Journal for Healthcare Quality最新文献_第8页

Organizational Learning in the Morbidity and Mortality Conference 发病率和死亡率会议的组织学习

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2023-11-21 DOI: 10.1097/jhq.0000000000000416

M. Batthish, Ayelet Kuper, Claire Fine, Ronald M. Laxer, G. R. Baker

{"title":"Organizational Learning in the Morbidity and Mortality Conference","authors":"M. Batthish, Ayelet Kuper, Claire Fine, Ronald M. Laxer, G. R. Baker","doi":"10.1097/jhq.0000000000000416","DOIUrl":"https://doi.org/10.1097/jhq.0000000000000416","url":null,"abstract":"The focus of morbidity and mortality conferences (M&MCs) has shifted to emphasize quality improvement and systems-level care. However, quality improvement initiatives targeting systems-level errors are challenged by learning in M&MCs, which occurs at the individual attendee level and not at the organizational level. Here, we aimed to describe how organizational learning in M&MCs is optimized by particular organizational and team cultures. A prospective, multiple-case study design was used. Using purposive sampling, three cases covering different medical/surgical specialties in North America were chosen. Data collection included direct observations of the M&MC, semistructured interviews with key M&MC members, and documentary information. The role of the M&MC in all cases integrated two key concepts: recognition of system-wide trends and learning from error, at an organizational and team level. All cases provided evidence of double-loop learning and used organizational memory strategies to ensure knowledge was retained within the organization. A patient safety culture was linked to the promotion of open communication, fostering learning from adverse events. This study describes three cases of systems-oriented M&MCs that reflected elements of organizational learning theory. The M&MC can therefore provide a context for organizational learning, allowing optimal learning from adverse events.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"112 7","pages":""},"PeriodicalIF":1.3,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139253358","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

Team-Based Care Model Improves Timely Access to Care and Patient Satisfaction in General Cardiology 以团队为基础的医疗模式提高了普通心脏病学治疗的及时性和患者满意度

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2023-11-21 DOI: 10.1097/jhq.0000000000000413

Christa M. Sharpe, Linda Eastham

{"title":"Team-Based Care Model Improves Timely Access to Care and Patient Satisfaction in General Cardiology","authors":"Christa M. Sharpe, Linda Eastham","doi":"10.1097/jhq.0000000000000413","DOIUrl":"https://doi.org/10.1097/jhq.0000000000000413","url":null,"abstract":"Appointment wait times have increased nationally since 2014, especially in cardiology. At a mid-Atlantic academic medical center, access to care in the general cardiology clinic was below national standards, which can negatively affect patient outcomes and satisfaction. Adopting a team-based care (TBC) model, advanced practice providers (APPs) were added to care teams with general cardiologists to provide timely outpatient management of cardiac conditions. This aimed to increase access to care and, consequently, patient satisfaction. A formative program evaluation using the Agency for Clinical Innovation framework assessed TBC's impact on these outcomes. Access to care and patient satisfaction measures for TBC and nonteam providers were compared with one another and national benchmarks. Nine months after implementation, the average time to new patient appointment for TBC providers was 31 days (47% decrease) and for nonteam providers was 41 days (20% decrease). TBC had a higher percentage of new patient appointments within 14 days than nonteam providers (39% and 20%, respectively). Patient satisfaction improved to the 98th percentile nationally for TBC but decreased to the 71st percentile for nonteam. These findings suggest that a TBC model using APPs can improve access to care and patient satisfaction in the outpatient general cardiology setting.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"115 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139252858","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 Quality Care and Patient Safety With Implementation of an Oversew Stitch in Lumbar Drains 通过在腰椎引流管中采用包缝技术提高护理质量和患者安全

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2023-11-21 DOI: 10.1097/jhq.0000000000000414

Erik C. Brown, Samantha Fay, Ahmed M. Raslan, Christina M. Sayama

{"title":"Improving Quality Care and Patient Safety With Implementation of an Oversew Stitch in Lumbar Drains","authors":"Erik C. Brown, Samantha Fay, Ahmed M. Raslan, Christina M. Sayama","doi":"10.1097/jhq.0000000000000414","DOIUrl":"https://doi.org/10.1097/jhq.0000000000000414","url":null,"abstract":"The lumbar drain exit site purse string oversew stitch is a well-described bedside intervention to stop or prevent cerebrospinal fluid (CSF) leak. It is not routinely placed at the time of lumbar drain placement. Via four plan-do-study-act (PDSA) cycles, we test the effect of prophylactic utilization of the lumbar drain exit site oversew stitch on house officers' paging burden, need to redress the drain, need to oversew the drain to stop a CSF leak, and need to replace the drain. We found that the simple act of placing an oversew stitch at the time of lumbar drain placement significantly reduced paging burden and reduced the frequency at which an oversew stitch was required to stop a CSF leak. Subjectively, during PDSA cycles during which overstitches were placed prophylactically, in-house residents perceived that there were less lumbar drains on service, although objectively, the overall number was unchanged. We conclude that prophylactic lumbar drain exit site stitch placement reduces risk and bedside interventions for patients and also reduces overall call burden on house officers. This simple intervention may therefore provide a more widespread improvement in care quality beyond lumbar drain care because house officers experience less burnout during their call shifts.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"57 6","pages":""},"PeriodicalIF":1.3,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139254239","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

Implementing a Discharge Follow-up Phone Call Program Reduces Readmission Rates in an Integrated Health System. 实施出院随访电话计划可降低综合医疗系统的重新就诊率。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2023-11-01 Epub Date: 2023-10-03 DOI: 10.1097/JHQ.0000000000000400

Amy Lukanski, Shelley Watters, Andrew L Bilderback, Dan Buchanan, Jacob C Hodges, David Burwell, Amy Triola, Oscar C Marroquin, Susan C Martin, Rachel L Zapf, Paula L Kip, Tami E Minnier

{"title":"Implementing a Discharge Follow-up Phone Call Program Reduces Readmission Rates in an Integrated Health System.","authors":"Amy Lukanski, Shelley Watters, Andrew L Bilderback, Dan Buchanan, Jacob C Hodges, David Burwell, Amy Triola, Oscar C Marroquin, Susan C Martin, Rachel L Zapf, Paula L Kip, Tami E Minnier","doi":"10.1097/JHQ.0000000000000400","DOIUrl":"10.1097/JHQ.0000000000000400","url":null,"abstract":"Abstract: In this study, we sought to determine the effect of implementing a large-scale discharge follow-up phone call program on hospital readmission rates. Previous work has shown that patients with unaddressed concerns during discharge have significantly higher rates of care complications and hospital readmissions. This study is an observational quality improvement project completed from April 17, 2020 to January 31, 2022 at 22 hospitals in a large, integrated academic health system. A nurse-led scripted discharge follow-up phone call program was implemented to contact all patients discharged from inpatient care within 72 hours of discharge. Readmission rates were tracked before and after project implementation. Over a 21-month span, 137,515 phone calls were placed, and 57.92% of patients were successfully contacted within 7 days of discharge. The 7-day readmission rate for contacted patients was 2.91% compared with 4.73% for noncontacted patients. The 30-day readmission rate for contacted patients was 11.00% compared with 12.17% for noncontacted patients. We have found that discharge follow-up phone calls targeting patients decreases risk of readmission, which improves overall patient outcomes.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"315-323"},"PeriodicalIF":1.3,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41134926","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

Comparison of Clinical, Economic, and Humanistic Outcomes Between Blood Collection Approaches: A Systematic Literature Review. 血液采集方法的临床、经济和人文结果比较：系统文献综述。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2023-11-01 Epub Date: 2023-09-27 DOI: 10.1097/JHQ.0000000000000399

Cathy Perry, Kimberly Alsbrooks, Alicia Mares, Klaus Hoerauf

{"title":"Comparison of Clinical, Economic, and Humanistic Outcomes Between Blood Collection Approaches: A Systematic Literature Review.","authors":"Cathy Perry, Kimberly Alsbrooks, Alicia Mares, Klaus Hoerauf","doi":"10.1097/JHQ.0000000000000399","DOIUrl":"10.1097/JHQ.0000000000000399","url":null,"abstract":"Background: A systematic literature review was performed to understand the prevalence, advantages, and disadvantages of blood collection using different approaches (direct venipuncture or vascular access devices), and interventions used to mitigate the disadvantages.Methods: The review included a broad range of study designs and outcomes. Database searches (Embase, MEDLINE, Cochrane library, and Centre for Reviews and Dissemination) were conducted in March 2021 and supplemented by hand searching.Results: One hundred forty-one publications were included. The data indicate that blood sampling from vascular access devices is common in emergency departments, trauma centers, and intensive care units. Studies showed that hemolysis and sample contamination place a considerable economic burden on hospitals. Significant cost savings could be made through enforcing strict aseptic technique, or using the initial specimen diversion technique.Conclusions: Hemolysis and sample contamination are far from inevitable in vascular access device-collected or venipuncture samples; both can be reduced through adherence to strict blood sampling protocols and utilization of the initial specimen diversion technique. Needle-free blood collection devices offer further hope for reducing hemolysis. No publication focused on the difficult venous access population; insertion success rates are likely to be lower (and the benefits of vascular access devices higher) in these patients.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"359-370"},"PeriodicalIF":1.3,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41174197","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}

引用次数: 0

Diagnostic Accuracy of a Trauma Risk Assessment Tool Among Geriatric Patients With Crash Injuries. 创伤风险评估工具在老年车祸患者中的诊断准确性。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2023-11-01 Epub Date: 2023-08-18 DOI: 10.1097/JHQ.0000000000000402

Oluwaseun John Adeyemi, Kester Gibbons, Luke B Schwartz, Ariana T Meltzer-Bruhn, Garrett W Esper, Corita Grudzen, Charles DiMaggio, Joshua Chodosh, Kenneth A Egol, Sanjit R Konda

{"title":"Diagnostic Accuracy of a Trauma Risk Assessment Tool Among Geriatric Patients With Crash Injuries.","authors":"Oluwaseun John Adeyemi, Kester Gibbons, Luke B Schwartz, Ariana T Meltzer-Bruhn, Garrett W Esper, Corita Grudzen, Charles DiMaggio, Joshua Chodosh, Kenneth A Egol, Sanjit R Konda","doi":"10.1097/JHQ.0000000000000402","DOIUrl":"10.1097/JHQ.0000000000000402","url":null,"abstract":"Abstract: The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is a risk stratification tool. We evaluated the STTGMA's accuracy in predicting 30-day mortality and the odds of unfavorable clinical trajectories among crash-related trauma patients. This retrospective cohort study (n = 912) pooled adults aged 55 years and older from a single institutional trauma database. The data were split into training and test data sets (70:30 ratio) for the receiver operating curve analysis and internal validation, respectively. The outcome variables were 30-day mortality and measures of clinical trajectory. The predictor variable was the high-energy STTGMA score (STTGMAHE). We adjusted for the American Society of Anesthesiologists Physical Status. Using the training and test data sets, STTGMAHE exhibited 82% (95% CI: 65.5-98.3) and 96% (90.7-100.0) accuracies in predicting 30-day mortality, respectively. The STTGMA risk categories significantly stratified the proportions of orthopedic trauma patients who required intensive care unit (ICU) admissions, major and minor complications, and the length of stay (LOS). The odds of ICU admissions, major and minor complications, and the median difference in the LOS increased across the risk categories in a dose-response pattern. STTGMAHE exhibited an excellent level of accuracy in identifying middle-aged and geriatric trauma patients at risk of 30-day mortality and unfavorable clinical trajectories.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 6","pages":"340-351"},"PeriodicalIF":0.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11309630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71428151","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}

引用次数: 0

An Initiative to Stop Antibiotics Prescribed for Urinary Symptoms When Urine Culture Is Negative. 当尿液培养呈阴性时，停止使用针对尿液症状的抗生素。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2023-11-01 DOI: 10.1097/JHQ.0000000000000403

Benjamin Kofoed, Jacob Morris, Jennifer Rich

引用次数: 0

Barriers to Health Information Exchange Among Ambulatory Physicians: Results From a Nationally Representative Sample. 门诊医师之间健康信息交流的障碍：来自全国代表性样本的结果。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2023-11-01 DOI: 10.1097/JHQ.0000000000000404

Elizabeth B Matthews, Victoria Stanhope, Yuanyuan Hu

引用次数: 0

Interventions to Reduce Inappropriate Physical Therapy Consultation in the Inpatient Setting: A Quality Improvement Initiative. 减少住院患者不适当物理治疗咨询的干预措施：一项质量改进举措。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2023-11-01 DOI: 10.1097/JHQ.0000000000000407

Moksha Patel, Tiffany A Gardner, Christopher White, Angela Keniston, Becky Maassen, Emily Gottenborg

{"title":"Interventions to Reduce Inappropriate Physical Therapy Consultation in the Inpatient Setting: A Quality Improvement Initiative.","authors":"Moksha Patel, Tiffany A Gardner, Christopher White, Angela Keniston, Becky Maassen, Emily Gottenborg","doi":"10.1097/JHQ.0000000000000407","DOIUrl":"10.1097/JHQ.0000000000000407","url":null,"abstract":"Abstract: Physical therapy (PT) in inpatient settings is a limited and valuable resource. Inappropriate PT consultation is costly and can lead to delays in care and discharge planning. Baseline data at an academic hospital revealed that approximately one in four PT consults were inappropriate (n = 29,230) across all services, as defined by an activity measure post-acute care \"6-Clicks\" basic mobility score of >22. Our interdisciplinary quality improvement team used the Six Sigma methodology to address this problem. We performed a root-cause analysis that identified high-impact root causes and implemented two targeted interventions: (1) A modified electronic health record PT order with clinical-decision support, and (2) nursing role change to assume PT-ordering responsibility. The rate of inappropriate PT consults decreased from 23.9% to <10% postintervention across all inpatient units, with the nursing role change reaching statistical significance (p < .0019). Our multifaceted intervention contributed to a significant reduction in unnecessary PT consults, expediting evaluation of patients qualifying for skilled inpatient therapy.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 6","pages":"332-339"},"PeriodicalIF":1.3,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71428152","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

Applying the Urgent Maternal Warning Signs Initiative in a Novel Setting. 在一个新颖的环境中应用紧急产妇警告信号倡议。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2023-11-01 Epub Date: 2023-10-03 DOI: 10.1097/JHQ.0000000000000401

Katherine Jenkins, Evelyn Quarshie, Crystal Phommasathit, Michelle Menegay, Allison Lorenz, Patrick Schneider, Reena Oza-Frank, Breanne Haviland, Heather Kristofzski-Raizor, Dyane Gogan Turner

{"title":"Applying the Urgent Maternal Warning Signs Initiative in a Novel Setting.","authors":"Katherine Jenkins, Evelyn Quarshie, Crystal Phommasathit, Michelle Menegay, Allison Lorenz, Patrick Schneider, Reena Oza-Frank, Breanne Haviland, Heather Kristofzski-Raizor, Dyane Gogan Turner","doi":"10.1097/JHQ.0000000000000401","DOIUrl":"10.1097/JHQ.0000000000000401","url":null,"abstract":"Abstract: Symptoms of urgent maternal warning signs (UMWS) may occur during pregnancy or after delivery and may have lasting effects or indicate a life-threatening situation if left untreated. The state department of health sponsored a quality improvement project (QIP) to broaden the reach of UMWS education beyond traditional clinical settings, to public health settings where prenatal and postpartum women are seen. Specifically, the QIP implemented process changes to provide education (written and verbal) and resources to individuals receiving services from Women, Infants, and Children clinics during pregnancy and up to 12 weeks postpartum. Clinics submitted participant-level data although the Research Electronic Data Capture secure data portal. The key results indicated an increase in both written and verbal education. In addition, the project monitored referrals made specific to conditions identified through project-specific data collection and the provision of UMWS education.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"324-331"},"PeriodicalIF":1.3,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172112","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