Urinary catheters are a common medical intervention, yet they can also be associated with harmful adverse events such as infection, urinary tract trauma, delirium and patient discomfort. The purpose of this study was to describe the use of the SafetyLEAP program to drive improvement efforts, and specifically to reduce the use of urinary catheters on general internal medicine wards. A pre and post intervention study using the SafetyLEAP program was performed with urinary catheter prevalence as the primary outcome on two general internal medicine wards in a large academic health sciences center. A total of n = 534 patients (n = 283 from ward #1; and n = 252 from ward #2) were included in the initial audit and feedback portion of the study and 1601 patients (n = 824 pre-intervention and n = 777 post-intervention were included in the planned quality improvement portion of the study). A total of 379 patients during the quality improvement intervention had a urinary catheter. Overall, the adherence to the SafetyLEAP program was 97.4% on both general internal medicine wards. The daily catheter point prevalence decreased from 22 to 13%. After the implementation of the program, the urinary catheter utilization ratio (defined as urinary catheter days/patient days) declined from 0.14 to 0.12. Catheter-associated urinary tract infections (CAUTI) were unchanged. The SafetyLEAP program can help provide a systematic approach to the detection, and reduction of safety incidents. Future studies should aim at refining and implementing this intervention broadly.

Aim: To evaluate an intervention to reduce unnecessary urinary catheter use and prevent catheter‐associated urinary‐tract infections (CAUTI) in hospitalized patients across an academic health science centre.Methods: We conducted a one‐group, pretest, posttest study with a theory‐based process evaluation. Phase 1 consisted of a pre/postintervention to test the impact of a CAUTI protocol. Audits on four units were conducted, and data were analysed descriptively. Phase 2 consisted of a theory‐based process evaluation to understand the barriers/enablers to the implementation. Semistructured interviews were conducted and then analysed using a systematic approach.Results: In Phase 1, all inpatients with urinary catheters admitted to the units (N = 4) during the study period (N = 99, pre) and (N = 99, post) were included. CAUTI prevalence rate was 18.2% pre versus 14.1% post (p = .563). In Phase 2, participants (N = 18) who worked on the units were interviewed, and a total of 13 barriers and 19 enablers were found.

Approximately 20% of renal cell carcinoma (RCC) is diagnosed because of paraneoplastic manifestations. RCC has been associated with a large variety of paraneoplastic syndromes (PNS), but it is rarely associated with PNS vasculitis. We present a case of a previously healthy male who presented with systemic vasculitis; bitemporal headaches, diplopia, polyarthritis, palpable purpura, tongue lesion, peri-orbital edema, scleritis, chondritis and constitutional symptoms. He was subsequently found to have oligometastatic RCC. Both his primary lesion and site of oligometastasis were treated with stereotactic radiotherapy (SBRT) and resulted in the resolution of his vasculitis, as well as sustained oncologic response. This is the first case to demonstrate that effective sustained treatment for PNS vasculitis due to oligometastatic RCC is possible with SBRT.

Problem: Despite increasing recognition of the importance of quality and patient safety in academic medicine, challenges remain with ensuring physician participation in quality assurance and quality improvement efforts, such as lack of compensation and enabling resources. An organizational culture that includes physician leadership and a supportive infrastructure is needed to encourage physician backing of quality and patient safety initiatives. Approach: The authors describe the development of a robust quality and patient safety program in the Department of Medicine at The Ottawa Hospital over the past 7 years and highlight how the department changed its organizational culture by prioritizing quality and patient safety and establishing the necessary infrastructure to support this program. Program development was characterized by 4 overarching themes: incentives, administrative structure and physician leadership, training and support, and system enhancements. Outcomes: As a result of the program, the department broadly implemented a standardized framework for conducting quality committee meetings and morbidity and mortality rounds and reviewing patient safety incidents and patient experience across its 16 divisions. This has led to 100% departmental compliance on corporate quality assurance metrics each year (e.g., regular multidisciplinary divisional quality committee meetings), along with physician participation in formal quality improvement initiatives that align with larger corporate goals. Next Steps: The authors reflect on lessons learned during the implementation of the program and the essential elements that contributed to its success. Next steps for the program include using a centralized repository of quality and patient safety data, including patient safety incident dashboards, to encourage greater divisional collaboration on quality improvement initiatives and continuous institutional learning over time. Another important avenue will be to create an academic hub for excellence in quality and a formal approach to reward and promote physicians for their quality work.

Objectives: Our aim in this study was to assess early adoption patterns of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in eligible patients with type 2 diabetes (T2DM) and heart failure with reduced ejection fracture (HFrEF), and to identify gaps in practice. Methods: A retrospective chart review was conducted of patients with T2DM and HFrEF admitted with decompensated heart failure to The Ottawa Hospital under cardiology or general internal medicine from June 2019 to May 2021. Patterns were assessed at 8-month intervals (1 period before release of the Diabetes Canada 2020 guidelines and 2 periods afterward). Baseline patient characteristics, comorbidities, and prescriber information were collected. Results: Of the 98 patients who met the inclusion criteria, 36.7% had a prescription for an SGLT2i, either on admission, discharge, or follow-up. Trends showed a gradual increase over time. On admission, 9.8% of patients were on an SGLT2i in period 1, 19.2% in period 2, and 23.3% in period 3. Patients receiving a prescription for SGLT2i on discharge were 0.0% in period 1, 10.0% in period 2, and 9.5% in period 3, all of whom were admitted under cardiology. On follow-up, 13.9% of eligible patients were started on an SGLT2i in period 1, 21.1% in period 2, and 35.0% in period 3. Endocrinology was the main prescriber of SGLT2i in the outpatient setting, followed by cardiology. Conclusions: Overall, trends show a slow but steady increase in early prescriptions of SGLT2i. However, most eligible patients were not started on therapy during our study period, with variability in practice between specialties, highlighting opportunities to boost uptake in the future. (c) 2024 The Author(s). Published by Elsevier Inc. on behalf of Canadian Diabetes Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: Frailty is associated with morbidity and mortality among people with chronic obstructive pulmonary disease (COPD), yet there are no established care pathways to manage frail patients with COPD. To address this gap, we developed, implemented and assessed the feasibility of a new frailty-focused care model for patients hospitalised with exacerbations of COPD. Methods: We conducted a prospective cohort study among hospitalised patients with acute exacerbations of COPD in an academic hospital in Canada over 18 months. We developed and implemented a frailty-focused care model using the degree of frailty to guide personalised assessments, education, and care interventions during and after hospital discharge. We assessed the feasibility of using frailty-focused care in a real-world setting with prespecified targets for recruitment rate, care model completion and collection of patient-reported outcomes including symptom burden, health confidence, health status and self-management scores. Patients were followed up at 3 months after hospitalisation to reassess patient-reported outcomes. Results: 87 patients used the frailty-focused care model during hospitalisation, 58 consented to participate in this study and 45 (78%) completed 3-month postdischarge follow-up. 47% (n=21) were at least mildly frail at baseline, with 35% (n=20) at risk of frailty. Target recruitment of 50 patients was achieved, and all participants completed core elements of frailty-focused care, including frailty assessment, personalised education and discharge planning. Patient-reported outcomes were measured in all participants in hospital, and in 78% (n=45) patients at 3-month follow-up. 23% (n=13) of patients initially reported feeling confident to manage their health condition. This improved to 62% (n=28) at 3-month follow-up. Conclusions: This study provides a foundation to build innovative care models for frail individuals with COPD and shows it is feasible to use frailty-focused care in a real-world hospital setting. Future work requires strong patient engagement to better align frailty-focused care with patient-centred goals.