Joint Commission journal on quality and patient safety最新文献

{"title":"Implementing Multiple Digital Technologies in Health Care: Seeing the Unintended Consequences for Patient Safety","authors":"James Shaw PT, PhD (is Canada Research Chair in Responsible Health Innovation (Tier 2) and Assistant Professor, Department of Physical Therapy, University of Toronto.), Payal Agarwal MSc, MD (is Integrated Chief Information and Innovation Officer, Grand River and St. Mary's General Hospitals, and Innovation Fellow, Women's College Hospital.), Onil Bhattacharyya MD, PhD (is Frigon-Blau Chair in Family Medicine Research at Women's College Hospital, and Associate Professor, Department of Family and Community Medicine, University of Toronto. Please address correspondence to James Shaw)","doi":"10.1016/j.jcjq.2024.02.001","DOIUrl":"10.1016/j.jcjq.2024.02.001","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139874980","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":"Refining a Framework to Enhance Communication in the Emergency Department During the Diagnostic Process: An eDelphi Approach","authors":"Milisa Manojlovich PhD, RN, FAAN (is Professor, Department of Systems, Populations and Leadership, University of Michigan School of Nursing.),&nbsp;Amanda P. Bettencourt PhD, APRN, CCRN-K, ACCNS-P (is Assistant Professor, Department of Family and Community Health, University of Pennsylvania School of Nursing.),&nbsp;Courtney W. Mangus MD (is Clinical Assistant Professor, Department of Emergency Medicine, University of Michigan.),&nbsp;Sarah J. Parker MPH (is Research Area Specialist, Department of Emergency Medicine, University of Michigan.),&nbsp;Sarah E. Skurla MPH (is Project Manager, Center for Clinical Management Research, US Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan.),&nbsp;Heather M. Walters MS (is Senior Research Project Manager, VA Ann Arbor Healthcare System.),&nbsp;Prashant Mahajan MD, MPH, MBA (is Professor, Department of Emergency Medicine, University of Michigan. Please address correspondence to. Milisa Manojlovich)","doi":"10.1016/j.jcjq.2024.01.013","DOIUrl":"10.1016/j.jcjq.2024.01.013","url":null,"abstract":"<div><h3>Background</h3><p>Emergency departments (EDs) are susceptible to diagnostic error. Suboptimal communication between the patient and the interdisciplinary care team increases risk to diagnostic safety. The role of communication remains underrepresented in existing diagnostic decision-making conceptual models.</p></div><div><h3>Methods</h3><p>The authors used eDelphi methodology, whereby data are collected electronically, to achieve consensus among an expert panel of 18 clinicians, patients, family members, and other participants on a refined ED–based diagnostic decision-making framework that integrates several potential opportunities for communication to enhance diagnostic quality. This study examined the entire diagnostic process in the ED, from prehospital to discharge or transfer to inpatient care, and identified where communication breakdowns could occur. After four iterative rounds of the eDelphi process, including a final validation round by all participants, the project's a priori consensus threshold of 80% agreement was reached.</p></div><div><h3>Results</h3><p>The authors developed a final framework that positions communication more prominently in the diagnostic process in the ED and enhances the original National Academies of Sciences, Engineering, and Medicine (NASEM) and ED–adapted NASEM frameworks. Specific points in the ED journey were identified where more attention to communication might be helpful. Two specific types of communication—information exchange and shared understanding—were identified as high priority for optimal outcomes. Ideas for communication-focused interventions to prevent diagnostic error in the ED fell into three categories: patient-facing, clinician-facing, and system-facing interventions.</p></div><div><h3>Conclusion</h3><p>This project's refinement of the NASEM framework adapted to the ED can be used to develop communications-focused interventions to reduce diagnostic error in this highly complex and error-prone setting.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139996308","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":"Implementation of an Interdisciplinary Transfer Huddle Intervention for Prolonged Wait Times During Inter-ICU Transfer","authors":"Sydney Hyder MD, MS (is Pulmonary Disease and Critical Care Medicine Attending, Division of Pulmonary, Critical Care and Sleep Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago.),&nbsp;Ryan Tang MD (is Internal Medicine Resident, Northwestern University Feinberg School of Medicine.),&nbsp;Reiping Huang PhD, MS (is Health Services Research and Adjunct Assistant Professor, Department of Surgery, Northwestern University Feinberg School of Medicine.),&nbsp;Amy Ludwig MD (is Clinical Fellow, Pulmonary Disease and Critical Care Medicine, Northwestern University Feinberg School of Medicine.),&nbsp;Kelli Scott PhD (is Assistant Professor of Medical Social Sciences, Center for Dissemination & Implementation Science, Northwestern University Feinberg School of Medicine.),&nbsp;Nandita Nadig MD, MS (is Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine. Please address correspondence to Sydney Hyder)","doi":"10.1016/j.jcjq.2024.01.009","DOIUrl":"10.1016/j.jcjq.2024.01.009","url":null,"abstract":"<div><h3>Background</h3><p>ICU transfers from a regional to a tertiary-level hospital are initiated typically for a higher level of care. Extended transfer wait times can negatively affect survival, length of stay (LOS), and cost.</p></div><div><h3>Methods</h3><p>In this prospective single-center study, the subjects were adult ICU patients admitted to regional hospitals between January and October 2022, for whom a request was made to transfer to a tertiary-level medical ICU. The authors developed and implemented an interdisciplinary transfer huddle intervention (THI) with the goal of reducing wait times by providing a consistent channel of communication between key stakeholders. The primary outcome was the number of hours elapsed between transfer request and the time of transfer to the tertiary hospital. Secondary outcomes included in-hospital mortality, discharge to home, ICU LOS, and hospital LOS. Data were abstracted from electronic health records and periods before (January to June 2022) and after (June to October 2022) the intervention were compared. Data were analyzed using logistic regression or negative binomial regression, adjusting for patient demographic and clinical characteristics. ICU fellows also completed a daily survey about barriers they perceived to the THI application.</p></div><div><h3>Results</h3><p>During the study period, 76 patients were transferred. The THI was completed 75.0% of the time. There were no statistically significant differences in the primary and secondary outcomes before and after the intervention. The top perceived barriers to transfer were lack of physical beds (50.0%) and staffing limitations (37.5%).</p></div><div><h3>Conclusion</h3><p>The authors successfully developed and implemented a transfer huddle to ensure consistent interdisciplinary communication for patients being transferred between ICUs and identified barriers to such transfer. However, transfer times and patient outcomes were not significantly different after the change. Future studies should consider staffing challenges, hospital capacity, and the role of dedicated transfer teams in in decreasing inter-ICU transfer wait times.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139639291","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":"Development and Evaluation of I-PASS-to-PICU: A Standard Electronic Template to Improve Referral Communication for Interfacility Transfers to the Pediatric ICU","authors":"Nehal R. Parikh DO (is Fellow Physician, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.),&nbsp;Leticia S. Francisco (is Pre-Med Student, College of Liberal Arts and Sciences, University of Iowa.),&nbsp;Shilpa C. Balikai DO (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.),&nbsp;Mitchell A. Luangrath MD (is Clinical Assistant Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.),&nbsp;Heather R. Elmore DNP, ARNP (is Pediatric Nurse Practitioner, Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa.),&nbsp;Jennifer Erdahl MSN, RN, CCRN-K (is Nurse Manager, Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital.),&nbsp;Aditya Badheka MBBS, MS (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.),&nbsp;Madhuradhar Chegondi MBBS, MD (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.),&nbsp;Christopher P. Landrigan MD, MPH (is Chief, Division of General Pediatrics, Boston Children's Hospital, and Director, Sleep and Patient Safety Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital / Harvard Medical School, Boston.),&nbsp;Priyadarshini Pennathur PhD (is Associate Professor, Department of Industrial, Manufacturing, and Systems Engineering, University of Texas at El Paso.),&nbsp;Heather Schacht Reisinger PhD (is Associate Professor, Department of Internal Medicine, Carver College of Medicine, University of Iowa, and Core Investigator, Institute for Clinical and Translational Science, University of Iowa.),&nbsp;Christina L. Cifra MD, MS (is Assistant Professor, Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital / Harvard Medical School and Adjunct Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa. Please address correspondence to Christina L. Cifra)","doi":"10.1016/j.jcjq.2024.01.010","DOIUrl":"10.1016/j.jcjq.2024.01.010","url":null,"abstract":"<div><h3>Background</h3><p>Miscommunication during interfacility handoffs to a higher level of care can harm critically ill children. Adapting evidence-based handoff interventions to interfacility referral communication may prevent adverse events. The objective of this project was to develop and evaluate a standard electronic referral template (I-PASS-to-PICU) to improve communication for interfacility pediatric ICU (PICU) transfers.</p></div><div><h3>Methods</h3><p>I-PASS-to-PICU was iteratively developed in a single PICU. A core PICU stakeholder group collaboratively designed an electronic health record (EHR)–supported clinical note template by adapting elements from I-PASS, an evidence-based handoff program, to support information exchange between referring clinicians and receiving PICU physicians. I-PASS-to-PICU is a receiver-driven tool used by PICU physicians to guide verbal communication and electronic documentation during PICU transfer calls. The template underwent three cycles of iterative evaluation and redesign informed by individual and group interviews of multidisciplinary PICU staff, usability testing using simulated and actual referral calls, and debriefing with PICU physicians.</p></div><div><h3>Results</h3><p>Individual and group interviews with 21 PICU staff members revealed that relevant, accurate, and concise information was needed for adequate admission preparedness. Time constraints and secondhand information transmission were identified as barriers. Usability testing with six receiving PICU physicians using simulated and actual calls revealed good usability on the validated System Usability Scale (SUS), with a mean score of 77.5 (standard deviation 10.9). Fellows indicated that most fields were relevant and that the template was feasible to use.</p></div><div><h3>Conclusion</h3><p>I-PASS-to-PICU was technically feasible, usable, and relevant. The authors plan to further evaluate its effectiveness in improving information exchange during real-time PICU practice.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631913","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 Outcomes in Patients Sent to the Emergency Department from Outpatient Providers: A Receiver-Driven Handoff Process Improvement","authors":"Kristina DeVore MSN, RN (is Nurse Navigator, Department of Nursing–Continuum of Care Management, University of Iowa Health Care.),&nbsp;Katherine Schneider MSN, RN (is Clinical Coordinator, Department of Emergency Medicine, Carver College of Medicine, University of Iowa.),&nbsp;Elyse Laures PhD, RN (is Nurse Scientist, Department of Nursing–Nursing Research and Evidence-Based Practice, University of Iowa Health Care.),&nbsp;Alison Harmon MSN, RN (is Director of Emergency Medical Transport Services, Department of Nursing, University of Iowa Health Care.),&nbsp;Paul Van Heukelom MD (is Associate Clinical Professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa. Please address correspondence to Katherine Schneider)","doi":"10.1016/j.jcjq.2024.01.008","DOIUrl":"10.1016/j.jcjq.2024.01.008","url":null,"abstract":"<div><h3>Background</h3><p>Outpatient providers refer to emergency departments (EDs) due to findings requiring assessment beyond existing capabilities. However, poor communication surrounding these transitions may hinder safety and timeliness of emergency care. Receiver-driven handoff (RDH) is a process that helps ensure that all pertinent information is shared. This quality improvement project aimed to (1) improve knowledge of RDH, (2) increase satisfaction and perceptions surrounding RDH, (3) modify behaviors in relation to RDH, and (4) decrease referred patients leaving without being seen (LWBS).</p></div><div><h3>Methods</h3><p>The Iowa Model and Implementation Framework guided this evidence-based quality improvement project. A multidisciplinary team developed and implemented a standardized RDH process consisting of screening to determine whether a patient was referred to the ED, review of electronic health record (EHR), and use of EHR documentation. Process measures were collected via questionnaire pre- and postimplementation and were analyzed quantitatively. Outcome measures were trended by a statistical process control p-chart, which was developed to demonstrate changes in the percentage of patients who were referred to the ED from the outpatient setting and LWBS.</p></div><div><h3>Results</h3><p>The average response for the question “How satisfied are you with the handoff of patient information from referring clinic providers to the ED?” increased from 1.51 preintervention to 2.04 postintervention (<em>p</em> = 0.005). Respondents rated the information received during handoff higher postintervention (2.12 vs. 2.52, <em>p</em> = 0.04). Compliance with screening for referral to the ED was 84.0%. The proportion of patients LWBS after referral decreased by 6.2 percentage points (<em>p</em> &lt; 0.001).</p></div><div><h3>Conclusion</h3><p>Using RDH in conjunction with a standardized triage screening may improve quality of information shared during this vulnerable transition and may assist in reduction of referred patients LWBS. The RDH process should be adapted into everyday workflow to ensure sustainability and effectiveness.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139636529","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":"Preoperative Communication Between Anesthesia, Surgery, and Primary Care Providers for Older Surgical Patients","authors":"Donna Ron MD (is Clinical Research Fellow, Department of Community and Family Medicine, and Department of Anesthesiology and Perioperative Medicine, Dartmouth Health and Geisel School of Medicine at Dartmouth.),&nbsp;Christine M. Gunn PhD (is Assistant Professor, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.),&nbsp;Jeana E. Havidich MD, MS (is Pediatric Anesthesiologist and Associate Professor, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth.),&nbsp;Madison M. Ballacchino (is Medical Student, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo.),&nbsp;Timothy E. Burdick MD, MBA, MSc (is Associate Professor, Department of Community and Family Medicine, Dartmouth Health and Geisel School of Medicine at Dartmouth, and Associate Professor, Dartmouth Institute for Health Policy and Clinical Practice.),&nbsp;Stacie G. Deiner MD, MS (is Anesthesiologist and Professor, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth. Please address correspondence to Donna Ron)","doi":"10.1016/j.jcjq.2024.01.006","DOIUrl":"10.1016/j.jcjq.2024.01.006","url":null,"abstract":"<div><h3>Background</h3><p>Suboptimal communication between clinicians remains a frequent driver of preventable adverse health care–related events, increased costs, and patient and physician dissatisfaction.</p></div><div><h3>Methods</h3><p>Cross-sectional surveys on preoperative interspecialty communication, tailored by stakeholder type, were administered to (1) primary care providers in northern New England, (2) anesthesia providers working in the perioperative clinic of a tertiary rural academic medical center, (3) surgeons from the same center, and (4) older surgical patients who underwent preoperative assessment at the same center.</p></div><div><h3>Results</h3><p>In total, 107/249 (43.0%) providers and 103/265 (39.9%) patients completed the survey. Preoperative communication was perceived as logistically challenging (59.8%), particularly across health systems. More than 77% of anesthesia and surgery providers indicated that they communicate frequently or sometimes, but 92.5% of primary care providers indicated that they rarely or never communicate with anesthesia providers. Some of the most common reasons for preoperative communication were discussion of complex patients, perioperative medication management, and optimization of comorbidities. Although 96.1% of older surgical patients reported that preoperative communication between providers is important, only 40.4% felt that their providers communicate very or extremely well. Many patients emphasized the importance of preoperative communication between providers to ensure transfer of critical clinical information.</p></div><div><h3>Conclusion</h3><p>Surgeons and anesthesiologists infrequently communicate with primary care providers in one rural tertiary center, in contrast to patient expectations and values. These study results will help identify priorities and potentially resolvable barriers to bridging the gap between the inpatient perioperative and outpatient primary care teams. Future studies should focus on strategies to improve communication between hospital and community providers to prevent complications and readmission.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139633114","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":"Team Relations and Role Perceptions During Anesthesia Crisis Management in Magnetic-Resonance Imaging Settings: A Mixed Methods Exploration","authors":"Hedwig Schroeck MD (is Associate Professor of Anesthesiology, Geisel School of Medicine at Dartmouth College, and Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.),&nbsp;Michaela A. Whitty MPH (is Manager of Perioperative Inventory and Logistics, Dartmouth Health, Lebanon, New Hampshire.),&nbsp;Bridget Hatton MPH (formerly with the Dartmouth Institute of Health Policy, Hanover, New Hampshire, is DrPH Student, Johns Hopkins Bloomberg School of Public Health, Baltimore.),&nbsp;Pablo Martinez-Camblor PhD (is Assistant Professor of Anesthesiology, and Biomedical Data Science, Geisel School of Medicine at Dartmouth College.),&nbsp;Louise Wen MD (is Clinical Assistant Professor, Geisel School of Medicine at Dartmouth College, and Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center.),&nbsp;Andreas H. Taenzer MD (is Professor of Anesthesiology, and Pediatrics, Geisel School of Medicine at Dartmouth College. Please address correspondence to Hedwig Schroeck)","doi":"10.1016/j.jcjq.2024.01.007","DOIUrl":"10.1016/j.jcjq.2024.01.007","url":null,"abstract":"<div><h3>Background</h3><p>An increasing number of procedures are performed in non-operating room anesthesia (NORA) settings, including magnetic resonance imaging (MRI) suites. Patient care in NORA is accomplished by interprofessional ad hoc teams (anesthesia clinicians, imaging technologists, and others), who do not regularly work together otherwise. The authors aimed to explore team relations and role perceptions during crisis situations in MRI settings among such ad hoc teams.</p></div><div><h3>Methods</h3><p>This mixed methods study used a convergent parallel design: The Relational Coordination Index (RCI) and a survey about role perceptions were administered to anesthesia and non-anesthesia personnel working in MRI settings, and semistructured interviews were conducted among a purposive sample. After descriptive statistics and thematic analysis, the authors integrated quantitative and qualitative findings to identify and describe overlapping and mismatched perceptions between the two groups.</p></div><div><h3>Results</h3><p>A total of 67 surveys (response rate 74.4%) and 17 interviews were analyzed. RCI ratings revealed moderate relational coordination between the anesthesia and non-anesthesia groups. Anesthesia and non-anesthesia respondents agreed that the anesthesia clinician assumes leadership during crisis management while non-anesthesia personnel assist. There were nuanced differences in expectations about the role of non-anesthesia personnel in calling for help, understanding specific equipment needs, and performing patient care actions. Many anesthesia clinicians felt unsure about crisis-relevant skills of their non-anesthesia colleagues. MRI technologists emphasized attention to magnetic safety as integral to their role, which was infrequently mentioned by anesthesia personnel.</p></div><div><h3>Conclusion</h3><p>Nuanced mismatches in role expectations within the interprofessional care team exist, which may hinder effective crisis management in MRI settings.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139633688","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","authors":"David W. Baker MD, MPH, FACP (is Editor-in-Chief, The Joint Commission Journal on Quality and Patient Safety. Please address correspondence to David W. Baker)","doi":"10.1016/j.jcjq.2024.01.004","DOIUrl":"10.1016/j.jcjq.2024.01.004","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024000084/pdfft?md5=67eee484c0019b42d20605899a7f5178&pid=1-s2.0-S1553725024000084-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139512435","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":"Measuring Healthcare Workplace Violence in Real Time","authors":"James P. Phillips MD, FACEP (is Associate Professor, Emergency Medicine, and Section Chief and Fellowship Director, Disaster and Operational Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, and Chair, Disaster Medicine Section, American College of Emergency Physicians, Irving, Texas. Please address correspondence to James P. Phillips)","doi":"10.1016/j.jcjq.2024.01.005","DOIUrl":"10.1016/j.jcjq.2024.01.005","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024000096/pdfft?md5=e664823c812117376738ec2da8cf94bd&pid=1-s2.0-S1553725024000096-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139512432","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":"Impact of a Hospitalist Co-Management Program on Medical Complications and Length of Stay in Neurosurgical Patients","authors":"Álvaro Marchán-López MD (Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid.),&nbsp;Jaime Lora-Tamayo MD, PhD (Department of Internal Medicine, Hospital Universitario 12 de Octubre.),&nbsp;Cristina de la Calle MD, PhD (Department of Internal Medicine, Hospital Universitario 12 de Octubre.),&nbsp;Luis Jiménez Roldán MD, PhD (Department of Neurosurgery, Hospital Universitario 12 de Octubre.),&nbsp;Luis Miguel Moreno Gómez MD, PhD (Department of Neurosurgery, Hospital Universitario 12 de Octubre.),&nbsp;Ignacio Sáez de la Fuente MD, PhD (Department of Critical Care Medicine, Hospital Universitario 12 de Octubre.),&nbsp;Mario Chico Fernández MD, PhD (Department of Critical Care Medicine, Hospital Universitario 12 de Octubre.),&nbsp;Alfonso Lagares MD, PhD (Department of Neurosurgery, Hospital Universitario 12 de Octubre, and School of Medicine, Complutense University, Madrid.),&nbsp;Carlos Lumbreras MD, PhD (Department of Internal Medicine, Hospital Universitario 12 de Octubre, and School of Medicine, Complutense University.),&nbsp;Ana García Reyne MD, PhD (Department of Internal Medicine, Hospital Universitario 12 de Octubre. Please address correspondence to Álvaro Marchán-López)","doi":"10.1016/j.jcjq.2024.01.003","DOIUrl":"10.1016/j.jcjq.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><p>The impact of co-management on clinical outcomes in neurosurgical patients<span> is uncertain. This study aims to describe the implementation of a hospitalist co-management program in a neurosurgery department and its impact on the incidence of complications, mortality, and length of stay.</span></p></div><div><h3>Methods</h3><p>The authors used a quasi-experimental study design that compared a historical control period (July–December 2017) to a prospective intervention arm. During the intervention period, patients admitted to a neurosurgery inpatient unit who were older than 65 years, suffered certain conditions, or were admitted from ICUs<span><span> were included in the co-management program. Two hospitalists joined the surgical staff and intervened in the </span>diagnostic<span><span> and therapeutical plan of patients, participating in clinical decisions and coordinating patient navigation with neurosurgeons. The incidence of moderate or severe complications measured by the Accordion Severity Grading System, in-hospital mortality, and length of stay of the two cohorts were compared. Multivariate regression was used to adjust for confounders, and the average </span>treatment effect was estimated using inverse probability of treatment weighting.</span></span></p></div><div><h3>Results</h3><p>The adjusted incidence of moderate or severe complications was lower among co-managed patients (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.39–0.91). Mortality was unchanged (OR 0.83, 95% CI 0.15–4.17). Length of stay was lower in co-managed patients, with a 1.3-day reduction observed after inverse probability of treatment weighting analysis.</p></div><div><h3>Conclusion</h3><p>Hospitalist co-management was associated with a reduced incidence of complications and length of stay in neurosurgical patients, but there was no difference in in-hospital mortality.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139457188","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}