Joint Commission journal on quality and patient safety最新文献

{"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":" ","pages":""},"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}

{"title":"The Joint Commission Journal on Quality and Patient Safety 50th Anniversary Article Collections: 50 Most Cited","authors":"","doi":"10.1016/j.jcjq.2024.07.006","DOIUrl":"10.1016/j.jcjq.2024.07.006","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 9","pages":"Pages 684-685"},"PeriodicalIF":2.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024002265/pdfft?md5=e1a7dfef405dcc387e584b3062d4cae1&pid=1-s2.0-S1553725024002265-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040660","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":"Preserving Resources: The Vital Role of Antimicrobial Stewardship Programs in Mitigating Antimicrobial Shortages.","authors":"Jennifer A Schweiger, Nicole M Poole, Sarah K Parker, John S Kim, Christine E MacBrayne","doi":"10.1016/j.jcjq.2024.08.002","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.08.002","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466009","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":"Identification of Hospitalized Patients Who May Benefit from a Serious Illness Conversation Using the Readmission Risk Score Combined with the Surprise Question.","authors":"Myrna Katalina Serna, Katrina Grace Sadang, Hanna B Vollbrecht, Catherine Yoon, Julie Fiskio, Joshua R Lakin, Anuj K Dalal, Jeffrey L Schnipper","doi":"10.1016/j.jcjq.2024.08.003","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.08.003","url":null,"abstract":"<p><strong>Background: </strong>Determining which patients benefit from a serious illness conversation (SIC) is challenging. The authors sought to determine whether Epic's Risk of Readmission Score (RRS), could be combined with a simple, validated, one-question mortality prognostic screen (the surprise question: Would you be surprised if the patient died in the next 12 months?) to identify hospitalized patients with SIC needs.</p><p><strong>Methods: </strong>In this retrospective study, the authors randomly selected encounters for patients ≥ 18 years of age to a general medicine service from January 2019 to October 2021 who had an RRS > 28%. Two adjudicators independently performed chart reviews for each encounter to answer the surprise question to create two distinct prognostic groups (yes vs. no). Fisher's exact test was used to assess for statistically significant differences in standardized documentation of SICs between groups.</p><p><strong>Results: </strong>Out of 2,879 encounters, 202 patient encounters were randomly selected. Adjudicators answered \"no\" to the surprise question for 156 (77.2%) patients. Patients for whom adjudicators answered \"no\" were generally older with higher comorbidity and more often had standardized documentation of a SIC (14 [9.0%] vs. 0.[0.0%], p = 0.042) compared to patients for whom adjudicators answered \"yes.\"</p><p><strong>Conclusion: </strong>Approximately three quarters of patients with a high RRS were predicted to have a lifespan of less than a year. Although these patients were significantly more likely to have a SIC, rates of SICs were extremely low. Combining available electronic health record (EHR) data with a simple one-question screening tool may help identify hospitalized patients who require a SIC in quality improvement initiatives.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287755","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":"Accuracy of a Proprietary Large Language Model in Labeling Obstetric Incident Reports.","authors":"Jeanene Johnson, Conner Brown, Grace Lee, Keith Morse","doi":"10.1016/j.jcjq.2024.08.001","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.08.001","url":null,"abstract":"<p><strong>Background: </strong>Using the data collected through incident reporting systems is challenging, as it is a large volume of primarily qualitative information. Large language models (LLMs), such as ChatGPT, provide novel capabilities in text summarization and labeling that could support safety data trending and early identification of opportunities to prevent patient harm. This study assessed the capability of a proprietary LLM (GPT-3.5) to automatically label a cross-sectional sample of real-world obstetric incident reports.</p><p><strong>Methods: </strong>A sample of 370 incident reports submitted to inpatient obstetric units between December 2022 and May 2023 was extracted. Human-annotated labels were assigned by a clinician reviewer and considered gold standard. The LLM was prompted to label incident reports relying solely on its pretrained knowledge and information included in the prompt. Primary outcomes assessed were sensitivity, specificity, positive predictive value, and negative predictive value. A secondary outcome assessed the human-perceived quality of the model's justification for the label(s) applied.</p><p><strong>Results: </strong>The LLM demonstrated the ability to label incident reports with high sensitivity and specificity. The model applied a total of 79 labels compared to the reviewer's 49 labels. Overall sensitivity for the model was 85.7%, and specificity was 97.9%. Positive and negative predictive values were 53.2% and 99.6%, respectively. For 60.8% of labels, the reviewer approved of the model's justification for applying the label.</p><p><strong>Conclusion: </strong>The proprietary LLM demonstrated the ability to label obstetric incident reports with high sensitivity and specificity. LLMs offer the potential to enable more efficient use of data from incident reporting systems.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287754","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":"Workplace Violence Pervasiveness in the Perioperative Environment: A Multiprofessional Survey","authors":"Della M. Lin MS, MD, FASA (is Anesthesiologist and Clinical Professor, Department of Surgery, John A Burns, School of Medicine, University of Hawaii.),&nbsp;Meghan B. Lane-Fall MD, MSHP (is David E. Longnecker Associate Professor of Anesthesiology and Critical Care and Associate Professor of Epidemiology, Perelman School of Medicine, University of Pennsylvania.),&nbsp;Joshua A. Lea DNP, MBA, CRNA (is Nurse Anesthetist, Massachusetts General Hospital, Boston.),&nbsp;Lynn J. Reede DNP, MBA, CRNA, FNAP (is Associate Clinical Professor and Doctor of Nursing Practice Program Director, Northeastern University.),&nbsp;Brandon D. Gomes DNP, CRNA (is Nurse Anesthetist, Southcoast Health, Charlton Memorial Hospital, Fall River, Massachusetts.),&nbsp;Yuwei Xia MD (is Anesthesia Resident, Jefferson Einstein Hospital, Philadelphia.),&nbsp;Jennifer A. Rock-Klotz MBA (is Manager of Analytics and Research Services, American Society of Anesthesiologists, Schaumburg, Illinois.),&nbsp;Thomas R. Miller PhD, MBA (is Director of Analytics and Research Services and Director, Center for Anesthesia Workforce Studies, American Society of Anesthesiologists. Please address correspondence to Della M. Lin)","doi":"10.1016/j.jcjq.2024.07.010","DOIUrl":"10.1016/j.jcjq.2024.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Workplace violence in health care has gained attention with its rising incidence and its impact on patient safety and clinician well-being. Legal and regulatory organizational requirements related to workplace violence are broadening, including updated Joint Commission standards. Although workplace violence surveys have been administered across health care settings, the few that have focused on the perioperative environment have predominantly been single-profession surveys.</div></div><div><h3>Methods</h3><div>This cross-sectional, prospective survey focused on perioperative care was conducted by the Anesthesia Patient Safety Foundation using simultaneous convenience sampling across professional societies representing anesthesiologist assistants, certified registered nurse anesthetists, physicians, and registered nurses. Descriptive statistics were used to summarize responses, and multivariable regression was used to model the odds of experiencing or witnessing physical or nonphysical workplace violence. Open-text entries were analyzed using thematic analysis.</div></div><div><h3>Results</h3><div>Of 4,662 survey respondents, 3,645 (78.2%) reported some form of workplace violence: 1,446 (31.0%) experienced physical workplace violence, 1,718 (36.9%) witnessed physical workplace violence, and 3,226 (69.2%) experienced nonphysical workplace violence. Fewer than half (49.8%) of the respondents experiencing physical workplace violence and fewer than one third (31.4%) of the respondents experiencing nonphysical workplace violence felt that the “situation was addressed and resolved to their satisfaction.”</div></div><div><h3>Conclusion</h3><div>Workplace violence is commonplace and reported by all perioperative professionals. There is a pressing need for actions at multiple levels to respond to and eventually eliminate perioperative workplace violence, preventing harm to both patients and staff.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 11","pages":"Pages 764-774"},"PeriodicalIF":2.3,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287757","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":"Enhancing Implementation of the I-PASS Handoff Tool Using a Provider Handoff Task Force at a Comprehensive Cancer Center","authors":"","doi":"10.1016/j.jcjq.2024.03.004","DOIUrl":"10.1016/j.jcjq.2024.03.004","url":null,"abstract":"<div><h3>Background</h3><p>Communication failures are among the most common causes of harmful medical errors. At one Comprehensive Cancer Center, patient handoffs varied among services. The authors describe the implementation and results of an organization-wide project to improve handoffs and implement an evidence-based handoff tool across all inpatient services.</p></div><div><h3>Methods</h3><p>The research team created a task force composed of members from 22 hospital services—advanced practice providers (APPs), trainees, some faculty members, electronic health record (EHR) staff, education and training specialists, and nocturnal providers. Over two years, the task force expanded to include consulting services and Anesthesiology. Factors contributing to ineffective handoffs were identified and organized into categories. The EHR I-PASS tool was used to standardize handoff documentation. Training was provided to staff on its use, and compliance was monitored using a customized dashboard. I-PASS champions in each service were responsible for the rollout of I-PASS in their respective services. The data were reported quarterly to the Quality Assessment and Performance Improvement (QAPI) governing committee. Provider handoff perception was assessed through the biennial Institution-wide safety culture survey.</p></div><div><h3>Results</h3><p>All fellows, residents, APPs, and physician assistants were trained in the use of I-PASS, either online or in person. Adherence to the I-PASS written tool improved from 41.6% in 2019 to 70.5% in 2022 (<em>p</em> &lt; 0.05), with improvements seen in most services. The frequency of updating I-PASS elements and the action list in the handoff tool also increased over time. The handoff favorability score on the safety culture survey improved from 38% in 2018 to 59% in 2022.</p></div><div><h3>Conclusion</h3><p>The implementation approach developed by the Provider Handoff Task Force led to increased use of the I-PASS EHR tool and improved safety culture survey handoff favorability.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 8","pages":"Pages 560-568"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024000734/pdfft?md5=2308c60ab04c20b7faee74dd13dee6aa&pid=1-s2.0-S1553725024000734-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860828","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":"Standardizing the Dosage and Timing of Dexamethasone for Postoperative Nausea and Vomiting Prophylaxis at a Safety-Net Hospital System","authors":"","doi":"10.1016/j.jcjq.2024.03.014","DOIUrl":"10.1016/j.jcjq.2024.03.014","url":null,"abstract":"<div><h3>Background</h3><p>A single dose of dexamethasone is routinely given during general anesthesia for postoperative nausea and vomiting (PONV) prophylaxis, although the exact dosage and timing of administration may vary between practitioners. The authors aimed to standardize the dosage and timing of this medication when given to adult patients undergoing general anesthesia for elective surgery.</p></div><div><h3>Methods</h3><p>Baseline data for 7,483 preintervention cases were analyzed. The researchers attempted to use a standard dose of 8 to 10 mg induction of anesthesia, which, based on a literature review, was effective for PONV prophylaxis, had a similar safety profile as a 4 to 5 mg dose (including in diabetic patients), and may confer additional benefits such as improved prophylaxis and quality of recovery. The interventions included standardizing the medication concentration vials, altering electronic health record quick-select button options, simplifying the intraoperative charting process, and educating the anesthesia providers. The research team then tracked compliance with the standard of care for 2,167 cases after the interventions.</p></div><div><h3>Results</h3><p>Overall compliance with the standard of care increased from 21.2% preintervention to 53.7% postintervention. The number of patients not receiving dexamethasone was reduced from 29.7% to 19.4%. Patients receiving a compliant dose at a noncompliant time increased from 16.3% to 23.8%. Postanesthesia care unit antiemetic administration also decreased after the interventions.</p></div><div><h3>Conclusion</h3><p>This study showed improvements in compliance with the dosage of medication with the interventions. However, compliance with the timing of administration remains challenging.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 8","pages":"Pages 601-605"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024000989/pdfft?md5=3d73540b49a5ee104118d56bf2122222&pid=1-s2.0-S1553725024000989-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140793611","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 Joint Commission Journal on Quality and Patient Safety 50th Anniversary Article Collections: John M. Eisenberg Patient Safety and Quality Awards","authors":"","doi":"10.1016/j.jcjq.2024.06.003","DOIUrl":"10.1016/j.jcjq.2024.06.003","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 8","pages":"Pages 612-614"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S155372502400196X/pdfft?md5=2415eb7deed7a6a31dae538310c6f054&pid=1-s2.0-S155372502400196X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141959416","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":"Screening and Intervention to Prevent Violence Against Health Professionals from Hospitalized Patients: A Pilot Study","authors":"","doi":"10.1016/j.jcjq.2024.03.015","DOIUrl":"10.1016/j.jcjq.2024.03.015","url":null,"abstract":"<div><h3>Background</h3><p>Health care providers, particularly nursing staff, are at risk of physical or emotional abuse from patients. This abuse has been associated with increased use of physical and pharmacological restraints on patients, poor patient outcomes, high staff turnover, and reduced job satisfaction.</p></div><div><h3>Methods</h3><p>In this study, a multidisciplinary team at Tufts Medical Center implemented the Brøset Violence Checklist (BVC), a screening tool administered by nurses to identify patients displaying agitated behavior. Patients who scored high on the BVC received a psychiatry consultation, followed by assessments and recommendations. This tool was implemented in an inpatient medical setting in conjunction with a one-hour de-escalation training led by nursing and Public Safety. The intervention design was executed through a series of three distinct Plan-Do-Study-Act cycles.</p></div><div><h3>Results</h3><p>This study measured the number of BVCs completed and their scores, the number of psychiatric consults placed, the number of calls to Public Safety, the number of staff assaults, nursing restraint use, and staff satisfaction. During the study period, restraint use decreased 17.6% from baseline mean and calls to Public Safety decreased 60.0% from baseline mean. In the staff survey, nursing staff reported feeling safer at work and feeling better equipped to care for agitated patients.</p></div><div><h3>Conclusion</h3><p>The BVC is an effective, low-cost tool to proactively identify patients displaying agitated or aggressive behavior. Simple algorithms for next steps in interventions and training help to mitigate risk and increase feelings of safety among staff. Regular psychiatric rounding and the identification of champions were key components in a successful implementation.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 8","pages":"Pages 569-578"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140769560","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}