International Journal for Quality in Health Care最新文献

{"title":"Analyzing and Mitigating the Risks of Patient Harm During Operating Room to Intensive Care Unit Patient Handoffs.","authors":"Nara Regina Spall Martins, Edson Zangiacomi Martinez, Cláudia Marquez Simões, Paul Barach, Maria José Carvalho Carmona","doi":"10.1093/intqhc/mzae114","DOIUrl":"https://doi.org/10.1093/intqhc/mzae114","url":null,"abstract":"<p><strong>Background: </strong>Patients continue to suffer from preventable harm and uneven quality outcomes. Reliable clinical outcomes depend on the quality of robust administrative systems and reliable support processes. Critically ill patient handoffs from the operating room to the intensive care unit are known high-risk events. We describe a novel perspective on how risk factors associated with the process of patient handoff communication between the operating room (OR) and the intensive care unit (ICU) can lead to flawed communication, degraded team awareness, medical errors and increased patient harm.</p><p><strong>Methods: </strong>Data was collected from two semi-structured focus groups using a five-step risk management approach at a tertiary hospital in São Paulo, Brazil. We conducted a failure modes, effects and analysis (FMEA) with multidisciplinary healthcare providers consisting of attending physicians, anesthesiologists, nurses, and physiotherapists involved in patient handoffs. We analyzed the results using a similitude analysis to evaluate the effectiveness of implementing this novel risk management approach.</p><p><strong>Results: </strong>We identified the handoffs risks associated with patients, staff, institution, and potential financial risks. The FMEA identified 12 process failures and 36 causes that generated 12 consequences and pointed to robust needed preventive measures to mitigate handoff risks. The clinical teams reported that this approach allowed them to see the process more completely as a whole not only in their narrow siloes, thus understanding the enablers and difficulties of the other team members and how this understanding can shed light on their mental models, actions and the process reliability. Teams identified key steps in the OR to ICU handoff process that are prone to the highest hazards to patients, hospital and staff and are currently targeted for process improvement. Evidence driven recommendations intended for reducing the risks associated with patient handoffs are presented.</p><p><strong>Conclusions: </strong>Implementing a dynamic risk management, interdisciplinary approach was used to redesign the OR to ICU patient handoff approach around the patient's and clinician's needs. The risk management program helped healthcare providers identify handoff steps, highlighting risky handoff process failures, making it possible to identify actionable failures, consequences, and define preventative action plans for mitigating the risks to improve the quality and safety of patient handoffs.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safeguarding quality of care in active conflict: priority issues and interventions in Sudan.","authors":"Sheila Leatherman, Aparna Ghosh Kachoria, Mohammed Idriss, Omer Ali, Christina Christopher, Ezequiel Garcia Elorrio","doi":"10.1093/intqhc/mzae112","DOIUrl":"https://doi.org/10.1093/intqhc/mzae112","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The maturity of lean management in a large academic medical center in Finland: a qualitative study.","authors":"Irmeli Hirvelä, Paulus Torkki, Mervi Javanainen, Elina Reponen","doi":"10.1093/intqhc/mzae111","DOIUrl":"10.1093/intqhc/mzae111","url":null,"abstract":"<p><strong>Background: </strong>Lean management (LM) provides hospitals with tools to respond to today's rapidly changing healthcare environment. However, evidence of its success is inconclusive. In some cases, well-executed LM supports effective, beneficial, and safe patient care; reduces costs; and increases patient and staff satisfaction. In other cases, however, the desired outcomes have not been achieved. Organizations must acknowledge the maturity level of LM to successfully implement it for continuous development. This study evaluates the maturity of Lean implementation using a structured interview with a framework based on the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) and utilizes findings about Lean adoption to evaluate factors that support and hinder its implementation, with the aim of assisting leaders in maintaining and developing Lean in health care.</p><p><strong>Methods: </strong>The article describes a case study done at Helsinki University Hospital. A qualitative study was conducted in three sectors (A, B, and C) of the hospital. Fifteen healthcare leaders from the three sectors participated in a semistructured interview based on the dimensions of the LHISI. Qualitative content analyses were based on grounded theory.</p><p><strong>Results: </strong>We concluded that the five dimensions (leadership, commitment, standard work, communication, and daily management system) of LHISI provide a comprehensive framework for qualitatively evaluating Lean in the hospital. We found that the five dimensions are influenced by other explanatory factors. These explanatory factors, knowledge about Lean, available data, and environmental, psychological, and organizational factors all support and hinder leadership, communication, daily management, and commitment to Lean in the hospital. The results highlight differences in the Lean maturity levels in the hospital. We noticed that 9 of 15 leaders had a misunderstanding of Lean, and all 3 sectors showed a lack of staff commitment to Lean in their units.</p><p><strong>Conclusion: </strong>To strengthen the organization-wide implementation of Lean, it is necessary to understand that LM is a comprehensive sociotechnical management system, for which it is not enough to mechanically implement Lean with tools and techniques alone. By focusing on and developing the five dimensions and explanatory factors, organizations can achieve a high maturity of Lean and reach their full potential. A good level of competency and commitment to Lean by the leaders and the staff alike are important for achieving goals, engaging the staff, and increasing the quality of patient care in the hospital. The long-term Lean development of a hospital organization can be followed and continuously maintained via easy-to-use maturity tools.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing neurosurgery clinic operations: a comparative study of interventions in Finland's public healthcare system.","authors":"Jukka Huttunen, Timo Koivisto","doi":"10.1093/intqhc/mzae106","DOIUrl":"10.1093/intqhc/mzae106","url":null,"abstract":"<p><strong>Background: </strong>The Finnish public healthcare system aims to ensure equal access to health services for all but faces challenges in meeting the demand for specialized care, such as neurosurgery, due to resource constraints. This study investigates interventions to increase resources at a neurosurgery outpatient clinic to improve patient care without compromising waiting times for diagnoses and treatments, leveraging Finland's unique healthcare landscape.</p><p><strong>Methods: </strong>The study was conducted at Kuopio University Hospital's Department of Neurosurgery, the sole provider of neurosurgical care in Eastern Finland. Two interventions were designed to optimize clinic operations: one focusing on dynamic resource allocation through continuous monitoring and the other on establishing a fixed additional neurosurgeon slot. Process capability and regression analysis were employed to evaluate the effects of these interventions on the number of outpatient visits and the variability in daily patient numbers.</p><p><strong>Results: </strong>The preliminary analysis showed an average of 9.3 outpatient visits per day (SD 5.2). The introduction of an additional neurosurgeon led to an increase of 5.014 visits per day, according to the regression analysis performed before the interventions. Following the interventions, the clinic observed an increase in the average number of daily outpatient visits to 9.8 after the first intervention and 11.6 after the second, with corresponding improvements in the number of neurosurgeons present. The second intervention, which established a predictable additional resource, resulted in a more significant improvement in process efficiency and stability. After the interventions, the number of new neurosurgical first patient visits increased by 7% (97 patients).</p><p><strong>Conclusion: </strong>This study demonstrates the importance of structured and predictable resource allocation in enhancing the efficiency of specialized healthcare services, particularly in neurosurgery. It also underscores the potential of planned interventions to manage and improve patient care in a publicly funded healthcare system, despite the challenges posed by limited resources and the need for prioritization. Moreover, the findings highlight the necessity of ongoing measurement and analysis of development projects to ensure sustained improvement and avoid regression in process quality.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the joint effect of clinical quality, meaningful use of HIT and patient-caregiver interaction on mortality rates in US acute care hospitals.","authors":"Aber Elsaleiby","doi":"10.1093/intqhc/mzae104","DOIUrl":"10.1093/intqhc/mzae104","url":null,"abstract":"<p><strong>Background: </strong>Healthcare quality has long been defined and assessed using different theories that outline care delivery as a product of clinical and non-clinical aspects. The clinical aspect is medicinal in nature, while the non-clinical symbolizes social and technological aspects of care. To the best of our knowledge, the joint effect of the clinical, social, and technological aspects of care on outcome quality of care has not been investigated in the literature. The current study empirically investigates, using the joint effect of the clinical, social, and technological care quality dimensions on mortality rates through analyzing longitudinal data from 3081 US hospitals.</p><p><strong>Methods: </strong>Six-year data from 3081 acute care hospitals are collected and analyzed using econometric analysis with two-stage least square instrumental variable regression models.</p><p><strong>Results: </strong>Hospitals that jointly focus on clinical, social, and technological care dimensions realize lower mortality rates. Combining clinical quality (CM) with either patient-caregiver interaction (PCI) or meaningful use of health infomration technology (MUHIT) reduces mortality rates. The lowest mortality rate is realized when hospitals combine CM, PCI, and MUHIT.</p><p><strong>Conclusion: </strong>Our study provides empirical evidence on the importance of combining clinical and non-clinical care measures to reduce mortality rates in hospitals. Our results indicate that hospitals that combine dual quality dimensions, clinical quality with either PCI or MUHIT, can also realize improvement in mortality rates. However, the best outcome can be realized by focusing on the triple quality dimensions (CM, PCI, and MUHIT). The study provides pointers to healthcare professionals and policymakers on the impact of non-clinical care on the clinical-mortality link in hospitals.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-Year Analysis of Hospital Complaints at a Japanese Tertiary Teaching Hospital.","authors":"Masashi Uramatsu, Yutaka Andoh, Takako Kojima, Shiro Mishima, Megumi Takahashi, Koutaro Uchida, Jun Wada, Tomoko Oto, Takashi Ishikawa, Paul Barach, Yoshikazu Fujisawa","doi":"10.1093/intqhc/mzae113","DOIUrl":"https://doi.org/10.1093/intqhc/mzae113","url":null,"abstract":"<p><strong>Background: </strong>Patient complaint taxonomies support the using of healthcare complaints as a powerful tool to improve the quality and safety of patient care. Hospitals use complaint data at the organisational level to address quality variation across service lines and departments.</p><p><strong>Methods: </strong>We applied a validated typology to identify where the complaints occur and gained deeper insights about how they can be more effectively utilised to drive and implement continuous quality improvement activities within a tertiary hospital. We included all complaints and opinions from patients and their families over a 5-year period at a large tertiary teaching hospital in Japan. Two analysts categorised the opinions into complaints and gratitude expressions, with complaints classified using Reader et al.'s taxonomy. We performed simple tabulations and determined the number of complaints across hospital sectors using the χ-square test, residual analysis and Cramer's V tests to check for significant correlations between the variables.</p><p><strong>Results a total of 6,607 complaints and comments were received. of these, 5,401 related to the clinical, administrative, and human relations domains, respectively (11.1%, 56.1%, and 32.8%). at the domain level, the most common complaints related to the relationships domain in both the medical and nursing departments. however, a detailed analysis of the category levels demonstrated that the medical department received the most complaints in the communication and patient rights category. whereas in the nursing department, the humanness/caring and patient rights categories were the most common categories for which complaints were received: </strong>The Administrative department complaints were mostly related to the Management domain, with the largest number of complaints related to the Institutional issue category. Conclusions: We used a validated taxonomy to identify trends in patient complaints and identified the key departments that required remedial improvement actions. All hospital departments received direct and targeted feedback on how to effectively improve their clinical services.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing the continuing challenges of developing and implementing clinical practice guidelines.","authors":"Phillip Phan","doi":"10.1093/intqhc/mzae110","DOIUrl":"10.1093/intqhc/mzae110","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Setting standards in residential aged care: identifying achievable benchmarks of care for long-term aged care services.","authors":"Johannes Schwabe, Gillian E Caughey, Robert Jorissen, Tracy Comans, Len Gray, Johanna Westbrook, Jeffrey Braithwaite, Peter Hibbert, Steven Wesselingh, Janet K Sluggett, Nasir Wabe, Maria C Inacio","doi":"10.1093/intqhc/mzae105","DOIUrl":"10.1093/intqhc/mzae105","url":null,"abstract":"<p><strong>Background: </strong>Benchmark is an important aspect of quality measurement and evaluation of long-term care services (LTCS) performance. In this study, we aimed to estimate achievable benchmarks of care (ABC©) for 12 quality indicators used to monitor the quality of care in Australian LTCS and to identify LTCS characteristics associated with attaining the estimated ABC.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using integrated population-based datasets from long-term care, health care, and social welfare sectors within the Registry of Senior Australians (ROSA) National Historical Cohort. All LTCS residents in 2019 were included. Twelve risk-adjusted quality indicators were examined. ABC were defined as the performance level of top-ranked LTCS, including those sequentially from rank 1 onward, until the combined number of residents included at least 10% of all residents nationally. Indicator-specific ABC for 2019 were estimated using Bayesian-adjusted performance fraction ranking. Logistic regressions estimated LTCS characteristics associated with ABC attainment.</p><p><strong>Results: </strong>2746 LTCS and 244 419 residents (≥65 years) between 1 January 2019 and 31 December 2019 were included. The cohort was mostly female (65%), with a median age of 86 years, and 56% had dementia. The ABC provide performance targets based on the observed levels of top-performing LTCS. The ABC for premature mortality (0.007%), weight loss hospitalizations (0.1%), pressure injuries (0.2%), delirium and dementia hospitalizations (0.2%), and medication-related adverse events (0.4%) were lower than 1% and attained by 17-59% of LTCS. The ABC for fractures (1.3%), falls (3.9%), and emergency department presentations (5.1%) were between 1 and 5% and attained by 7-11% of LTCS. The ABC for antipsychotic use (10.5%), chronic opioid use (12.6%), high sedative load exposure (26.8%), and antibiotic use (47.8%) were between 10 and 50% and met by 6-7% of LTCS. Smaller LTCS and government-owned LTCS were more likely to achieve the ABC compared to medium, larger, private, and not-for-profit LTCS.</p><p><strong>Conclusion: </strong>This is the first national estimation of ABC for Australian LTCS, identifying real-world examples of LTCS with relatively better national performance. The ABC are realistic goals for LTCS improvement efforts. They can be leveraged as national standards in quality monitoring reports and incentive programs. Smaller and government LTCS were generally more likely to attain ABC.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11633664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a patient-centered computerized clinical decision support system with patient-level outcome measures.","authors":"Mari Nezu, David Greenfield, Usman Iqbal, Takeshi Morimoto","doi":"10.1093/intqhc/mzae107","DOIUrl":"10.1093/intqhc/mzae107","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of integrated medicines management on quality of discharge medication information-a secondary endpoint in a randomized controlled trial.","authors":"Liv Mathiesen, Tram Bich Michelle Nguyen, Ingrid Dæhlen, Morten Mowé, Marianne Lea","doi":"10.1093/intqhc/mzae100","DOIUrl":"10.1093/intqhc/mzae100","url":null,"abstract":"<p><strong>Background: </strong>High-quality discharge information is important to promote patient safety when patients are transferred from hospital to primary care. Patients with multiple long-term conditions are especially vulnerable to insufficient transfer of medication information, as they use many medications and have complex interactions with the healthcare services. The aim of this study was to investigate the effect of integrated medicines management provided to hospitalized multimorbid patients on the quality of the discharge medication information.</p><p><strong>Methods: </strong>Multimorbid patients ≥18 years, using a minimum of four regular medications from a minimum of two therapeutic medication classes were recruited from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016 and randomly assigned, 1:1, to the intervention or control group. Intervention patients received integrated medicines management throughout the hospital stay. Control patients received standard care. This paper reports the results of a prespecified secondary endpoint analysis of the randomized controlled trial; the difference between the intervention and control group in the quality of discharge medication information.</p><p><strong>Results: </strong>The analysis population comprised 384 patients. Integrated medicines management improved the discharge summary quality score of the medication information from 5.8 ± 1.5 to 8.6 ± 2.6 [mean difference 2.7, 95% confidence interval (CI) 2.3-3.2, P < .001]. In total, 171 intervention patients (89%) received a patient discharge information letter, compared to 66 control patients (35%), P < .001. The quality score of the medication information in the patient discharge information letter was improved from 6.0 ± 1.8 in the control group to 10.0 ± 1.3 in the intervention group (mean difference 4.0, 95% CI 3.6-4.4, P < .001).</p><p><strong>Conclusion: </strong>Integrated medicines management delivered to multimorbid patients during a hospital stay improved the quality of the medication information in discharge summaries as well as patient discharge information letters and ensured that a discharge information letter in lay language was prepared for almost all patients who were involved in the management of their medications after discharge.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}