Journal for Healthcare Quality最新文献

Implementation of an Evidence-Based Treatment Protocol and Order Set for Alcohol Withdrawal Syndrome. 实施基于证据的戒酒综合症治疗方案和医嘱集。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-11-01 Epub Date: 2024-07-24 DOI: 10.1097/JHQ.0000000000000452

Nathan Robert Luzum, Anna Beckius, Thomas W Heinrich, Kimberly Stoner

{"title":"Implementation of an Evidence-Based Treatment Protocol and Order Set for Alcohol Withdrawal Syndrome.","authors":"Nathan Robert Luzum, Anna Beckius, Thomas W Heinrich, Kimberly Stoner","doi":"10.1097/JHQ.0000000000000452","DOIUrl":"10.1097/JHQ.0000000000000452","url":null,"abstract":"Background: Alcohol withdrawal syndrome (AWS) is highly prevalent in hospital inpatients. Recent evidence supports use of phenobarbital and gabapentin in certain patients, and screening tools for severe withdrawal risk can be used to guide care. Inpatients with AWS should also be considered for evidence-based treatment for alcohol use disorder (AUD).Purpose: The purpose of this quality improvement study was to monitor clinical outcomes and prescribing habits after updating an electronic order set for inpatient AWS management at a large, academic hospital.Methods: Protocol updates included use of the Prediction of Alcohol Withdrawal Severity Scale, phenobarbital and gabapentin protocols, and linkage to treatment resources. Data were collected for 10 months before and 14 months after implementation.Results: Intensive care unit (ICU) transfer rate decreased by 2.3%, whereas length of stay and readmissions were not significantly different. In patients treated with the order set, ICU transfer and length of stay outcomes were superior. Patients treated through the order set were more likely to receive evidence-based treatment for AWS and AUD.Conclusions: Electronic order sets can promote evidence-based practice for AWS. The updated protocol will remain in place at the study institution, with future efforts focused on education and ease of use to increase order set utilization.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"340-347"},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761927","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}

引用次数: 0

Streamlining Atrial Fibrillation Care: Building a Comprehensive Program to Provide High-Quality, Individualized Care. 简化心房颤动护理：建立提供高质量、个性化护理的综合计划。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-11-01 DOI: 10.1097/JHQ.0000000000000450

David Lam, Jen Farrell, Bob Fletcher, Adam Zivin

{"title":"Streamlining Atrial Fibrillation Care: Building a Comprehensive Program to Provide High-Quality, Individualized Care.","authors":"David Lam, Jen Farrell, Bob Fletcher, Adam Zivin","doi":"10.1097/JHQ.0000000000000450","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000450","url":null,"abstract":"Abstract: Atrial fibrillation is the most common sustained arrhythmia with a variable presentation ranging from asymptomatic incidental diagnosis by physical examination or electrocardiogram screening, to severely symptomatic requiring emergent treatment. The variation in care represents an opportunity to build a comprehensive center of excellence within a hospital system. We present our experience building the Swedish Comprehensive AFib Network and a dedicated AFib clinic at a large quaternary urban medical center. We focused on patient and referral engagement, standardized protocols to promote best practices, data collection to improve quality of care, and broad evaluation of a single but multidisciplinary disease process. We hope this can offer insight into how other programs can be started for atrial fibrillation or other disease-focused clinics. We report our experience in the first 2 years, having evaluated over 700 new patients, and demonstrated an improvement in the rate of anticoagulation usage and a reduction in hospitalizations among patients included in our program.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"46 6","pages":"333-339"},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584600","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}

引用次数: 0

Increasing Diabetic Retinopathy Screening in Resident-Run Clinic Through Partnership With Ophthalmology Clinic: A Pilot Study. 通过与眼科诊所合作，在驻地诊所增加糖尿病视网膜病变筛查：试点研究。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-11-01 Epub Date: 2024-10-09 DOI: 10.1097/JHQ.0000000000000455

Catherine Mahoney, Caitlin Toomey

{"title":"Increasing Diabetic Retinopathy Screening in Resident-Run Clinic Through Partnership With Ophthalmology Clinic: A Pilot Study.","authors":"Catherine Mahoney, Caitlin Toomey","doi":"10.1097/JHQ.0000000000000455","DOIUrl":"10.1097/JHQ.0000000000000455","url":null,"abstract":"Abstract: Despite the importance of early detection of diabetic retinopathy, many diabetic patients fail to receive the recommended screening. The objective of this quality-improvement initiative was to increase diabetic retinopathy screening through a partnership between primary care and ophthalmology, where primary care clinic staff may schedule patients directly for screening appointments at point of referral. To our knowledge, this intervention is the first described to use an interspecialty partnership to increase screening. We implemented the intervention at a resident-run primary care clinic with a medically underserved patient population. The pilot intervention took place over a 6-month time frame. The completion rate of diabetic retinopathy screening examinations was compared before and after intervention and was found to increase in a statistically significant manner from 34.7% to 40.5% ( p = .01). The no-show rate did improve from 66.7% preintervention to 46.0% postintervention; however, this change was not statistically significant ( p = .44). During this pilot, the intervention was able to increase diabetic retinopathy screening completion rate; however, further efforts should be aimed at addressing no-shows. Overall, this initiative was a positive step toward the goal of every diabetic patient undergoing the appropriate screening examinations.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"365-369"},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394395","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}

引用次数: 0

Improving Time to Antibiotics for Long-Bone Open Fractures: A Quality Improvement Initiative. 缩短长骨开放性骨折患者使用抗生素的时间：质量改进计划。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-11-01 Epub Date: 2024-07-12 DOI: 10.1097/JHQ.0000000000000451

Samita M Heslin, Candice King, Robert Schwaner, James Vosswinkel, Adam Singer, Eric J Morley

{"title":"Improving Time to Antibiotics for Long-Bone Open Fractures: A Quality Improvement Initiative.","authors":"Samita M Heslin, Candice King, Robert Schwaner, James Vosswinkel, Adam Singer, Eric J Morley","doi":"10.1097/JHQ.0000000000000451","DOIUrl":"10.1097/JHQ.0000000000000451","url":null,"abstract":"Abstract: Open fractures, which are exposed to the external environment, are at a high risk of infection. Administering antibiotics within 60 minutes of emergency department (ED) arrival is crucial to prevent infection. However, this is difficult to achieve due to high ED patient volumes. The purpose of our project was to improve time to antibiotics for patients presenting with long-bone open fractures at a Level 1 trauma center ED. We used the Lean Six Sigma Define, Measure, Analyze, Improve, and Control project framework to guide our efforts. Our interventions composed of developing educational initiatives, creating an electronic medical record order set, and restructuring the ED workflow to prioritize long-bone open fractures for immediate evaluation and antibiotic administration in our critical care zone. After our intervention, the time to antibiotics for long-bone open fractures improved significantly, decreasing from 76 to 40 minutes ( p < .001), with the percentage of patients receiving antibiotics within 60 minutes of ED arrival increasing from 64% to 92% ( p < .001). Age, sex, mechanism of injury, antibiotic choice, and location of the open fracture remained consistent between the two groups. Our results highlight the successful application of process improvement methodologies in improving antibiotic administration time for long-bone open fractures.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"326-332"},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761928","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}

引用次数: 0

A Process Evaluation Approach to Central Line-Associated Bloodstream Infection Reduction in a Neonatal Population. 减少新生儿中央管路相关血流感染的过程评估方法。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-11-01 DOI: 10.1097/JHQ.0000000000000453

Soraya Riley, Erin Osterholm, Emily Vadner, Julianne Cramer

{"title":"A Process Evaluation Approach to Central Line-Associated Bloodstream Infection Reduction in a Neonatal Population.","authors":"Soraya Riley, Erin Osterholm, Emily Vadner, Julianne Cramer","doi":"10.1097/JHQ.0000000000000453","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000453","url":null,"abstract":"Objective: To reduce the rate of central line-associated bloodstream infections (CLABSI) in the M Health Fairview Neonatal Intensive Care Unit (NICU) from 2.15 infections per 1,000 central line days to less than one per 1,000 line days using process evaluation.Methods: An interdisciplinary team used process mapping and Failure Modes and Effects Analysis (FMEA) to identify root causes and improvement opportunities in central line maintenance. The focus was on neonates born at <32 weeks of gestational age and weighing less than 750 g. Interventions included standardized clean space, algorithms to reduce line access, and standardized kits for line maintenance.Results: Over 4 years, the project achieved an 86.6% reduction in CLABSI events, decreasing from 15 events in 2019 to two in 2023. The CLABSI rate dropped by 85%, from 2.15 to 0.32 per 1,000 line days. Statistical analysis indicated a significant reduction in FMEA risk scores for the identified failure modes, with an average reduction of 33%.Conclusion: The process-focused approach and interdisciplinary collaboration significantly reduced CLABSI rates in the NICU. Future efforts should aim to maintain these improvements and achieve a target of zero CLABSI events.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"46 6","pages":"348-358"},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584597","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}

引用次数: 0

Thank You to Reviewers. 感谢审稿人。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-11-01 DOI: 10.1097/JHQ.0000000000000459

Cathy E Duquette

引用次数: 0

A Note from the Editor-in-Chief. 主编的说明

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-11-01 DOI: 10.1097/JHQ.0000000000000458

Cathy E Duquette

引用次数: 0

The Use of a Single Risk Assessment Tool for Mortality and Numerous Hospital-Acquired Conditions. 使用单一风险评估工具评估死亡率和多种医院获得性病症。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-11-01 Epub Date: 2024-10-15 DOI: 10.1097/JHQ.0000000000000456

Erwin Wang, Aditya Samaroo, Joseph Weisstuch, Bret Rudy

{"title":"The Use of a Single Risk Assessment Tool for Mortality and Numerous Hospital-Acquired Conditions.","authors":"Erwin Wang, Aditya Samaroo, Joseph Weisstuch, Bret Rudy","doi":"10.1097/JHQ.0000000000000456","DOIUrl":"10.1097/JHQ.0000000000000456","url":null,"abstract":"Abstract: Quality assessment organizations leverage numerous patient safety measures to evaluate hospital performance, resulting in significant financial, administrative, and operational burdens on health systems. Low-intensity approaches that allow for reliable risk stratification of patients can reduce the required investment. The Braden score is a routinely performed bedside nursing evaluation validated to assess risk for hospital-acquired pressure injury. We hypothesized that the tool can be used to evaluate risk for other hospital-related adverse outcomes, including mortality, catheter-associated urinary tract infection (CAUTI), and central line-associated bloodstream infection (CLABSI). We found that abnormal Braden scores have significant association with numerous adverse outcome measures, including mortality, CLABSI, CAUTI, and iatrogenic hypoglycemia. Because of its frequency of reevaluation, we have found preliminary evidence that leveraging this tool can reduce harm by quickly identifying the most at-risk patients for various types of iatrogenic harm. We conclude that in the face of increasing automation and technical applications, for example, artificial intelligence-driven tools, highly reliable clinician bedside physical examination and evaluation can still have significant, low-cost, and high-value impact in improving patient safety.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"370-379"},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478390","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}

引用次数: 0

Collaboration to Remove Barriers to Pump Integration With the Electronic Health Record. 合作消除泵与电子健康记录整合的障碍。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-11-01 Epub Date: 2024-10-09 DOI: 10.1097/JHQ.0000000000000454

Celeste R Romp, Lori Ross, Sabrina Baucom, Breanna K Dalmolin, Catherine Chang

{"title":"Collaboration to Remove Barriers to Pump Integration With the Electronic Health Record.","authors":"Celeste R Romp, Lori Ross, Sabrina Baucom, Breanna K Dalmolin, Catherine Chang","doi":"10.1097/JHQ.0000000000000454","DOIUrl":"10.1097/JHQ.0000000000000454","url":null,"abstract":"Background: The Institute for Safe Medication Practices and The Joint Commission recommend the implementation of bidirectional smart infusion pump interoperability with the electronic health record (EHR) to improve medication safety. However, there are barriers associated with implementation of this process.Purpose: The purpose of this process improvement project was to identify, evaluate, and implement improvements in pump integration with the EHR to decrease manual programming and increase the use of the smart pump functions (the dose error reduction system or infusion guardrails).Methods: A medication safety task force was formed, and end users were surveyed for barriers. The task force found and implemented solutions to improve the process.Results: Infusion pump integration rates for seven hospitals improved from 79.4% to 91.8% ( p < .001), and the use of smart pump programming increased from 84.7% to 93.6%.Conclusions: Including all stakeholders in the project allowed barriers to be identified and solutions to be implemented. As more healthcare systems implement technology-related processes to improve patient safety, this work can guide medication safety teams on how to optimize technology use by removing barriers to the use of pump integration with the EHR.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"359-364"},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478389","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}

引用次数: 0

A Composite Score Reflecting an Initiative to Reduce Harm, Protect Patients, and Promote Safety. 综合评分反映了减少伤害、保护患者和促进安全的举措。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-10-09 DOI: 10.1097/JHQ.0000000000000457

Katelynd Smith, Julia McAvoy, John D Six, Lisa Goss

引用次数: 0