is further catalyzed by the sharing of locally adapted pathwaysand experience between LHCs.TARGET AUDIENCE(S):

1. Clinical researcher2. Evidence synthesizer, developer of systematic reviews or

meta-analyses3. Guideline developer4. Guideline implementer5. Developer of guideline-based products6. Quality improvement manager/facilitator7. Medical educator8. Health care policy analyst/policy-maker9. Medical providers and executives10. Allied health professionals11. Consumers and patients representatives12. Nurses

P90– The translation of SDCEP Guidance on Dental

Caries in Children into practice

Douglas Stirling, PhD (Presenter) (NHS Educationfor Scotland, Dundee, Scotland, United Kingdom);Heather Cassie, BSc (University of Dundee, Dundee,Scotland, United Kingdom); Debbie Bonetti, PhD(University of Dundee, Dundee, Scotland, UnitedKingdom); Linda Young, PhD (NHS Education forScotland, Dundee, Scotland, United Kingdom);Gillian MacKenzie, PhD (NHS Education forScotland, Dundee, Scotland, United Kingdom);Jan Clarkson, PhD (University of Dundee, Dundee,Scotland, United Kingdom)

PRIMARY TRACK: Guideline implementationSECONDARY TRACK: Other guideline implementationBACKGROUND (INTRODUCTION): The Scottish DentalClinical Effectiveness Programme (SDCEP) is developingguidance on the Prevention and Management of Dental Cariesin Children. This builds on previous evidence-based guidelines(SIGN 47 & 83) and aims to support dental teams in providingappropriate preventive care and in making decisions aboutcaries management options.

The aim of this study was to identify current practice andbeliefs about behaviors associated with key recommendationswithin the guidance to inform both guidance development andimplementation.LEARNING OBJECTIVES (TRAINING GOALS):

1. To understand how SDCEP gains an appreciation ofguidance implementation concerns.

2. To understand how knowledge of current practice andbeliefs about key behaviors may inform implementationinterventions.

METHODS: A cross-sectional survey was sent to key stake-holders and a random sample of dental health professionalsduring the guidance consultation. Questions to elicit self-re-ported behavior and beliefs toward 15 behaviors identified askey to successful implementation of the guidance were in-cluded. In addition, semi-structured interviews were conductedwith a sample of dental professionals to better understand

barriers and facilitators associated with following the guidancerecommendations.RESULTS: Forty-four questionnaires were completed and 15interviews conducted. On average, each respondent carried outonly eight of the 15 key behaviors in their daily practice. Fiftypercent reported that they intend to change their practice hav-ing read the guidance, on average by complying with oneadditional behavior. Of the least performed behaviors, all wereperceived to be important, but two were identified as particu-larly difficult, suggesting that a single intervention is unlikelyto be sufficient to change professional behavior in line with theguidance recommendations.DISCUSSION (CONCLUSION): The guidance document–in the format distributed for consultation and/or alone–is un-likely to result in the implementation of all recommendedbehaviors. The approach described provides valuable insightinto current practice, likely impact of the guidance, and poten-tial implementation interventions.TARGET AUDIENCE(S):

1. Guideline developer2. Guideline implementer

P91– An indicator to improve quality of

multidisciplinary review meetings for cancer patients

Sophie Goubet (Presenter) (Haute Autorite deSante, La Plaine Saint Denis, France)

PRIMARY TRACK: Guideline implementationSECONDARY TRACK: Performance measures/indicators/quality incentives and guidelinesBACKGROUND (INTRODUCTION): The French Na-tional Authority for Health (HAS) generalizes quality indica-tors (QIs) in health care organizations (HCOs).LEARNING OBJECTIVES (TRAINING GOALS):

1. To analyze quality of multidisciplinary review meetings(MRMs) for cancer patients using a QI.

2. To obtain benchmarking data and bring about an incitingeffect on the improvement of the professional practices.

METHODS: The QI was elaborated by the French NationalInstitute for Medical Research (INSERM), taking into accountthe national cancer plan (2003), ministerial regulations (2005),and guidelines established by the National Cancer Institute,HAS, and health professionals (2006) providing quality stan-dards for MRMs. Before carrying out generalization of this QIin HCOs for cancer patients, it was tried out in voluntaryHCOs. Eight-two HCOs collected data on 60 random medicalrecords. Each HCO got its results accompanied by references(national, regional, and by type of HCO) in order to compareeach other. The QI was defined as the proportion of cancerpatients at initial phase of treatment with a dated MRM reportand for which treatment decision-making was realized by atleast three different specialized physicians.RESULTS: There were 4114 medical records analyzed. Meanrate was rather poor (27%). The comparison between HCOsshowed an important difference between the lowest rate (0%)and the highest rate (87%, 95% CI 78-95). MRM reports atinitial phase of treatment were missing in 32% of cases. MRM

125Poster

reports without the names of three different physicians or theirspecialties were standards with the worst conformity: respec-tively, 17% and 55%. Undated MRM reports and without-a-treatment decision-making were standards with better results:respectively, 3% and 4%.DISCUSSION (CONCLUSION): This experiment showsthat quality of MRMs for cancer patients can be highly im-proved and allows one to objectify standards on which theHCOs must do their utmost. This QI will be included in theFrench national accreditation procedure for HCOs and its col-lection will be done every year for generalization.TARGET AUDIENCE(S):

1. Guideline developer2. Guideline implementer3. Developer of guideline-based products4. Quality improvement manager/facilitator5. Medical educator6. Medical providers and executives7. Allied health professionals8. Consumers and patients representatives9. Nurses

P92– Assessment of post-acute phase

management of myocardial infarction using quality

indicators

Sophie Goubet (Presenter) (Haute Autorite deSante, Saint Denis La Plaine, France)

PRIMARY TRACK: Guideline implementationSECONDARY TRACK: Performance measures/indicators/quality incentives and guidelinesBACKGROUND (INTRODUCTION): French acute careHCOs have collected data on six mandatory quality indicators(QIs) relating to post-acute phase management of myocardialinfarction (MI) for two successive years (2009 and 2010).These QIs were elaborated taking into account European andAmerican guidelines, and clinical practice guidelines providedby the French National Authority for Health.LEARNING OBJECTIVES (TRAINING GOALS):

1. To compare 2009 and 2010 QI results in order to assessevolution in quality of post-acute phase management ofpatients with MI.

2. To analyze variability between HCOs.METHODS: All acute care HCOs collected retrospective dataon 60 random medical records (principal diagnosis: MI). Apaired t-test was applied to compare 2009 and 2010 QIs means.Variability between HCOs was analyzed when the paired t-testwas significant. QIs with fewer than 30 records were excludedfrom the analysis (QI3 Level 2 ACE inhibitor at discharge ifLVEF � 40% and QI6 Advice on stopping smoking).RESULTS: In January 2010, 29 HCOs completed data col-lection (8%); 1580 medical records were analyzed in 2009 and1517 in 2010. Improvement was significant for 3 QIs (P �0.05; QI1 Aspirin/clopidogrel at discharge with mean 2009 �92% and mean 2010 � 96%; QI4 Level 2 Monitoring statinuse by lipid lab test with mean 2009 � 10% and mean 2010 �

26%, and QI5 Advice on diet with mean 2009 � 37% andmean 2010 � 51%). There was no significant difference be-tween 2009 and 2010 means for all other QIs (QI2 beta-blocker at discharge, QI3 Level 1 LVEF measurement, andQI4 Level 1 Statin at discharge). In 2010, there was variabilitybetween HCOs for QI4 Level 2 and QI5, except for QI1.DISCUSSION (CONCLUSION): In spite of these encour-aging interim results (full data collection will be completed inMarch 2010), there is still room for improving management ofMI after acute phase. Variability for QI1 will be checked whenall HCOs will have performed their 2010 data collection. Ifresults are confirmed, maintenance of QI1 will be discussedwith health professionals.TARGET AUDIENCE(S):

1. Guideline developer2. Guideline implementer3. Developer of guideline-based products4. Quality improvement manager/facilitator5. Medical educator6. Medical providers and executives7. Allied health professionals8. Consumers and patients representatives

P93– Code SMART: The use of an early alert

system to increase compliance with sepsis bundles

Noeen Ahmad, DO (Presenter) (Newark Beth IsraelMedical Center, Newark, New Jersey);Jennifer Larosa, MD (Newark Beth Israel, Newark,New Jersey)

PRIMARY TRACK: Guideline implementationSECONDARY TRACK: Performance measures/indicators/quality incentives and guidelinesBACKGROUND (INTRODUCTION): Septic shock is oneof the leading causes of mortality in the world. Organizationssuch as the Surviving Sepsis Campaign have developed sepsismanagement and resuscitation bundles to help physicians treatsepsis and reduce mortality.

Early alert systems, such as Code STEMI, also have beenknown to reduce mortality. We hypothesized that an early alertsystem for septic shock would help improve compliance oftreatment and thus reduce mortality. We coined the phrase“Code SMART” for Sepsis Management Alert ResponseTeam.LEARNING OBJECTIVES (TRAINING GOALS):

1. Identification of patients with septic shock.2. Implementation of sepsis management bundles and re-

suscitation bundles.METHODS: Emergency room personnel can call a CodeSMART based on a screening tool. This overhead alert systemwould alert the intensive care unit physician and nurses, phar-macy, and bed management that a patient was suspected to bein septic shock. Another order set including elements of thesepsis management bundle and resuscitation bundle would beimplemented.

126 Otolaryngology–Head and Neck Surgery, Vol 143, No 1S1, July 2010