Rates of hospice enrollment increased over time but remained under accepted quality benchmarks with variations evident in those who receive hospice services. Efforts to increase access to earlier hospice care for all patients dying with melanoma are essential.

Abstract. Objective: To determine whether continuous quality improvement (CQI) methodology could improve and maintain IL-372 documentation compliance in an academic emergency department (ED). The impact on transcription costs, billing practices, and average patient length of stay was also analyzed. Methods: Baseline IL-372 compliance data were collected and shared with staff during a multidisciplinary educational session. Faculty dictation became mandatory. Pocket-sized dictation templates were provided. A Documentation Improvement Committee monitored outcomes. Each month of the study period, a compliance officer reviewed approximately 100 records. The following indicators were monitored: IL-372 compliance rates, dictation rates, transcription costs, down-coding rates, percentage of billable records, and average patient length of stay. Individualized results were provided to faculty. Results: During the ten-month study period, compliance rates increased from 60% to 100% (p-trend < 0.001), while dictation rates increased from 69% to 100% (p < 0.001). Rates of down-coding adjustments improved from 54% to 2% (p-trend < 0.001). The percentage of billable records increased from 65% to 100% (p-trend < 0.001). Transcription costs increased a modest 16%. The average patient length of stay remained unchanged. Conclusion: The application of CQI methodology, combined with the availability of dictation, resulted in sustained improvement in IL-372 compliance. This was associated with a parallel increase in dictation rates, although concurrent transcription costs increased only modestly. The percentage of billable records increased, while the number of charts requiring down-coding decreased, both beneficial outcomes. Average length of stay was not adversely impacted by this added documentation requirement.

Aims To evaluate the ETAT+ course on the recognition and treatment of sick children, supported by visits from UK Consultant Paediatricians, in 6 district hospitals in Rwanda. Methods RCPCH supported ETAT+ courses were delivered followed by four, six monthly one week visits by six UK Consultant Paediatricians for training, support and review of service delivery. At each visit implementation plans were devised and progress reviewed. Changes were identified by internal assessment and direct observation.

Methods All final year medical students for last 2 years in Rwanda attended a full 5 day ETAT+ course. It is designed for hospital staff, but full course was chosen as the following year the students will be working in district hospitals, usually as the most senior doctors. They took a knowledge test (multiple choice questions) at the start of the course. After the course, the same knowledge test was taken and two clinical skills scenarios were assessed, using standardised criteria. Candidates had to retake the scenario if they did not pass all the criteria and failed if they did not pass all the criteria on retesting. At the end of the academic year, 3–9 months later, their knowledge and clinical skills were reassessed with the same knowledge and clinical skills tests. Results Between Nov 2011-May 2012, 91 medical students attended one of 4 courses. In August 2012, 81 students were re-evaluated. The knowledge test results (figure 1): pre-course, median score was 47% (inter-quartile range 35.65); after the course 71% (inter-quartile range 63, 75). There was a statistically significant improvement in performance (Wilcoxon matched-pairs signed rank test p < 0.0001). On re-evaluation, median MCQ results were 67%, (inter-quartile range 52, 75), not significantly different from post-course performance. Clinical skills assessments (Table 1) showed that 95% passed immediately after the course, with 72% passing both at their first attempt. On re-evaluation, 74% passed, 47% at their first attempt (Chi-squared p < 0.01). Abstract G117 Figure 1 Knowledge test results Abstract G117 Table 1 Table 1 Clinical skills Post-course (n = 91) Re-evaluation (n = 81) Passed first attempt 65 (72%) 38 (47%) Passed second attempt 22 (24%) 22 (27%) Failed 4 (4%) 21 (26%) Conclusion On evaluation immediately after the full ETAT+ course, there was a marked improvement in knowledge and most passed the clinical skills. The medical students coped well with the full course. On re-evaluation 3 – 9 months later they retained their knowledge but clinical skills declined, showing refresher courses are required to maintain clinical skills.

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