American journal of medical quality : the official journal of the American College of Medical Quality最新文献

{"title":"The Impact of Earplugs and Eye Masks on Sleep Quality in Hospital Patients.","authors":"Tianyi Wang, Jawad Al-Khafaji, Gabriel Solomon","doi":"10.1097/JMQ.0000000000000158","DOIUrl":"10.1097/JMQ.0000000000000158","url":null,"abstract":"","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"39 1","pages":"50-51"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10756640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139050042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Potentially Preventable 7-day Readmission Rates in Hospital Medicine Patients at a Comprehensive Cancer Center.","authors":"Cerena K Leung, Natalie C Walton, Ed Kheder, Ali Zalpour, Justine Wang, Daria Zavgorodnyaya, Sonia Kondody, Christina Zhao, Heather Lin, Eduardo Bruera, Joanna-Grace M Manzano","doi":"10.1097/JMQ.0000000000000157","DOIUrl":"10.1097/JMQ.0000000000000157","url":null,"abstract":"<p><p>This study aimed to describe the potentially preventable 7-day unplanned readmission (PPR) rate in medical oncology patients. A retrospective analysis of all unplanned 7-day readmissions within Hospital Medicine at MD Anderson Cancer Center from September 1, 2020 to February 28, 2021, was performed. Readmissions were independently analyzed by 2 randomly selected individuals to determine preventability. Discordant reviews were resolved by a third reviewer to reach a consensus. Statistical analysis included 138 unplanned readmissions. The estimated PPR rate was 15.94%. The median age was 62.50 years; 52.90% were female. The most common type of cancer was noncolon GI malignancy (34.06%). Most patients had stage 4 cancer (69.57%) and were discharged home (64.93%). Premature discharge followed by missed opportunities for goals of care discussions were the most cited reasons for potential preventability. These findings highlight areas where care delivery can be improved to mitigate the risk of readmission within the medical oncology population.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"14-20"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10841441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Learning Environment: Past, Present, and Future.","authors":"Donald E Casey","doi":"10.1097/JMQ.0000000000000165","DOIUrl":"10.1097/JMQ.0000000000000165","url":null,"abstract":"<p><p>In this issue of AJMQ, Graduate Medical Education leaders from a large nationally renowned academic medical center describe in detail the \"Residents and Fellows Leading Interprofessional Continuous Improvement Teams\" program with a focus on the collaboration within their health system in alignment with Clinical Learning Environment review since its inception. In addition, the authors share key outcomes of the program using the reach, effectiveness, adoption, implementation, maintenance framework, additional structural (eg, timeline) and outcome (eg, scholarship) measures for further context within Graduate Medical Education and Undergraduate Medical Education, and describe elements which supported the program's success and lessons learned.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"39 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139050041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Front-Line Health Care Workers' COVID-19 Infection Contamination Risks: A Human Factors and Risk Analysis Study of Personal Protective Equipment.","authors":"Devin Doos, Ashley M Hughes, Trang Pham, Paul Barach, Anna Bona, Lauren Falvo, Malia Moore, Dylan D Cooper, Rami Ahmed","doi":"10.1097/JMQ.0000000000000159","DOIUrl":"10.1097/JMQ.0000000000000159","url":null,"abstract":"<p><p>Infectious risks escalate with complex donning and doffing personal protective equipment (PPE) protocols. Recent studies suggest that PPE donning and doffing behaviors that deviate from protocol during PPE reuse compounded the risks of health care worker (HCW) self-contamination. This study quantified the occurrence of behaviors associated with known risks in PPE use and reuse. We conducted a prospective study of emergency department HCWs and video-recorded PPE donning and doffing 5 times in simulated patient encounters. Trained coders recorded HCW behaviors according to an evidence-based guide. All 28 participants deviated from the Centers for Disease Control and Prevention (CDC) sanctioned donning and doffing protocol order, and most were documented to have (92.85%) self-contaminated at least once during each simulated clinical encounter. Behaviors that compounded self-contamination due to PPE reuse were also observed. Wide variation in PPE donning and doffing behaviors was found among front-line, experienced HCWs. Future work is needed to determine which deviations put HCWs at increased risk for accidental self-contamination and what changes are needed to the CDC protocol for protecting HCW from infections.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"4-13"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Many Lives Will You Save? A Mixed Methods Evaluation of a Novel, Online Game for Patient Safety and Quality Improvement Education.","authors":"Gabriela Ruiz Colón, Kambria Evans, Mia Kanzawa, Anuradha Phadke, Laurence Katznelson, Lisa Shieh","doi":"10.1097/JMQ.0000000000000153","DOIUrl":"10.1097/JMQ.0000000000000153","url":null,"abstract":"<p><p>Medical trainees have limited knowledge of quality improvement and patient safety concepts. The authors developed a free quality improvement/patient safety educational game entitled Safety Quest (SQ). However, 1803 undergraduate medical trainees, graduate medical trainees, and continuing medical education learners globally completed at least 1 level of SQ. Pre- and post-SQ knowledge and satisfaction were assessed among continuing medical education learners. Thematic analysis of feedback given by trainees was conducted. Among graduate medical trainees, SQ outranked other learning modalities. Three content areas emerged from feedback: engagement, ease of use, and effectiveness; 87% of comments addressing engagement were positive. After completing SQ, 98.6% of learners passed the post-test, versus 59.2% for the pretest ( P < 0.0001). Ninety-three percent of learners agreed that SQ was engaging and interactive, and 92% believed it contributed to their professional growth. With an increased need for educational curricula to be delivered virtually, gamification emerges as a unique strategy that learners praise as engaging and effective.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"306-313"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10617663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50164298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CDC's Adapting Clinical Guidelines for the Digital Age Lacks Real-World Context.","authors":"Robert E Matthews, Douglas Romer","doi":"10.1097/JMQ.0000000000000152","DOIUrl":"10.1097/JMQ.0000000000000152","url":null,"abstract":"","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"38 6","pages":"317-319"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Rothman Index in Predicting Readmission after Colorectal Resection.","authors":"Kent J Peterson, Carly M O'Donnell, Daniel C Eastwood, Aniko Szabo, Katherine Y Hu, Timothy J Ridolfi, Kirk A Ludwig, Carrie Y Peterson","doi":"10.1097/JMQ.0000000000000149","DOIUrl":"10.1097/JMQ.0000000000000149","url":null,"abstract":"<p><p>The Rothman Index (RI) is a real-time health indicator score that has been used to quantify readmission risk in several fields but has never been studied in gastrointestinal surgery. In this retrospective single-institution study, the association between RI scores and readmissions after unplanned colectomy or proctectomy was evaluated in 427 inpatients. Patient demographics and perioperative measures, including last RI, lowest RI, and increasing/decreasing RI score, were collected. In the selected cohort, 12.4% of patients were readmitted within 30 days of their initial discharge. Last RI, lowest RI, decreasing RI, and increasing RI scores remained significant after controlling for covariates in separate multivariate regression analyses. The last RI score at the time of discharge was found to be the most strongly associated with 30-day readmission risk following colorectal resection. These findings support the RI as a potential tool in the inpatient management of postoperative patients to identify those at high risk of readmission.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"38 6","pages":"287-293"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of In-Hospital Orthopaedic Spine Consultations: Evaluating the Impact of Health Care Policy.","authors":"Parker L Brush, Alexa Tomlak, Nick Pohl, Yunsoo Lee, Rajkishen Narayanan, Matthew H Meade, Mark J Lambrechts, Charles L Lawall, Jackson Weber, Amit Syal, Patrick O'Connor, Jose A Canseco, I David Kaye, Mark F Kurd, Alexander R Vaccaro, Chris K Kepler, Alan S Hilibrand, Gregory D Schroeder","doi":"10.1097/JMQ.0000000000000155","DOIUrl":"10.1097/JMQ.0000000000000155","url":null,"abstract":"<p><p>Access to specialty and private practice providers has been a divisive policy issue over the last decade, complicated by the conflict between a reduction in government-funded health care reimbursement and the need for health care providers to sustain a financially sound practice. This study evaluates the orthopedic spine consult service at an academic tertiary care center at 2 separate time points over a 5-year period to better understand the impact of decreasing orthopedic reimbursement rates and the increasing prevalence of federally supported medical insurance on the access to specialty care. In total 500 patients in 2017 and 480 patients in 2021 were included for the final analysis. A higher percentage of consults in 2021 came from the emergency department (74.0% versus 60.4%, P < 0.001); however, the emergency department saw fewer spinal cord injuries (11.9% versus 21.4%, P < 0.001), and the spinal cord injuries were less severe (3.1% versus 6.2% Association Impairment Scale A or B, P = 0.034). A smaller percentage of patients in 2021 went on to receive orthopedic spine surgery following consultation (35.2% versus 43.8%, P = 0.007), and those receiving surgery had an operation performed farther out from the initial consultation (4.73 versus 4.09 days, P < 0.001). Additionally, fewer patients with Medicare insurance (23.5% versus 30.8%) and more patients with Medicaid insurance (20.2% versus 12.4%) were seen in 2021 compared with 2017 (P = 0.003). Overall, this study found an increased proportion of Medicaid patients seen by the spine consult service but a decrease in the acuity of consults. Measures to improve access to health insurance under the Affordable Care Act have revealed the complexity of this issue in health care. This study's findings have demonstrated that while more patients did have insurance coverage following the Affordable Care Act, they still face a barrier to accessing outpatient orthopedic spine providers.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"38 6","pages":"300-305"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IDEAL PICU Rounds: Improving Daily Efficiency by Applying Lean Principles.","authors":"William Edward Cagle, Kacy Bennett Bagwell, Margaret Oates Poisson, Amy Marien Petro, Kaitlin Verdone","doi":"10.1097/JMQ.0000000000000156","DOIUrl":"10.1097/JMQ.0000000000000156","url":null,"abstract":"<p><p>The objective of this project was to improve communication, patient throughput, and rounding efficiency. Primary outcome studied was transfer/discharge order entry time and secondary outcomes included medication order entry time, staff perception, and time spent per patient. The location was a level one pediatric intensive care unit in an academic children's hospital. Utilizing Lean Six methodologies the major contributor to increased variability was different attending physician rounding patterns. These patterns were evaluated by a multidisciplinary committee, and the most efficient was adopted by all attending physicians during the study period. Data was collected by secret observers and a pre-post staff perception survey. Transfer/discharge order entry improved by 45 minutes/patient. Medication order entry improved by 89 minutes/order. Staff survey showed increased satisfaction in 9 of 12 aspects. Time spent per patient increased by 20%. In conclusion, standardization of rounds improved patient throughput, medication order entry, and staff satisfaction while increasing value-added time during rounds.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"38 6","pages":"279-286"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Multimodal Analgesia on Length of Stay and Patient Satisfaction After COVID-19: A Retrospective Study Examining Lean Methodology in Pain Management for Patients Undergoing Partial Nephrectomies.","authors":"Aimee Pehrson, Gulsah Onar, Matthew Vance, Wesley White, Jason Buehler","doi":"10.1097/JMQ.0000000000000143","DOIUrl":"10.1097/JMQ.0000000000000143","url":null,"abstract":"Introduction: Opioids are considered the standard of care for managing post-operative pain for nephrectomies, often with side effects that impact key hospital indicators. Research has shown that discharging patients earlier assists in operational efficiency from decreasing excessive holds in the emergency room to reducing the number of postoperative readmissions. At the University of Tennessee Medical Center, the COVID-19 pandemic strained healthcare delivery, prompting changes in pain management strategies to increase hospital resources. The purpose of this cross-sectional, retrospective study was to determine if applying lean methodology to the use of quadratus lumborum (QL) nerve blocks, as part of a multimodal pain management strategy, impacted hospital resources while maintaining patient satisfaction in patients undergoing partial nephrectomies. Methods: All patients (n=217) who underwent non-emergent partial nephrectomies from 01/01/2019-12/31/2021 were included in this study. Continuous variables were measured by central tendency, and non-parametric Mann-Whitney U test was used to examine significance (p < .05). Statistical process control was applied at the level 3-sigma. Results: Among participants who received multimodal analgesia, the length of stay significantly decreased (p=.013) compared to","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"38 6","pages":"320-321"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}