Journal for Healthcare Quality最新文献

{"title":"Value of Using a Structured Improvement Approach: A Dedicated Education Unit Exemplar.","authors":"Shea Polancich, Elizabeth Byrd, Rebecca S Miltner, Greg Eagerton, Michele Talley, Linda Moneyham, Jill Stewart, Connie White-Williams","doi":"10.1097/JHQ.0000000000000393","DOIUrl":"10.1097/JHQ.0000000000000393","url":null,"abstract":"<p><strong>Abstract: </strong>Using a structured approach to improvement that integrates methodological frameworks and commonly used improvement tools and techniques allows an improvement team to systematically implement and evaluate an intervention. Authors from one academic medical center will describe our four-step structured improvement approach in the design of a dedicated education unit (DEU) pilot to potentially meet a critical post-COVID-19 workforce need. Using our structured improvement approach, we successfully piloted a DEU with a unit-based clinical educator and 16 nursing students over 26 clinical days and received 13 preintervention surveys from participants. Although the DEU pilot was small with limited data, the structured improvement approach resulted in an organized and systematic way of designing, implementing, and evaluating improvement.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 4","pages":"220-232"},"PeriodicalIF":1.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9819622","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":"Delays in Care During the COVID-19 Pandemic in the Veterans Health Administration.","authors":"Peter Mills, Robin Pendley Louis, Edward Yackel","doi":"10.1097/JHQ.0000000000000383","DOIUrl":"10.1097/JHQ.0000000000000383","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to review patient safety reports in the Veterans Health Administration (VHA) related to delays during an 11-month period that included months of the COVID-19 pandemic.</p><p><strong>Design: </strong>A retrospective descriptive analysis of COVID-19 patient safety reports related to delays that were submitted in the Joint Patient Safety Event Reporting System database to the VHA National Center of Patient Safety from January 01, 2020 to November 15, 2020 was conducted. There were 897 COVID-19 patient safety events related to delays; 200 cases were randomly selected for analysis, with 148 meeting inclusion criteria.</p><p><strong>Results: </strong>The results showed delays in laboratory results, level of care, treatment and interventional procedures, specific aspects of care, radiology treatment, and diagnosis. Causes for delays included poor communication between staff, problems in getting laboratory results, confusion over policy, and misunderstanding of COVID-19-specific rules.</p><p><strong>Conclusions: </strong>Healthcare delays can be reduced during a pandemic by proactively standardizing medical processes/procedures when testing for infection, improving staff to staff communication teaching the SBAR (situation, background, assessment, and recommendations) communication model, and using simulation to identify latent safety issues and educating medical personnel on new protocols related to the pandemic. Simulation can be used to test new protocols developed during the pandemic.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 4","pages":"242-253"},"PeriodicalIF":0.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10121222","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 Combined Effect of Delirium and Falls on Length of Stay and Discharge.","authors":"Benjamin Kalivas,&nbsp;Jingwen Zhang,&nbsp;Kristine Harper,&nbsp;Jennifer Dulin,&nbsp;Marc Heincelman,&nbsp;Justin Marsden,&nbsp;Kelly J Hunt,&nbsp;Patrick D Mauldin,&nbsp;William P Moran,&nbsp;Meghan K Thomas","doi":"10.1097/JHQ.0000000000000377","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000377","url":null,"abstract":"<p><strong>Introduction: </strong>Delirium or a fall are associated with many negative outcomes including increased length of stay (LOS) and discharge to a facility; however, this relationship is incompletely understood.</p><p><strong>Methods: </strong>A cross-sectional study of all hospitalizations in a large, tertiary care hospital evaluated the effect of delirium and a fall on the outcomes of LOS and risk of being discharged to a facility.</p><p><strong>Results: </strong>The study included 29,655 hospital admissions. A total of 3,707 (12.5%) patients screened positive for delirium and 286 (0.96%) had a reported fall. After adjustment for covariates, relative to patients without delirium or a fall, patients with delirium only had a 1.64-fold longer LOS; patients with fall only had a 1.96-fold longer LOS; and patients who had delirium and fall had a 2.84-fold longer LOS. The adjusted odds of discharge to a facility, relative to those without delirium or a fall, was 8.98 times higher in those with delirium and a fall.</p><p><strong>Conclusions: </strong>Delirium and falls influence LOS and likelihood of being discharged to a facility. The joint impact of falls and delirium on LOS and facility discharge was more than additive. Hospitals should consider the integrated management of delirium and falls.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 3","pages":"177-190"},"PeriodicalIF":1.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9675160","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":"Implementation of ED I-PASS as a Standardized Handoff Tool in the Pediatric Emergency Department.","authors":"Evan Yanni,&nbsp;Sharon Calaman,&nbsp;Ethan Wiener,&nbsp;Jeffrey S Fine,&nbsp;Selin T Sagalowsky","doi":"10.1097/JHQ.0000000000000374","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000374","url":null,"abstract":"<p><strong>Introduction: </strong>Communication, failures during patient handoffs are a significant cause of medical error. There is a paucity of data on standardized handoff tools for intershift transitions of care in pediatric emergency medicine (PEM). The purpose of this quality improvement (QI) initiative was to improve handoffs between PEM attending physicians (i.e., supervising physicians ultimately responsible for patient care) through the implementation of a modified I-PASS tool (ED I-PASS). Our aims were to: (1) increase the proportion of physicians using ED I-PASS by two-thirds and (2) decrease the proportion reporting information loss during shift change by one-third, over a 6-month period.</p><p><strong>Methods: </strong>After literature and stakeholder review, Expected Disposition, Illness Severity, Patient Summary, Action List, Situational Awareness, Synthesis by Receiver (ED I-PASS) was implemented using iterative Plan-Do-Study-Act cycles, incorporating: trained \"super-users\"; print and electronic cognitive support tools; direct observation; and general and targeted feedback. Implementation occurred from September to April of 2021, during the height of the COVID-19 pandemic, when patient volumes were significantly lower than prepandemic levels. Data from observed handoffs were collected for process outcomes. Surveys regarding handoff practices were distributed before and after ED I-PASS implementation.</p><p><strong>Results: </strong>82.8% of participants completed follow-up surveys, and 69.6% of PEM physicians were observed performing a handoff. Use of ED I-PASS increased from 7.1% to 87.5% ( p < .001) and the reported perceived loss of important patient information during transitions of care decreased 50%, from 75.0% to 37.5% ( p = .02). Most (76.0%) participants reported satisfaction with ED I-PASS, despite half citing a perceived increase in handoff length. 54.2% reported a concurrent increase in written handoff documentation during the intervention.</p><p><strong>Conclusion: </strong>ED I-PASS can be successfully implemented among attending physicians in the pediatric emergency department setting. Its use resulted in significant decreases in reported perceived loss of patient information during intershift handoffs.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 3","pages":"140-147"},"PeriodicalIF":1.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9675162","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":"Implementing an Electronic Root Cause Analysis Reporting System to Decrease Hospital-Acquired Pressure Injuries.","authors":"Amy Alvarez Armstrong","doi":"10.1097/JHQ.0000000000000371","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000371","url":null,"abstract":"<p><strong>Abstract: </strong>Hospital-acquired pressure injuries (HAPIs) continue to increase in comparison to other hospital-acquired conditions, despite advancements in prevention and wound care practices. In 2017, an interprofessional skin team (IST) was formed at an academic medical center to improve patient care and reduce HAPIs. Intentional wound, ostomy, continence (WOC) nurse rounding coupled with IST efforts steadily decreased HAPIs in the organization by 39%. In an effort to continue to improve care, a root cause analysis (RCA) of HAPIs was initiated in two intensive care units (ICUs) in October 2019. Using the Plan-Do-Study-Act model, two WOC nurses and a nursing professional development specialist from the IST developed the HAPIs RCA process. Rapid cycle process improvement demonstrated the need to transition from a paper form to an electronic process to increase accessibility for all nursing units and patients to benefit. In May 2020, an electronic reporting system for RCAs for HAPIs began. After implementation, there has been a 53.5% reduction in HAPIs over 2 years. The standardized, electronic RCA process has resulted in improvement, dissemination of best practices, and fostering nonpunitive accountability for each unit's HAPIs.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 3","pages":"125-132"},"PeriodicalIF":1.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9724085","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":"Cervical Collars and Dysphagia Among Geriatric TBIs and Cervical Spine Injuries: A Retrospective Cohort Study.","authors":"Stephanie Jarvis,&nbsp;Alexandre Sater,&nbsp;Jeffrey Gordon,&nbsp;Allan Nguyen,&nbsp;Kaysie Banton,&nbsp;David Bar-Or","doi":"10.1097/JHQ.0000000000000379","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000379","url":null,"abstract":"<p><strong>Introduction: </strong>Dysphagia, a complication of traumatic brain injuries (TBIs), can lead to death. Cervical collar (c-collar) restriction may increase the risk for dysphagia. The objective was to determine how c-collars affect dysphagia rates.</p><p><strong>Methods: </strong>This retrospective cohort study included geriatric TBIs or cervical spine injuries (January 2016 to December 2018) at a Level 1 trauma center. Outcomes (dysphagia, aspiration, and respiratory failure) were compared by c-collar placement.</p><p><strong>Results: </strong>There were 684 patients: 21.5% had a c-collar and 78.5% did not. Demographics, injury severity score, and Glasgow Coma Scale were comparable. Dysphagia (53.7% vs. 39.3%, p = .002) and respiratory failure (17.0% vs. 6.9%, p = .0002) were more common among patients with c-collars. Aspiration rates ( p = .11) were similar. After adjustment, patients with a c-collar had a significantly higher odds of dysphagia and respiratory failure. Among patients who did not receive swallow therapy, aspiration ( p = .02) and respiratory failure ( p < .0001) were more common for those with c-collars.</p><p><strong>Conclusions: </strong>C-collar placement increased the risk for dysphagia and respiratory failure. There was evidence that swallow therapy may modify the effect of c-collar placement. For patients who did not receive swallow therapy, aspiration was more common among those with a c-collar. Dysphagia screening among patients with a c-collar may improve patient quality.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 3","pages":"160-168"},"PeriodicalIF":1.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/31/jhq-45-160.PMC10153662.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9668347","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":"Provider and Patient Experiences of Delays in Primary Care During the Early COVID-19 Pandemic.","authors":"Kimberly A Muellers,&nbsp;Katerina Andreadis,&nbsp;Jessica S Ancker,&nbsp;Carol R Horowitz,&nbsp;Rainu Kaushal,&nbsp;Jenny J Lin","doi":"10.1097/JHQ.0000000000000380","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000380","url":null,"abstract":"<p><strong>Background: </strong>The necessary suspension of nonacute services by healthcare systems early in the COVID-19 pandemic was predicted to cause delays in routine care in the United States, with potentially serious consequences for chronic disease management. However, limited work has examined provider or patient perspectives about care delays and their implications for care quality in future healthcare emergencies.</p><p><strong>Objective: </strong>This study explores primary care provider (PCP) and patient experiences with healthcare delays during the COVID-19 pandemic.</p><p><strong>Methods: </strong>PCPs and patients were recruited from four large healthcare systems in three states. Participants underwent semistructured interviews asking about their experiences with primary care and telemedicine. Data were analyzed using interpretive description.</p><p><strong>Results: </strong>Twenty-one PCPs and 65 patients participated in interviews. Four main topics were identified: (1) types of care delayed, (2) causes for delays, (3) miscommunication contributing to delays, and (4) patient solutions to unmet care needs.</p><p><strong>Conclusions: </strong>Both patients and providers reported delays in preventive and routine care early in the pandemic, driven by healthcare system changes and patient concerns about infection risk. Primary care practices should develop plans for care continuity and consider new strategies for assessing care quality for effective chronic disease management in future healthcare system disruptions.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 3","pages":"169-176"},"PeriodicalIF":1.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10026964","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":"Review of the National Quality Forum's Measure Endorsement Process.","authors":"Sujith Ramachandran,&nbsp;Shishir Maharjan,&nbsp;Irene Nsiah,&nbsp;Benjamin Y Urick,&nbsp;Alexcia Carr,&nbsp;Matthew Foster","doi":"10.1097/JHQ.0000000000000378","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000378","url":null,"abstract":"<p><strong>Abstract: </strong>The National Quality Forum (NQF) evaluates healthcare performance measures for endorsement based on a broad set of criteria. We extracted data from NQF technical reports released between spring 2018 and spring 2019. Measures were commonly stewarded by federal agencies (44.29%), evaluated for maintenance (67.14%), classified as outcome (42.14%) or process (39.29%) measures, and used a statistical model for risk adjustment (48.57%). For 80% of the measures reviewed, a patient advocate was present on the reviewing committee. Validity was evaluated using face validity (65.00%) or score-level empirical validity (67.14%), and reliability was frequently evaluated using score-level testing (71.43%). Although 91.56% of all reviewed measures were endorsed, most standing committee members voted moderate rather than high support on key assessment criteria like measure validity, measure reliability, feasibility of use, and whether the measure addresses a key performance gap. Results show that although the Consensus Development Process includes multidisciplinary stakeholder input and thorough evaluations of measures, continued work to identify and describe appropriate and robust methods for reliability and validity testing is needed. Further work is needed to study the extent to which stakeholder input is truly representative of diverse viewpoints and improve processes for considering social factors when risk adjusting.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 3","pages":"148-159"},"PeriodicalIF":1.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10043965","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":"Provider-To-Provider Communication About Care Transitions: Considering Different Health Technology Tools.","authors":"Eliza W Beal,&nbsp;Natasha Kurien,&nbsp;Matthew J DePuccio,&nbsp;Allan Tsung,&nbsp;Ann Scheck McAlearney","doi":"10.1097/JHQ.0000000000000375","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000375","url":null,"abstract":"<p><strong>Abstract: </strong>Transitions in patient care require exchanges of information between providers. This period of transition presents a range of challenges, and inadequate transitions can have serious consequences for patients. Our objective was to understand providers' perspectives about patient care transitions, especially around communication between providers and the role of health information technology in provider-to-provider communication. Semi-structured interviews were conducted. Deductive-dominant thematic analysis was used to allow categorization of data based on general themes derived from the interview guides, as well as identification of emergent themes. We characterized three main themes involving providers' perspectives about care transitions. Themes included communication challenges, communication preferences, and suggestions for improving the care transition processes. With respect to challenges around communication, providers highlighted four main concerns. These concerns included the existence of too many methods of communication, high volume of communication, challenges with involvement of multiple providers delivering longitudinal care, and difficulty communicating with providers outside the health system. Providers noted opportunities to improve transitions including improving standardization, enhancing the specialty to primary care transition process, and increasing communication back to the referring provider. Implementation and evaluation of these improvements could be considered by health systems to enhance care transitions.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 3","pages":"133-139"},"PeriodicalIF":1.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10044436","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":"Nurse Engagement in Antibiotic Stewardship Programs: A Scoping Review of the Literature.","authors":"Cara Thurman Johnson, Laura J Ridge, Amanda J Hessels","doi":"10.1097/JHQ.0000000000000372","DOIUrl":"10.1097/JHQ.0000000000000372","url":null,"abstract":"<p><strong>Introduction: </strong>Hospital-based antibiotic stewardship programs (ASPs) are an important strategy in combating antibiotic resistance. Four antibiotic stewardship interventions are recommended by the CDC as particularly well-designed to engage nurses. However, there is limited information on whether and how existing hospital-based ASPs reflect these practices.</p><p><strong>Purpose: </strong>To describe how nurses are being engaged in hospital ASPs and to what extent this overlaps with the CDC framework.</p><p><strong>Methods: </strong>This scoping review included studies published in the last 10 years on engaging nurses in hospital-based ASPs. Three databases, PubMed, CINAHL, and Embase, were searched.</p><p><strong>Results: </strong>The search yielded 195 unique articles. Ten articles were retained for review detailing how nurses are engaged. One CDC recommended intervention, initiating discussion of antibiotic treatment, appeared in nine studies.</p><p><strong>Conclusions: </strong>Although hospitals are engaging nurses in antibiotic stewardship programs, their selected approaches do not reflect the full breadth of the opportunities identified by the CDC. More detail as to how exactly nurses engage would also be a useful addition to the literature.</p><p><strong>Implications: </strong>More research is needed on nurse engagement on culturing or testing and penicillin allergy evaluation. Standardized measures should be collected and reported to measure the impact of engaging nurses in ASPs.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 2","pages":"69-82"},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9991980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9753009","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}