampYC8ll1Ck3X1UJw9vyv_Ul1nvOBUsqUlIqql9VJI5XshITT6uc3Py8TkuzHYEYkJjiymjTiio6g26xZfQzEmkAmNKUXyZKixZxJMaZ4izOGlfhAjN3W4l8WDM5bv_pcXAlfVS8GM2U8f1jPqh-fP32_uKyvv365uvh4XfdcsLUuk7Uo22EQDadK9IMB55rWgIEegDt-rLwRwMWgenTO8c5JoTqEQbAWmrPqaue6aA56SX426U5H4_X9QUyjNmn1dkJNacs7KiVzzvIBXU85B8PAKEZND1hYH3bWsvUzOltumMz0BPq0E_wvPcZbzaigTQtdIbx9IKR4s2Fe9eyzxWkyAeOWNShVvgxAqCJ984_0ELcUylsdVYwBMNkWFdtVNsWcEw6P0zCqj3nQ93nQxzzoPQ_FU--e0voD_b_-N1zptk4</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2881122175</pqid></control><display><type>article</type><title>Simple signage and targeted education can lead to process improvement in acute appendicitis care</title><source>BMJ Open Access Journals</source><source>PubMed Central</source><creator>Atwood, Rex ; Benoit, Patrick ; Hennrikus, William ; Kraemer, Laura ; Gunasingha, Rathnayaka Mudiyanselage ; Kindvall, Angela ; Jessie, Elliot ; Gosztyla, Carolyn ; Bradley, Matthew</creator><creatorcontrib>Atwood, Rex ; Benoit, Patrick ; Hennrikus, William ; Kraemer, Laura ; Gunasingha, Rathnayaka Mudiyanselage ; Kindvall, Angela ; Jessie, Elliot ; Gosztyla, Carolyn ; Bradley, Matthew</creatorcontrib><description>IntroductionAn institution-wide protocol for uncomplicated acute appendicitis was created to improve compliance with best practices between the emergency department (ED), radiology and surgery. Awareness of the protocol was spread with the publication of a smartphone application and communication to clinical leadership. On interim review of quality metrics, poor protocol adherence in diagnostic imaging and antimicrobial stewardship was observed. The authors hypothesised that two further simple interventions would result in more efficient radiographic diagnosis and antimicrobial administration.Materials and methodsSurgery residents received targeted in-person education on the appropriate antibiotic choices and diagnostic imaging in the protocol. Signs were placed in the emergency and radiology work areas, immediately adjacent to provider workstations highlighting the preferred imaging for patients with suspected appendicitis and the preferred antibiotic choices for those with proven appendicitis. Protocol adherence was compared before and after each intervention.ResultsTargeted education was associated with improved antibiotic stewardship within the surgical department from 30% to 91% protocol adherence before/after intervention (p&lt;0.005). Visible signs in the ED were associated with expedited antimicrobial administration from 50% to 90% of patients receiving antibiotics in the ED prior to being brought to the operating room before/after intervention (p&lt;0.005). Diagnostic imaging after the placement of signs showed improved protocol adherence from 35% to 75% (p&lt;0.005).ConclusionThis study demonstrates that smartphone-based applications and communication among clinical leadership achieved suboptimal adherence to an institutional protocol. Targeted in-person education reinforcement and visible signage immediately adjacent to provider workstations were associated with significantly increased adherence. This type of initiative can be used in other aspects of acute care general surgery to further improve quality of care and hospital efficiency.</description><identifier>ISSN: 2399-6641</identifier><identifier>EISSN: 2399-6641</identifier><identifier>DOI: 10.1136/bmjoq-2023-002327</identifier><identifier>PMID: 37879672</identifier><language>eng</language><publisher>London: British Medical Journal Publishing Group</publisher><subject>Antibiotics ; Antimicrobial agents ; Appendectomy ; Appendicitis ; Clinical medicine ; Compliance ; Disease prevention ; Education ; Emergency medical care ; Health professions education ; Healthcare quality improvement ; Initiatives ; Intervention ; Laparoscopy ; Medical records ; Medicine ; Original Research ; Patients ; Signs ; Smartphones ; Surgery</subject><ispartof>BMJ open quality, 2023-10, Vol.12 (4), p.e002327</ispartof><rights>Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2023 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-b461t-7785e75ff634086bfa2dd35a2a2b224d4b224436246f8beddd49d7689e2f61523</cites><orcidid>0000-0002-2335-8035 ; 0000-0002-1132-4559</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://bmjopenquality.bmj.com/content/12/4/e002327.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://bmjopenquality.bmj.com/content/12/4/e002327.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793,55350,77660,77686</link.rule.ids></links><search><creatorcontrib>Atwood, Rex</creatorcontrib><creatorcontrib>Benoit, Patrick</creatorcontrib><creatorcontrib>Hennrikus, William</creatorcontrib><creatorcontrib>Kraemer, Laura</creatorcontrib><creatorcontrib>Gunasingha, Rathnayaka Mudiyanselage</creatorcontrib><creatorcontrib>Kindvall, Angela</creatorcontrib><creatorcontrib>Jessie, Elliot</creatorcontrib><creatorcontrib>Gosztyla, Carolyn</creatorcontrib><creatorcontrib>Bradley, Matthew</creatorcontrib><title>Simple signage and targeted education can lead to process improvement in acute appendicitis care</title><title>BMJ open quality</title><addtitle>BMJ Open Qual</addtitle><description>IntroductionAn institution-wide protocol for uncomplicated acute appendicitis was created to improve compliance with best practices between the emergency department (ED), radiology and surgery. Awareness of the protocol was spread with the publication of a smartphone application and communication to clinical leadership. On interim review of quality metrics, poor protocol adherence in diagnostic imaging and antimicrobial stewardship was observed. The authors hypothesised that two further simple interventions would result in more efficient radiographic diagnosis and antimicrobial administration.Materials and methodsSurgery residents received targeted in-person education on the appropriate antibiotic choices and diagnostic imaging in the protocol. Signs were placed in the emergency and radiology work areas, immediately adjacent to provider workstations highlighting the preferred imaging for patients with suspected appendicitis and the preferred antibiotic choices for those with proven appendicitis. Protocol adherence was compared before and after each intervention.ResultsTargeted education was associated with improved antibiotic stewardship within the surgical department from 30% to 91% protocol adherence before/after intervention (p&lt;0.005). Visible signs in the ED were associated with expedited antimicrobial administration from 50% to 90% of patients receiving antibiotics in the ED prior to being brought to the operating room before/after intervention (p&lt;0.005). Diagnostic imaging after the placement of signs showed improved protocol adherence from 35% to 75% (p&lt;0.005).ConclusionThis study demonstrates that smartphone-based applications and communication among clinical leadership achieved suboptimal adherence to an institutional protocol. Targeted in-person education reinforcement and visible signage immediately adjacent to provider workstations were associated with significantly increased adherence. This type of initiative can be used in other aspects of acute care general surgery to further improve quality of care and hospital efficiency.</description><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Appendectomy</subject><subject>Appendicitis</subject><subject>Clinical medicine</subject><subject>Compliance</subject><subject>Disease prevention</subject><subject>Education</subject><subject>Emergency medical care</subject><subject>Health professions education</subject><subject>Healthcare quality improvement</subject><subject>Initiatives</subject><subject>Intervention</subject><subject>Laparoscopy</subject><subject>Medical records</subject><subject>Medicine</subject><subject>Original Research</subject><subject>Patients</subject><subject>Signs</subject><subject>Smartphones</subject><subject>Surgery</subject><issn>2399-6641</issn><issn>2399-6641</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>DOA</sourceid><recordid>eNp1klFv1iAUhhujccvcD_COxBtvqnBKgV4Zs6hbssQL9RopnFa-tNBBu2T_Xr51mc7EmwPhvO-TA7xV9ZrRd4w14n0_H-JNDRSampYC8ll1Ck3X1UJw9vyv_Ul1nvOBUsqUlIqql9VJI5XshITT6uc3Py8TkuzHYEYkJjiymjTiio6g26xZfQzEmkAmNKUXyZKixZxJMaZ4izOGlfhAjN3W4l8WDM5bv_pcXAlfVS8GM2U8f1jPqh-fP32_uKyvv365uvh4XfdcsLUuk7Uo22EQDadK9IMB55rWgIEegDt-rLwRwMWgenTO8c5JoTqEQbAWmrPqaue6aA56SX426U5H4_X9QUyjNmn1dkJNacs7KiVzzvIBXU85B8PAKEZND1hYH3bWsvUzOltumMz0BPq0E_wvPcZbzaigTQtdIbx9IKR4s2Fe9eyzxWkyAeOWNShVvgxAqCJ984_0ELcUylsdVYwBMNkWFdtVNsWcEw6P0zCqj3nQ93nQxzzoPQ_FU--e0voD_b_-N1zptk4</recordid><startdate>20231001</startdate><enddate>20231001</enddate><creator>Atwood, Rex</creator><creator>Benoit, Patrick</creator><creator>Hennrikus, William</creator><creator>Kraemer, Laura</creator><creator>Gunasingha, Rathnayaka Mudiyanselage</creator><creator>Kindvall, Angela</creator><creator>Jessie, Elliot</creator><creator>Gosztyla, Carolyn</creator><creator>Bradley, Matthew</creator><general>British Medical Journal Publishing Group</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-2335-8035</orcidid><orcidid>https://orcid.org/0000-0002-1132-4559</orcidid></search><sort><creationdate>20231001</creationdate><title>Simple signage and targeted education can lead to process improvement in acute appendicitis care</title><author>Atwood, Rex ; Benoit, Patrick ; Hennrikus, William ; Kraemer, Laura ; Gunasingha, Rathnayaka Mudiyanselage ; Kindvall, Angela ; Jessie, Elliot ; Gosztyla, Carolyn ; Bradley, Matthew</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b461t-7785e75ff634086bfa2dd35a2a2b224d4b224436246f8beddd49d7689e2f61523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Antibiotics</topic><topic>Antimicrobial agents</topic><topic>Appendectomy</topic><topic>Appendicitis</topic><topic>Clinical medicine</topic><topic>Compliance</topic><topic>Disease prevention</topic><topic>Education</topic><topic>Emergency medical care</topic><topic>Health professions education</topic><topic>Healthcare quality improvement</topic><topic>Initiatives</topic><topic>Intervention</topic><topic>Laparoscopy</topic><topic>Medical records</topic><topic>Medicine</topic><topic>Original Research</topic><topic>Patients</topic><topic>Signs</topic><topic>Smartphones</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Atwood, Rex</creatorcontrib><creatorcontrib>Benoit, Patrick</creatorcontrib><creatorcontrib>Hennrikus, William</creatorcontrib><creatorcontrib>Kraemer, Laura</creatorcontrib><creatorcontrib>Gunasingha, Rathnayaka Mudiyanselage</creatorcontrib><creatorcontrib>Kindvall, Angela</creatorcontrib><creatorcontrib>Jessie, Elliot</creatorcontrib><creatorcontrib>Gosztyla, Carolyn</creatorcontrib><creatorcontrib>Bradley, Matthew</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing &amp; Allied Health Database</collection><collection>ProQuest Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>ProQuest Consumer Health Database</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>BMJ open quality</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Atwood, Rex</au><au>Benoit, Patrick</au><au>Hennrikus, William</au><au>Kraemer, Laura</au><au>Gunasingha, Rathnayaka Mudiyanselage</au><au>Kindvall, Angela</au><au>Jessie, Elliot</au><au>Gosztyla, Carolyn</au><au>Bradley, Matthew</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Simple signage and targeted education can lead to process improvement in acute appendicitis care</atitle><jtitle>BMJ open quality</jtitle><stitle>BMJ Open Qual</stitle><date>2023-10-01</date><risdate>2023</risdate><volume>12</volume><issue>4</issue><spage>e002327</spage><pages>e002327-</pages><issn>2399-6641</issn><eissn>2399-6641</eissn><abstract>IntroductionAn institution-wide protocol for uncomplicated acute appendicitis was created to improve compliance with best practices between the emergency department (ED), radiology and surgery. Awareness of the protocol was spread with the publication of a smartphone application and communication to clinical leadership. On interim review of quality metrics, poor protocol adherence in diagnostic imaging and antimicrobial stewardship was observed. The authors hypothesised that two further simple interventions would result in more efficient radiographic diagnosis and antimicrobial administration.Materials and methodsSurgery residents received targeted in-person education on the appropriate antibiotic choices and diagnostic imaging in the protocol. Signs were placed in the emergency and radiology work areas, immediately adjacent to provider workstations highlighting the preferred imaging for patients with suspected appendicitis and the preferred antibiotic choices for those with proven appendicitis. Protocol adherence was compared before and after each intervention.ResultsTargeted education was associated with improved antibiotic stewardship within the surgical department from 30% to 91% protocol adherence before/after intervention (p&lt;0.005). Visible signs in the ED were associated with expedited antimicrobial administration from 50% to 90% of patients receiving antibiotics in the ED prior to being brought to the operating room before/after intervention (p&lt;0.005). Diagnostic imaging after the placement of signs showed improved protocol adherence from 35% to 75% (p&lt;0.005).ConclusionThis study demonstrates that smartphone-based applications and communication among clinical leadership achieved suboptimal adherence to an institutional protocol. Targeted in-person education reinforcement and visible signage immediately adjacent to provider workstations were associated with significantly increased adherence. This type of initiative can be used in other aspects of acute care general surgery to further improve quality of care and hospital efficiency.</abstract><cop>London</cop><pub>British Medical Journal Publishing Group</pub><pmid>37879672</pmid><doi>10.1136/bmjoq-2023-002327</doi><orcidid>https://orcid.org/0000-0002-2335-8035</orcidid><orcidid>https://orcid.org/0000-0002-1132-4559</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2399-6641
ispartof BMJ open quality, 2023-10, Vol.12 (4), p.e002327
issn 2399-6641
2399-6641
language eng
recordid cdi_doaj_primary_oai_doaj_org_article_005490771ddc4fedb0442a12a810ab2e
source BMJ Open Access Journals; PubMed Central
subjects Antibiotics
Antimicrobial agents
Appendectomy
Appendicitis
Clinical medicine
Compliance
Disease prevention
Education
Emergency medical care
Health professions education
Healthcare quality improvement
Initiatives
Intervention
Laparoscopy
Medical records
Medicine
Original Research
Patients
Signs
Smartphones
Surgery
title Simple signage and targeted education can lead to process improvement in acute appendicitis care
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T23%3A59%3A57IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Simple%20signage%20and%20targeted%20education%20can%20lead%20to%20process%20improvement%20in%20acute%20appendicitis%20care&rft.jtitle=BMJ%20open%20quality&rft.au=Atwood,%20Rex&rft.date=2023-10-01&rft.volume=12&rft.issue=4&rft.spage=e002327&rft.pages=e002327-&rft.issn=2399-6641&rft.eissn=2399-6641&rft_id=info:doi/10.1136/bmjoq-2023-002327&rft_dat=%3Cproquest_doaj_%3E2881122175%3C/proquest_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-b461t-7785e75ff634086bfa2dd35a2a2b224d4b224436246f8beddd49d7689e2f61523%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2881122175&rft_id=info:pmid/37879672&rfr_iscdi=true