The Joint Commission journal on quality improvement最新文献

Effects of Hydroxyurea Treatment on Haemolysis in Patients with Sickle Cell Disease at Muhimbili National Hospital, Tanzania. 羟基脲治疗对坦桑尼亚 Muhimbili 国立医院镰状细胞病患者溶血的影响。

The Joint Commission journal on quality improvement Pub Date : 2021-08-31 Epub Date: 2021-08-15 DOI: 10.4314/tjs.v47i3.25

Azra Gangji, Upendo Masamu, Josephine Mgaya, Joyce Ndunguru, Agnes Jonathan, Irene Kida Minja, Julie Makani, Emmanuel Balandya, Paschal Ruggajo, Siana Nkya

{"title":"Effects of Hydroxyurea Treatment on Haemolysis in Patients with Sickle Cell Disease at Muhimbili National Hospital, Tanzania.","authors":"Azra Gangji, Upendo Masamu, Josephine Mgaya, Joyce Ndunguru, Agnes Jonathan, Irene Kida Minja, Julie Makani, Emmanuel Balandya, Paschal Ruggajo, Siana Nkya","doi":"10.4314/tjs.v47i3.25","DOIUrl":"10.4314/tjs.v47i3.25","url":null,"abstract":"<p><p>Tanzania is one of the countries with a high burden of sickle cell disease (SCD). Haemolytic anaemia is a clinical feature of SCD, and has been linked to major complications leading to morbidity and mortality. Treatment with hydroxyurea (HU) has shown to induce foetal haemoglobin (HbF) which in turn decreases haemolysis in patients. This study aimed to investigate the effects of HU on haemolysis in SCD patients attending Muhimbili National Hospital, Tanzania by comparing their haemolytic parameters before and after therapy. Patients meeting the criteria were initiated on HU therapy for 3 months. Two haemolytic biomarkers: unconjugated plasma bilirubin levels and absolute reticulocyte counts were measured from patients' blood samples at baseline and after 3 months of HU therapy and compared. Both absolute reticulocyte counts and indirect plasma bilirubin levels significantly declined after HU therapy. Median (IQR) plasma unconjugated bilirubin levels dropped significantly from 20.3 (12.7-34.4) μmol/L to 14.5 (9.6-24.1) μmol/L (p < 0.001) and mean (SD) absolute reticulocyte counts dropped significantly from 0.29 (0.1) × 10<sup>9</sup>/L to 0.17 (0.1) × 10<sup>9</sup>/L (p < 0.001) after therapy, thus, a decline in both haemolytic biomarkers after treatment was observed. This study found a potential for use of HU therapy in managing SCD patients in our settings evidenced by improvements in their haemolytic parameters. Clinical trials with a lager sample size conducted for a longer time period would be beneficial in guiding towards the inclusion of HU in treatment protocols for the Tanzanian population.</p>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"19 1","pages":"1165-1173"},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11361406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78419946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

To Our Readers 致读者

The Joint Commission journal on quality improvement Pub Date : 2015-01-01 DOI: 10.1016/S1070-3241(16)30009-8

Steven Berman (Editor-in-Chief)

引用次数: 0

System Innovation: Concord Hospital 制度创新:协和医院

The Joint Commission journal on quality improvement Pub Date : 2002-12-01 DOI: 10.1016/S1070-3241(02)28072-4

Paul N. Uhlig MD, MPA (Associate Professor of Surgery), Jeffrey Brown MEd, Anne K. Nason MS, ARNP (Cardiac Services Nurse Practitioner), Addie Camelio BSW (Social Worker), Elise Kendall RPh (Staff Pharmacist)

{"title":"System Innovation: Concord Hospital","authors":"Paul N. Uhlig MD, MPA (Associate Professor of Surgery), Jeffrey Brown MEd, Anne K. Nason MS, ARNP (Cardiac Services Nurse Practitioner), Addie Camelio BSW (Social Worker), Elise Kendall RPh (Staff Pharmacist)","doi":"10.1016/S1070-3241(02)28072-4","DOIUrl":"10.1016/S1070-3241(02)28072-4","url":null,"abstract":"<div><h3>Background</h3><p>The Cardiac Surgery Program at Concord Hospital (Concord, NH) restructured clinical teamwork for improved safety and effectiveness on the basis of theory and practice from human factors science, aviation safety, and high-reliability organization theory. A team-based, collaborative rounds process—the Concord Collaborative Care Model—that involved use of a structured communications protocol was conducted daily at each patient’s bedside.</p></div><div><h3>Methods</h3><p>The entire care team agreed to meet at the same time each day (8:45 <span>am</span> to 9:30 <span>am</span>) to share information and develop a plan of care for each patient, with patient and family members as active participants. The cardiac surgery team developed a structured communications protocol adapted from human factors science. To provide a forum for discussion of team goals and progress and to address system-level concerns, a biweekly system rounds process was established.</p></div><div><h3>Results</h3><p>Following implementation of collaborative rounds, mortality of Concord Hospital’s cardiac surgery patients declined significantly from expected rates. Satisfaction rates of open heart patients scores were consistently in the 97th–99th percentile nationally. A quality of work life survey indicated that in every category, providers expressed greater satisfaction with the collaborative care process than with the traditional rounds process. Practice patterns in the Cardiac Surgery Program at Concord Hospital have changed to a much more collaborative and participatory process, with improved outcomes, happier patients, and more satisfied practitioners. A culture of continuous program improvement has been implemented that continues to evolve and produce benefits.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 12","pages":"Pages 666-672"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28072-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22155132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 85

Advocacy: The Lexington Veterans Affairs Medical Center 倡导:列克星敦退伍军人事务医疗中心

The Joint Commission journal on quality improvement Pub Date : 2002-12-01 DOI: 10.1016/S1070-3241(02)28069-4

Steve S. Kraman MD (Chief of Staff), Linda Cranfill (Quality Manager), Ginny Hamm JD (Staff Attorney), Toni Woodard (Patient Safety Officer)

{"title":"Advocacy: The Lexington Veterans Affairs Medical Center","authors":"Steve S. Kraman MD (Chief of Staff), Linda Cranfill (Quality Manager), Ginny Hamm JD (Staff Attorney), Toni Woodard (Patient Safety Officer)","doi":"10.1016/S1070-3241(02)28069-4","DOIUrl":"10.1016/S1070-3241(02)28069-4","url":null,"abstract":"<div><h3>Background</h3><p>After the Veterans Affairs Medical Center (VAMC) in Lexington, Kentucky, lost two major malpractice cases in the mid-1980s, leaders started taking a more proactive approach to identifying and investigating incidents that could result in litigation. An informal risk management team met regularly to discuss litigation-prone incidents. During one in-depth review, the team learned that a medication error had caused the patient’s death. Although the family would probably never have found out, the team decided to honestly inform the family of exactly what had happened and assist in filing for any financial settlement that might be appropriate. This decision evolved into an organizationwide full disclosure policy and procedure.</p></div><div><h3>Disclosure policy and procedure</h3><p>The Lexington VAMC’s policy on full disclosure includes informing patients and/or their families of adverse events known to have caused harm or injury to the patient as a result of medical error or negligence. The disclosure includes discussions of liability and also includes apology and discussion of remedy and compensation.</p></div><div><h3>Results</h3><p>Full disclosure is the right thing to do and the moral and ethical thing to do. Moreover, doing the right thing actually seems to have mitigated the financial repercussions of inevitable adverse events that result in injury to patients. As reported in 1999, Lexington VAMC was in the top quarter of medical centers for number of tort claims filed but was in the lowest quarter for malpractice payouts resulting from these torts.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 12","pages":"Pages 646-650"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28069-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22155129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 29

John M. Eisenberg Patient Safety Awards. Research: David W. Bates, MD, MSc, Brigham and Women's Hospital. Interview by Steven Berman. John M. Eisenberg患者安全奖。研究:大卫W.贝茨，医学博士，硕士，布莱根妇女医院。Steven Berman采访。

The Joint Commission journal on quality improvement Pub Date : 2002-12-01

David W Bates

引用次数: 0

Research: David W. Bates, MD, MSc, Brigham and Women’s Hospital 研究:大卫W.贝茨，医学博士，硕士，布莱根妇女医院

The Joint Commission journal on quality improvement Pub Date : 2002-12-01 DOI: 10.1016/S1070-3241(02)28070-0

Steven Berman

引用次数: 1

Individual Lifetime Achievement: Julianne M. Morath, RN, MS 个人终身成就奖:Julianne M. Morath，注册会计师，硕士

The Joint Commission journal on quality improvement Pub Date : 2002-12-01 DOI: 10.1016/S1070-3241(02)28068-2

Julianne M. Morath RN, MS (Chief Operating Officer), Maggie Teele

{"title":"Individual Lifetime Achievement: Julianne M. Morath, RN, MS","authors":"Julianne M. Morath RN, MS (Chief Operating Officer), Maggie Teele","doi":"10.1016/S1070-3241(02)28068-2","DOIUrl":"10.1016/S1070-3241(02)28068-2","url":null,"abstract":"<div><h3>Background</h3><p>This article provides a brief biography of Julianne M. Morath, describes the scope and impact of her patient safety initiatives at Children’s Hospitals and Clinics in Minneapolis and St Paul, and includes an interview in which Morath responds to questions about challenges to patient safety and medical accident reduction.</p></div><div><h3>Biography in brief</h3><p>With a 25-year career spanning the spectrum of health care, Morath has served in leadership positions in health care organizations in Minnesota, Rhode Island, Ohio, and Georgia.</p></div><div><h3>Leadership at the front line</h3><p>Morath joined Children’s Hospitals and Clinics in 1999 and launched a major patient safety initiative that put Children’s on the map. Elements of the initiative included a culture of learning, patient safety action teams, open discussion of medical accidents and error, blameless reporting, and a full accident disclosure policy.</p></div><div><h3>An interview with Julie Morath</h3><p>As the greatest challenge to leadership ownership of the patient safety initiative, Morath cites the need to confront the myths of the medical system and to develop the awareness of the issues of patient safety. She believes that clinicians on the front lines will be convinced that patient safety isn’t “just another fad of the month” when leadership action is disciplined and aligns with what is being espoused. She advises other leaders of health care organizations interested in establishing a culture of safety to start with a personal and passionate belief that harm-free care is possible, to commit to informed action, and to identify and develop champions throughout the organization and medical staff.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 12","pages":"Pages 637-645"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28068-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22155173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

System Innovation: Veterans Health Administration National Center for Patient Safety 系统创新:退伍军人健康管理局国家患者安全中心

The Joint Commission journal on quality improvement Pub Date : 2002-12-01 DOI: 10.1016/S1070-3241(02)28071-2

Jeffrey R. Heget (Administrative Officer), James P. Bagian MD, PE (Director), Caryl Z. Lee RN, MSN (Program Manager), John W. Gosbee MD, MS (Director)

{"title":"System Innovation: Veterans Health Administration National Center for Patient Safety","authors":"Jeffrey R. Heget (Administrative Officer), James P. Bagian MD, PE (Director), Caryl Z. Lee RN, MSN (Program Manager), John W. Gosbee MD, MS (Director)","doi":"10.1016/S1070-3241(02)28071-2","DOIUrl":"10.1016/S1070-3241(02)28071-2","url":null,"abstract":"<div><h3>Background</h3><p>In 1998 the Veterans Health Administration (VHA) created the National Center for Patient Safety (NCPS) to lead the effort to reduce adverse events and close calls systemwide. NCPS’s aim is to foster a culture of safety in the Department of Veterans Affairs (VA) by developing and providing patient safety programs and delivering standardized tools, methods, and initiatives to the 163VA facilities.</p></div><div><h3>A novel approach</h3><p>To create a system-oriented approach to patient safety, NCPS looked for models in fields such as aviation, nuclear power, human factors, and safety engineering. Core concepts included a nonpunitive approach to patient safety activities that emphasizes systems-based learning, the active seeking out of close calls, which are viewed as opportunities for learning and investigation, and the use of interdisciplinary teams to investigate close calls and adverse events through a root cause analysis (RCA) process. Participation by VA facilities and networks was voluntary. NCPS has always aimed to develop a program that would be applicable both within the VA and beyond.</p></div><div><h3>Key action items and results related to RCA</h3><p>NCPS’s full patient safety program was tested and implemented throughout the VA system from November 1999 to August 2000. Program components included an RCA system for use by caregivers at the front line, a system for the aggregate review of RCA results, information systems software, alerts and advisories, and cognitive aids. Following program implementation, NCPS saw a 900-fold increase in reporting of close calls of high-priority events, reflecting the level of commitment to the program by VHA leaders and staff.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 12","pages":"Pages 660-665"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28071-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22155131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 48

Developing a Comprehensive Electronic Adverse Event Reporting System in an Academic Health Center 学术医疗中心不良事件综合电子报告系统之开发

The Joint Commission journal on quality improvement Pub Date : 2002-11-01 DOI: 10.1016/S1070-3241(02)28062-1

Coleen Kivlahan MD, MPH (Associate Dean and Director of Health Improvement), William Sangster MD, Kathryn Nelson MHA, Jennifer Buddenbaum MHA (Project Coordinator), Kenneth Lobenstein JD

{"title":"Developing a Comprehensive Electronic Adverse Event Reporting System in an Academic Health Center","authors":"Coleen Kivlahan MD, MPH (Associate Dean and Director of Health Improvement), William Sangster MD, Kathryn Nelson MHA, Jennifer Buddenbaum MHA (Project Coordinator), Kenneth Lobenstein JD","doi":"10.1016/S1070-3241(02)28062-1","DOIUrl":"10.1016/S1070-3241(02)28062-1","url":null,"abstract":"<div><h3>Background</h3><p>In September 2000 University of Missouri Health Care (MUHC) conducted an assessment of patient safety activities. At least six separate data systems for reporting adverse events, with multiple conflicting paper reports, were found during this analysis. The disparate nature of these systems and their inability to be linked ensured that few systemic prevention activities were undertaken. In January 2001 an interdisciplinary team was convened with the goal of creating a comprehensive approach to patient safety reporting and resolution.</p></div><div><h3>Implementation</h3><p>A secure, Web-based system, the MUHC Patient Safety Network System (PSN), was created that allows staff, physicians, patients, families, and visitors to report comments, adverse events, and near-miss events from any computer in the hospital and from home, using the Internet. Anonymous reporting is an option for near-miss events. Reports are immediately available to department managers responsible for resolution; managers are alerted to the presence of a report by e-mail. As a result, a pilot study performed in two MUHC intensive care units documented dramatic reductions in resolution time using the PSN. The pilot also demonstrated an increased willingness to report by physicians and respiratory therapists. Training was accomplished in the fall of 2001, and the PSN was successfully implemented throughout the hospital on January 1, 2002.</p></div><div><h3>Next steps</h3><p>Implementation of the PSN has recently been extended to all ambulatory care settings. An additional component of the PSN that is being built will allow physicians to report complications.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 11","pages":"Pages 583-594"},"PeriodicalIF":0.0,"publicationDate":"2002-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28062-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22106215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 65

Benefits of a Mobile, Point-of-Care Anticoagulation Therapy Management Program 移动、护理点抗凝治疗管理项目的好处

The Joint Commission journal on quality improvement Pub Date : 2002-11-01 DOI: 10.1016/S1070-3241(02)28066-9

James M. Gill MD, MPH (Director), Mark K. Landis RN, BSN (Coumadin Care Center Coordinator)

{"title":"Benefits of a Mobile, Point-of-Care Anticoagulation Therapy Management Program","authors":"James M. Gill MD, MPH (Director), Mark K. Landis RN, BSN (Coumadin Care Center Coordinator)","doi":"10.1016/S1070-3241(02)28066-9","DOIUrl":"10.1016/S1070-3241(02)28066-9","url":null,"abstract":"<div><h3>Background</h3><p>Current guidelines recommend anticoagulation therapy for a number of medical conditions, but this therapy also has the potential for serious complications, particularly bleeding complications. Maintenance of anticoagulation within a narrow therapeutic window usually entails frequent monitoring with a blood test called the international normalized ratio (INR). Anticoagulation therapy management (ATM) clinics lead to improvements in quality of care, in terms of improved INR control and reduced complications. This study examined the impact of a mobile multisite, office-based ATM program that operated in seven cardiology offices in all three counties in Delaware.</p></div><div><h3>ATM program</h3><p>The ATM program was managed by a trained nurse who rotated among all seven offices. Patients made office visits to the nurse and received patient education, point-of-care INR testing, and medication adjustment based on a physician-approved algorithm.</p></div><div><h3>Methods</h3><p>This retrospective cohort study compared INR levels in the year before (May 1998–Apr 1999) and the year after (Aug 1999–Jul 2000) the start of the ATM program.</p></div><div><h3>Results</h3><p>From the year before to the year after implementation of the ATM program, the percentage of in-range INRs increased from 40.7% to 58.5% (p < 0.001). The percentage in the modified target range also increased (50.0% to 62.9%, <em>p</em> < 0.001).</p></div><div><h3>Discussion</h3><p>This study demonstrates the positive impact of a statewide office-based ATM program. If similar programs could be implemented in other networks of specialty offices or primary care offices, they could have a significant benefit to quality of care for patients who require anticoagulation therapy.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 11","pages":"Pages 625-630"},"PeriodicalIF":0.0,"publicationDate":"2002-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28066-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22106129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 16