Joint Commission journal on quality and patient safety最新文献

{"title":"Direct to Radiology Emergency Avoidance Management (DREAM): A Quality Improvement Research Study on Reducing Emergency Department Overcrowding.","authors":"Behroze Adi Vachha, Evan Ruppell, Kevin Reynolds, Rebecca Mahoney, Bruce Weinstein, Max P Rosen, Steven Baccei","doi":"10.1016/j.jcjq.2026.08.002","DOIUrl":"https://doi.org/10.1016/j.jcjq.2026.08.002","url":null,"abstract":"<p><strong>Background: </strong>Primary-care referrals to the emergency department (ED) for advanced imaging, often due to workflow and insurance barriers, contribute to unnecessary ED visits and ED overcrowding. Redirecting lower-acuity patients to outpatient evaluation may reduce treatment time and ease ED burden. This pilot study evaluated a Direct-to-Radiology Emergency Avoidance Management (DREAM) program for outpatients with urgent complaints. The authors hypothesized that DREAM patients would have a shorter time from arrival to imaging report finalization (AIRF) than comparable ED patients who underwent similar computed tomography (CT) examinations and were discharged without requiring higher-level care.</p><p><strong>Methods: </strong>In this retrospective study, primary care patients requiring same-day CT imaging for urgent complaints (defined as conditions requiring timely medical evaluation to prevent clinical deterioration but not necessarily requiring immediate life-saving intervention) were enrolled in the DREAM program and compared to ED patients evaluated during the same period who underwent similar urgent CT examinations and did not require admission/escalation of care. The primary outcome was AIRF (minutes). Ordering outpatient providers and involved radiologists completed a perception survey.</p><p><strong>Results: </strong>A total of 155 patients (median age 61 years) in the DREAM group were compared with 4,182 ED patients (median age 59 years). AIRF for DREAM outpatients (median 156 minutes, interquartile range [IQR] 130-196 minutes) was significantly shorter than the ED cohort (median 305 minutes, IQR 158-484), p < 0.001. Imaging revealed positive findings in 62/155 (40.0%) of DREAM patients; 9 of these were referred to the ED within 48 hours, while the remainder were managed conservatively as outpatients.</p><p><strong>Conclusion: </strong>The DREAM program safely delivered appropriate care for most patients while avoiding unnecessary ED visits and improving efficiency. DREAM may alleviate ED overcrowding and optimize healthcare resource use.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955966","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":"Virtual Practice Facilitation and Implementation of Cardiovascular Quality Improvement Strategies in Primary Care Clinics: A Descriptive Study","authors":"Megan McHugh PhD (is Professor, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine.),&nbsp;Jennifer E. Bannon MSHI, BSN (is Lead Practice Facilitator, Institute for AI in Medicine, Northwestern University Feinberg School of Medicine.),&nbsp;Ann Kan MS (is Data Analyst, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine.),&nbsp;Amy Krefman MS (is Doctoral Student, Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine.),&nbsp;Carrie Butt (is Practice Facilitator, Altarum, Ann Arbor, Michigan.),&nbsp;JD Smith PhD (is Associate Professor, Spencer Fox Eccles School of Medicine, University of Utah.),&nbsp;Anya Day MPH (is Vice President, Altarum.),&nbsp;Theresa L. Walunas PhD (is Associate Professor, Institute for AI in Medicine, Northwestern University Feinberg School of Medicine. Please address correspondence to Megan McHugh)","doi":"10.1016/j.jcjq.2026.04.005","DOIUrl":"10.1016/j.jcjq.2026.04.005","url":null,"abstract":"<div><h3>Background</h3><div>Practice facilitation (or practice coaching) is a scientifically supported approach for improving evidence-based guideline adoption in primary care. Practice facilitation has historically occurred in person; however, the COVID-19 pandemic led to the adoption of many hybrid and virtual practice facilitation (VPF) projects. The impact of VPF on quality improvement (QI) implementation outcomes is unknown. The purpose of this study was to describe the relationship between VPF and implementation of 18 evidence-based QI strategies, based on a hybrid cardiovascular QI project in 49 primary care clinics in Michigan.</div></div><div><h3>Methods</h3><div>This was an exploratory study drawing on interviews and descriptive statistics. The authors conducted interviews with 5 practice facilitators (PFs) to identify their perspectives on the strategies most appropriate for VPF and perceived effects of VPF on implementation. Descriptive statistics were used to report practices’ use of VPF and total implementation scores after 12 months.</div></div><div><h3>Results</h3><div>Approximately 20% (62 of 304) of facilitation meetings were virtual. PFs reported that in-person facilitation was beneficial for strategies involving observation, demonstration, and workflow changes (for example, blood pressure measurement); virtual facilitation was appropriate for strategies involving information sharing (for example, referrals to quit line). Practices that received some or all of their QI time virtually showed a larger increase in total implementation score after one year, compared to those who received all visits in person.</div></div><div><h3>Conclusion</h3><div>Some QI strategies, particularly those involving information sharing, may be well suited to VPF, while others that require observation or workflow change may benefit from in-person support. Practices that used at least some VPF showed greater improvements in implementation scores, though future research is needed to more rigorously assess how facilitation modality relates to implementation outcomes.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"52 8","pages":"Pages 350-357"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147929714","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":"Using Artificial Intelligence to Detect Housing Status in Unstructured Electronic Health Record Data","authors":"Abbott Gifford BA (is Medical Student, University of California, San Francisco (UCSF) School of Medicine),&nbsp;Shraddha Pandey BA (is Research Fellow and Medical Student, UCSF School of Medicine),&nbsp;Hannah Decker MD (is Research Fellow and Resident Physician, Department of Surgery, UCSF),&nbsp;Margot Kushel MD (is Professor and Division Chief, Division of Health and Society, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, and Director, UCSF Benioff Homelessness and Housing Initiative),&nbsp;Logan Pierce MD (is Assistant Clinical Professor, Division of Hospital Medicine, Department of Medicine, UCSF, and Managing Director, Department of Medicine Data Core, UCSF),&nbsp;Elizabeth Wick MD (is a colorectal surgeon and Professor of Surgery and Vice Chair for Quality and Safety, Department of Surgery, University of California, San Francisco. Please address correspondence to Elizabeth Wick)","doi":"10.1016/j.jcjq.2026.04.010","DOIUrl":"10.1016/j.jcjq.2026.04.010","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"52 8","pages":"Pages 406-408"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971818","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":"Complex Factors Associated with Disruptive Medical Professional Behavior","authors":"Lori A. Crane PhD, MPH (is Principal Researcher, Colorado Physician Health Program, Denver, and Professor, Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus,),&nbsp;Sarah R. Early PsyD (is Executive Director, Colorado Physician Health Program,),&nbsp;Amanda L. Kimmel MPA (is Director of Public Affairs, Colorado Physician Health Program,),&nbsp;Joyce M. Davidson PhD, LCSW (is Director of Clinical Services, Colorado Physician Health Program,),&nbsp;Laura F. Martin MD (is Associate Medical Director, Colorado Physician Health Program,),&nbsp;Michael H. Gendel MD (is Medical Director Emeritus, Colorado Physician Health Program,),&nbsp;Doris C. Gundersen MD (is Medical Director Emerita, Colorado Physician Health Program,),&nbsp;Scott A. Humphreys MD (is Medical Director, Colorado Physician Health Program. Please address correspondence to Lori A. Crane)","doi":"10.1016/j.jcjq.2026.04.002","DOIUrl":"10.1016/j.jcjq.2026.04.002","url":null,"abstract":"<div><h3>Background</h3><div>Disruptive behavior in medical settings, which includes bullying, intimidating, and other behaviors, is associated with medical errors, low patient and team satisfaction, high job turnover, and understaffing throughout the healthcare system. State-level Physician and Professional Health Programs (PHPs) provide valuable coordination of evaluation, treatment, and monitoring for disruptive behavior in medical settings. The aim of this study was to describe characteristics of 308 physicians, physician assistants, anesthesiology assistants, and trainees in these fields referred to the Colorado Physician Health Program (CPHP) for disruptive behavior between 2015 and 2022.</div></div><div><h3>Methods</h3><div>Using agency records and case reviews, the authors describe participant characteristics, diagnoses, recommendations for treatment and third-party evaluations, bivariate relationships, and outcomes.</div></div><div><h3>Results</h3><div>Nearly three quarters of participants were male and had mandatory referrals. With a comprehensive evaluation conducted by a psychiatrist, 33.1% received a psychiatric diagnosis and 26.3% were identified as having symptoms of a personality disorder. Situational stress was identified in 54.9%, with workplace stress being most common and more frequent in females (46.2%) than males (34.1%) (<em>p</em> &lt; 0.05). The most recommended treatment was coaching (49.7%), followed by therapy (29.9%), psychiatric treatment (17.2%), and education (14.3%). Nearly all (95.1%) successfully completed participation, with 57.8% completing within one year. Those with psychiatric diagnoses took longer to complete participation (median 390 vs. 279 days; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Thorough assessment of disruptive behavior can uncover multiple underlying conditions in providers and the systems in which they work. Agencies tasked with addressing this behavior should identify underlying conditions and consider them when developing personalized treatment plans that may address more than disruptive behavior.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"52 8","pages":"Pages 332-341"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856265","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":"Assessing Clinicians with Persistent and Severe Professionalism Concerns: Implications of a Statewide Physician and Professional Health Program Evaluation for Quality, Safety, and Professional Culture","authors":"William O. Cooper MD, MPH (is Professor, Departments of Pediatrics and Health Policy, and President, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center.),&nbsp;Gerald B. Hickson MD (is Professor of Pediatrics and Medical Education and Founding Director, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center. Please address correspondence to William O. Cooper)","doi":"10.1016/j.jcjq.2026.05.003","DOIUrl":"10.1016/j.jcjq.2026.05.003","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"52 8","pages":"Pages 329-331"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143519","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":"Predicting the Sustainability of Quality Improvement Initiatives in Healthcare: A Data-Driven Study","authors":"Jiun-Yih Lee MHA (is Section Chief, Shin Kong Wu Ho-Su Memorial Hospital.),&nbsp;Jui-Ting Chang MD, PhD (is Director of Center for Lean Healthcare Quality Management, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, and Assistant Professor, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan. Please address correspondence to Jui-Ting Chang)","doi":"10.1016/j.jcjq.2026.04.006","DOIUrl":"10.1016/j.jcjq.2026.04.006","url":null,"abstract":"<div><h3>Background</h3><div>Sustaining the effects of healthcare quality improvement (QI) initiatives remains a persistent challenge. Although sustainability is widely recognized as an important goal of QI, empirical evidence on factors associated with post-project persistence remains limited. This study aimed to identify factors associated with post-project persistence in hospital-based QI initiatives and to examine the feasibility of using a random forest model to classify projects across persistence-duration categories.</div></div><div><h3>Methods</h3><div>This retrospective cross-sectional study analyzed 123 QI projects implemented at a tertiary medical center in Taiwan between 2015 and 2023. Sustainability was operationalized as the duration of observable post-project effects documented in project records and classified into three categories: &lt; 1 year, 1–3 years, and &gt; 3 years. Twenty candidate factors were assessed using a study-specific questionnaire with acceptable content validity (content validity index [CVI] 0.92). A random forest classifier was developed using 10-fold cross-validation and evaluated using class-specific area under the ROC (receiver operating characteristic) curve (AUC), F1-score, and confusion matrix analysis.</div></div><div><h3>Results</h3><div>The most influential predictors were alignment with clinical needs (17.67%), substantial benefits to patients (15.06%), team members’ knowledge and skills in QI (14.38%), degree of information technology intervention (10.31%), and improvements in work efficiency (10.31%). Model performance was strongest for the &lt; 1-year and 1–3-year categories, with AUC values of 0.99 and 0.91, respectively. Performance for the &gt; 3-year category was more limited (AUC 0.87, F1-score 0.29), with only one long-term case correctly classified in the test set, likely reflecting class imbalance and the small number of long-term projects. Five critical factors influencing sustainability were identified: alignment with clinical needs, substantial patient benefits, team competency in QI methods, information technology integration, and work efficiency improvements. The model demonstrated high predictive accuracy for short- and mid-term sustainability but lower accuracy for long-term impacts due to sample imbalances.</div></div><div><h3>Conclusion</h3><div>This study provides preliminary evidence that post-project persistence in healthcare QI initiatives is associated with clinical alignment, patient benefit, team QI competency, information technology support, and work efficiency improvement. The random forest model performed better in distinguishing short- and mid-term persistence than long-term persistence. These findings offer an initial data-driven basis for understanding conditions that may support the persistence of QI effects in practice and support the need for further multicenter validation.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"52 8","pages":"Pages 358-364"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147948561","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":"Stakeholders’ Attitudes on Automating Data Abstraction in a Surgical Quality Improvement Program","authors":"Trenton M. Haltom PhD (Qualitative Methodologist, Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston, and Assistant Professor, Department of Medicine, Section of Health Services Research, Baylor College of Medicine),&nbsp;Tracey Rosen MSPH (Senior Program Manager–Research, Department of Management, Policy, and Community Health, University of Texas School of Public Health),&nbsp;Patricia V. Chen PhD (Qualitative Methodologist, IQuESt, and Assistant Professor, Department of Medicine, Section of Health Services Research, Baylor College of Medicine),&nbsp;Laura A. Petersen MD MPH (Center Director, IQuESt, and Professor, Department of Medicine, Section of Health Services Research, Baylor College of Medicine),&nbsp;Alex H.S. Harris PhD, MS (Research Career Scientist, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, and Professor, Department of Surgery, Stanford University),&nbsp;Nader N. Massarweh MD, MPH (Senior Vice President and Chief Quality officer, Grady Health System, Atlanta. Please address correspondence to Trenton M. Haltom)","doi":"10.1016/j.jcjq.2026.04.012","DOIUrl":"10.1016/j.jcjq.2026.04.012","url":null,"abstract":"<div><h3>Background</h3><div>National surgical quality improvement programs rely on a labor-intensive process of manual data abstraction. There have been few efforts to understand stakeholders’ attitudes on programmatic workflows, data collection processes, or identification of modifications to workflows that might enhance efficiency. Given contemporary data science methods, the attitudes of stakeholders regarding data collection automation could have implications for future national quality program modernization efforts.</div></div><div><h3>Methods</h3><div>Qualitative interviews were conducted with US Department of Veterans Affairs (VA) surgical quality nurses (SQNs) and researchers who use VA Surgical Quality Improvement (VASQIP) data from a national integrated health system. All transcripts were analyzed using thematic analysis.</div></div><div><h3>Results</h3><div>Data were obtained from 42 interviews (26 with SQNs and 16 with researchers) from 37 medical facilities across the United States. The authors found five themes pertaining to participant’s attitudes regarding (1) automating data abstraction, (2) interpreting variable definitions, (3) the need for standardizing documentation, (4) factoring in human review of data collected automatically, and (5) SQNs’ job security concerns.</div></div><div><h3>Conclusion</h3><div>SQNs and VASQIP researchers expressed general interest and optimism about developing data science methods to automate data collection. However, participants considered human review a necessary part of data collection. More work is needed on how to automate data collection within existing surgical quality improvement programs.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"52 8","pages":"Pages 342-349"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148225390","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":"Using Large Language Models to Determine Reasons for Missed Colon Cancer Screening Follow-Up","authors":"Christopher Y.K. Williams MB BChir, MA (is CEO at Quality Health (qualityhealth.io) and was previously Postdoctoral Scholar, Bakar Computational Health Sciences Institute, University of California, San Francisco (UCSF).),&nbsp;Urmimala Sarkar MD, MPH (is Professor, Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and UCSF.),&nbsp;Julia Adler-Milstein PhD (is Professor, Division of Clinical Informatics and Digital Transformation, Department of Medicine, UCSF.),&nbsp;Lisa Rotenstein MD, MBA (is Associate Professor, Division of Clinical Informatics and Digital Transformation, and Division of General Internal Medicine, Department of Medicine, UCSF. Please address correspondence to Christopher Y. K. Williams)","doi":"10.1016/j.jcjq.2026.04.003","DOIUrl":"10.1016/j.jcjq.2026.04.003","url":null,"abstract":"<div><h3>Background</h3><div>Identifying reasons for missed preventive care, such as follow-up colonoscopy after an abnormal stool-based colon cancer screening test, is critical for quality improvement initiatives. However, manual chart review is time-consuming and costly. This study serves as a proof-of-concept demonstration of using large language models (LLMs) to automate the identification of documented reasons for care gaps.</div></div><div><h3>Methods</h3><div>In this cross-sectional study of patients aged 45 years or older at the University of California, San Francisco with an abnormal outpatient fecal immunochemical test/fecal occult blood test (FIT/FOBT) who did not undergo a colonoscopy within 90 days of the abnormal test, the authors investigated the potential of an LLM to determine (a) whether reasons for a lack of follow-up colonoscopy are documented in the clinical notes and (b) whether an LLM can accurately classify those reasons into clinically meaningful categories.</div></div><div><h3>Results</h3><div>A total of 846 patients with abnormal FIT/FOBTs who did not receive a colonoscopy within 90 days of the abnormal test were included in this study. Based on LLM categorization of patient note content, 270 (31.9%) patients did not have any reference to colonoscopy/colorectal cancer screening in their notes, 379 (44.8%) patients had mentions of colonoscopy/colorectal cancer screening without explicit reasons for not having a colonoscopy provided, and 197 (23.3%) patients had notes detailing explicit reasons for not having a colonoscopy. Overall LLM classification accuracy was 89.0%. The most common reasons for not having a colonoscopy included refused/not interested (35.2%), comorbidities (18.7%), and patient unavailable (16.8%).</div></div><div><h3>Conclusion</h3><div>This pilot study suggests that LLMs can accurately categorize reasons for the absence of follow-up colonoscopy after an abnormal FIT/FOBT. These results suggest that LLMs have the potential to automate chart review for quality improvement initiatives.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"52 8","pages":"Pages 392-399"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874495","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":"A Comparative Analysis of Hospital-Acquired Complications and Sentinel Event Reporting Across Australia, Canada, New Zealand, England, and the United States","authors":"Lauren T. Southerland MD MPH (is Associate Professor, Department of Emergency Medicine, Ohio State University College of Medicine.),&nbsp;James D. van Oppen PhD, FRCEM, MRCP (FRCEM, MRCP, is Clinical Lecturer in Emergency Medicine, Centre for Urgent and Emergency Care Research, University of Sheffield.),&nbsp;Lucas B. Chartier MDCM, MPH, MBA (is Chief Patient Safety Officer, Department of Emergency Medicine, University Health Network, Toronto, and Associate Professor, Division of Emergency Medicine, Department of Medicine, University of Toronto.),&nbsp;Samuel F. Allingham BMath(Hons), MBiostat (is Senior Health Data Analyst, Australian Commission on Safety and Quality in Health Care, Sydney.),&nbsp;Alasdair M.J. MacLullich PhD (is Professor of Geriatric Medicine, Edinburgh Delirium Research Group, Ageing and Health, University of Edinburgh.),&nbsp;Carolyn Hullick BMed, PhD (is Chief Medical Officer, Australian Commission on Safety and Quality in Health Care, and Conjoint Associate Professor, University of Newcastle. Please address correspondence to Lauren T. Southerland)","doi":"10.1016/j.jcjq.2026.04.011","DOIUrl":"10.1016/j.jcjq.2026.04.011","url":null,"abstract":"<div><h3>Background</h3><div>National health systems evaluate hospital safety and quality by incentivizing or mandating the reporting of both <em>hospital-acquired complications</em> (HACs), which are potentially preventable iatrogenic conditions, and <em>sentinel events,</em> which are potentially preventable but severely harmful incidents. The objective of this study was to describe the landscape of currently reported hospital quality measures across countries.</div></div><div><h3>Methods</h3><div>The authors compared HACs and sentinel events across five well-developed national reporting systems (Australia, Canada, New Zealand, England, and the United States) and collated publicly reported rates and/or event counts. Reported measures were first categorized using existing Australian groupings, with additional categories added by consensus.</div></div><div><h3>Results</h3><div>Per country, the number of unique HACs ranged from 7 to 43. The United States, Australia, New Zealand, and Canada have measures in the categories of <em>Pressure injuries, Falls and in-hospital injuries, Healthcare-associated infections</em>, and <em>Thromboembolism</em>. The United Kingdom England system reports aggregated counts under broader categories. Per country, the number of unique sentinel events ranged from 5 to 17 measures. “Unintended retention of a foreign body after a surgery” and “transfusion of incompatible blood” are a HAC, a sentinel event, or both depending on national definitions.</div></div><div><h3>Conclusion</h3><div>Hospital quality reporting varies considerably across countries, which may complicate comparisons and sharing of successful improvement strategies. Targets for harmonization were identified.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"52 8","pages":"Pages 374-391"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015412","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":"Bridging Language Gaps in Emergency Care: Expanding Qualified Bilingual Staff and Evaluating Interpreter Modalities","authors":"Amy Mu BA (is Medical Student, University of Texas Southwestern Medical Center, Dallas.),&nbsp;Kristin S. Alvarez PharmD (is Senior Director, Value Based Care, Center of Innovation and Value, Parkland Health, Dallas.),&nbsp;Wendy Young BSN, MBA (is Director, Language Services, Parkland Health.),&nbsp;Abeer Abdelrahim MPH (is Medical Student, University of Texas Southwestern Medical Center.),&nbsp;Jillian Smartt BSN, RN, CCRP (is Research Program Coordinator, Center of Innovation and Value, Parkland Health.),&nbsp;Lonnie Roy PhD (is Director Health Systems Research, Parkland Health.),&nbsp;Carl Mirus IV MD, MPH (is Assistant Professor of Emergency Medicine, University of Texas Southwestern Medical Center. Please address correspondence to Carl Mirus IV)","doi":"10.1016/j.jcjq.2026.04.008","DOIUrl":"10.1016/j.jcjq.2026.04.008","url":null,"abstract":"<div><h3>Background</h3><div>Language concordant care (LCC) improves safety and equity for patients with non-English language preferences (NELP). In emergency departments (EDs), high volume and acuity can exacerbate language barriers. At Parkland Health, a large safety-net hospital, few ED physicians held Qualified Bilingual Staff (QBS) designation despite a significant Spanish-speaking patient population. This quality improvement initiative aimed to increase QBS certification by 25% and exam attempts by 50% from February 2024 to October 2024, with a secondary aim to assess interpreter modality preferences among non-bilingual physicians.</div></div><div><h3>Methods</h3><div>Using Plan-Do-Study-Act cycles, we surveyed 181 ED physicians on language proficiency, QBS awareness, and testing barriers. Interventions included adjusting exam logistics and clinical relevance, recognizing Spanish-speaking medical school graduates as QBS-eligible without testing, and publicizing changes to acknowledge physician feedback. Interpreter preferences were collected from non-bilingual respondents. Data were analyzed descriptively.</div></div><div><h3>Results</h3><div>Survey response rate was 81% (147/181). Of respondents, 83/147 (56%) spoke a non-English language, with 69/83 (83%) reporting Spanish. At baseline, 4/69 (6%) of Spanish-speaking physicians held QBS designation. Eight months later, 15/69 (22%) had attempted certification, resulting in 12/69 (17%) becoming QBS-designated. Almost all non-bilingual respondents preferred in-person interpreters (44/44, 100%). In-person services were valued for rapport and accuracy; technical issues were reported with video interpretation.</div></div><div><h3>Conclusions</h3><div>Removing logistical barriers and incorporating physician feedback increased QBS designation in a large, multilingual ED. The gap between preference and use of in-person interpretation highlights the need for faster access to in-person services or more reliable alternatives. Sustaining gains will require ongoing feedback, preparation resources, and tracking patient outcomes to inform expansion.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"52 8","pages":"Pages 365-373"},"PeriodicalIF":3.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283594","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}