QI Project
Comprehensive List of EQuIP India
QI projects 2017 – 2022
Cohort 2022
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Quality Theme of the QI projects
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Quality Goals achieved | Key outcomes achieved |
Link to A3 sheet and the Graduation Presentation |
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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%.
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· Developed a system of dietician consults in radiation oncology outpatient clinic and diet plan for every patient. · Implemented nutritional counselling and diet education pamphlets |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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 |
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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. |
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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. |
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Cohort 2021 |
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● 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. |
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● 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 |
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● 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% |
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● 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 |
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● 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. |
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● 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 |
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● 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 teleconsultation |
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● Achieved the goal of adequate and timely phone follow-up for enrolled Children, from baseline 20% to 99%
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● 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. |
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● 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%. |
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● The waiting time of > 90% of patients with scheduled appointments, reduced to < 2hrs |
● The percentage of scheduled appointments increased from 21% to 42 % |
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Cohort 2019
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● 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 |
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● 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 |
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● 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 |
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● The waiting time to 1st Radiation Therapy was reduced successfully from 8 hours to 6.6 hours |
● 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 |
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● 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 |
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● 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 |
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● Reduced the waiting time at the Palliative care OPD from 35 minutes to 20 minutes |
● Improved patient – staff relationship ● Efficient functioning of OPD processes |
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● 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 ● Improved the satisfaction of families, with care provided ● Increased donations to support activities of the organisation |
Cohort 2018
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● 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 |
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● Improved the percentage of complete documentation of PC Home Visits from zero to 90%. |
● Care coordination and triaging of patients improved |
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● 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 support |
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● 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 discharge |
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● The average discharge time was reduced from baseline 3.5 hours to average 45 minutes across the project time |
● Improved the patient experience ● Improved staff satisfaction ● Improved turn over as it released in-patient beds for others in need |
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● 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. |
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● 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 |
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Cohort 2017
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● 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 |
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● 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 |
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● 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 |
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● 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 |
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● 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. |
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● 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 |
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● 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 |