Joint Commission journal on quality and patient safety最新文献

{"title":"Accuracy of a Proprietary Large Language Model in Labeling Obstetric Incident Reports","authors":"Jeanene Johnson MPH, BSN (is Quality Improvement Advisor, Quality Improvement Department, Stanford Medicine Children's Health, Palo Alto, California.),&nbsp;Conner Brown BS (is Data Scientist, Stanford Medicine Children's Health.),&nbsp;Grace Lee MD, MPH (is Professor, Department of Pediatrics, Stanford University School of Medicine, and Chief Quality Officer, Stanford Medicine Children's Health.),&nbsp;Keith Morse MD, MBA (is Clinical Associate Professor, Department of Pediatrics, Stanford University School of Medicine, and Medical Director of Clinical Informatics, Stanford Medicine Children's Health)","doi":"10.1016/j.jcjq.2024.08.001","DOIUrl":"10.1016/j.jcjq.2024.08.001","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 12","pages":"Pages 877-881"},"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}

{"title":"A Systemwide Strategy to Embed Equity into Patient Safety Event Analysis","authors":"","doi":"10.1016/j.jcjq.2024.04.004","DOIUrl":"10.1016/j.jcjq.2024.04.004","url":null,"abstract":"<div><h3>Background</h3><p>There is a lack of framework to incorporate equity into event analysis. This quality improvement initiative involved the development of equity tools that were introduced in a two-hour interactive, case-based training across 11 acute care facilities at the largest municipal health care system in the United States. A pre and post survey (which included analysis of a clinical vignette) was also conducted to assess for knowledge and comfort embedding equity in patient safety event analysis, and to measure discomfort or distress during the training. A separate assessment was used to evaluate the tools.</p></div><div><h3>Equity Tools</h3><p>A visual aid, the Patient Equity Wheel, was created to facilitate more comprehensive and robust health equity discussions by compiling a comprehensive list of equity categories, including internal, external, and organizational dimensions of equity. The Wheel was designed for use during each phase of event analysis. An Embedding Equity in Root Cause Analysis Worksheet was developed to aid in assessing considerations of equitable care in the investigation process and includes questions to ask staff to further assess bias or equitable care factors.</p></div><div><h3>Initiative Outcome and Key Insights</h3><p>Participant knowledge and level of comfort increased after training. The most commonly unrecognized categories of bias were Training/Competencies, Structural Workflow, and Culture/Norms. Most participants responded that they had no discomfort or distress during the training. Post-training feedback noted that the tools were being used across the system in various stages of event analysis and have been reported to improve health equity conversations.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 8","pages":"Pages 606-611"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140790909","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":"Evaluating Real-World Implementation of INFORM (Improving Nursing Home Care through Feedback on Performance Data): An Improvement Initiative in Canadian Nursing Homes","authors":"","doi":"10.1016/j.jcjq.2024.04.009","DOIUrl":"10.1016/j.jcjq.2024.04.009","url":null,"abstract":"<div><h3>Background</h3><p>INFORM (Improving Nursing Home Care through Feedback on Performance Data) was a research intervention that equipped nursing home managers with skills to conduct local improvement projects and supported them in improving performance through modifiable elements in their units. Prior reports have found positive and sustained outcomes from INFORM intervention. In this article, the authors report findings from a formative service evaluation of INFORM as modified for implementation in real-world settings.</p></div><div><h3>Methods</h3><p>INFORM was transformed for real-world implementation with an initial cohort of 26 nursing homes in British Columbia, Canada (INFORM BC). Three stakeholder groups were involved: nursing home teams, an academic team that modified INFORM for implementation, and a BC team that implemented INFORM and coached participating nursing home teams in applying it locally. Service evaluation was conducted drawing on participants from all three stakeholder groups, using convenience sampling, with numbers varying by data source. Using a mixed methods design, outcome data included qualitative and quantitative assessment of surveys, discussions, observations, and a review of documents and resources.</p></div><div><h3>Results</h3><p>The majority of nursing home teams reported positive outcomes relative to the usefulness and relevance of the initiative for local needs despite a number of operational challenges during implementation. A key factor in their success was combining targeted external support with the opportunity to set goals and measure success locally. Challenges included a lack of time at the nursing home level, COVID-19–related disruptions, and issues with role clarity and alignment of expectations among the academic and BC teams.</p></div><div><h3>Conclusion</h3><p>INFORM BC advanced the processes of change planning and transferable learning among nursing home managers and their local teams. Success was facilitated externally but defined and achieved locally. Future iterations should probe outcome sustainability and how nursing home teams adapt the INFORM approach in practice.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 8","pages":"Pages 579-590"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024001223/pdfft?md5=57536e6e6dec894838eb39457f26e932&pid=1-s2.0-S1553725024001223-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283710","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":"Racial/Ethnic Disparities in Peripartum Pain Assessment and Management","authors":"","doi":"10.1016/j.jcjq.2024.03.009","DOIUrl":"10.1016/j.jcjq.2024.03.009","url":null,"abstract":"<div><h3>Objective</h3><p>This study was conducted to determine if there were racial/ethnic disparities in pain assessment and management from labor throughout the postpartum period.</p></div><div><h3>Methods</h3><p>This was a retrospective cohort study of all births from January 2019 to December 2021 in a single urban, quaternary care hospital, excluding patients with hysterectomy, ICU stay, transfusion of more than 3 units of packed red blood cells, general anesthesia, or evidence of a substance abuse disorder. We characterized and compared patterns of antepartum and postpartum pain assessments, epidural use, pain scores, and postpartum pain management by racial/ethnic group with bivariable analyses. Multivariable regression was performed to test for an association between race/ethnicity and amount of opioid pain medication in milligram equivalent units, stratified by delivery mode.</p></div><div><h3>Results</h3><p>There were 18,085 births between 2019 and 2021 with available race/ethnicity data. Of these, 58.3% were white, 15.0% were Hispanic, 11.9% were Asian, 7.4% were Black, and the remaining 7.4% were classified as Other/Declined. There were no significant differences by race/ethnicity in the number of antepartum or postpartum pain assessments or the proportion of patients who received epidural analgesia. Black and Hispanic patients reported the highest maximum postpartum pain scores after vaginal and cesarean birth compared to white and Asian patients. However, Black and Hispanic patients received lower daily doses of opioid medications than white patients, regardless of delivery mode. After adjusting for patient factors and non-opioid medication dosages, all other racial/ethnic groups received less opioid medication than white patients.</p></div><div><h3>Conclusion</h3><p>Inequities were found in postpartum pain treatment, including among patients reporting the highest pain levels.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 8","pages":"Pages 552-559"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273108","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":"Improving Appropriate Use of Peripherally Inserted Central Catheters Through a Statewide Collaborative Hospital Initiative: A Cost-Effectiveness Analysis","authors":"","doi":"10.1016/j.jcjq.2024.04.003","DOIUrl":"10.1016/j.jcjq.2024.04.003","url":null,"abstract":"<div><h3>Background</h3><p>Quality improvement (QI) programs require significant financial investment. The authors evaluated the cost-effectiveness of a physician-led, performance-incentivized, QI intervention that increased appropriate peripherally inserted central catheter (PICC) use.</p></div><div><h3>Methods</h3><p>The authors used an economic evaluation from a health care sector perspective. Implementation costs included incentive payments to hospitals and costs for data abstractors and the coordinating center. Effectiveness was calculated from propensity score-matched observations across two time periods for complications (venous thromboembolism [VTE], central line–associated bloodstream infection [CLABSI], and catheter occlusion): preintervention period (January 2015 through December 2016) and intervention period (January 2017 through December 2021). Cost-effectiveness was presented as the cost-offset per averted complication, reflecting the health care costs avoided due to having lower complication rates.</p></div><div><h3>Results</h3><p>Across 35 hospitals, this study sampled 17,418 PICCs placed preintervention and 26,004 placed during the intervention period. PICC complications decreased significantly following the intervention. CLABSIs decreased from 2.1% to 1.5%, VTEs from 3.2% to 2.3%, and catheter occlusions from 10.8% to 7.0% (all <em>p</em> &lt; 0.01). Estimated number of complications prevented included 871 CLABSIs, 2,535 VTEs, and 8,743 catheter occlusions. Project implementation costs were $31.8 million, and the cost-offset related to avoided complications was $64.4 million. Each participating hospital averaged $932,073 in cost-offset over seven years, and the average cost-offset per complication averted was $2,614 (95% CI [confidence interval] $2,314–$3,003).</p></div><div><h3>Conclusion</h3><p>A large-scale, multihospital QI initiative to improve appropriate PICC use yielded substantial return on investment from cost-offset of prevented complications.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 8","pages":"Pages 591-600"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140796408","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}