高度率医院跨专业、多层次的日常会诊管理。

IF 1 Q4 HEALTH POLICY & SERVICES
Pracha Peter Eamranond, Arti Bhukhen, Donna DiPalma, Schawan Kunuakaphun, Thomas Burke, John Rodis, Michael Grey
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引用次数: 2

摘要

目的:本解释性案例研究的目的是解释跨专业、多层次精益日常管理(LDM)的实施,并定量报告其对医院安全的影响。设计/方法/方法:本案例研究解释了2018年底在圣弗朗西斯医院和医疗中心(SFHMC)实施的LDM实施框架和与跨专业、多层次LDM相关的质量指标的变化。应用精益、全面质量管理(TQM)和高可靠性科学的概念开发了LDM的四层和gemba舍入组件。采用双尾t检验分析,比较干预期(2019年1月至2019年12月)与基线期(2017年和2018年日历年)的严重安全事件(sse)的统计学显著性。其他质量和效率指标也被跟踪。结果:与2017年和2018年相比,LDM与2019年sss下降相关(p≤0.01)。在该院历史上第一个完整的日历季度中,没有报告中心静脉相关血流感染(CLABSI)或导尿管相关尿路感染(CAUTI)。医院获得性压力伤害为每1,000个病人日0.2个,达到了研究限制/影响的年度目标:LDM可能极大地有助于改善安全结果。本观察性研究是在一家城市、高视力、低成本医院进行的,可能不具有其他医院的代表性。需要进一步研究以确定该模型是否可以更广泛地应用于其他环境。实际影响:可以迅速实施LDM,以改善医院安全和其他保健质量结果。这需要重新分配医院工作人员的时间,但不需要任何重大资本或其他投资。社会影响:随着医院系统从基于数量的卫生保健提供模式转向基于价值的卫生保健提供模式,使用LDM的动态干预措施可以在帮助所有患者方面发挥关键作用,特别是在服务不足的环境中,在现有资源有限的情况下,需要低成本的可持续性卫生保健。原创性/价值:虽然许多医院系统将组织round作为常规的质量改进过程,但本研究表明,动态的、强烈的LDM模型可以在几个月内显著提高安全性。这是在一个具有挑战性的城市环境中进行的,针对的是资源有限的高敏度人群。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Interprofessional, multitiered daily rounding management in a high-acuity hospital.

Purpose: The purpose of this explanatory case study is to explain the implementation of interprofessional, multitiered lean daily management (LDM) and to quantitatively report its impact on hospital safety.

Design/methodology/approach: This case study explained the framework for LDM implementation and changes in quality metrics associated with the interprofessional, multitiered LDM, implemented at Saint Francis Hospital and Medical Center (SFHMC) at the end of 2018. Concepts from lean, Total Quality Management (TQM) and high reliability science were applied to develop the four tiers and gemba rounding components of LDM. A two-tailed t-test analysis was utilized to determine statistical significance for serious safety events (SSEs) comparing the intervention period (January 2019-December 2019) to the baseline period (calendar years 2017 and 2018). Other quality and efficiency metrics were also tracked.

Findings: LDM was associated with decreased SSEs in 2019 compared to 2017 and 2018 (p ≤ 0.01). There were no reportable central line-associated blood stream infection (CLABSI) or catheter-associated urinary tract infection (CAUTI) for first full calendar quarter in the hospital's history. Hospital-acquired pressure injuries were at 0.2 per 1,000 patient days, meeting the annual target of <0.5 per 1,000 patient days. Outcomes for falls with injury, hand hygiene and patient experience also trended toward target. These improvements occurred while also observing a lower observed to expected length of stay (O/E LOS), which is the organizational marker for hospital's efficiency.

Research limitations/implications: LDM may contribute greatly to improve safety outcomes. This observational study was performed in an urban, high-acuity, low cost hospital which may not be representative of other hospitals. Further study is warranted to determine whether this model can be applied more broadly to other settings.

Practical implications: LDM can be implemented quickly to achieve an improvement in hospital safety and other health-care quality outcomes. This required a redistribution of time for hospital staff but did not require any significant capital or other investment.

Social implications: As hospital systems move from a volume-based to value-based health-care delivery model, dynamic interventions using LDM can play a pivotal role in helping all patients, particularly in underserved settings where lower cost care is required for sustainability, given limited available resources.

Originality/value: While many hospital systems promote organizational rounding as a routine quality improvement process, this study shows that a dynamic, intense LDM model can dramatically improve safety within months. This was done in a challenging urban environment for a high-acuity population with limited resources.

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来源期刊
CiteScore
4.00
自引率
6.70%
发文量
6
期刊介绍: ■Successful quality/continuous improvement projects ■The use of quality tools and models in leadership management development such as the EFQM Excellence Model, Balanced Scorecard, Quality Standards, Managed Care ■Issues relating to process control such as Six Sigma, Leadership, Managing Change and Process Mapping ■Improving patient care through quality related programmes and/or research Articles that use quantitative and qualitative methods are encouraged.
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