Cohort 2022 | Cohort 2021 | Cohort 2019 | Cohort 2018 | Cohort 2017 |
Cohort 2022:
Sir No. | Quality Theme of the QI projects | Quality Goals achieved | Key outcomes achieved | Link to A3 sheet and the Graduation Presentation |
---|---|---|---|---|
1. | Improving nutrition in patients of head and neck cancer undergoing treatment. (efficiency, safety, patient experience) | Improved the percentage of patients experiencing weight loss of ≥10% of body weight from 70% to <10%. | • Developed a system of dietician consults in radiation oncology outpatient clinic and diet plan for every patient. • Implemented nutritional counselling and diet education pamphlets |
https://vimeo.com/831162109 |
2. | To decrease the average number of days taken for optimal pain control. (efficacy, efficiency, timeliness, patient experience) | Reduced the average number of days taken to reduce palliative cancer patients’ self-reported pain score from more than 6/10 to less than 4/10 from 8 days to 3 days | • Developed institutional pain management protocol and implemented pain charts, pain diaries. • Improved awareness on opioid use among health care workers, patients and caregivers through educational programs and information leaflets. |
https://vimeo.com/831172546 |
3. | Improving the Breast Imaging and reporting time of priority breast scans for suspected breast cancer patients. (efficacy, efficiency, timeliness) | Increased the percentage of patients reverting back to surgical oncology OPD with breast imaging reports within one working day from 0% to 30%. | • Collaborated with radiology to create priority slots for surgical oncology. • Tagging priority scans for improve communication to get priority slots. |
https://vimeo.com/831167438 |
4. | Quality improvement project to mitigate delay in the discharge process of oncology patients admitted to private ward (Efficiency, timeliness, patient experience and satisfaction) | Reduced the average time of discharge of private oncology patients from 6 to 4.5 hours. | • Efficient discharge summary process through checklists and automation. • System alert for faster clearance in billing sections. |
https://vimeo.com/831178242 |
5. | Patient feedback (patient experience and satisfaction) | Incorporation of patient feedback registration from 0-30% within completion of treatment. | • Creation of a documentation process to get patient feedback. • Creating awareness among patients for feedback during consults and using banners. |
https://vimeo.com/831143162 |
6. | Communication of bad news to advanced cancer patients in gynaec-oncology. (Experience and satisfaction) | Improved the physician satisfaction of communication from 30-60% | • Standardized the communication protocol like SPIKES for routine clinical use. • Physician training for improved communication. |
https://vimeo.com/831152020 |
7. | Patient priority and needs guiding palliative care delivery (Equity, Patient Experience and satisfaction) | Increased the patient priorities and needs assessment during palliative care outpatient consult from 25-90%. | • Created a standard template for documentation of patient needs. • Created and tested a repository of patients need in different languages. |
https://vimeo.com/831126259 |
8. | “QUICK PAC- Single check Pre anaesthesia clearance. (safety, efficacy, efficiency, timeliness) | The Pre anaesthesia clearance - first time - improved from 60-80%. | • Implemented and tested electronic Pre anaesthesia clearance checklist. • Manage referral for comorbidities in house and improved coordination with surgical team. |
https://vimeo.com/831175721 |
9. | Reduction of treatment initiation time for lung and colorectal cancer patients. (Efficiency, timeliness) | Reduced the treatment initiation time from 31 days to 17 days. | • Implemented smooth navigation of patients through electronic retrieval of medical records, segregation of new and follow up patients and providing counselling. | https://vimeo.com/831124028 |
10. | Early discharge- Better service (Efficiency, timeliness, patient experience and satisfaction) | Reduced the discharge turnaround time of surgical patients from 180 to 110 minutes. | • Test and implement SOP for the discharge process. • Simplified the billing process. |
https://vimeo.com/831173522 |
11. | Ensuring compliance to treatment in advanced head and neck cancer patients undergoing chemoradiation. (Safety, Efficacy, Timeliness) | Improved compliance to weekly chemotherapy from 66-90%. | • Implemented telephonic reminder call for chemotherapy. • Counselling and Education of patient about plan of management. |
https://vimeo.com/831388486 |
12. | Reducing delays for radiation treatment initiation. (Efficiency, timeliness, patient experience and satisfaction) | Reduced the average time from CT simulation to radiation initiation in curative planed patient from 20 to around 12 days. | • Implemented SOP for radiation planning process and use of radiation treatment scheduler. • Utilized the KEVAT services for coordination of radiation care plan. |
https://vimeo.com/831124629 |
13. | Timely completion of planned surgery in gastrointestinal surgical oncology team. (Efficiency, timeliness) | Improved the rate of planned surgeries within 30 days of registration from 25-40% | • Improved turnaround time for pathology reporting through checklists, training sessions. • Streamlined the appointment process. |
https://vimeo.com/831393046 |
14. | Adherence of patients to outpatient OPD visits (Efficacy, Efficiency) | Improved the adherence of OPD appointments from 60 to 70%. | • Incorporated the follow up planning at the time of discharge. • Implemented telephonic follow up calls reminder for visits. |
https://vimeo.com/831161363 |
15. | Reducing wait times for daily radiotherapy treatments- READY RT ((Efficiency, timeliness, patient experience and satisfaction) | Reduced the average daily waiting time from 65 minutes to 45 minutes. | • Implemented dedicated radiotherapy treatment time slots with reporting time. • Organized physician review visits. |
https://vimeo.com/831171492 |
16. | Encouraging caregiver for screening (Efficiency, timeliness, patient experience and satisfaction) | Increased the caregiver participation in screening from 38% to 50%. | • Training and process flow for clinicians to encourage caregivers. • Encouraging health seeking behaviour of caregivers through audiovisual aids, pamphlets. |
https://vimeo.com/831156900 |
17. | Lack of pain assessment in head and neck cancer patients (timeliness, patient experience and satisfaction) | Increased the objective pain assessment in head and neck cancer patients on their initial visit from 18% to 80%. | • Training of health care workers on pain assessment and scoring. • Pain score documentation and availability of pain charts. |
https://vimeo.com/831169768 |
18. | Patient deferral from treatment in head and neck surgical oncology (Equity, Patient Experience and satisfaction) | Reduced the default rate in head and neck outpatient clinic from 40 to 20%. | • Providing financial support through job opportunities while at hospital and awareness of support policy. • Tracking of patients through patient navigator and home care teams |
https://vimeo.com/831169224 |
19. | Prolonged waiting time for patient attending surgical oncology clinic. (Efficiency, timeliness, patient experience and satisfaction) | Decreased the waiting time of patients in surgical oncology clinic from 157 to 100 minutes. | • Appointment time scheduling of outpatient patients in clinic. • Ensuring start of clinic in time. |
https://vimeo.com/831144031 |
20. | Wait times for starting chemotherapy (Efficiency, timeliness, patient experience and satisfaction) | Reduced wait times to start chemotherapy from 10 to 5 hours. | • Accelerated approval of chemotherapy process. • Prioritize blood sample collection and reporting. |
https://vimeo.com/831164334 |
Cohort 2021:
Sir No. | Quality Theme of the QI projects | Quality Goals achieved | Key outcomes achieved | Link to A3 sheet and the Graduation Presentation |
---|---|---|---|---|
21. | Effective screening of palliative care outpatients for psychosocial distress and needs (efficacy, efficiency, timeliness) | Improved psychosocial assessment of palliative care outpatients from the baseline of 11% to more than 45% | • Developed a SCREENING CHECKLIST with Designated space to identify palliative care outpatients who are likely to be "at risk" for psychosocial distress. • Tested feasibility of Distress Thermometer scores for psychosocial assessment in a palliative care setting • Tested feasibility of phone-follow-up for those unable to come and needing close follow up. |
https://vimeo.com/697271130 |
22. | Improve the assessment of delirium in patients with advanced cancer at home care settings(efficacy, efficiency, timeliness of care) | Improved assessment of delirium in home-bound palliative care patients from 25% to 50% | • Pre-emptive screening approach led to improved patient comfort and caregiver satisfaction and QoL for ~160 patients and their families. | https://vimeo.com/697273347 |
23. | Improve cervical screening of women attending the general Gynecology clinic(safety, efficacy, efficiency, timeliness) | The number of pap smears amongst women in the age group of 25-60 years, visiting the general Gynecology clinic, increased from the current 34% to 70% | • The awareness on cervical cancer prevention by vaccination and screening amongst patient/family visiting general gynecology clinic from increased from 50% to 80% • The awareness on cervical cancer vaccination and prevention among healthcare workers in the general gynecology clinic improved from 77% to 100% . |
https://vimeo.com/697273797 |
24. | Early integration of Palliative care in Oncology – to reduce serious health related suffering (safety, efficacy, efficiency, timeliness) | Increased referral of Stage IV cancer patients from oncology to the specialist palliative care team from current 7.5% to 25% | • Developed institution-specific “Referral criteria” through a Delphi consensus process. | https://vimeo.com/697274979 |
25. | Improve bed utilization in chemotherapy day care services (efficacy, efficiency, timeliness, patient experience, staff satisfaction) | Increased the chemotherapy day care unit bed utilization from the existing 61 % to 75 % | • This resulted in; i) Reduced waiting time for patients; ii) Timely administration of chemotherapy services; iii) Improved patient satisfaction. • Developed and regularized the protocol for pain assessment within the outpatient and in-patient patients records.. |
https://vimeo.com/697275795 |
26. | Improve objective pain assessment in Oncology outpatient and In-patient settings(efficacy, efficiency, safety, patient experience, staff satisfaction) | Improved objective pain assessment in oncology outpatient and In-patient settings from 0% to more than 80% | • This improvement reduced the overall hospital revisits of oncology patients from faraway locations • Physician training for improved communication. |
https://vimeo.com/700758539 |
27. | Improve follow up among head and neck cancer patients post definitive treatment with Radiation | The 6th month follow up of post-radiation head and neck cancer patients improved from 41% to more than 60% | • Established a unit dedicated to teleconsultatio. | https://vimeo.com/697285557 |
28. | To ensure that enrolled children receive adequate and timely phone follow-up by the palliative care team.(patient experience, staff satisfaction, efficacy of care) | Achieved the goal of adequate and timely phone follow-up for enrolled Children, from baseline 20% to 99% | • This helped parents with self-management of care of their child, reduced their hospital visits, and cut down both costs as well as saved time that took to travel and see a physician. | https://vimeo.com/700762220 |
29. | To reduce the weight loss of head and neck cancer patients on curative radiation therapy (efficiency, safety, patient experience, staff satisfaction) | Weight loss of cancer patients on curative radiation therapy decreased from a baseline average of 50% before the QI project to 20% after completion of the project. | • Of these patients, only 22% of all patients studied had weight loss, more than 5%. | https://vimeo.com/700761179 |
30. | To identify and address the waiting time before chemotherapy in day care setting(Timeliness, efficacy, efficiency) | The waiting time of > 90% of patients with scheduled appointments, reduced to < 2hrs. | • The percentage of scheduled appointments increased from 21% to 42 % . | https://vimeo.com/697274496 |
Cohort 2019:
Sir No. | Quality Theme of the QI projects | Quality Goals achieved | Key outcomes achieved | Link to A3 sheet and the Graduation Presentation |
---|---|---|---|---|
31. | Improving Colposcopy coverage of camp-screened positive women (efficacy, efficiency of Preventive Oncology care) | Improved colposcopy coverage in camp-screened women from the community, from 12.5% to 95% | • Developed an App to visualize all abnormal results at once with colour triage and contact number • Report generation time improved with modification of staff roles and processes e.g. fixed day follow-up up visits. • Devised App to visualize & review the camp screen results quickly by colour coding of abnormal results. • Gained some ground towards WHO 2030 cervical cancer elimination strategies. |
https://vimeo.com/696043247 |
32. | Improve identification and effective management of acute mucositis related pain to prevent drop-out from curative intent Radiotherapy for head and neck cancer patients (safety, efficacy, efficiency through treatment adherence) |
Reduced the prevalence of Mucositis related pain in patients on curative intent Radiotherapy for head and neck cancer, from the baseline 70% to 20% | • 100% of patients’ pain score is documented as the care-processes changed. • The burden experienced by residents, technologists, & nurses were measured and found insignificant. • Interventions improved the patient compliance to treatment, and the overall treatment duration adhered to. • Reduced secondary morbidities e.g. improved the nutritional intake • Systematized the access of patients to Palliative care during curative phase of their treatment. • Better patient rapport, trust, and confidence. |
https://vimeo.com/696043956 |
33. | Improve the initial work - up time of patients coming to the breast cancer clinic (Time efficiency, efficacy, efficiency) | Reduced the work up time of breast cancer patients visiting onco-surgical unit, by 2 hours in at least 50% of patients | • The number of mammography /weeks increased by 52% with better utilisation of the machine and operation theatre • The inter-team interactions became more cohesive and satisfaction of the patient improved. • Improved the hospital revenue; and positive influence on OP scheduling |
https://vimeo.com/696044969 |
34. | Improving the initial work - up time of patients and reduce the time to 1st Radiation Therapy in a tertiary cancer centre : (Time efficiency efficacy, efficiency of care) | The waiting time to 1st Radiation Therapy was reduced successfully from 8 hours to 6.6 hours /td> | • 40-man hours of working day and 80-man hours of waiting time /day • The satisfaction scores (VAS score) of patients, caregivers, and RT technicians and Drs improved • The altered processes improved the audit possibilities of electronic documents pre-Radiotherapy |
https://vimeo.com/696041000 |
35. | Improving in-patient referrals from Oncology to Palliative Medicine (Early Integration of Palliative care in oncology) | Improved the percentage of referrals from oncology to palliative care from 12% to 50 % | • Developed a structured referral form with a built-in feedback form. | https://vimeo.com/696042518 |
36. | Implementation of Palliative Care for critically ill cancer patients in the ICU (Efficacy, efficiency, equity by Integration of Palliative Care in oncology Critical Care) | Improved the reference rate of critically ill cancer patients in the ICU to access palliative care, from zero to 50 % | • Developed the institution-specific trigger tool for Palliative-care referral • Achieved major practice change: patients began to get admitted directly for supportive care, without entering ICU. • Policy change achieved- mandatory use of the tool for all ICU patients |
https://vimeo.com/696042028 |
37. | Improve Patient satisfaction by reducing waiting Time in PC OPD (Time efficiency) | Reduced the waiting time at the Palliative care OPD from 35 minutes to 20 minutes | • Improved patient – staff relationship • Efficient functioning of OPD processes. |
https://vimeo.com/696045489 |
38. | Setting culture appropriate standards for a comfortable dying of terminally ill cancer patients at home (efficacy, efficiency through care continuum, timeliness) | Incorporated advance care directives into EOL care policy where none existed | • Ensured satisfactory end of life care within the community settings. • Improved staff satisfaction in the care of the dying patients with advanced cancer from current 6 to 8 by the end of the project. • Developed a bereavement policy • Cultural change in the organisation towards death and dying • mproved the satisfaction of families, with care provided • Increased donations to support activities of the organisation |
https://vimeo.com/696044514 |
Cohort 2018:
Sir No. | Quality Theme of the QI projects | Quality Goals achieved | Key outcomes achieved | Link to A3 sheet and the Graduation Presentation |
---|---|---|---|---|
39. | Assess death and dying experience of patients who died in IPM (Quality of Death). | The team achieved a rate of assessment of death and dying experience of in-patients from the family caregivers perspective from 0% to 100% during the project period | • Developed a Tool to assess death and dying experience. | |
40. | Improve documentation and data recording in the palliative clinic of a tertiary cancer care centre(Safety, efficacy of care, efficiency, staff satisfaction) | Improved the percentage of complete documentation of PC Home Visits from zero to 90%. | • Care coordination and triaging of patients improved. | |
41. | To improve turnaround time in decision -making for patient support – at a community based cancer support organisation(Time-efficiency) | The team was able to reduce the turn-around time from the patient's 1st visit with application for economic support, to activating medical support from a baseline of 46 days in Dec 2018 to 15 days by June 2019 | • Tool developed for patient/families to provide feedback regarding delays in patient suppor | https://vimeo.com/696044969 |
42. | Improving nursing staff satisfaction in the in-patient Palliative care unit at a tertiary cancer care centre (Safety, timeliness, efficacy of care) | The team improved the satisfaction score of IP nursing staff on the clarity of doctor’s orders and care-plan, from the baseline of 4/10 to 9/10 (0= not satisfied at all & 10= completely satisfied) | • Developed Questionnaire tool - used during admission, during daily rounds and during discharg. | https://vimeo.com/696041000 |
43. | Quality initiative to improve daytime discharge process at the in-patient palliative care unit at a Tertiary Cancer Care Centre(Timeliness, staff satisfaction, patient experience | The average discharge time was reduced from baseline 3.5 hours to average 45 minutes across the project time | • Improved the patient experienc. • Improved staff satisfaction • Improved turn over as it released in-patient beds for others in need |
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44. | Lack of a structured screening program to identify patients to be prioritized for home care and insufficient number of home visits. (Efficiency, timeliness, efficacy of care, staff satisfaction, patient experience) | The number of home care for identified patients increased from 5 home visits per week to 10 per week by June 10th, 2019. | • ESAS based triage for patients for Screening and identifying needs of patients actually requiring Home based Palliative care services - achieved by 28th February 2019. | |
45. | The comprehensive assessment of patients attending out-patient palliative care clinic was not standardized -Tertiary Cancer Care Centre ((Efficiency, timeliness, efficacy of care, staff satisfaction, patient experience) | The percentage of patients attending out-patient palliative care clinic receiving a comprehensive patient assessment, increased from 29% to 55% | • Utilised the 4S form, to document the somatic, social , spiritual, and psychological domains (and consent) as comprehensive assessment of a patient in outpatient palliative care |
Cohort 2017:
Sir No. | Quality Theme of the QI projects | Quality Goals achieved | Key outcomes achieved | Link to A3 sheet and the Graduation Presentation |
---|---|---|---|---|
46. | Activate early palliative care referral for patients with advanced Oral Cancer by a tertiary cancer centre | The delays for referring patients with oral cancer to the palliative medicine clinic decreased from a baseline average of 48.02 days to 12.94 days by the end of the project period | • Documentation of symptom burden became a routine process during oncologist consultations, which is a marked change in practice, after the referral protocol was implemented was implemented. | https://vimeo.com/698960757 |
47. | Improve satisfaction of the home-care unit with the quality care delivered to registered patients by a community-based palliative care organisation. (Efficiency, timeliness, efficacy of care, staff satisfaction, patient experience) | The satisfaction of home-care unit staff during the project period progressively increased from baseline of 5.82 –7.6 by the end of the project period | • An algorithm-based triaging process based on the intensity of care needs was developed. • A field support team was established to respond to the logistical concerns and to manage unplanned homecare • An additional homecare team got activated to respond to unplanned urgent home visits • The homecare brochure developed during the project continues to clarify the non-emergency nature of homecare service and what may or may not be expected • The project activated a grant for an Integrated Hospital Based Continuity of Care project which supports patients in all settings and the triage is done using the tool. |
https://vimeo.com/698959466 |
48. | Initiate documentation of prognostic discussions of patients seen by the community-based palliative care organisation. (Efficiency, timeliness, efficacy of care, staff satisfaction, patient experience) | Increase in the documentation of discussion on prognostication with patients and families, from baseline zero to 75 % | • The newly developed form was found to serve also as a conversation guide, and improved confidence levels of team members in engaging with patients • It further simplified and streamlined the discussion on prognostication as a routine sustained process. |
https://vimeo.com/698962734 |
49. | Identify and improve referral of patients by the community for homecare services provided by the community-based palliative care organisation.(Timeliness, efficiency of care) | Outcome was a document with details on homecare for the public to understand about its nature of care, what services are provided etc | • Another document to decide the frequency of homecare as per the symptoms was also made. | https://vimeo.com/698961979 |
50. | Identify patients who need palliative home care the most, and address their needs through homecare service -study at a tertiary cancer care centre: (Timeliness, efficiency of care) | Improved the number of weekly Home-based care visits from two at baseline to over 6/week. | • The team created an electronic medical record system to register and triage patients, with mapping of their location and follow-up using unique codes. | https://vimeo.com/698960228 |
51. | Improve the rates of early palliative care referrals for outpatients with lung cancer in a tertiary cancer centre .(Timeliness, efficiency of care) | Increase in referrals of needy patients to palliative care from an average of 50% to 75% | • The learning from this project triggered other studies employing A3 methodology-based QI project in other domains. | https://vimeo.com/698961452 |
52. | Facilitate appropriate medical decisions at the hospice by improving the access to the required information (safety, .(efficacy, efficiency of care) | The confidence score of the hospice doctor regarding the goals of care of patients transferred from hospital to hospice improved from baseline of 1.5/10 to 6.5/10 | • The coordination and communications between the involved teams at the hospital, and hospice accentuated the care provided | https://vimeo.com/698958434 |