Rebecca Afford, Megan Chan, Rana Garelnabi, Fariba Haji Ali Akbari, Sam M Wiseman
{"title":"Improving First Case Operating Room Efficiency.","authors":"Rebecca Afford, Megan Chan, Rana Garelnabi, Fariba Haji Ali Akbari, Sam M Wiseman","doi":"10.1097/JHQ.0000000000000433","DOIUrl":"10.1097/JHQ.0000000000000433","url":null,"abstract":"<p><strong>Introduction: </strong>Improving transition to the operating room (OR) can enhance healthcare efficiency. Our aim was to determine whether adopting a communication board (CB) for first case surgical patients reduced delays to OR.</p><p><strong>Methods: </strong>A retrospective observational study was conducted from April to October 2021. We calculated differences in surgical daycare (SDC) departure time before and after implementation of the CB, differences in departure whether the CB was used or not, delay in variability between surgical specialties, and overall adoption of the CB.</p><p><strong>Results: </strong>After CB adoption, 13% of first cases left SDC by predefined target times. The mean delay in transfer was 18:51 minutes. When the CB was used, cases were on average 10:43 late, compared with 26:00 when it was not used. Otolaryngology had the shortest delays while plastic surgery had the longest. Reasons for delays included staffing delays, holds, and pending laboratory results.</p><p><strong>Conclusions: </strong>Introducing a CB significantly reduced delays in transferring first case surgical patients from SDC to the OR.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"228-234"},"PeriodicalIF":0.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872399","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}
Parker A Rhoden, Luke Hall, Michelle Stancil, Windsor Westbrook Sherrill
{"title":"EHR Smart Phrases Used as Enrollment Mechanism in Diabetes Self-Management Support Programs: Preliminary Outcomes.","authors":"Parker A Rhoden, Luke Hall, Michelle Stancil, Windsor Westbrook Sherrill","doi":"10.1097/JHQ.0000000000000438","DOIUrl":"10.1097/JHQ.0000000000000438","url":null,"abstract":"<p><strong>Abstract: </strong>Diabetes in the United States is increasing rapidly. Innovative strategies are needed for diabetes prevention and self-management. This study assessed the usability, acceptability, and awareness of an electronic health record (EHR) tool for referring patients to a community-based diabetes self-management support program. Mixed-methods approaches were used, using EHR data and key informant interviews to assess the implementation of this quality improvement (QI) process intervention. The implementation of a smart phrase tool within the EHR led to a substantial increase in referrals (773) to the Health Extension for Diabetes (HED) program. Clinical health care professionals have actively used the referral mechanism; they reported using smart phrases to increase efficiency in patient care. Lack of training and program awareness was identified as a barrier to adoption. Awareness of the HED program and .HEDREF smart phrase was limited, but improved with targeted QI and training interventions. The .HEDREF smart phrase demonstrated effectiveness in increasing patient referrals to the HED program, highlighting the potential of EHR tools to streamline documentation and promote patient engagement in diabetes self-management. Future research should focus on broader health care contexts, patient perspectives, and integration of technology for optimal patient outcomes.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"46 4","pages":"235-244"},"PeriodicalIF":0.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460178","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 Behavioral Optimization and Outcomes Support Team in a Medical/Surgical Telemetry Unit.","authors":"Chikaodi Kay, Marilyn Miller, Brandon Buckingham","doi":"10.1097/JHQ.0000000000000436","DOIUrl":"10.1097/JHQ.0000000000000436","url":null,"abstract":"<p><strong>Background: </strong>A community hospital reported 21 staff assaults with injuries and 242 emergency response code green (CG) calls for violent behaviors, resulting in a loss of time in the 2022 fiscal year. Evidence has shown that exposure to violent behavior can compromise effective patient care and lead to job dissatisfaction, high turnover, and higher healthcare costs.</p><p><strong>Purpose: </strong>This quality improvement project aims to develop and implement behavioral optimization and outcome support team (BOOST) in a medical-surgical telemetry unit to reduce patient-to-staff assaults/injuries.</p><p><strong>Methods: </strong>BOOST was piloted for 15 weeks; process data included staff knowledge and satisfaction with BOOST; outcome data included the number of BOOST and CG calls and staff assaults/injuries. The team members included registered psychiatric nurses, nursing supervisors, and security officers. Data were collected and analyzed weekly using a run chart.</p><p><strong>Results: </strong>The survey data demonstrated increased staff knowledge of the behavioral response team and staff satisfaction with the BOOST implementation. No staff injuries or assaults were reported during the BOOST implementation.</p><p><strong>Conclusions: </strong>Behavioral optimization and outcome support team was effective in de-escalating patients and the team provided support to nursing staff. BOOST utilization can effectively reduce assaults and injuries in the workplace.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"e40-e48"},"PeriodicalIF":0.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863796","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}
Anne H VanBuren, Tricia M Montgomery, John R McConaghy, Jeffrey Lawrence, Nazhat Taj-Schaal, Melissa Unger, Nate R Rogers
{"title":"Ambulatory Quality Improvement Despite COVID-19: Blueprint for a Successful System for Continuous Improvement.","authors":"Anne H VanBuren, Tricia M Montgomery, John R McConaghy, Jeffrey Lawrence, Nazhat Taj-Schaal, Melissa Unger, Nate R Rogers","doi":"10.1097/JHQ.0000000000000444","DOIUrl":"10.1097/JHQ.0000000000000444","url":null,"abstract":"<p><strong>Abstract: </strong>In this article, we describe our experience developing and implementing a multipronged approach to improve performance across a strategic subset of quality measures within primary care. Detailed techniques include data visualization and analytics, process reengineering, team engagement, visual project management, continuous improvement methods and training, and incentives and recognition. We achieved positive change across 12 high priority measures which we deemed the \"High Value Framework (HVF)\" by fostering a collaborative, nonpunitive, problem-solving culture. We focused on measures that had the greatest potential for impact from a clinical, reimbursement, and reputational perspective. More importantly, we sustained gains despite the challenges posed by the COVID-19 pandemic, thereby demonstrating programmatic resilience and high process reliability. This systematic approach serves as a practical blueprint for other healthcare entities seeking to navigate the complexities of quality improvement in a dynamic environment. The model provides a strategic framework for prioritizing and standardizing quality measures, effectively engaging stakeholders, and managing organizational change. Our model emerged from a need to address real-world operational challenges, rather than as an academic or theoretical exercise, and was developed independently of existing literature on measure prioritization and standardization at the time of its inception.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"251-258"},"PeriodicalIF":0.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960484","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":"A Qualitative Study of Factors Influencing Hospital Participation in the Healthcare Equality Index.","authors":"V Peter Abdow, Julian K Marable, Eileen S Moore","doi":"10.1097/JHQ.0000000000000426","DOIUrl":"10.1097/JHQ.0000000000000426","url":null,"abstract":"<p><strong>Abstract: </strong>Gender and sexual minority individuals experience higher rates of mistreatment and discrimination in healthcare compared with their non-lesbian, gay, bisexual, transgender, queer, and other nonheterosexual (LGBTQ+) peers. The Healthcare Equality Index (HEI) aims to create more inclusive environments and to provide metrics for quality improvement. Currently, only one adult hospital in the District of Columbia has earned the highest recognition from the HEI. Our institution is part of the same regional health system as this hospital, yet has never been evaluated by the HEI. This study explores the knowledge, attitudes, and perceptions surrounding the HEI at our institution to assess the feasibility of its participation. During the study period of July 2021 to June 2022, a total of 12 physicians, administrators, and educators from both hospitals and our affiliated school of medicine were interviewed. All participants expressed support after HEI requirements and improving inclusivity for LGBTQ+ patients. Participants at the other hospital cited unanimous support amongst hospital administrators as key for successful HEI implementation. Participants also mentioned cost, staff shortages, and the school of medicine's religious affiliation as potential barriers to this goal. Ultimately, hospital implementation of HEI guidelines is feasible despite shifting institutional priorities and resource limitations through greater stakeholder buy-in and streamlining a systemwide approach.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"177-187"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425801","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}
Helen Jingshu Jin, Jennifer Koichopolos, Bradley Moffat, Patrick Colquhoun, Bronagh Morgan, Launa Elliot, Robert Sibbald, Terry Zwiep
{"title":"General Surgery Resuscitation Preference Documentation: A Quality Improvement Initiative.","authors":"Helen Jingshu Jin, Jennifer Koichopolos, Bradley Moffat, Patrick Colquhoun, Bronagh Morgan, Launa Elliot, Robert Sibbald, Terry Zwiep","doi":"10.1097/JHQ.0000000000000439","DOIUrl":"10.1097/JHQ.0000000000000439","url":null,"abstract":"<p><strong>Background/purpose: </strong>Documentation of resuscitation preferences is crucial for patients undergoing surgery. Unfortunately, this remains an area for improvement at many institutions. We conducted a quality improvement initiative to enhance documentation percentages by integrating perioperative resuscitation checks into the surgical workflow. Specifically, we aimed to increase the percentage of general surgery patients with documented resuscitation statuses from 82% to 90% within a 1-year period.</p><p><strong>Methods: </strong>Three key change ideas were developed. First, surgical consent forms were modified to include the patient's resuscitation status. Second, the resuscitation status was added to the routinely used perioperative surgical checklist. Finally, patient resources on resuscitation processes and options were updated with support from patient partners. An audit survey was distributed mid-way through the interventions to evaluate process measures.</p><p><strong>Results: </strong>The initiatives were successful in reaching our study aim of 90% documentation rate for all general surgery patients. The audit revealed a high uptake of the new consent forms, moderate use of the surgical checklist, and only a few patients for whom additional resuscitation details were added to their clinical note.</p><p><strong>Conclusions: </strong>We successfully increased the documentation percentage of resuscitation statuses within our large tertiary care center by incorporating checks into routine forms to prompt the conversation with patients early.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"46 3","pages":"188-195"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872984","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}
Cory Hussain, Laura J Podewils, Nancy Wittmer, Ann Boyer, Maria C Marin, Rebecca L Hanratty, Romana Hasnain-Wynia
{"title":"Leveraging Ethnic Backgrounds to Improve Collection of Race, Ethnicity, and Language Data.","authors":"Cory Hussain, Laura J Podewils, Nancy Wittmer, Ann Boyer, Maria C Marin, Rebecca L Hanratty, Romana Hasnain-Wynia","doi":"10.1097/JHQ.0000000000000425","DOIUrl":"10.1097/JHQ.0000000000000425","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare disparities may be exacerbated by upstream incapacity to collect high-quality and accurate race, ethnicity, and language (REaL) data. There are opportunities to remedy these data barriers. We present the Denver Health (DH) REaL initiative, which was implemented in 2021.</p><p><strong>Methods: </strong>Denver Health is a large safety net health system. After assessing the state of REaL data at DH, we developed a standard script, implemented training, and adapted our electronic health record to collect this information starting with an individual's ethnic background followed by questions on race, ethnicity, and preferred language. We analyzed the data for completeness after REaL implementation.</p><p><strong>Results: </strong>A total of 207,490 patients who had at least one in-person registration encounter before and after the DH REaL implementation were included in our analysis. There was a significant decline in missing values for race (7.9%-0.5%, p < .001) and for ethnicity (7.6%-0.3%, p < .001) after implementation. Completely of language data also improved (3%-1.6%, p < .001). A year after our implementation, we knew over 99% of our cohort's self-identified race and ethnicity.</p><p><strong>Conclusions: </strong>Our initiative significantly reduced missing data by successfully leveraging ethnic background as the starting point of our REaL data collection.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"160-167"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933734","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}
John Sorge, Susan Szpunar, Theodore Daniel, Louis Saravolatz
{"title":"Using the Electronic Medical Record to Address Code Status Documentation: A Quality Improvement Project.","authors":"John Sorge, Susan Szpunar, Theodore Daniel, Louis Saravolatz","doi":"10.1097/JHQ.0000000000000428","DOIUrl":"10.1097/JHQ.0000000000000428","url":null,"abstract":"<p><strong>Abstract: </strong>Code status (CS) is often overlooked while admitting patients to the hospital. This is important for patients with end-stage disease. This quality improvement project investigated whether a CS pop-up alert in the electronic medical record, combined with provider education, improved addressing CS. The project consisted of a baseline chart review, implementation of the alert and physician education, and a postintervention chart review. We reviewed 1828 charts at baseline and 1,775 at postintervention. From univariable analysis, there were improvements in addressing CS, being full code, cardiopulmonary resuscitation, intubation, use of vasopressors, and cardioversion technique categories (all p < .001). Documentation of do not resuscitate did not change. From logistic regression, after controlling for age, race, end-stage liver disease, stroke, cancer, hospital unit, and sepsis, patients in the postintervention period were two times more likely to have CS addressed (odds ratio [OR] = 2.04, p < .001). There was a significant improvement in CS documentation from our interventions.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"e1-e7"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319592","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}
Christian O Bohan, Joseph Mlinarich, Donna Hahn, Mark Shelly, Navneet Dang
{"title":"The CLABSI Playbook: Design and Implementation of a Multipronged Approach to Decrease CLABSIs.","authors":"Christian O Bohan, Joseph Mlinarich, Donna Hahn, Mark Shelly, Navneet Dang","doi":"10.1097/JHQ.0000000000000423","DOIUrl":"10.1097/JHQ.0000000000000423","url":null,"abstract":"<p><strong>Abstract: </strong>Central line-associated blood stream infections (CLABSIs) are a quality marker for the critical care environment. They have become an area of particular interest because they cost the healthcare system close to a billion dollars per year and have a significant impact on patient safety. Through a preliminary analysis of our system's CLABSI rates, we found significantly higher rates than the national average, prompting further investigation. We decreased our CLABSI rate by over 40% from 2021 (1.6 per 1,000 line days) to the fourth quarter of 2022 (0.91) and kept the rate below or around the national rate (0.86) for the last three quarters of 2022. Through looking at current outcome data, identifying key stakeholders, developing dedicated committees, conducting root cause analyses, monitoring progress, adjusting procedures, scaling to the system, and continuously monitoring and reporting results, we have shown the efficacy of this kind of quality improvement structure and strive to reduce our hospital system's impact on avoidable healthcare-associated patient harm.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"46 3","pages":"131-136"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873832","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}
David P Ebertz, Emily Steinhagen, Christine E Alvarado, Katherine Bingmer, Daniel Asher, Amy Berardinelli, John Ammori
{"title":"Eliminating Hands-Off Handoffs: Improvement in Perioperative Handoff Communication With a Multidisciplinary Tool Initiative.","authors":"David P Ebertz, Emily Steinhagen, Christine E Alvarado, Katherine Bingmer, Daniel Asher, Amy Berardinelli, John Ammori","doi":"10.1097/JHQ.0000000000000424","DOIUrl":"10.1097/JHQ.0000000000000424","url":null,"abstract":"<p><strong>Introduction: </strong>Handoffs between the operating room (OR) and post-anesthesia care unit (PACU) require a high volume and quality of information to be transferred. This study aimed to improve perioperative communication with a handoff tool.</p><p><strong>Methods: </strong>Perioperative staff at a quaternary care center was surveyed regarding perception of handoff quality, and OR to PACU handoffs were observed for structured criteria. A 25-item tool was implemented, and handoffs were similarly observed. Staff was then again surveyed. A multidisciplinary team led this initiative as a collaboration.</p><p><strong>Results: </strong>After implementation, nursing reported improved perception of time spent (2.63-3.68, p = .02) and amount of information discussed (2.85-3.73, p = .05). Anesthesia also reported improved personal communication (3.69-4.43, p = .004), effectiveness of handoffs (3.43-3.82, p = .02), and amount of information discussed (4.26-4.76, p = .05). After implementation, observed patient information discussed during handoffs increased for both surgical and anesthesia team members. The frequency of complete and near-complete handoffs increased (40%-74%, p < .001).</p><p><strong>Conclusions: </strong>A structured handoff tool increased the amount of essential information reported during handoffs between the OR and PACU and increased team members' perception of handoffs.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"168-176"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425721","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}