Hospital-acquired pressure injury is a common preventable condition. Our hospital is a 144-bed governmental hospital in the Kingdom of Saudi Arabia that was found to have a 7.5% prevalence of hospital-acquired pressure injury in 2016. The aim of the improvement project was to reduce the prevalence of pressure injuries in our hospital from 7.5% to below 4% by the end of 2017. Our strategy for improvement was based on the Institute for Healthcare Improvement Model for Improvement. The change strategy was based on implementing an evidence-based risk assessment tool and a bundled evidence-based pressure injury prevention (PIP) intervention termed PIP bundle. After implementing the change package, we observed a reduction in the prevalence of pressure injuries by 84% (RR 0.16;95% CI 0.07 to 0.3; p value <0.0001) over a period of 12 weeks, in addition to an improvement in the compliance of pressure injury risk assessment and PIP interventions. The use of an evidenced-based bundled approach to prevent hospital-acquired pressure injuries has resulted in a significant reduction in the rate of pressure injuries. Improvement results were sustainable. In addition, our outcome measure exhibited minimal variability.

Diabetes mellitus is a metabolic disease characterised by elevated levels of blood glucose and is a leading cause of disability and mortality. Uncontrolled type 2 diabetes leads to complications such as retinopathy, nephropathy and neuropathy. Improved treatment of hyperglycaemia is likely to delay the onset and progression of microvascular and neuropathic complications.This article describes the efforts of 18 governmental hospitals in the Kingdom of Saudi Arabia that enrolled in a collaborative improvement project to improve the poor glycaemic control (HbA1c >9% to be less than 15%) of patients with diabetes by the end of 2021 among all the chronic illness clinics in the enrolled military hospitals. Enrolled hospitals were required to implement an evidence-based change package that included the implementation of diabetes clinical practice guidelines with standardised assessment and care planning tools. Furthermore, care delivery was standardised using a standard clinic scope of service that focused on multidisciplinary care teams. Finally, hospitals were required to implement diabetes registries that were used by case managers for poorly controlled patients.The project timetable was from October 2018 to December 2021. Diabetes poor control (HbA1c >9%) showed improved mean difference of 12.7% (34.9% baseline, 22.2% after) with a p value of 0.01. Diabetes optimal testing significantly improved from 41% at the start of the project in the fourth quarter of 2018, reaching 78% by the end of the fourth quarter of 2021. Variation between hospitals showed a significant reduction in the first quarter of 2021.The collaborative multilevel approach of standardising the care based on the best available evidence through policies, guidelines and protocols, patient-focused care and integrated care plan by a multidisciplinary team was associated with noticeable improvement in all key performance indicators of the project.

Emergency department (ED) boarding is an indicator of less efficient hospital flow and is associated with longer inpatient length of stay, higher readmission rates and increased risk of mortality and medical errors. In addition to being associated with poor patient and staff satisfaction.This article describes the efforts of six tertiary care governmental hospitals in the Kingdom of Saudi Arabia that have enrolled in a collaborative improvement project to reduce ED boarding time.The hospitals implemented a multifaceted system intervention that included forming multidisciplinary flow improvement teams, implementing the National Health Service (NHS) SAFER patient flow bundle, visual management system and multidisciplinary ED bed huddles.By the end of the project, all hospitals significantly reduced ED boarding time with a pooled mean difference of – 7.1 hours (16.6 before, 9.5 hours after, p<0.001), reaching a pooled average of 2 hours in March 2020.Furthermore, by the end of the third learning session, all hospitals were able to achieve a boarding time below 6 hours. The enrolled hospitals also experienced an improvement in hospital flow process measures without any increase in 30-day readmission rates or bed occupancy rates.Our project demonstrates that implementing multifaceted system-wide interventions improves hospital flow and ED boarding time. Additionally, our project demonstrates a significant correlation between improvements in ED boarding time, daily consultant-led rounds and early discharge from inpatient units and time till discharge.

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Maternal morbidities and mortalities remain high globally, yet are preventable events. Maternal haemorrhage is a primary cause of both maternal morbidity and mortality. In this collaborative project, multipronged evidence-based interventions, inclusive of embedded morbidity surveillance trigger tools were implemented to increase maternal morbidity reporting and improve the safety culture, while structured morbidity and mortality reviews aided in the reduction maternal mortality.