Journal for Healthcare Quality最新文献_第5页

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":"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 Survey for Charting Intake, Output, and Body Weight in the Electronic Medical Record. 在电子病历中记录摄入量、排出量和体重的调查。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-09-01 Epub Date: 2024-05-14 DOI: 10.1097/JHQ.0000000000000437

Jianling Tao, Sara May, Mingyi Li, Marianne Monahan, Donna Phanumas, Charles Seelig

{"title":"A Survey for Charting Intake, Output, and Body Weight in the Electronic Medical Record.","authors":"Jianling Tao, Sara May, Mingyi Li, Marianne Monahan, Donna Phanumas, Charles Seelig","doi":"10.1097/JHQ.0000000000000437","DOIUrl":"10.1097/JHQ.0000000000000437","url":null,"abstract":"Background: The accuracy of documentation of body weight and fluid balance in hospitalized patients is frequently questioned.Methods: We conducted a survey to understand provider perceptions of the accuracy of intake, output, and weight charting in the electronic medical record. We sent a six-item questionnaire to nurses and physicians who provide inpatient service in a community-based teaching hospital of the Northeastern United States. We compared the response difference between nurses and physicians by Fisher exact test.Results: One hundred eight nurses and 39 physicians participated in the survey. Both nurses and physicians responded that the accuracy of documentation is crucial. However, only 25.7% of participating physicians and 38.3% of participating nurses considered that documentation in the electronic medical record is reliable. Both physicians and nurses assumed that the nurses are too busy to collect and document the data, and the variability of non-patient weight and variations in body weight measurement under different conditions account for inaccuracies in the documented body weight.Conclusions: Assessing the accuracy of documenting intake, output, and body weight in the electronic medical record is warranted. Providers believe that educating patients about fluid balance and volume assessment help to improve the accuracy in charting intake, output, and body weight in the electronic medical record.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"293-299"},"PeriodicalIF":0.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140921753","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

Optimizing the Team Approach: Designing a Clinical Care Pathway for Functional Neurological Disorder. 优化团队方法：为功能性神经紊乱设计临床护理路径。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-09-01 Epub Date: 2024-06-14 DOI: 10.1097/JHQ.0000000000000445

Laurey Brown, Meredith Norwood, Laurie G Thompson

{"title":"Optimizing the Team Approach: Designing a Clinical Care Pathway for Functional Neurological Disorder.","authors":"Laurey Brown, Meredith Norwood, Laurie G Thompson","doi":"10.1097/JHQ.0000000000000445","DOIUrl":"10.1097/JHQ.0000000000000445","url":null,"abstract":"Abstract: Functional neurological disorder (FND) sits at the intersection of neurology and psychology and has a variety of presentations, severity, and symptomatology. It affects a considerable number of pediatric patients and overwhelmingly influences healthcare spending. Diagnosis, treatment, and outcomes are varied, challenging, and lack standardization, often leading to frustration from patients, caregivers, and providers. Multidisciplinary care is essential though communication is often complex and disjunct. Using quality improvement tools and experiences from one institution, a team was established to ameliorate these concerns. A clinical care pathway was designed for the diagnosis and treatment of FND in the pediatric inpatient setting. This pathway was the result of the multidisciplinary team effort and an outcome, highlighting the need for early and intentional diagnosis with diagnosing provider specified, provider education and consistent language, patient and caregiver education, and clear and thorough discharge planning. Through the implementation of this pathway, it is anticipated that patient and provider satisfaction will improve as will the outcomes and care given to affected individuals. This work can be applied to the global treatment of FND and raise awareness to effectively managed care as well as the opportunity for clinicians to drive institutional change.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"276-280"},"PeriodicalIF":0.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421504","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

Impact of Collaborative Leadership, Workplace Social Capital, and Interprofessional Collaboration Practice on Patient Safety Climate. 协作式领导、工作场所社会资本和跨专业协作实践对患者安全氛围的影响。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-09-01 Epub Date: 2024-05-17 DOI: 10.1097/JHQ.0000000000000443

Ryohei Kida, Katsumi Fujitani, Hironobu Matsushita

{"title":"Impact of Collaborative Leadership, Workplace Social Capital, and Interprofessional Collaboration Practice on Patient Safety Climate.","authors":"Ryohei Kida, Katsumi Fujitani, Hironobu Matsushita","doi":"10.1097/JHQ.0000000000000443","DOIUrl":"10.1097/JHQ.0000000000000443","url":null,"abstract":"Purpose: Patient safety climate is an important factor in promoting patient safety for healthcare organizations. This study investigated the relationship between collaborative leadership and patient safety climate, the mediation effect of workplace social capital, or interprofessional collaboration practice.Methods: A web-based cross-sectional questionnaire survey was administered between May 2021 and May 2022, to employees of three acute care hospitals in Japan. The relationship between variables was verified by structural equation modeling.Results: A total of 1,276 staff members participated in the study. Collaborative leadership affected the workplace social capital (β = .734) and interprofessional collaboration (β = .561), which were positively associated with patient safety climate (β = .403 and .405, respectively), verifying the mediating relationship of workplace social capital and interprofessional collaboration between collaborative leadership and patient safety climate.Conclusions: Collaborative leadership enhances the reciprocity and interprofessional practices of the healthcare team. The interaction among interprofessional team members fosters a patient safety climate. The results of this survey suggest that the development of collaborative leadership, which encourages interprofessional collaboration and fosters workplace social capital, is inherently crucial for cultivating a patient safety climate.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"268-275"},"PeriodicalIF":0.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960489","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 Lung Cancer Screening at an Academic Medical Center. 改善学术医疗中心的肺癌筛查。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-09-01 DOI: 10.1097/JHQ.0000000000000449

Cynthia Cantu, Rebecca Jones, Dolores Garcia, Arlene Reyes, Ramon S Cancino

{"title":"Improving Lung Cancer Screening at an Academic Medical Center.","authors":"Cynthia Cantu, Rebecca Jones, Dolores Garcia, Arlene Reyes, Ramon S Cancino","doi":"10.1097/JHQ.0000000000000449","DOIUrl":"10.1097/JHQ.0000000000000449","url":null,"abstract":"Introduction: Lung cancer ranks as the third most prevalent cancer in the United States. The use of low-dose computed tomography (LDCT) screening significantly reduces mortality from this disease. Unfortunately, Texas lags in completing lung cancer screening (LCS) for high-risk patients, ranking 48th among all states. It is crucial to implement quality improvement (QI) initiatives in Texas. In collaboration with the American Cancer Society, the primary care center (PCC) at our institution led a multidisciplinary QI project aimed at enhancing LCS through LDCT for eligible PCC patients.Methods: The study included patients eligible for screening and who fall into the following categories: established patients with Medicaid, low-income or uninsured established patients, and established patients with either Medicare or commercial insurance. Enhancements to electronic medical records, education for clinical staff and patients, and a coordinated, multidisciplinary effort were implemented.Results: The study revealed a substantial 40.2% improvement in LCS rates.Conclusion: The US Preventive Services Task Force guidelines rely on an accurate history of patient's tobacco use to identify patients eligible for LCS. This QI project achieved success in improving the thoroughness of tobacco use history documentation and surpassed our target for increasing LCS by more than 10%.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"46 5","pages":"286-292"},"PeriodicalIF":0.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093999","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