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Key learning points from a CHD necrotising enterocolitis learning collaborative across high- and low-performing centres
No full textObjective: Patients with CHD are at risk for developing necrotising enterocolitis. Currently, no standardised approaches for identification, diagnosis, and treatment of necrotising enterocolitis exists, and there are varying rates and management strategies of necrotising enterocolitis across centres. We used the Paediatric Cardiac Critical Care Consortium to identify high- and low-performing centres based on necrotising enterocolitis rates and convened a necrotising enterocolitis working group. The aims of the group were to understand why variability exists, identify risk factors, and create a foundation for a prospective improvement project.
Methods: Nine centres participated, and collaborative learning sessions were held with multidisciplinary input. REDCap surveys were disseminated to centres to create consensus among site practices and recommendations.
Results: The following topics were discussed: diagnosis, risk factors, and management. Diagnosis consensus suggests (1) Diagnosis would benefit from a comprehensive scoring tool, and (2) ultrasound may serve as a highly sensitive diagnostic tool for those at high risk with the absence of other radiologic findings of necrotising enterocolitis. Risk factor consensus suggests (1) those with ductal-dependent systemic blood flow are the highest risk, and (2) vasopressors with splanchnic constriction should be used with caution. Management consensus suggests (1) breastmilk be used first-line for feeding, 2) resume feeds 24-48 hours after a necrotising enterocolitis rule-out, and 3) surgical deference to physical examination and laboratory evaluation above radiographic findings.
Conclusion: Variability exists in diagnosing necrotising enterocolitis and feeding approaches for at-risk patients. Opportunities exist for collaboration to standardise definitions, compare outcomes, identify risk factors, and create consensus on the management of necrotising enterocolitis
Comparative effectiveness of stool-based screening vs colonoscopy on long-term colorectal cancer incidence: A retrospective cohort analysis
No full text2025 ACC/AHA/ASE/ASNC/SCCT/SCMR Advanced Training Statement on Advanced Cardiovascular Imaging: A Report of the ACC Competency Management Committee
No full text2025 ACC/AHA/ASE/ASNC/SCCT/SCMR Advanced Training Statement on Advanced Cardiovascular Imaging: A Report of the ACC Competency Management Committee
No full textAdvancing Turn Equality to Reduce Pressure Injuries: A Nurse-Led Visual Tool for Acute Care Units
No full textBackground
Despite the implementation of evidence-based bundles, hospital-acquired pressure injuries remain a persistent challenge. The literature highlights inconsistent patient repositioning and a lack of team accountability as key contributors. Visual tools and interdisciplinary engagement have shown promise in promoting reliable turning practices.
Local Problem
Audits on two critical care units and one progressive care unit revealed that patients were frequently left in supine positions and not rotated equally. Night shifts demonstrated the greatest gaps in documentation and compliance. The electronic medical record did not provide an at-a-glance overview of turning history, creating confusion among nursing and ancillary staff, and hindering consistent repositioning.
Method
A nurse-led team introduced a visual “turn tool” that displayed each patient’s last position and time since turning. The tool was posted outside rooms and updated collaboratively by staff. Implementation followed a Plan-Do-Study-Act model, with education, feedback collection, and staff champions reinforcing use. Weekly audits reviewed electronic medical record documentation, and daily audits reviewed the turn tool for turn equality (balanced usage of left, right, and supine positions across 12 hours).
Results/Conclusions
Post-implementation audits demonstrated turn equality rates consistently ranging from 91% to 100% across all three units. Staff surveys indicated increased communication, accountability, and engagement in repositioning practices. Importantly, no new hospital-acquired sacral pressure injuries were reported in any of the three monitored units after the tool’s implementation. Staff reported improved interdisciplinary hand-offs and heightened awareness of turn schedules.
Implications for Practice
This low-cost, nurse-driven intervention successfully improved turn equality and pressure injury prevention. The tool promoted shared ownership of patient safety and was easily adopted across shifts. Future plans include evaluating long-term sustainability, continuing education efforts, and expanding the tool to other facilities
Optimizing Sepsis Management: A Journey from Audit to EHR Solutions
No full textBackground:
Sepsis is a leading cause of mortality across the enterprise. While Sepsis and Septic Shock Early Management Bundle (SEP-1) treatment reduces sepsis mortality, the NC/GA Division lacks comprehensive SEP-1 performance reports to identify care gaps and improve outcomes.
Local Problem:
The NC/GA Division SEP-1 data, based on minimum patient sample size, is insufficient, with Pineville averaging only 9.5 abstracted patients per month. The Centers for Medicare and Medicaid Servies (CMS) abstraction process is lengthy, excluding significant patient populations (i.e. COVID, freestanding emergency departments), and is a composite metric leading to inconclusive performance insights.
Method:
We developed an internal audit tool to review all sepsis cases presenting to the Emergency Department, aligning with updated sepsis definitions. By eliminating systemic inflammatory response syndrome criteria and automatically calculating arrival times to crucial bundle elements, we significantly reduced abstraction time. This tool provided detailed insights into SEP-1 performance, facilitated timely feedback to clinicians, allowed chart revisions before CMS review, identified educational needs and barriers that would prevent future success. Physician partnership and front-end clinician engagement were vital components.
Results/Conclusions:
In 2024, our internal tool abstracted 938 patient charts, compared to 114 by CMS, with a 74% CMS abstraction congruency rate. Pineville accomplished a 50% improvement in SEP-1 bundle compliance, from 34% to 51%. The average chart abstraction time was 10 minutes, compared to the lengthy CMS process. Sepsis mortality targets were exceeded, with an O/E of 0.88, saving approximately 40 lives in 2024.
Implications for Practice:
Developing a tool that delivers comprehensive insights with minimal abstraction time is essential for performance improvement. Recognized across the NC/GA Division, this nurse-led initiative enabled Pineville to pioneer EHR-integrated solutions that enhance sepsis care and provide real-time performance insights, achieving widespread adoption across 27 hospitals, serving 1.4 million patients annually
Patient Identification: Call Check Connect
No full textBackground: Lack of staff participation in verifying correct patient in conversations via phone or in-person has led to an increase in patient safety events within our site.
Local problem: While receiving telemetry monitoring, a patient experienced sustained bradycardia (slow heart rate). When the concern was initially escalated to the care team, there was confusion regarding which patient was experiencing the clinical decline. The lack of use of the high reliability tool read/repeat back and patient identifiers lead to a delay in escalation to the clinician and a clinical intervention delay. Ultimately leading to a major safety event.
Method: The safety event was brought to the Professional Governance Council (PGC). The PGC created the initiative “Call, Check, Connect”. Using this patient identifier the goal is to verify patient first/last name and room when communicating over telecommunication to ensure correct patient is being discussed. All units had staff educated and signed off between September 2024- October 2024. Sign-offs were sent to PGC, and audits began in November 2024.
Results: From November 2024 to March 2025 over 447 audits were completed over 40 units. Identification using room numbers was shown to be inefficient for the emergency department. This was due to patients switching locations related to incoming patient needs. It was found the patient’s full name and date of birth was more efficient within their unit. Of the 447 audits 92% used Call, Check, Connect to identify patients over the phone.
Implication for nursing practice: By ensuring correct patient verification, the goal is to decrease patient safety events related to identification. This is a nurse driven quality improvement created at our site
Reducing Driveline Infections in LVAD Patients Through Standardized Education and Practice
No full textBackground/Rationale:
Left Ventricular Assist Device (LVAD) patients are at high risk for driveline infections, which increase hospital stays, costs, and complications. At Advocate Christ Medical Center, Q1 2024 data showed an average infection rate of 25%, peaking at 43% in February. Variation in caregiver and nursing techniques contributed to inconsistent practices. Literature supports that standardizing education and sterile technique can improve outcomes.
Purpose:
To reduce driveline infections by 40% over 12 months by implementing structured nurse training, caregiver education, and consistent dressing change techniques.
Implementation Plan:
Beginning October 1, 2024, the unit launched standardized RN education through video modules, hands-on training, and competency checklists. Caregiver instruction was divided into manageable parts. Alcohol packets were introduced between glove changes to maintain sterility. A bedside checklist and sign-off forms ensure each step is followed. Only RNs with over one year of experience complete teaching and sign-offs. A second outpatient sign-off ensures skill retention post-discharge. Staff rotate through 3-month competency refreshers.
Outcomes:
Preliminary data shows improved RN knowledge and confidence. Early compliance audits indicate more consistent dressing techniques. Infection rate reduction data will be assessed upon project completion in Fall 2025.
Implications for Practice:
This model promotes sustainable infection prevention, consistent patient education, and nurse confidence. It is being considered for expansion to other high-risk units. Standardizing training and integrating ongoing audits supports long-term success and patient safety