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Inpatient colonoscopy bowel preparation quality is frequently suboptimal. This quality improvement (QI) intervention is focused on regimenting this process to impact important outcomes.

Define, Measure, Analyze, Improve and Control (DMAIC) methodology was employed, including generating a root-cause analysis to identify factors associated with inpatient bowel quality. These findings motivated the creation of a standardized electronic health record (EHR)-based order set with consistent instructions and anticipatory guidance for administering providers.

There were 264 inpatient colonoscopies evaluated, including 198 procedures pre-intervention and 66 post-intervention. The intervention significantly improved the adequacy of right colon bowel preparations (75.0 percent vs 86.9 percent, p = 0.04) but not overall preparation quality (73.7 percent vs 80.3 percent, p = 0.22). The intervention led to numerical improvement in the proportion of procedures in which the preparation quality interfered with making a diagnosis (10 percent–6 percent, p = 0.29) or resulted in an aborted procedure (3.5 percent–1.5 percent, p = 0.39). After the intervention, provider satisfaction with the ordering process significantly increased (23.3 percent vs 61.1 percent, p < 0.001).

The QI intervention significantly reduced the number of inpatient colonoscopies with inadequate preparation in the right colon, while also modestly improving the diagnostic yield and proportion of aborted procedures. Importantly, the standardized EHR order set substantially improved provider satisfaction, which should justify broader use of such tools.

Novel clinical outcomes such as ability to answer diagnostic questions were improved using this intervention. The results align with strategic goals to enhance provider experience and continuously improve quality of patient care.

Co-existing health conditions and frequent hospital usage are pervasive in homeless populations. Without a home to be discharged to, appropriate discharge care and treatment compliance are difficult. The Medical Respite Centre (MRC) model has gained traction in the USA, but other international examples are scant. The purpose of this paper is to address this void, presenting findings from an evaluation of The Cottage, a small short-stay respite facility for people experiencing homelessness attached to an inner-city hospital in Melbourne, Australia.

This mixed methods study uses case studies, qualitative interview data and hospital administrative data for clients admitted to The Cottage in 2015. Hospital inpatient admissions and emergency department presentations were compared for the 12-month period pre- and post-The Cottage.

Clients had multiple health conditions, often compounded by social isolation and homelessness or precarious housing. Qualitative data and case studies illustrate how The Cottage couples medical care and support in a home-like environment. The average stay was 8.8 days. There was a 7 per cent reduction in the number of unplanned inpatient days in the 12-months post support.

The paper has some limitations including small sample size, data from one hospital only and lack of information on other services accessed by clients (e.g. housing support) limit attribution of causality.

MRCs provide a safe environment for individuals to recuperate at a much lower cost than inpatient admissions.

There is limited evidence on the MRC model of care outside of the USA, and the findings demonstrate the benefits of even shorter-term respite post-discharge for people who are homeless.

Purpose – Data preparation plays an important role in data mining as most real life data sets contained missing data. This paper aims to investigate different treatment methods for missing data. Design/methodology/approach – This paper introduces, analyses and compares well‐established treatment methods for missing data and proposes new methods based on naïve Bayesian classifier. These methods have been implemented and compared using a real life geriatric hospital dataset. Findings – In the case where a large proportion of the data is missing and many attributes have missing data, treatment methods based on naïve Bayesian classifier perform very well. Originality/value – This paper proposes an effective missing data treatment method and offers a viable approach to predict inpatient length of stay from a data set with many missing values.

The purpose of this study was to see the impact of increased out-of-pocket expenditure oh health care exerting budget pressure on households, which leads to change in dietary consumption.

It was a hospital-based cross-sectional study comprising 414 patients with a chronic or major illness attending a large tertiary care public hospital at Delhi, India. Each patient represented a household with total number of family members of 2,550 in the study. Questionnaire was used to gather data on factors responsible for changes in consumption of 12 major food items.

Moderate decrease in food consumption of a household after major illness is associated with: rural residence (p < 0.001), decrease in savings (p < 0.001), more number of household items sold (p < 0.001), education of the children affected (p < 0.001), upper socio-economic status (SES) (p < 0.001) and children started working after illness in family (p = 0.043). In addition to decrease in food items, there was also deterioration in quality of food preparation. More than 80% of the families did not change the intake of cereals (rice and wheat), pulses and sugar. Food items that were decreased by most families were fruits, followed by milk and its products, vegetables, meat and egg, oils and ghee.

This study is a subset of other two studies previously published. The authors had not been able to cover this aspect fully in those two studies but understood the importance of impact of expenditure on illness on food consumption. The authors studied change in food consumption pattern (not amount) in subjects after illness. The impact of weather changes in food consumption on the impacted nutritional status of family has not been studied. The authors only collected cross-sectional, observational data and recall bias cannot be completely ruled out and corrected. With such data, only associations could be concluded, not causality. The illness condition of a household was measured by presence of chronic disease and inpatient treatment. Such measures did not take into account the types of illness and number of episodes. Data of this study cannot capture whether food intake of family prior to illness was sufficient/in excess/deficient. The Kuppuswamy scale, mostly used in urban and peri-urban settings, was also used for rural subjects in the study, which might have resulted in impaired capture of rural SES. The authors did not assess whether families were allocated food grains by schemes like public distribution system, which might have resulted in biased decrease in food consumption. Questionnaire used was not validated.

This study demonstrates the various factors that act as barriers to proper food consumption, including non-financial factors. The policy of user fee in government is hitting poorer section, and equity and access to health are compromised. Health expenditure should be increased by public sector policies to implement uniform healthcare. There is need for more studies to identify measures that could be put in place when designing policies and interventions for the uniform distribution of benefits.

The policy of user fee in government is hitting poorer section, and equity and access to health are compromised. Health expenditure should be increased by public-sector policies to implement uniform healthcare.

Major or chronic illness affects money acquisition and priorities of expenditure, resulting in deterioration in quality of food consumption and by a household.

Surgical site infection (SSI) is a common complication in surgical practice. SSIs represent almost a fifth of healthcare-associated infections in Scotland, and have deleterious effects on mortality, morbidity, length of stay, and cost to the health service. SSIs in neurosurgery may be more consequential than in other specialities given the potentially devastating effects of central nervous system infection. The paper aims to discuss these issues.

In 2014, the authors became concerned about an anecdotal increase in infection rates in the authors’ unit. While national guidance on SSI surveillance existed in England and Scotland, the authors had no relevant procedures or policies in Glasgow, and began the process of establishing a surveillance programme. This was driven by clinicians but faced challenges due to a lack of involvement of the wider organisation in the early stages.

SSIs were initially reported via a form-filling system. This developed into an editable hospital intranet database, but still suffered from the problems of voluntary entries and under-reporting. Following the formal engagement of management structures and the funding of a surveillance nurse, the authors’ programme developed robustness, and resilience. With the advent of an SSI committee, the authors now have a well-established programme that ingrains SSI prevention in the collective learning and organisational memory of the authors’ unit.

Clinicians must lead on the development of these programmes, but long-term durability requires engagement and support from the wider organisation.

The article aims to globally illuminate and inform the healthcare delivery systems of the potential value of integrated care pathways (ICPs) application to the management and control of infection in the hospital setting

An analysis of recent pertinent literature (1993‐2004) is given, preceded by a broad overview of both the subjects of infection control and ICPs.

There are scanty examples of ICPs applied to infection control albeit successfully with demonstrable merits which include improvements in the quality and cost of care. However, there is a lack of robust studies on the subject which warrants further research.

Infection control is a major challenge to all healthcare providers seeking practical solutions. This source article may stimulate further informed debate to curb the problem of hospital acquired infection (HAI) which remains a major cause of morbidity and mortality despite all the great advancement in medicine.

The capacity available to deliver outpatient surgical services is outweighed by the demand. Although additional investment is sometimes needed, better aligning resources, increasing operational efficiency and considering new processes all have a role in improving delivering these services. The purpose of this paper is to evaluate the safety of a physician associate (PA) delivered virtual outpatient department (VOPD) consultation service that was established in a General and Colorectal Surgery Department at an Irish teaching hospital.

A series of low-risk surgical patients were referred by senior surgeons to a PA delivered virtual clinic (VOPD). Medical records belonging to half the included patients were randomly selected for review by two doctors three months following discharge back to primary care to confirm appropriate standards of care and documentation and to audit any recorded adverse incidents or outcomes.

In total, 191 patients had been reviewed by the PA in the VOPD with 159 discharged directly back to primary care. Among the 95 medical records that were reviewed by the NCHDs, there were no recorded adverse incidents after discharge. Medical record keeping was deficient in 1 out of 95 reviewed cases.

Using a PA delivered VOPD consultation appears to have a role in following up patients who have undergone low-risk procedures irrespective of age or co-morbidity when selected appropriately. This may assist in reducing the demand on outpatient services by reducing unnecessary return visits, thereby increasing the capacity for new referrals.

While there are reported examples to date of virtual clinics, these relate to services delivered by registered medical practitioners. Here, the authors demonstrate the acceptability of this model of care in an Irish population as delivered by a PA.

Addresses how flow times and capacity calculations can be made for a service process such as the Bariatric Surgery Center at a clinic. Highlights how these calculations can be made for a service process just as in any manufacturing setting. Discusses the notions of critical paths and bottlenecks and what factors affect both time and capacity. Also, discusses the relative profitability of two types of bariatric surgery, the goal being to link product profitability to the process.