J-tubes are associated with higher complication rates requiring tube replacement compared with PEG tubes. The main causes of J-tube replacement are dislodgement and obstruction.

Background Liver cirrhosis is a leading cause of morbidity, premature mortality and acute care utilization in patients with digestive disease. In the province of Alberta, hospital readmission rates for patients with cirrhosis are estimated at 44% at 90 days. For hospitalized patients, multiple care gaps exist, the most notable stemming from i) the lack of a structured approach to best practice care for cirrhosis complications, ii) the lack of a structured approach to broader health needs and iii) suboptimal preparation for transition of care into the community. Cirrhosis Care Alberta (CCAB) is a 4-year multi-component pragmatic trial which aims to address these gaps. The proposed intervention is initiated at the time of hospitalization through implementation of a clinical information system embedded electronic order set for delivering evidence-based best practices under real-world conditions. The overarching objective of the CCAB trial is to demonstrate effectiveness and implementation feasibility for use of the order set in routine patient care within eight hospital sites in Alberta. Methods A mixed methods hybrid type I effectiveness-implementation design will be used to evaluate the effectiveness of the order set intervention. The primary outcome is a reduction in 90-day cumulative length of stay. Implementation outcomes such as reach, adoption, fidelity and maintenance will also be evaluated alongside other patient and service outcomes such as readmission rates, quality of care and cost-effectiveness. This theory-based trial will be guided by Normalization Process Theory, Consolidated Framework on Implementation Research (CFIR) and the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) Framework. Discussion The CCAB project is unique in its breadth, both in the comprehensiveness of the multi-component order set and also for the breadth of its roll-out. Lessons learned will ultimately inform the feasibility and effectiveness of this approach in “real-world” conditions as well as adoption and adaptation of these best practices within the rest of Alberta, other provinces in Canada, and beyond. Trial registration ClinicalTrials.gov: NCT04149223, November 4, 2019.

Background:The recently developed GRS-Canada is a validated instrument whose implementation leads to improved quality and patient experience of colonoscopy. The GRS-C has two dimensions dealing with clinical quality and quality of the patient experience. Both have ratings for 6 different categories resulting in a total of 12 dimensions for the "total" GRS-C score. The GRS-C has four grading levels, going from D, the lowest level, to level A, the highest. In order to reach a certain level all questions in each domain need to be answered positively. 18 months ago the GRS was introduced in seven of the eight hospital sites where endoscopy is performed in the Edmonton Zone: University of Alberta Hospital, Royal Alexandra, Grey Nuns, Misericordia, Sturgeon, Leduc and Fort Saskatchewan. The 8 th hospital WestView recently also started. Aims: The aim is to get all sites up to an A level over the next four years. Here we report on how scores improved as a result of an integrated QA program that was launched. Methods: The CAG website created for online submission of the GRS and associated improvement process was used to enter scores. This was done once every year. Results:As can be seen marked improvements were seen in 6 of the 7 hospitals all of whom have been actively working on the project for at least 1 year. In many dimension there was improvement from a D level to a C. One site was unchanged and an eighth site is just starting. Patient surveys have been started which will further help improve scores over time. Conclusions: Important improvements were seen in GRS-Canada scores in Edmonton Zone endoscopy units using an integrated QA program. The program was supported by a project manager.