Joint Commission journal on quality and patient safety最新文献

{"title":"The Joint Commission Journal on Quality and Patient Safety 50th Anniversary Article Collections: Diagnostic Excellence","authors":"","doi":"10.1016/j.jcjq.2024.09.003","DOIUrl":"10.1016/j.jcjq.2024.09.003","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528268","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":"Supporting Professionalism in a Crisis Requires Leadership and a Well-Developed Plan.","authors":"Gerald B Hickson","doi":"10.1016/j.jcjq.2024.10.007","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.10.007","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590582","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":"Quality and Simulation Professionals Should Collaborate.","authors":"Amy Lu, May C M Pian-Smith, Amanda Burden, Gladys L Fernandez, Sally A Fortner, Robert V Rege, Douglas P Slakey, Jose M Velasco, Jeffrey B Cooper, Randolph H Steadman","doi":"10.1016/j.jcjq.2024.10.001","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.10.001","url":null,"abstract":"<p><p>Simulation is underutilized as a tool to improve healthcare quality and safety despite many examples of its effectiveness to identify and remedy quality and safety problems, improve teamwork, and improve various measures of quality and safety that are important to healthcare organizations, eg, patient safety indicators. We urge quality and safety and simulation professionals to collaborate with their counterparts in their organizations to employ simulation in ways that improve the quality and safety of care of their patients. These collaborations could begin through initiating conversations among the quality and safety and simulation professionals, perhaps using this article as a prompt for discussion, identifying one area in need of quality and safety improvement for which simulation can be helpful, and beginning that work. (Sim Healthcare 19(5):319-325, 2024).</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557876","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 Joint Commission Journal on Quality and Patient Safety 50th Anniversary Article Collections: Quality Improvement in Non-Hospital Settings","authors":"","doi":"10.1016/j.jcjq.2024.08.008","DOIUrl":"10.1016/j.jcjq.2024.08.008","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024002629/pdfft?md5=ff5842c0ca54fcf1a36685f7a3a60b9f&pid=1-s2.0-S1553725024002629-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314253","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":"Strategies to Mitigate the Pandemic Aftermath on Perioperative Professionalism.","authors":"Crystal C Wright, Maureen D Triller, Anne S Tsao, Stephanie A Zajac, Cindy Segal, Elizabeth P Ninan, Jenise B Rice, William O Cooper, Carin A Hagberg, Mark W Clemens","doi":"10.1016/j.jcjq.2024.09.004","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.09.004","url":null,"abstract":"<p><strong>Background: </strong>This retrospective comparative cohort study aimed to evaluate the effects of COVID-19 on professionalism within the perioperative environment of a tertiary cancer center across three periods: pre-pandemic, pandemic, and an interventional endemic phase.</p><p><strong>Methods: </strong>A retrospective observational review of a prospectively maintained safety event report (SER) database at MD Anderson Cancer Center, with an intervention during the COVID-19 endemic phase, was conducted. This was performed to compare the incidence of professionalism-related events (PRE), which are included in the SER database, during the COVID-19 pandemic period (March 2020 to May 2022), with a pre-pandemic period (September 2011 to February 2020) and a postintervention endemic phase (June 2022 to March 2023). Study interventions included the application of the Vanderbilt Professionalism Escalation Model with broad staff and surgical team education.</p><p><strong>Results: </strong>During the study period, 17,425 SERs were reviewed. Of these, 11,731 (mean 115.0 SERs/month) were reported in the pre-pandemic period, 4,004 SERs (mean 148.3 SERs/month) in the pandemic period, and 1,690 SERs (mean 169.0 SERs/month) in the endemic phase (p = 0.001). There was a statistically significant increase in the incidence of PRE during the pandemic compared to the pre-pandemic and endemic periods. Specifically, 264 PRE (1.5%) were identified during the study period: 114 PRE (mean 1.1 PRE/month) in the pre-pandemic period, 121 PRE (mean 4.5 PRE/month) in the pandemic period, and 29 PRE (mean 2.9 PRE/month) in the endemic phase (p = 0.001). The increase in PRE during the pandemic period corresponded to a concomitant increase in staff turnover rates (15.5%) compared to the pre-pandemic period (8.3%). However, a time shift of four months into the postintervention endemic phase demonstrated a successful reduction to less than pre-pandemic levels of staff turnover (6.7%, p = 0.001).</p><p><strong>Conclusion: </strong>The COVID-19 pandemic was associated with a significant increase in SERs describing professionalism lapses among health care providers in the perioperative environment. Hospital organizations must recognize the impact of professionalism on morale and turnover and seek to mitigate its effects. Education, promoting individual accountability, confidential reporting, addressing wellness concerns, and providing modes of resilience can enhance workplace culture and potentially cultivate better employee retention rates.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590577","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":"Engaging Physicians in Improvement Priorities Through the American Board of Medical Specialties Portfolio Program.","authors":"Teena Nelson, Spencer Walter, Ann Williamson, Kevin Graves, Peggy Paulson, Greg Ogrinc","doi":"10.1016/j.jcjq.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.09.001","url":null,"abstract":"<p><strong>Background: </strong>Physician involvement in quality improvement and patient safety (QIPS) work is critical for success. It is often difficult to engage physicians in this work given competing priorities and lack of individual benefits for participation.</p><p><strong>Program inception and development: </strong>The American Board of Medical Specialties (ABMS) Portfolio Program was created to establish a systematic process for review and approval of health care organizations' implementation of QIPS work and that allows organizations to offer continuing certification credit to physicians who meaningfully engage in that same work. What started as a pilot program in 2010 between Mayo Clinic and the American Boards of Family Medicine, Internal Medicine, and Pediatrics has grown to include more than 100 organizations in 2024.</p><p><strong>Evolution of the program: </strong>The Portfolio Program has expanded from academic medical centers and medical schools to include government agencies, hospital groups, associations, and other types of health organizations. It has provided credit for more than 5,000 activities, and credit has been issued to physicians more than 60,000 times. To make QIPS submissions easier, standardized templates were created for certain types of quality improvement work; for example, the COVID-19 template facilitated the awarding of continuing certification credit to more than 10,000 physicians.</p><p><strong>Conclusion: </strong>The ABMS Portfolio Program helps organizations establish a framework around QIPS work so physicians can receive continuing certification credit for their engagement. It also provides structure to establish processes and procedures for awarding credit and is flexible enough to meet the needs of each organization.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500818","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":"Health Care Workers' Trust in Leadership: Why It Matters and How Leaders Can Build It.","authors":"Jessica Greene, Diane Gibson, Lauren A Taylor, Daniel B Wolfson","doi":"10.1016/j.jcjq.2024.09.002","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.09.002","url":null,"abstract":"<p><strong>Background: </strong>Rebuilding patient trust in the US health care system has received considerable attention recently, but there has been little focus on health care workers' (HCWs) trust in the leaders of health care delivery organizations. This study explores (1) the professional impact on HCWs of trusting the leaders of the organizations where they work and (2) the leadership actions that build HCWs' trust.</p><p><strong>Methods: </strong>The authors examined these questions using a survey that was crowdsourced to 353 HCWs through social media posts and e-mails from national health organizations. For each open-ended question, qualitative codes were identified, iteratively finalized, and applied to each response. Descriptive statistics were used to analyze the closed-ended questions and examine how often each qualitative code was raised.</p><p><strong>Results: </strong>One in five (20.2%) HCWs trusted leadership \"very much,\" more than a third (36.9%) trusted \"somewhat,\" and 42.9% had lower levels of trust. Almost all (97.7%) reported that the degree of trust they had in their organization's leadership affected them professionally. Among HCWs who trusted their organization's leadership, the most common impact was feeling professional satisfaction, followed by providing higher-quality work. HCWs described three main ways health care organization leaders earned their trust: communicating effectively (being transparent and soliciting HCWs' input), treating HCWs well (with respect and kindness and providing good compensation), and prioritizing patient care.</p><p><strong>Conclusion: </strong>The findings suggest health care organizations would benefit from leaders seeking to earn HCWs' trust. With trust in leadership, HCWs report higher work quality and greater professional satisfaction.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466008","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":"Housing Instability Screening and Referral Programs: A Scoping Review.","authors":"Shravan Asthana, Luis Gago, Joshua Garcia, Molly Beestrum, Teresa Pollack, Lori Post, Cynthia Barnard, Mita Sanghavi Goel","doi":"10.1016/j.jcjq.2024.08.007","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.08.007","url":null,"abstract":"<p><strong>Background: </strong>Housing instability in the United States is a critical social determinant of health, influencing health outcomes and health care utilization. This scoping review aimed to analyze literature on US health system screening and response programs addressing housing instability, highlighting methodologies, geographic and demographic variations, and policy implications.</p><p><strong>Methods: </strong>Adhering to PRISMA-ScR guidelines, the review included studies focusing on US health systems that screen and refer for housing instability. Major scholarly databases, including PubMed and Scopus, were queried. Screening and response program characteristics, methodologies, and outcomes were characterized.</p><p><strong>Results: </strong>Thirty studies published between 2003 and 2023 were included in this study. Included studies were primarily cross-sectional (26.7%) or quality improvement (20.0%), among 9 other designs. Screening programs were predominantly implemented in academic hospital systems (46.7%) and in the Northeast (63.3%). Of the 25 adult population studies, 68.0% were in outpatient settings, and of the 23 studies providing detailed information on their process, 52.2% used electronic health record entry. Of the 22 studies that describe their screening tool, 15 used institution-specific tools, and only 4 of the remaining 7 studies used identical tools. Of the 20 studies that described their response to positive screenings, 13 provided patients with a paper or electronic referral to a collaborating community partner, while only 6 aided the patient in connecting with community resources.</p><p><strong>Conclusion: </strong>This study found significant variability in screening and response programs for housing instability among US health care providers. A lack of standardized definitions and methodologies hampers effective comparison and implementation of these programs. Future research should focus on standardizing screening methods and measurement of interventions and outcomes to address housing instability.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400262","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":"Reducing Automated Dispensing Cabinet Overrides in the Perianesthesia Care Unit: A Quality Improvement Project.","authors":"Christine D Franciscovich, Anna Bieniek, Katie Dunn, Ursula Nawab","doi":"10.1016/j.jcjq.2024.08.006","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.08.006","url":null,"abstract":"<p><strong>Background: </strong>Automated dispensing cabinets (ADCs) are used to store and dispense medications at the point of care. Medications accessed from an ADC before pharmacist order verification are removed using override functionality. Bypassing pharmacist verification can lead to medication errors; therefore, The Joint Commission considers overrides acceptable only in limited scenarios. During an 18-month period, the override rate in our perianesthesia care unit (PACU) was 17%, with oral midazolam accounting for roughly 40% of overrides. A multidisciplinary quality improvement (QI) project was initiated with a goal to reduce overrides by 10% (17% to 15%) by December 31, 2021.</p><p><strong>Methods: </strong>Key drivers for reducing overrides included timely medication order entry, nursing practice to wait for verification, and timely pharmacist medication order verification. Interventions related to the latter two drivers included nursing education, individual interviews, and a workflow change involving nurse-to-pharmacy communication prior to medication overrides. Interventions were implemented in three Plan-Do-Study-Act cycles beginning in July 2021. Outcome metrics were average monthly percentage of total medication overrides and overrides for oral midazolam, which were analyzed using statistical process control charts.</p><p><strong>Results: </strong>Following interventions, the average monthly percentage of total medication overrides decreased from 17% to 8% in July 2021, and further to 4% in February 2022. Oral midazolam overrides decreased from 22% to 9% in July 2021, and further to 3% in February 2022.</p><p><strong>Conclusion: </strong>Both total and oral midazolam overrides were reduced by changing nursing and pharmacy workflow. Reducing ADC overrides is a complex process balancing operational flow and safety efforts.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390713","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 Burden of Health Care Utilization, Cost, and Mortality Associated with Select Surgical Site Infections.","authors":"Sonali Shambhu, Aliza S Gordon, Ying Liu, Maximilian Pany, William V Padula, Peter J Pronovost, Eugene Hsu","doi":"10.1016/j.jcjq.2024.08.005","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.08.005","url":null,"abstract":"<p><strong>Objective: </strong>To assess the additional health care utilization, cost, and mortality resulting from three surgical site infections (SSIs): mediastinitis/SSI after coronary artery bypass graft, SSI after bariatric surgery for obesity, and SSI after certain orthopedic procedures.</p><p><strong>Methods: </strong>This retrospective observational cohort study used commercial and Medicare Advantage/Supplement claims from 2016 to 2021. Patients with one of three SSIs were compared to a 1:1 propensity score-matched group of patients with the same surgeries but without SSI on outcomes up to one year postdischarge.</p><p><strong>Results: </strong>The total sample size was 4,620. Compared to their matched cohorts, the three SSI cohorts had longer mean index inpatient length of stay (LOS; adjusted days difference ranged from 1.73 to 6.27 days, all p < 0.001) and higher 30-day readmission rates (adjusted odds ratio ranged from 2.83 to 25.07, all p ≤ 0.001). The SSI cohort for orthopedic procedures had higher 12-month mortality (hazard ratio 1.56, p = 0.01), though other cohorts did not have significant differences. Total medical costs were higher in all three SSI cohorts vs. matched comparison cohorts for the index episode and 6 months and 1 year postdischarge. Average adjusted 1-year total medical cost differences ranged from $40,606 to $68,101 per person, depending on the cohort (p < 0.001), with out-of-pocket cost differences ranging from $330 to $860 (p < 0.05).</p><p><strong>Conclusion: </strong>Patients with SSIs experienced higher LOS, readmission rates, and total medical costs, and higher mortality for some populations, compared to their matched comparison cohorts during the first year postdischarge. Identifying strategies to reduce SSIs is important both for patient outcomes and affordability of care.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390714","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}