Hesham Metwalli Mousli, Iman El Sayed, Adel Zaki and Sherif Abdelmonem
This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for…
Abstract
Purpose
This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.
Design/methodology/approach
The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.
Findings
DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.
Research limitations/implications
The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.
Practical implications
Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.
Originality/value
DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.
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Ola Bakr Shalby, Hala Mohamed Elkady, Elsayed Abdel Raouf Nasr and Mohamed Kohail
Nano-Clay (NC) is reported as a candidate partial replacement for cement, due to its abundance and relatively low cost - beside reported promotion of different concrete…
Abstract
Purpose
Nano-Clay (NC) is reported as a candidate partial replacement for cement, due to its abundance and relatively low cost - beside reported promotion of different concrete properties. On the other hand, Steel Fibres (SF) has proven to have a positive effect on post fire exposure residual strength of concrete. This paper aims to present the outcomes of a comprehensive research program assessing a hybrid mix between NC and SF in concrete mixtures (NCSF-CRETE).
Design/methodology/approach
Physical chemical and physical characterization of NC is performed using different tools as XRF spectrometer, and TEM micrograph. Fresh concrete properties of NSCF-CRETE as slump and air content are investigated. Enhancement in permeability using NSCF is verified by comparing its resistance to the penetration of chlorides resistance with regular concrete mix. Besides, the proposed NCSF-CRETE compressive strength is evaluated compared to mixes with NC and SF each used separately at different curing ages. Besides, NSCF and compared mixes are exposed to an indirect fire testing program – two hours exposure – for: 300, 450 and 600°C. Degradation in compressive strength was investigated after exposure to different temperatures and percentage of residual strength is reported.
Findings
Results indicated an improved performance of NCSF -CRETE of about 40% compared to regular concrete in compressive strength at normal conditions. This improvement extended to its behavior when subjected to indirect fire exposure NSCF also maintained 40% more strength than the residual in regular concrete mix – which suffered severe damage – after 2 h exposure to 600°C.
Originality/value
Using NCSF-Crete allows retrofitting the structure after exposure to such drastic conditions.
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Abobakr Al-Sakkaf, Tarek Zayed, Ashutosh Bagchi, Sherif Mahmoud and David Pickup
Heritage buildings are significant for their historical and architectural value. Due to the lack of rating systems designed specifically for heritage buildings, it is essential to…
Abstract
Purpose
Heritage buildings are significant for their historical and architectural value. Due to the lack of rating systems designed specifically for heritage buildings, it is essential to develop and validate a heritage building assessment tool that considers its specific characteristics. The purpose of this study is to provide an extensive review of research on Sustainability of Heritage Buildings (SHBs).
Design/methodology/approach
This review highlights methodologies applied in SHBs research and analyzes major global rating systems in order to identify their deficiencies for SHBs assessment. A systematic review was employed and articles from the top 10 high impact factor journals were studied. Twelve major global rating systems and their assessment criteria were identified.
Findings
Significant variability was observed among the assessment tools since each tool assesses several criteria, factors and indicators that fit its local context. Part of this variability can also be seen in the rating scales, threshold values and accreditation titles. As a result, the final sustainability ranking for a given building cannot be compared among the 12 rating systems. Most importantly, these systems fail to analyze some factors such as energy that are considered important with respect to heritage building assessment.
Originality/value
Since no specific rating system could be identified in this review as the most appropriate for heritage buildings, a new sustainability assessment tool that is specific to heritage buildings should be developed. Such a tool will enable facility managers to evaluate and improve the sustainability of their heritage buildings while preserving them.