Quality Management in Health Care最新文献

{"title":"Experimental Study on Video Discharge Instructions for Pediatric Fever in an Emergency Department.","authors":"Carmen Luna-Arana, Cristina Castro-Rodríguez, Ana Jové-Blanco, Andrea Mora-Capín, Clara Ferrero García-Loygorri, Paula Vázquez-López","doi":"10.1097/QMH.0000000000000463","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000463","url":null,"abstract":"<p><strong>Background and objectives: </strong>Fever is a frequent cause of consultation in the pediatric emergency department (PED). Adequate discharge instructions are essential to guarantee good management at home and can reduce caregivers' anxiety and re-consultations. This study compares the improvement of caregivers' knowledge regarding fever between verbal discharge instructions and the addition of a video to verbal information. As a secondary outcome, we compared the rate of return visits.</p><p><strong>Methods: </strong>An experimental, prospective, single-center study was conducted in a tertiary hospital PED. Patients between 3 months and 5 years old with febrile syndrome were enrolled. Patients with comorbidities or SARS-COV2 infection were excluded. First, caregivers answered a written test concerning fever characteristics, management, and warning signs. Patients were assigned by simple randomization to a control group (standard verbal and written instructions) or to an intervention group (which additionally received video instructions). After discharge, investigators contacted caregivers by telephone. Caregivers were asked to answer the same questions as in the written test in addition to the need for subsequent visits (at the PED or any other healthcare facility) after discharge.</p><p><strong>Results: </strong>Seventy-three patients were randomized to the intervention group and 77 to the control group (2 were lost during follow-up). There were no differences in the acquisition of caregiver's knowledge, with a median score improvement of 2 points in both groups (control group interquartile range (IQR) 1-2; intervention group IQR 1-3) (P = .389). In the intervention group, we observed a significant increase of correct answers in 4 out of 7 questions compared to 3 out of 7 questions in the control group. In the control group, 18.7% reconsulted compared to 10.9% in the intervention group (P = .188).</p><p><strong>Conclusions: </strong>Video instructions were not superior to verbal instructions at improving caregivers' knowledge of fever overall. However, more questions obtained a significant score increase in those that received video and verbal instructions. Our results suggest that the addition of video instructions could help reduce return visits.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating DMAIC Philosophy and Bow-Tie Model for Quantitative Risk Assessment in Health Care.","authors":"Heng Zhao, Yingyan Liu","doi":"10.1097/QMH.0000000000000457","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000457","url":null,"abstract":"<p><strong>Background and objectives: </strong>Medical risks are considered to endanger patients and impact the health care system. Such iatrogenic risks necessitate hospitals taking a more proactive method to quantitatively analyze medical risk, and then to implement more targeted precautions. To address this problem, a novel quantitative risk assessment framework is proposed and further applied in radiotherapy risk assessment.</p><p><strong>Methods: </strong>A framework combining DMAIC (Define, Measure, Analyze, Improve, Control) and bow-tie model is used to assess health care risk. The uncertainty of medical risks is quantified with fuzzy set theory. The impact and the priority of medical risks were classified based on the risk matrix, and then the precautions were implemented to mitigate their impact. A case study of radiation treatment is provided.</p><p><strong>Results: </strong>The probabilities and impacts of risk events for radiation treatment were quantified based on the proposed framework, and risk protection measures were proposed to mitigate the undesired consequence.</p><p><strong>Conclusion: </strong>The proposed framework showing an effective method of quantitative risk assessment of health care. The study also enriches the risk assessment methods in health care by providing a conductive and normalized framework.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor on \"Burnout Among Family Physicians in the United States: A Review of the Literature\".","authors":"Priscila R Armijo, Rachel Esparza, Dana Al-Assi, Narjust Florez, Roberta Gebhard","doi":"10.1097/QMH.0000000000000486","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000486","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Audit and Feedback to Improve the Quality of Consultation Notes.","authors":"Omrum Uzun, Gökhan Metan","doi":"10.1097/QMH.0000000000000473","DOIUrl":"10.1097/QMH.0000000000000473","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Quality Improvement Review Board: An Innovative Approach to Oversight of Projects That Do Not Meet Criteria of Human Subject Research.","authors":"Toni L Denison, Kristyn U Sorensen, Michael P Blanton, Lara Johnson, Theresa Byrd, Steven E Pass, Lacy Philips, Joyce Miller, Lance R McMahon, Barbara Cherry","doi":"10.1097/QMH.0000000000000446","DOIUrl":"10.1097/QMH.0000000000000446","url":null,"abstract":"<p><p>This article describes the development of an institutional quality improvement review board (QIRB) as an effective and efficient method for reviewing and overseeing institutional quality improvement (QI) initiatives. QI projects involve the systematic collection and analysis of data and the implementation of interventions designed to improve the quality of clinical care and/or educational programs for a distinct population in a specific setting. QI projects are fundamentally distinct from human subjects research (HuSR); however, the differences between them are subtle and highly nuanced. Determining whether a project meets the definition of QI or qualifies as HuSR, thus requiring institutional review board (IRB) review, can be confusing and frustrating. Nevertheless, this distinction is highly consequential due to the heavy regulatory requirements involved in HuSR and IRB oversight. Making the correct determination of a project's regulatory status is essential before the project begins. Project leaders may not realize that their work meets the definition of HuSR and, therefore, might conduct the project without appropriate IRB review. Therefore, best practices dictate that project leaders should not decide which type of institutional review is appropriate for their projects. In addition, when QI project teams attempt to disseminate the results of their work, documentation of formal review and approval is generally required by peer-reviewed journals and professional organizations. However, institutional review mechanisms are rarely available. Projects that do not meet the definition of HuSR fall outside the purview of IRBs and most institutions do not have an alternative review body. This creates frustration for both project leaders and IRB administrators. Apart from IRB review, a separate process for reviewing QI projects offers several benefits. These include (1) relieving the burden on busy IRB staff; (2) promoting scholarly activity; (3) protecting the institution, project leaders, and participants from HuSR conducted outside of appropriate IRB review; and (4) promoting rigorous QI methods.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"269-277"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139983694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing Nursing-Sensitive Quality Indicators for the Central Sterile Supply Department: A Modified Delphi Study.","authors":"Ruixue Hu, Yanhua Chen, Juan Hu, Liangying Yi","doi":"10.1097/QMH.0000000000000418","DOIUrl":"10.1097/QMH.0000000000000418","url":null,"abstract":"<p><strong>Background and objectives: </strong>Previous studies have shown that improving quality management in the central sterile supply department (CSSD) is an effective measure to control and decrease hospital-acquired infections. This study aimed to establish nursing-sensitive quality indicators for CSSD nursing in China.</p><p><strong>Methods: </strong>We drafted nursing-sensitive quality indicators on the basis of the Structure-Process-Outcome model, and then conducted 2 rounds of consultation with experts using a modified Delphi method to determine the indicators and scientific methods of measurement.</p><p><strong>Results: </strong>We identified five CSSD nursing-sensitive quality indicators. Recovery rates of the 2 rounds of valid questionnaires were 100%. Expert authority coefficients were 0.810 and 0.902, respectively. Kendall's coefficients of concordance were 0.168 and 0.210, respectively ( P < .05).</p><p><strong>Conclusion: </strong>Evidence-based nursing-sensitive quality indicators for the CSSD were established.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"253-260"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139997309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Call for Papers.","authors":"","doi":"10.1097/QMH.0000000000000002","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000002","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":"33 4","pages":"291"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Unnecessary Transfusions of RBCs in Inpatients Admitted Across Niagara Health Community Hospitals.","authors":"Yazan Abu Yousef, Ashis Bagchee-Clark, Krista Walters, Mary Green, Mary Salib, Ankush Chander, Madelyn P Law, Mohammad Refaei","doi":"10.1097/QMH.0000000000000442","DOIUrl":"10.1097/QMH.0000000000000442","url":null,"abstract":"<p><strong>Background and objectives: </strong>Blood products are scarce resources. Audits on the use of red blood cells (RBCs) in tertiary centers have repeatedly highlighted inappropriate use. Earlier retrospective audit at our local community hospitals has demonstrated that only 85% and 54% of all requests met Choosing Wisely Canada guidelines for pre-transfusion hemoglobin (Hb) of 80 g/L or less and single unit, respectively. We sought to improve RBC utilization by 15% over a period of 12 months (meeting Choosing Wisely Canada criteria of pre-transfusion Hb ≤80g/L by >80% and single-unit transfusion by >65%).</p><p><strong>Methods: </strong>Following repeated PDSA (Plan-Do-Study-Act) cycles, we implemented educational strategies, prospective transfusion medicine (TM) technologist-led screening of orders, and an RBC order set.</p><p><strong>Results: </strong>The 3-month median percentages of appropriate RBC use for pre-transfusion Hb and single unit (September-November 2021) across all 3 hospitals were 90% and 71%, respectively. Overall, the rate of appropriate RBCs based on pre-transfusion Hb remained above target (>80%), with minimal improvement across all hospitals (median percentage at pre- and post-technologist screening periods of 87% and 90%, respectively). The median percentage of appropriate RBCs based on single-unit transfusion orders has improved across all Niagara Health hospitals with sustained targets (3-month median percentage at pre- and post-technologist screening and most recent time periods of 54%, 56%, and 71%, respectively).</p><p><strong>Conclusions: </strong>We have taken a collaborative, multifaceted approach to optimizing utilization of RBCs across the Niagara Health hospitals. The rates of appropriate RBC use were comparable with the provincial and national accreditation benchmark standards. In particular, the TM technologist-led screening was effective in producing sustained improvement with respect to single-unit transfusion. One of the balancing outcomes was increasing workload on technologists. Local and provincial efforts are needed to facilitate recruitment and retention of laboratory technologists, especially in community hospitals.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"278-285"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139983693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Huddles in Improving the Patient Safety Attitudes Among Clinical Team Members.","authors":"Yi-Hung Lai, Ching-Wein Chang, Ming-Ju Wu, Hsin-Hua Chen, Shih-Ping Lin, Chun-Shih Chin, Cheng-Hsien Lin, Sz-Iuan Shiu, Chun-Yi Wu, Ying-Cheng Lin, Hui-Chi Chen, Shu-Chin Hou, Hung-Ru Lin","doi":"10.1097/QMH.0000000000000455","DOIUrl":"10.1097/QMH.0000000000000455","url":null,"abstract":"<p><strong>Background and objectives: </strong>Huddles among members of interdisciplinary medical teams involve short stand-up sessions and allow team members to focus on existing or emerging patient safety issues, thereby facilitating team communication. Hospital managers are able to recognize the current situation of the organization through patient safety attitudes, strengthen team members' awareness of patient safety, and improve the quality of health care. The purpose of this study was to determine the effects of huddles on improving team members' attitudes toward patient safety.</p><p><strong>Methods: </strong>We used a quasi-experimental design and selected 2 adult wards with similar properties as the experimental and comparison groups by convenience sampling. Data collection was from December 1, 2021, to June 30, 2022, at a teaching hospital in central Taiwan. Team members of the ward performing huddles formed the experimental group, and they participated 2 times per week in 15-minute huddles from 8:15 to 8:30 am for a total of 4 weeks. The comparison group adopted the routine team care process. Both groups completed the Safety Attitudes Questionnaire during the pre- and post-tests of the study.</p><p><strong>Results: </strong>The experimental group scored significantly higher in the post-test than in the pre-test in all aspects of safety attitudes, with the exception of stress recognition . These improved aspects were teamwork climate (76.47 ± 15.90 vs 83.29 ± 13.52, P < .001), safety climate (75.94 ± 16.14 vs 82.81 ± 13.74, P < .001), job satisfaction (74.34 ± 20.22 vs 84.40 ± 17.22, P <.001), perceptions of management (78.02 ± 19.99 vs 85.51 ± 15.97, P < .001), and working conditions (78.85 ± 17.87 vs 86.81 ± 14.74, P < .001).</p><p><strong>Conclusion: </strong>Through the huddles, clinical team members improved their understanding of different aspects of safety attitudes. Such a study provided ward units with real-time improvement and adjustment in terms of patient safety during their medical work processes with better patient safety.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"239-245"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140294374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Metaphors That May Reinforce Misconceptions Are Associated With Increased Trust in the Clinician.","authors":"Calvin Chandler, Ali Azarpey, Niels Brinkman, David Ring, Lee Reichel, Sina Ramtin","doi":"10.1097/QMH.0000000000000447","DOIUrl":"10.1097/QMH.0000000000000447","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study measured patient reactions to medical metaphors used in musculoskeletal specialty offices and asked: (1) Are there any factors associated with patient thoughts and emotions in response to common metaphors? (2) Is there a difference between patient ratings of metaphors rated as potentially reinforcing misconceptions and those that are more neutral?</p><p><strong>Methods: </strong>In a cross-sectional study, 228 patients presenting to multiple musculoskeletal specialty offices rated reactions to 4 metaphors presented randomly from a set of 14. Two were categorized as potentially reinforcing common misconceptions and 2 as relatively neutral. Bivariate tests and multivariable regression identified factors associated with patient ratings of levels of emotion (using the standard assessment manikins) and aspects of experience (communication effectiveness, trust, and feeling comfortable rated on 11-point ordinal scales) in response to each metaphor.</p><p><strong>Results: </strong>Levels of patient unhelpful thinking or distress regarding symptoms were not associated with patient ratings of patient emotion and experience in response to metaphors. Metaphors that reinforce misconceptions were associated with higher ratings of communication effectiveness, trust, and comfort ( P < .05).</p><p><strong>Conclusion: </strong>The observation that metaphors that validate a person's understanding of his or her illness may elicit trust even if those metaphors have the potential to reinforce misconceptions may account for the common usage of such metaphors. Clinicians can work to incorporate methods for building trust without reinforcing misconceptions.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"246-252"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140294375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}