Quality Management in Health Care最新文献

{"title":"Choosing Wisely and Promoting High-Value Care and Staff Safety During the COVID-19 Pandemic in a Large Safety Net System.","authors":"Mona Krouss, Sigal Israilov, Nessreen Mestari, Joseph Talledo, Daniel Alaiev, Joshua B Moskovitz, Robert T Faillace, Amit Uppal, Ian Fagan, Joan Curcio, Jinel Scott, Michael Bouton, Kenra Ford, Victor Cohen, Eric K Wei, Hyung J Cho","doi":"10.1097/QMH.0000000000000431","DOIUrl":"10.1097/QMH.0000000000000431","url":null,"abstract":"<p><strong>Background and objectives: </strong>As the COVID-19 pandemic brought surges of hospitalized patients, it was important to focus on reducing overuse of tests and procedures to not only reduce potential harm to patients but also reduce unnecessary exposure to staff. The objective of this study was to create a Choosing Wisely in COVID-19 list to guide clinicians in practicing high-value care at our health system.</p><p><strong>Methods: </strong>A Choosing Wisely in COVID-19 list was developed in October 2020 by an interdisciplinary High Value Care Council at New York City Health + Hospitals, the largest public health system in the United States. The first phase involved gathering areas of overuse from interdisciplinary staff across the system. The second phase used a modified Delphi scoring process asking participants to rate recommendations on a 5-point Likert scale based on criteria of degree of evidence, potential to prevent patient harm, and potential to prevent staff harm.</p><p><strong>Results: </strong>The top 5 recommendations included avoiding tracheal intubation without trial of noninvasive ventilation (4.4); not placing routine central venous catheters (4.33); avoiding routine daily laboratory tests and batching laboratory draws (4.19); not ordering daily chest radiographs (4.17); and not using bronchodilators in the absence of reactive airway disease (4.13).</p><p><strong>Conclusion: </strong>We successfully developed Choosing Wisely in COVID-19 recommendations that focus on evidence and preventing patient and staff harm in a large safety net system to reduce overuse.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"94-100"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41210939","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":"Interprofessional Collaboration and Patient/Family Engagement on Rounds in a Comprehensive Stroke Center: A Mixed-Methods Study","authors":"Anping Xie, E. A. Barany, Elizabeth K. Tanner, E. Blakeney, Mona N. Bahouth, Ginger C. Hanson, Bryan R. Hansen, Kathryn M. McDonald, Rachel Marie E. Salas, Tenise Shakes, Heather Watson, Elizabeth K. Zink, Dorna P. Hairston","doi":"10.1097/qmh.0000000000000437","DOIUrl":"https://doi.org/10.1097/qmh.0000000000000437","url":null,"abstract":"\u0000 \u0000 Daily rounds provide an opportunity for interprofessional collaboration and patient/family engagement, which are critical to stroke care. As part of a quality improvement program, we conducted a baseline assessment to examine interprofessional collaboration and patient/family engagement during the current rounding process in a 12-bed comprehensive stroke center. Findings from the baseline assessment will be used to inform the development, implementation, and evaluation of a new rounding model.\u0000 \u0000 \u0000 \u0000 The baseline assessment used a mixed-methods approach with a convergent parallel design. Although observations of the current rounding process were conducted to quantitatively assess interprofessional collaboration and patient/family engagement on rounds, qualitative interviews were conducted with different stakeholders to identify strengths and weaknesses of the current rounding process, as well as suggestions for facilitating interprofessional collaboration and patient/family engagement.\u0000 \u0000 \u0000 \u0000 We observed 103 table rounds and 99 bedside rounds and conducted 30 interviews with patients, families, and clinicians. Although the current process was perceived to facilitate interprofessional collaboration, the participation of nurses and other health care professionals on rounds was inconsistent due to competing clinical duties. Good practices for engaging patients and families during bedside rounds were also performed inconsistently.\u0000 \u0000 \u0000 \u0000 These findings lead to recommendations for revising the rounding process with poststroke patients, utilizing a more interprofessional collaborative approach with focus on patient/family engagement.\u0000","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":"116 44","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140381693","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":"An Overview on Research in a University Hospital, Using a Payback Framework Categorization Approach.","authors":"Stefania Medellin-Lacedelli, Elvira Castro-Martinez, Fernando Martinez-Hernandez, Mirza Romero-Valdovinos, Lourdes Suarez-Roa, Pablo Maravilla, Hector Prado-Calleros, Ana Flisser, Octavio Sierra-Martinez","doi":"10.1097/QMH.0000000000000415","DOIUrl":"10.1097/QMH.0000000000000415","url":null,"abstract":"<p><strong>Background and objective: </strong>Little information is available on how to assess the impact of research studies conducted in government hospitals in Latin America and specifically in Mexico. We aimed to determine the returns on investment of the research projects that were carried out in the Hospital General \"Dr. Manuel Gea Gonzalez\" (HGMGG), a general university hospital located in Mexico City, using a categorization model.</p><p><strong>Methods: </strong>We conducted a study including bibliometric analyses of publications associated with all research studies performed during the period 2016-2019 in the HGMGG and investigator interviews, according to the payback framework categorization model.</p><p><strong>Results: </strong>All studies analyzed had a positive impact based on outcomes in 5 \"payback categories\": (1) knowledge; (2) research targeting, capacity building, and absorption; (3) policy and product development; (4) health benefits; and (5) broader economic benefits.</p><p><strong>Conclusions: </strong>To date, it has not been possible to establish a set of indicators that show the results of the investigations carried out by medical specialists in training, who carry out the bulk of medical care in general hospitals and in the National Institutes of Health in Mexico. We identified, in the 5 categories of the payback framework model, different areas of opportunity to improve the benefits of the hospital's medical services through the development of scientific research projects.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"29-38"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10782936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9692324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Personalized Pain Program: A New Transitional Perioperative Pain Care Delivery Model to Improve Surgical Recovery and Address the Opioid Crisis.","authors":"Traci J Speed, Marie N Hanna, Anping Xie","doi":"10.1097/QMH.0000000000000450","DOIUrl":"10.1097/QMH.0000000000000450","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":"33 1","pages":"61-63"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10764066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139074880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Waste Segregation in the Operating Room to Decrease Overhead Cost.","authors":"Daniel Plezia, Valerie K Sabol, Christoffer Nelson, Virginia C Simmons","doi":"10.1097/QMH.0000000000000416","DOIUrl":"10.1097/QMH.0000000000000416","url":null,"abstract":"<p><strong>Background and objectives: </strong>Operating rooms (ORs) disproportionally contribute 20% to 33% of hospital waste nationwide and therefore have a major impact on hospital waste management. Seventy percent of general OR waste is incorrectly eliminated as clinical waste, which compounds unnecessary financial burden and produces negative environmental impact. The primary purpose of this quality improvement (QI) project was to evaluate the effectiveness of waste segregation education for OR anesthesia staff on improving waste segregation compliance in the OR.</p><p><strong>Methods: </strong>A waste segregation QI project was implemented at a 19-OR hospital. Sharps bins in each OR were monitored for weight in pounds and 6 ORs were monitored for percent compliance both pre- and post-institution of a waste segregation education. In addition, a waste segregation knowledge assessment, waste segregation barriers assessment, and a demographic survey were administered to anesthesia staff. Twenty-two certified registered nurse anesthetists (CRNAs), 13 anesthesiologists, and 4 anesthesia technicians responded to the initial surveys and assessments while 30 of these original 39 participants (77%) responded following the educational intervention. A cost analysis was calculated pre- and post-implementation by multiplying total weight of the sharps bins by the price per pound of sharps.</p><p><strong>Results: </strong>Twenty-three percent of participants reported having formal waste segregation training. Survey responses revealed that the greatest barrier to waste segregation involved bin location (56.4%), followed by lack of time to segregate (25.6%), lack of knowledge of what content goes in the bin (25.6%), and lack of incentive (25.6%). A waste segregation knowledge assessment showed improvement from pre- ( M = 9.18, SD = 1.66) to post-implementation ( M = 9.90, SD = 1.64). Pre-implementation sharps bin compliance was 50.70% while post-implementation bin compliance improved to 58.44%. A 27.64% decrease in sharps disposal cost occurred following implementation, which is estimated to produce a $2964 cost savings per year.</p><p><strong>Conclusions: </strong>Waste segregation education for anesthesia staff increased their waste management knowledge, improved sharps waste bin compliance, and produced an overall cost savings.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"44-51"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9599383","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":"Closing the Gap in Direct Admissions: A Quality Improvement Project.","authors":"Amanda L McKenna, Laurel E Carter, Adam M Kase, Josiah D McCain, Patrick J Fitzgerald, Alex M Kesler, Suneel Varma, J Colt Cowdell","doi":"10.1097/QMH.0000000000000412","DOIUrl":"10.1097/QMH.0000000000000412","url":null,"abstract":"<p><strong>Background and objectives: </strong>Direct admissions (DAs) are nonemergent admissions to the inpatient unit that bypass the emergency department. Our institution lacked a standardized DA process, which resulted in postponement of prompt patient care. The purpose of the present study was to review and modify the existing DA process and to decrease the time between patient arrival for DA and placement of initial clinician orders.</p><p><strong>Methods: </strong>A team was assembled and tasked with using quality improvement tools (eg, Define-Measure-Analyze-Improve-Control, fishbone diagrams, process mapping) to streamline the DA process to decrease average time between patient arrival for DA and initial clinician orders, from 84.4 minutes in July 2018 to 60 minutes or less by June 2019, without negatively affecting patient admission loyalty questionnaire scores.</p><p><strong>Results: </strong>In a standardized and streamlined DA process, average time between patient arrival and provider order placement decreased to less than 60 minutes. This reduction was achieved without substantially affecting patient loyalty questionnaire scores.</p><p><strong>Conclusion: </strong>By using a quality improvement methodology, we developed a standardized DA process that resulted in prompt care for patients without decreasing admission loyalty scores.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"52-58"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9605158","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":"Emergency Medical Treatment and Labor Act: Impact on Health Care, Nursing, Quality, and Safety.","authors":"Theresa Ryan Schultz, Jacqueline Forbes, Ashley Hafen Packard","doi":"10.1097/QMH.0000000000000438","DOIUrl":"10.1097/QMH.0000000000000438","url":null,"abstract":"<p><p>Nurse knowledge and expertise in Emergency Medical Treatment and Labor Act (EMTALA) are a prerequisite to meet emergency department practice laws and regulatory standards. EMTALA is a federal law that requires anyone coming to an emergency department for care to be stabilized and treated, regardless of their insurance status or ability to pay. Regulatory standard infractions resulting from an EMTALA violation complaint may include (1) penalties and/or fines, (2) future unannounced Centers for Medicare & Medicaid Services surveys, (3) documented Centers for Medicare & Medicaid Services deficiencies that require timely response, action plans, and audit for expected outcomes, (4) Medicare/Medicaid nonpayment for services, and (5) termination of a hospital's Medicare agreement. The consequences of EMTALA violations target physicians and hospitals; however, nurses are most often the first provider the patient encounters upon arrival to the emergency department. It is therefore essential that nurses maintain a proficient understanding of EMTALA laws, which requires special training, monitoring, periodic competency assessment strategies, and continuing education throughout their career. Furthermore, additional clinician education is needed on how to manage the complex expectations that are imposed on health care providers by regulatory policy. Doing this promotes safe, effective, patient-centered, timely, and efficient health care regulations from the beginning of one's introduction to the health care industry and throughout his or her career. This article seeks to ( a ) emphasize nursing staff's responsibility for EMTALA adherence, ( b ) identify the gaps among health care quality, safety, and nursing workforce competency standards that are imposed to meet the demands of EMTALA laws, and ( c ) provide recommendations for continuing education, monitoring, and periodic competency assessment strategies that may strengthen EMTALA compliance.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"39-43"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41210940","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":"Re: Watson H. The Center for Nursing Inquiry: Developing Nurse-Led Inquiry. Qual Manag Health Care . 2022;31(3):149-150.","authors":"Lisa Di Prospero, Sara Morassaei","doi":"10.1097/QMH.0000000000000403","DOIUrl":"10.1097/QMH.0000000000000403","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"59-60"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9966884","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":"Interprofessional Team Collaboration as a Mediator Between Workplace Social Capital and Patient Safety Climate: A Cross-Sectional Study.","authors":"Ryohei Kida, Risa Suzuki, Katsumi Fujitani, Kaori Ichikawa, Hironobu Matsushita","doi":"10.1097/QMH.0000000000000421","DOIUrl":"10.1097/QMH.0000000000000421","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patient-safety climate is one of the most important organizational factors contributing to health care quality. We hypothesized that a patient safety climate is fostered by the willingness to collaborate and trust among members as well as by daily collaborative practices. This study aimed to clarify the effect of workplace social capital on patient safety climate. We also sought to investigate the mediating effect of interprofessional team collaboration on the relationship between workplace social capital and patient safety climate.</p><p><strong>Methods: </strong>This cross-sectional survey was conducted from November 2021 to January 2022 using anonymous web-based questionnaires. The survey was distributed to 1495 employees working in a hospital in Tokyo, Japan. The questionnaire included the patient safety climate scale, workplace social capital scale, Japanese version of the Assessment of Interprofessional Team Collaboration Scale-II (AITCS-II-J), and demographic items. Structural equation modeling was performed to verify the associations among the 3 variables. In addition, a significance test for indirect effects was conducted using the bootstrap method to confirm the mediating effect of AITCS-II-J.</p><p><strong>Results: </strong>A total of 725 employees participated in this survey, and 632 data items were analyzed. Nurses were the highest number of respondents (68.2%), followed by physicians (13.3%). Workplace social capital and patient safety were directly and significantly associated (β = .309, P < .01). Furthermore, the partially indirect effect of the AITCS-II-J on the association between workplace social capital and patient safety climate was also significant (β = .430, P < .01).</p><p><strong>Conclusions: </strong>Workplace social capital was significantly and directly related to patient safety climate and was also significantly related to patient safety climate partially mediated by interprofessional team collaboration. Our findings suggest the importance of workplace social capital and routine multidisciplinary collaboration for a patient safety climate to manage health care quality.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"12-17"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10119244","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":"Improving Speed to Bedside: Standardized Tools to Inform High-Quality, Timely Clinical Implementations.","authors":"Ashley Krueger, Andrew Knighton, Timothy R Fowles, Griffin Olsen, Rajendu Srivastava","doi":"10.1097/QMH.0000000000000448","DOIUrl":"10.1097/QMH.0000000000000448","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":"33 1","pages":"64-66"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139074879","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}