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Kennepp L. 2023 Resolutions: It's time to revamp your pressure injury prevention programs. Healthc Manage Forum 2023; 36:5-14. [PMID: 36510467 DOI: 10.1177/08404704221137542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The success of any quality improvement project begins with acknowledging problems, defining and addressing each issue in detail, and setting goals. In the case of pressure injuries, the answer is fairly simple. Reduce the number of pressure injuries. Yet, the process yielding a "means to the end" is quite complex. It not only requires a team of interdisciplinary healthcare providers and leaders to ensure success; it requires continuous effort. The intention of this article is to highlight the importance of a comprehensive Pressure Injury Prevention (PIP) program and offer guidance based on evidence. Utilizing an organized framework for planning will help healthcare providers ensure all critical steps are completed. The Standardized Pressure Injury Prevention Protocol (SPIPP) provides detail surrounding the necessary steps toward compliance with best practice guidelines. A comprehensive checklist provided within the SPIPP article is designed to discuss specific details of the PIP program. The author of this article offers a broader framework and checklist, The Pressure Injury Prevention Implementation Checklist (PIPIC) based on blending several quality improvement methodologies. Challenges associated with pressure injuries continue to affect the lives of both patients and caregivers. Entering a new year, new month, or even new day brings the opportunity for change and improvement. Revamping a PIP program requires careful thought, planning, and dedication, but it is not insurmountable. Organizing a team to address the issues and approach the task with an organized, evidence-based plan will improve the overall PIP program success.
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2
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Bastogne T, Caputo F, Prina-Mello A, Borgos S, Barberi-Heyob M. A state of the art in analytical quality-by-design and perspectives in characterization of nano-enabled medicinal products. J Pharm Biomed Anal 2022; 219:114911. [DOI: 10.1016/j.jpba.2022.114911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 01/15/2023]
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3
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The Importance of Professional Development in a Programmatic Assessment System: One Medical School’s Experience. EDUCATION SCIENCES 2022. [DOI: 10.3390/educsci12030220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (CCLCM) was created in 2004 as a 5-year undergraduate medical education program with a mission to produce future physician-investigators. CCLCM’s assessment system aligns with the principles of programmatic assessment. The curriculum is organized around nine competencies, where each competency has milestones that students use to self-assess their progress and performance. Throughout the program, students receive low-stakes feedback from a myriad of assessors across courses and contexts. With support of advisors, students construct portfolios to document their progress and performance. A separate promotion committee makes high-stakes promotion decisions after reviewing students’ portfolios. This case study describes a systematic approach to provide both student and faculty professional development essential for programmatic assessment. Facilitators, barriers, lessons learned, and future directions are discussed.
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4
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Ralston SL, Holmes AV, Gautham KS, Hyman D, Brady P. Do We Really Need a Scholarly Quality Improvement Workforce? Pediatrics 2022; 149:184821. [PMID: 35230432 DOI: 10.1542/peds.2020-045948f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Shawn L Ralston
- Department of Pediatrics, Johns Hopkins University College of Medicine, Baltimore, Maryland.,Johns Hopkins Children's Center, Baltimore, Maryland
| | - Alison Volpe Holmes
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Kanekal S Gautham
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Hospital, Houston, Texas
| | - Daniel Hyman
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Children's Hospital Colorado, Aurora, Colorado
| | - Patrick Brady
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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5
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Brown A, Grierson L. Two sides of the same coin: Quality improvement and program evaluation in health professions education. J Eval Clin Pract 2022; 28:3-9. [PMID: 34291535 DOI: 10.1111/jep.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022]
Abstract
Health professions education is in constant pursuit of new ways of teaching and assessment in order to improve the training of healthcare professionals. Educators are often challenged with designing, implementing, and evaluating programs in the context of their professional practice, particularly those in response to dynamic and emerging social needs. This article explores the synergies and intersections of two approaches-quality improvement and program evaluation-and the potential utility of their combinations within our field to design, evaluate, and most importantly, improve educational programming. We argue that the inclusion of established quality improvement frameworks within program evaluation provides a proven mechanism for driving change, can optimize programming within the multi-contextual education systems, and, ultimately, that these two approaches are complementary to one another. These combinations hold great promise for optimizing programming in alignment with social missions, where it has been difficult for institutions worldwide to generate and capture evidence of social accountability.
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Affiliation(s)
- Allison Brown
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence Grierson
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Education Research, Innovation, and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada
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6
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Ring MT, Pfrimmer DM. Propofol as a Drug of Diversion: Changing Disposal Practices to Reduce Risk. Crit Care Nurse 2021; 41:45-53. [PMID: 34851389 DOI: 10.4037/ccn2021123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Propofol is a drug of diversion because of its high-volume use, lack of prescribed control mechanisms, and accessibility. As a result, intensive care unit nurses and other health care professionals are placed at unnecessary risk. Decreasing the risk of drug diversion can save lives, licenses, and livelihoods. LOCAL PROBLEM Objectives were to reduce the risk of drug diversion and diminish the environmental impact of medication discarded down the sink. Disposing of residual propofol into activated carbon pouches was successful and sustainable in operating rooms at the study institution. Literature findings supported this intervention because of propofol's potential for abuse, ongoing diversion events, ease of access, poor control mechanisms, lack of standardization, excessive waste, and ecological impact. METHODS The intensive care unit with the highest propofol use was selected to replicate the propofol disposal process used in the operating rooms. Activated carbon pouches and bottle cap removal tools were located in each intensive care unit room at the nurses' workstation for ease of use. Audits of unsecured waste bins and staff surveys of institutional policy awareness, disposal processes, barriers, and concerns were completed before and after the intervention. RESULTS Survey results determined significant concern for drug diversion risk. The pilot project displayed success: 44.1% of propofol bottles in waste bins were full before the intervention and 0% were full afterward. CONCLUSION Following institutional approval, this propofol disposal process was replicated in all intensive care units and the emergency department in the study institution.
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Affiliation(s)
- Michael T Ring
- Michael T. Ring is a nurse manager at Mayo Clinic, Rochester, Minnesota
| | - Dale M Pfrimmer
- Dale M. Pfrimmer is a hospice patient care coordinator at Mayo Clinic
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7
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Kranz C, Macali J, Phengphoo S, Schvaneveldt N, Patterson B, Guo JW. Game-Based Quality Improvement Teaching: Using Taters in Nursing Education. J Nurs Educ 2021; 60:590-593. [PMID: 34605680 DOI: 10.3928/01484834-20210730-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Quality improvement (QI) is difficult to teach in the classroom; therefore, nursing students are often under-prepared to participate in such projects after graduation. The Plan-Do-Study-Act method is commonplace in QI instruction and is often used in nursing. This study proposed and evaluated a gameful learning approach to improve understanding and engagement of a QI process using Potato Head figures. METHOD An observational design was utilized. Following classroom activity, students self-selected to join focus groups to discuss gameful learning experiences in learning QI techniques. Transcripts were analyzed using thematic analysis. RESULTS Overall, learners found the activity was effective in teaching QI. Positive and negative themes were identified, including fun and competitive, interactive and communication, and teamwork; disconnection between QI topic and game, and unclear instruction, respectively. CONCLUSION Using gameful learning helped students understand and engage with QI projects that may translate to clinical practice for new graduate nurses. [J Nurs Educ. 2021;60(10):590-593.].
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Algorri M, Abernathy MJ, Cauchon NS, Christian TR, Lamm CF, Moore CMV. Re-Envisioning Pharmaceutical Manufacturing: Increasing Agility for Global Patient Access. J Pharm Sci 2021; 111:593-607. [PMID: 34478754 DOI: 10.1016/j.xphs.2021.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
The traditional paradigm for pharmaceutical manufacturing is focused primarily upon centralized facilities that enable mass production and distribution. While this system reliably maintains high product quality and reproducibility, its rigidity imposes limitations upon new manufacturing innovations that could improve efficiency and support supply chain resiliency. Agile manufacturing methodologies, which leverage flexibility through portability and decentralization, allow manufacturers to respond to patient needs on demand and present a potential solution to enable timely access to critical medicines. Agile approaches are particularly applicable to the production of small-batch, personalized therapies, which must be customized for each individual patient close to the point-of-care. However, despite significant progress in the advancement of agile-enabling technologies across several different industries, there are substantial global regulatory challenges that encumber the adoption of agile manufacturing techniques in the pharmaceutical industry. This review provides an overview of regulatory barriers as well as emerging opportunities to facilitate the use of agile manufacturing for the production of pharmaceutical products. Future-oriented approaches for incorporating agile methodologies within the global regulatory framework are also proposed. Collaboration between regulators and manufacturers to cohesively navigate the regulatory waters is ultimately needed to best serve patients in the rapidly-changing healthcare environment.
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Affiliation(s)
- Marquerita Algorri
- Department of Global Regulatory Affairs and Strategy-CMC, Amgen Inc, Thousand Oaks, California 91320, USA
| | - Michael J Abernathy
- Department of Global Regulatory Affairs and Strategy-CMC, Amgen Inc, Thousand Oaks, California 91320, USA
| | - Nina S Cauchon
- Department of Global Regulatory Affairs and Strategy-CMC, Amgen Inc, Thousand Oaks, California 91320, USA.
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9
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Luo Y, Wang J, Zhang M, Wang Q, Chen R, Wang X, Wang H. COVID-19-another influential event impacts on laboratory medicine management. J Clin Lab Anal 2021; 35:e23804. [PMID: 34032325 PMCID: PMC8183907 DOI: 10.1002/jcla.23804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/02/2021] [Accepted: 04/10/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Before public health emergencies became a major challenge worldwide, the scope of laboratory management was only related to developing, maintaining, improving, and sustaining the quality of accurate laboratory results for improved clinical outcomes. Indeed, quality management is an especially important aspect and has achieved great milestones during the development of clinical laboratories. CURRENT STATUS However, since the coronavirus disease 2019 (COVID-19) pandemic continues to be a threat worldwide, previous management mode inside the separate laboratory could not cater to the demand of the COVID-19 public health emergency. Among emerging new issues, the prominent challenges during the period of COVID-19 pandemic are rapid-launched laboratory-developed tests (LDTs) for urgent clinical application, rapid expansion of testing capabilities, laboratory medicine resources, and personnel shortages. These related issues are now impacting on clinical laboratory and need to be effectively addressed. CONCLUSION Different from traditional views of laboratory medicine management that focus on separate laboratories, present clinical laboratory management must be multidimensional mode which should consider consolidation of the efficient network of regional clinical laboratories and reasonable planning of laboratories resources from the view of overall strategy. Based on relevant research and our experience, in this review, we retrospect the history trajectory of laboratory medicine management, and also, we provide existing and other feasible recommended management strategies for laboratory medicine in future.
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Affiliation(s)
- YunTao Luo
- Shanghai center for clinical laboratoryShanghaiChina
| | - JingHua Wang
- Shanghai center for clinical laboratoryShanghaiChina
| | - MinMin Zhang
- Shanghai center for clinical laboratoryShanghaiChina
| | | | - Rong Chen
- Shanghai center for clinical laboratoryShanghaiChina
| | - XueLiang Wang
- Shanghai center for clinical laboratoryShanghaiChina
| | - HuaLiang Wang
- Shanghai center for clinical laboratoryShanghaiChina
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10
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Parikh N, Gargollo P, Granberg C. Improving Operating Room Efficiency Using the Six Sigma Methodology. Urology 2021; 154:141-147. [PMID: 33984368 DOI: 10.1016/j.urology.2021.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/30/2020] [Accepted: 02/08/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To help improve operating room efficiency in a tertiary care facility, Six Sigma analysis was utilized. Six Sigma is a technique driven by data, methodology, and a philosophy of continuous improvement to help create a system in which 99.99966% of products are free from defects. This process helps to reduce variability and waste in production, while increasing quality and decreasing cost of the final product. METHODS The steps of define, measure, analyze, improve, and control (DMAIC) methodology were used. Variables measured included close-to-cut time, patient-out to patient-in time, and room utilization. Statistical analysis was conducted, while an individual was sent to shadow various levels of operating room personnel to help recognize possible shortcomings in the system, including communication and coordination errors. RESULTS Baseline results were recorded for each surgical specialty to help determine the specific needs of each OR team. Changes in workflow, such as staggered start anesthesia times, were recommended for each level of personnel based on statistical analysis and observation. Results were followed for several years with initial data showing success of the process. However, ongoing construction and resistance to change has prevented further review. CONCLUSION While Six Sigma can be a valuable tool, it is essential to have a proper leadership team that includes all stake holders. The process requires horizontal and vertical leadership as well as buy-in from all individuals affected by the process. The synergy of these factors is key for success.
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Affiliation(s)
- Niki Parikh
- Department of Urology, Mayo Clinic, Rochester, MN.
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11
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Larsen AST, Norheim KL, Marandi RZ, Hansen EA, Madeleine P. A field study investigating sensory manifestations in recreational female cyclists using a novel female-specific cycling pad. ERGONOMICS 2021; 64:571-581. [PMID: 33210555 DOI: 10.1080/00140139.2020.1853819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/14/2020] [Indexed: 06/11/2023]
Abstract
This randomised controlled field study aimed to design a female-specific cycling pad with reduced padding in the crotch area (half-pad) and test its effects on self-reported sensory manifestations in comparison with full-padded cycling bib shorts. Recreational female road cyclists (n = 183) participated (divided into two groups). Self-reported sensory manifestations were collected six times over 12 weeks. Sitting discomfort, wetness perception, thermal, texture sensation, and wear discomfort decreased over time for the crotch and sitting-bones areas in both groups. Irritation and tenderness in the crotch area also decreased over time in both groups. Irritation and tenderness in the sitting-bones area were only higher at week two in the half-pad compared with the full-pad group. Cycling with the half-padded shorts compared with the full-padded ones had no negative effects on sensory manifestations beside the observed transient change at week two. This suggests that foam thickness in the crotch area can be reduced in female-specific cycling pads. Practitioner's Summary: Road cycling might result in discomfort and non-traumatic injuries in the female genital area. This field study compares two different cycling pads; a half-pad and a full-pad, over a 12-week period among female recreational road cyclists. Reducing the foam thickness in the crotch area of the pad does not change sensory manifestations, i.e. discomfort, wetness perception, texture-, and thermal-sensation as well as wear discomfort. Abbreviations: CS-Q: online Cycling bib Shorts Questionnaire; VADER: Valence Aware Dictionary and sEntiment Reasoner.
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Affiliation(s)
- Anna Sofie T Larsen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- FUSION ApS, Svenstrup J, Denmark
| | - Kristoffer L Norheim
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ramtin Z Marandi
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ernst A Hansen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Pascal Madeleine
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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12
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Hines K, Mouchtouris N, Getz C, Gonzalez G, Montenegro T, Leibold A, Harrop J. Bundled Payment Models in Spine Surgery. Global Spine J 2021; 11:7S-13S. [PMID: 33890801 PMCID: PMC8076809 DOI: 10.1177/2192568220974977] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
STUDY DESIGN The following is a narrative discussion of bundled payments in spine surgery. OBJECTIVE The cost of healthcare in the United States has continued to increase. To lower the cost of healthcare, reimbursement models are being investigated as potential cost saving interventions by driving incentives and quality improvement in fields such a spine surgery. METHODS Narrative overview of literature pertaining to bundled payments in spine surgery synthesizing findings from computerized databases and authoritative texts. RESULTS Spine surgery is challenging to define payment modes because of high cost variability and surgical decision-making nuances. While implementing bundled care payments in spine surgery, it is important to understand concepts such as value-based purchasing, episodes of care, prospective versus retrospective payment models, one versus two-sided risk, risk adjustment, and outlier protection. Strategies for implementation underscore the importance of risk stratification and modeling, adoption of evidence based clinical pathways, and data collection and dissemination. While bundled care models have been successfully implemented, challenges facing institutions adopting bundled care payment models include financial stressors during adoption of the model, distribution of risks, incentivization of treating only low risk patients, and nuanced variation in procedures leading to variation in costs. CONCLUSION An alternative for fee for service payments, bundled care payments may lead to higher cost savings and surgeon accountability in a patient's care.
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Affiliation(s)
- Kevin Hines
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Nikolaos Mouchtouris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Charles Getz
- Department of Orthopedic Surgery, Rothman Institute, Philadelphia, PA, USA
| | - Glenn Gonzalez
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Thiago Montenegro
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Adam Leibold
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA,James Harrop, Division of Spine and Peripheral Nerve Surgery, Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut Street 3rd Floor, Philadelphia, PA 19107, USA.
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13
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Boyle S, Tyrrell O, Quigley A, Wall C. Improving ward level efficiency using a modified treatment room layout according to Lean methodologies. Ir J Med Sci 2021; 191:127-132. [PMID: 33712978 DOI: 10.1007/s11845-021-02590-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Standardised ward treatment rooms have the potential to improve efficiency in performing routine tasks. Our aim was to produce a standardised layout for commonly used equipment using a Lean approach. METHODS A standardised layout was devised for equipment used for venepuncture, intravenous cannulation (IVC), arterial blood gas sampling, urinary catheter insertion and nasogastric tube insertion. Stakeholder engagement was sought from house officers (HO), nursing staff, store staff and care attendants. HO were timed gathering equipment pre- and post-intervention, and a questionnaire was distributed. Feedback from all potential stakeholders contributed to the final design using repeat Plan, Do, Study, Act (PDSA) cycles. RESULTS The intervention was implemented across 20 inpatient wards, in 3 tertiary university teaching hospitals. The mean time taken to gather equipment for IVC significantly reduced, from 94.9 to 33.9 s (n = 166; p < 0.0001). Self-reported frustration among HO with the treatment room significantly decreased from 54.9 to 4.5% (p < 0.0001). There was a 62.3% reduction in the need for HO to ask other ward staff for help to locate equipment. CONCLUSION This study demonstrates improved efficiency with a time saving of over 1 min for a very commonly performed ward-based task. Ward-based staff reported reduced frustration and less interruptions following the standardisation and optimisation of treatment room layouts.
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Affiliation(s)
- Seamus Boyle
- Tallaght University Hospital Sligo, Sligo, F91 H684, Ireland.
| | - Oisín Tyrrell
- Tallaght University Hospital Sligo, Sligo, F91 H684, Ireland
| | - Ailbhe Quigley
- Tallaght University Hospital Sligo, Sligo, F91 H684, Ireland
| | - Catherine Wall
- Tallaght University Hospital Sligo, Sligo, F91 H684, Ireland
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14
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Reynolds MS, Spencer SP, Dunaway A, Buckingham D, Bartman T. Scientific Approach to Assess if Change Led to Improvement-Methods for Statistical Process Control Analysis in Quality Improvement. J Emerg Nurs 2020; 47:198-205. [PMID: 33397579 DOI: 10.1016/j.jen.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022]
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15
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Houck MM, Speaker P. Project FORESIGHT: A ten-year retrospective. Forensic Sci Int Synerg 2020; 2:275-281. [PMID: 33015598 PMCID: PMC7522487 DOI: 10.1016/j.fsisyn.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022]
Abstract
Forensic service providers fulfill a fundamental role in a criminal justice system by providing scientific information that aids investigations and court proceedings. While the focus is often on the science aspect of these organizations, the provision is also of paramount importance. Historically, calls for more and better information about forensic laboratory performance (in essence, benchmarking) have gone unheard. Project FORESIGHT, created in 2008, filled this need through engagement with the forensic management community to build a needs-based process for providing operational data that can be used to enhance a laboratory's performance. With over 10 years of industry data, Project FORESIGHT is the de facto standard for benchmarking forensic service provision.
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Affiliation(s)
- Max M. Houck
- Forensic Portfolio Innovator, Global Forensic and Justice Center, Florida International University, USA
| | - Paul Speaker
- Department of Finance, John C. Chambers College of Business and Economics, West Virginia University, USA
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16
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Wind LS, Knight TG, Auten JJ, Bates JS, Marucci L, Creedle CJ, Foster MC, Muluneh B. Evaluation and optimization of a clinical pharmacist driven transitions of care model for malignant hematology. J Oncol Pharm Pract 2020; 27:283-287. [PMID: 32290764 DOI: 10.1177/1078155220916516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To implement and optimize a pilot transitions of care model for scheduled chemotherapy admissions in patients with hematologic malignancies at our institution.Methodology: We utilized the plan-do-study-act (PDSA) quality improvement technique to prospectively measure success of interventions related to improving transitions of care processes that occurred in multiple stages including development of standardized operating procedures, electronic medical record documentation, and education to the malignant hematology multidisciplinary group. Chart review was performed retrospectively for at least nine patients per PDSA cycle. Areas of intervention addressed and measured regarding communication between the ambulatory care and acute care settings included: admission purpose, processes related to insurance benefits investigations for specialty medications required in the post-discharge setting, and plan for growth factors, prophylactic antimicrobials, and follow-up.Results and conclusions: We included 28 patients and performed a total of three PDSA cycles demonstrating specific improvements in: communication regarding status of benefits investigations performed for specialty medications prior to admission, resolution of these benefits investigations at various time points, improvement in efficient use of the electronic medical record for chemotherapy orders, and patient instructions for appropriate use of prophylactic antimicrobials. Although improvement was noted initially with prescribing of discharge antiemetics and antimicrobials, regression to baseline was noted with the third PDSA cycle.
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Affiliation(s)
- Lucas S Wind
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | | | - Jessica J Auten
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Jill S Bates
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Leonardo Marucci
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Crista J Creedle
- Division of Nursing, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Matthew C Foster
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Benyam Muluneh
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
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Monitoring telehealth vomiting calls as a potential public health early warning system for seasonal norovirus activity in Ontario, Canada. Epidemiol Infect 2020; 147:e112. [PMID: 30869009 PMCID: PMC6518795 DOI: 10.1017/s0950268818003357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Norovirus is a predominant cause of infectious gastroenteritis in countries worldwide [1-5]. It accounts for approximately 50% of acute gastroenteritis (AGE) and >90% of viral gastroenteritis outbreaks [6, 7]. The incubation period ranges between 10 and 48 h and illness duration is generally 1-3 days with self-limiting symptoms; however, this duration is often longer (e.g. 4-6 days) in vulnerable populations such as hospital patients or young children [2, 8]. Symptomatic infection of norovirus presents as acute vomiting, diarrhoea, abdominal cramps and nausea, with severe vomiting and diarrhoea (non-bloody) being most common [2, 5, 9].
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18
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Subramony A, Kocolas I, Srivastava R. Pediatric Hospitalists Improving Patient Care Through Quality Improvement. Pediatr Clin North Am 2019; 66:697-712. [PMID: 31230617 DOI: 10.1016/j.pcl.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article reviews the industrial underpinnings of the quality improvement (QI) movement and describes how QI became integrated within the larger health care landscape, including hospital medicine. QI methodologies and a framework for using them are described. Key components that make up a successful QI clinical project are outlined, with a focus on the essential role of pediatric hospitalists and practical professional tips to be successful. QI training opportunities are reviewed with opportunities for hospitalists to get involved in QI on a national level. National QI networks are showcased, with multiple examples of advanced improvement projects that have significantly improved patient outcomes highlighted.
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Affiliation(s)
- Anupama Subramony
- Department of Pediatrics, Cohen Children's Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-01 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Irene Kocolas
- Division of Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine/Primary Children's Hospital, Intermountain Healthcare, 100 Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Raj Srivastava
- Division of Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine/Primary Children's Hospital, Healthcare Delivery Institute, Intermountain Healthcare, 5026 State Street, Murray, UT 84107, USA
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Development and Performance of Electronic Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction-2 Automated Acuity Scores. Pediatr Crit Care Med 2019; 20:e372-e379. [PMID: 31397827 PMCID: PMC7115250 DOI: 10.1097/pcc.0000000000001998] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Develop and test the performance of electronic version of the Children's Hospital of Pittsburgh Pediatric Risk of Mortality-IV and electronic version of the Children's Hospital of Pittsburgh Pediatric Logistic Organ Dysfunction-2 scores. DESIGN Retrospective, single-center cohort derived from structured electronic health record data. SETTING Large, quaternary PICU at a freestanding, university-affiliated children's hospital. PATIENTS All encounters with a PICU admission between January 1, 2009, and December 31, 2017, identified using electronic definitions of inpatient encounter. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The main outcome was predictive validity of each score for hospital mortality, assessed as model discrimination and calibration. Discrimination was examined with the area under the receiver operating characteristics curve and the area under the precision-recall curve. Calibration was assessed with the Hosmer-Lemeshow goodness of fit test and calculation of a standardized mortality ratio. Models were recalibrated with new regression coefficients in a training subset of 75% of encounters selected randomly from all years of the cohort and the calibrated models were tested in the remaining 25% of the cohort. Content validity was assessed by examining correlation between electronic versions of the scores and prospectively calculated data (electronic version of the Children's Hospital of Pittsburgh Pediatric Risk of Mortality-IV) and an alternative informatics approach (Children's Hospital of Pittsburgh Pediatric Logistic Organ Dysfunction-2 score). The cohort included 21,335 encounters. Correlation coefficients indicated strong agreement between different methods of score calculation. Uncalibrated area under the receiver operating characteristics curves were 0.96 (95% CI, 0.95-0.97) for electronic version of the Children's Hospital of Pittsburgh Pediatric Logistic Organ Dysfunction-2 score and 0.87 (95% CI, 0.85-0.89) for electronic version of the Children's Hospital of Pittsburgh Pediatric Risk of Mortality-IV for inpatient mortality. The uncalibrated electronic version of the Children's Hospital of Pittsburgh Pediatric Risk of Mortality-IV standardized mortality ratio was 0.63 (0.59-0.66), demonstrating strong agreement with previous, prospective evaluation at the study center. The uncalibrated electronic version of the Children's Hospital of Pittsburgh Pediatric Logistic Organ Dysfunction-2 score standardized mortality ratio was 0.20 (0.18-0.21). All models required recalibrating (all Hosmer-Lemeshow goodness-of-fit, p < 0.001) and subsequently demonstrated acceptable goodness-of-fit when examined in a test subset (n = 5,334) of the cohort. CONCLUSIONS Electronically derived intensive care acuity scores demonstrate very good to excellent discrimination and can be calibrated to institutional outcomes. This approach can facilitate both performance improvement and research initiatives and may offer a scalable strategy for comparison of interinstitutional PICU outcomes.
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Jankowski CJ, Walsh MT. Quality Improvement in Ambulatory Anesthesia: Making Changes that Work for You. Anesthesiol Clin 2019; 37:349-360. [PMID: 31047134 DOI: 10.1016/j.anclin.2019.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The pace of busy ambulatory surgical practice makes it difficult to begin and sustain quality improvement efforts. However, evolving patient and payer expectations of high-value care make these endeavors more urgent. Lean, a term coined in 1990 to describe the Toyota Production System, has been applied by large and small health systems to eliminate waste; increase value for customers; and develop the ability of physicians, nurses, and other health care workers to manage and continuously improve their work. This article reviews some of the steps necessary to successfully adopt lean in an ambulatory surgical setting.
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Affiliation(s)
- Christopher J Jankowski
- Mayo Clinic College of Medicine and Science, Charlton 1-145, 200 First Street, Southwest, Rochester, MN 55905, USA.
| | - Michael T Walsh
- Mayo Clinic College of Medicine and Science, Charlton 1-145, 200 First Street, Southwest, Rochester, MN 55905, USA
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Affeltranger B, Potvin L, Ferron C, Vandewalle H, Vallée A. [Proportionate universalism: Towards “real equality” of prevention in France]. SANTE PUBLIQUE 2019; 30:13-24. [PMID: 30547478 DOI: 10.3917/spub.184.0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Although their design may feature a considerable amount of universalism, prevention strategies often produce results that are socially and/or spatially differentiated. This differentiation process can induce social or territorial gradients of access to and/or effectiveness of prevention and, in turn, worsen health inequalities. This process also accentuates the gap between the principles of certain public policies and their practical implementation, raising the question of the real benefit of these policies for beneficiaries. Although Sir Marmot considers proportionate universalism to be a strategy to tackle health inequalities, the practical modalities of implementation of this principle have been rarely described in the literature until very recently. This pragmatic paper therefore presents a causal analysis of differentiation processes, underlines the need for self-reflexive prevention strategies, and investigates practical implications of proportionate universalism.
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Larson LA, Finley JL, Gross TL, McKay AK, Moenck JM, Severson MA, Clements CM. Using a Potentially Aggressive/Violent Patient Huddle to Improve Health Care Safety. Jt Comm J Qual Patient Saf 2019; 45:74-80. [PMID: 30638871 DOI: 10.1016/j.jcjq.2018.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unexpected situations of workplace violence are occurring in the United States at increasing rates in health care environments, warranting increased attention to processes supporting safety for health care workers. At a large, academic hospital, two patient safety incidents had occurred in a two-year period in which a patient had become violent at the time of admission from the emergency department (ED) to the medical unit. METHODS A multidisciplinary quality improvement (QI) team was formed to address the risk of violent patient events. Using two iterative Plan-Do-Study-Act (PDSA) cycles, the QI team designed and tested a huddle handoff communication tool, the Potentially Aggressive/Violent Huddle Form. An ED nurse would initiate the huddle process by informing the admitting unit that a patient at risk for violence was being admitted. The admitting care team would then call the ED team so that both teams participated in the handoff call together. The huddle process occurred for 21 transfers in the first PDSA cycle and for 18 transfers in the second. RESULTS RNs from the ED and the six medical units reported feeling safe during the transfer process 100% of the time during both tests of change PDSAs (vs. 54.7% at baseline). In the ED, from the first test of change to the second test of change, satisfaction with the process improved from 53.3% to 75.0%. CONCLUSION The huddle handoff communication tool and other methods to facilitate the transfer of potentially violent patients have the potential to decrease the number and severity of violent incidents in the health care workplace.
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Rohrbasser A, Harris J, Mickan S, Tal K, Wong G. Quality circles for quality improvement in primary health care: Their origins, spread, effectiveness and lacunae- A scoping review. PLoS One 2018; 13:e0202616. [PMID: 30557329 PMCID: PMC6296539 DOI: 10.1371/journal.pone.0202616] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/04/2018] [Indexed: 01/02/2023] Open
Abstract
Quality circles or peer review groups, and similar structured small groups of 6–12 health care professionals meet regularly across Europe to reflect on and improve their standard practice. There is debate over their effectiveness in primary health care, especially over their potential to change practitioners’ behaviour. Despite their popularity, we could not identify broad surveys of the literature on quality circles in a primary care context. Our scoping review was intended to identify possible definitions of quality circles, their origins, and reported effectiveness in primary health care, and to identify gaps in our knowledge. We searched appropriate databases and included any relevant paper on quality circles published until December 2017. We then compared information we found in the articles to that we found in books and on websites. Our search returned 7824 citations, from which we identified 82 background papers and 58 papers about quality circles. We found that they originated in manufacturing industry and that many countries adopted them for primary health care to continuously improve medical education, professional development, and quality of care. Quality circles are not standardized and their techniques are complex. We identified 19 papers that described individual studies, one paper that summarized 3 studies, and 1 systematic review that suggested that quality circles can effectively change behaviour, though effect sizes varied, depending on topic and context. Studies also suggested participation may affirm self-esteem and increase professional confidence. Because reports of the effect of quality circles on behaviour are variable, we recommend theory-driven research approaches to analyse and improve the effectiveness of this complex intervention.
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Affiliation(s)
- Adrian Rohrbasser
- Department of Continuing Education University of Oxford, Oxford, United Kingdom
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- * E-mail:
| | - Janet Harris
- University of Sheffield School of Health & Related Research, Sheffield, United Kingdom
| | - Sharon Mickan
- The Gold Coast Health, Griffith University, Southport, Australia
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Abstract
Purpose The purpose of this paper is to present a case study of a successful quality improvement project in an acute care hospital focused on reducing the time of the total patient visit in the emergency department. Design/methodology/approach A multidisciplinary quality improvement team, using the PDSA (Plan, Do, Study, Act) Cycle, analyzed the emergency department care delivery process and sequentially made process improvements that contributed to project success. Findings The average turnaround time goal of 90 minutes or less per visit was achieved in four months, and the organization enjoyed significant collateral benefits both internal to the organization and for its customers. Practical implications This successful PDSA process can be duplicated by healthcare organizations of all sizes seeking to improve a process related to timely, high-quality patient care delivery. Originality/value Extended wait time in hospital emergency departments is a universal problem in the USA that reduces the quality of the customer experience and that delays necessary patient care. This case study demonstrates that a structured quality improvement process implemented by a multidisciplinary team with the authority to make necessary process changes can successfully redefine the norm.
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Abstract
Responding to this issue's invitation to bring new disciplinary insights to the field of improvement science, this article takes as its starting point one of the field's guiding metaphors: the imperative to "mind the gap". Drawing on insights from anthropology, history, and philosophy, the article reflects on the origins and implications of this metaphoric imperative, and suggests some ways in which it might be in tension with the means and ends of improvement. If the industrial origins of improvement science in the twentieth century inform a metaphor of gaps, chasms, and spaces of misalignment as invariably imperfect and potentially dangerous, and therefore requiring bridging or closure, other currents that feed the discipline of improvement science suggest the potential value and uses of spaces of openness and ambiguity. These currents include the science of complex adaptive systems, and certain precepts of philosophical pragmatism acknowledged to inform improvement science. Going a step further, I reflect on whether or not these two contrasting approaches within improvement science should be treated as incommensurable paradigms, and what each approach tells us about the very possibility of accommodating seemingly irreconcilable or incommensurable approaches within improvement science.
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Lawson T, Weekes L, Hill M. Ensuring success and sustainability of a quality improvement project. BJA Educ 2018; 18:147-152. [PMID: 33456825 DOI: 10.1016/j.bjae.2018.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 10/17/2022] Open
Affiliation(s)
- T Lawson
- Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - L Weekes
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - M Hill
- Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
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Optimizing Performance: Revolutionizing the Sepsis Team with a Fresh Start. Pediatr Qual Saf 2018. [PMCID: PMC6132758 DOI: 10.1097/pq9.0000000000000063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Methods: Results: Conclusion:
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Ammentorp J, Wolderslund M, Timmermann C, Larsen H, Steffensen KD, Nielsen A, Lau ME, Winther B, Jensen LH, Hvidt EA, Hvidt NC, Gulbrandsen P. How participatory action research changed our view of the challenges of shared decision-making training. PATIENT EDUCATION AND COUNSELING 2018; 101:639-646. [PMID: 29137836 DOI: 10.1016/j.pec.2017.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 11/02/2017] [Accepted: 11/03/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This paper aims to demonstrate how the use of participatory action research (PAR) helped us identify ways to respond to communication challenges associated with shared decision-making (SDM) training. METHODS Patients, relatives, researchers, and health professionals were involved in a PAR process that included: (1) two theatre workshops, (2) a pilot study of an SDM training module involving questionnaires and evaluation meetings, and (3) three reflection workshops. RESULTS The PAR process revealed that health professionals often struggled with addressing existential issues such as concerns about life, relationships, meaning, and ability to lead responsive dialogue. Following the PAR process, a communication programme that included communication on existential issues and coaching was drafted. CONCLUSION By involving multiple stakeholders in a comprehensive PAR process, valuable communication skills addressing a broader understanding of SDM were identified. A communication programme aimed to enhance skills in a mindful and responsive clinical dialogue on the expectations, values, and hopes of patients and their relatives was drafted. PRACTICAL IMPLICATIONS Before integrating new communication concepts such as SDM in communication training, research methods such as PAR can be used to improve understanding and identify the needs and priorities of both patients and health professionals.
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Affiliation(s)
- Jette Ammentorp
- Health Services Research Unit, Lillebaelt Hospital, Denmark; Institute for Regional Health Research, University of Southern Denmark, Denmark.
| | - Maiken Wolderslund
- Health Services Research Unit, Lillebaelt Hospital, Denmark; Institute for Regional Health Research, University of Southern Denmark, Denmark
| | - Connie Timmermann
- Health Services Research Unit, Lillebaelt Hospital, Denmark; Institute for Regional Health Research, University of Southern Denmark, Denmark
| | - Henry Larsen
- SDU Design, University of Southern Denmark, Kolding, Denmark
| | - Karina Dahl Steffensen
- Institute for Regional Health Research, University of Southern Denmark, Denmark; Centre for Shared Decision Making, Lillebaelt Hospital, Vejle, Denmark; Department of Clinical Oncology, Vejle Hospital, Vejle, Denmark
| | | | - Marianne E Lau
- Mental Health Services, Capital Region of Denmark, Denmark
| | - Bodil Winther
- Department of Clinical Oncology, Vejle Hospital, Vejle, Denmark
| | - Lars Henrik Jensen
- Institute for Regional Health Research, University of Southern Denmark, Denmark; Department of Clinical Oncology, Vejle Hospital, Vejle, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Denmark
| | - Pål Gulbrandsen
- Institute for Regional Health Research, University of Southern Denmark, Denmark; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; HØKH Research Centre, Akershus University Hospital, Lørenskog, Norway
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Køster B, Søndergaard J, Nielsen JB, Olsen A, Bentzen J. Reliability and consistency of a validated sun exposure questionnaire in a population-based Danish sample. Prev Med Rep 2018; 10:43-48. [PMID: 29552457 PMCID: PMC5852403 DOI: 10.1016/j.pmedr.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/26/2017] [Accepted: 02/05/2018] [Indexed: 12/27/2022] Open
Abstract
An important feature of questionnaire validation is reliability. To be able to measure a given concept by questionnaire validly, the reliability needs to be high. The objectives of this study were to examine reliability of attitude and knowledge and behavioral consistency of sunburn in a developed questionnaire for monitoring and evaluating population sun-related behavior. Sun related behavior, attitude and knowledge was measured weekly by a questionnaire in the summer of 2013 among 664 Danes. Reliability was tested in a test-retest design. Consistency of behavioral information was tested similarly in a questionnaire adapted to measure behavior throughout the summer. The response rates for questionnaire 1, 2 and 3 were high and the drop out was not dependent on demographic characteristic. There was at least 73% agreement between sunburns in the measurement week and the entire summer, and a possible sunburn underestimation in questionnaires summarizing the entire summer. The participants underestimated their outdoor exposure in the evaluation covering the entire summer as compared to the measurement week. The reliability of scales measuring attitude and knowledge was high for majority of scales, while consistency in protection behavior was low. To our knowledge, this is the first study to report reliability for a completely validated questionnaire on sun-related behavior in a national random population based sample. Further, we show that attitude and knowledge questions confirmed their validity with good reliability, while consistency of protection behavior in general and in a week's measurement was low. Objectively validated questionnaires tested for reliability/behavioral consistency. Strong reliability of the knowledge and attitude items was shown. Knowledge about behavioral consistency between questionnaire measurement periods A recommendable design for short term evaluation of skin cancer prevention campaigns
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Affiliation(s)
- B Køster
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark.,Research Unit of General Practice, University of Southern, Denmark
| | - J Søndergaard
- Research Unit of General Practice, University of Southern, Denmark
| | - J B Nielsen
- Research Unit of General Practice, University of Southern, Denmark
| | - A Olsen
- Research Centre, Danish Cancer Society, Denmark
| | - J Bentzen
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
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Using Continuous Quality-Improvement Techniques to Evaluate and Enhance an Internal Medicine Residency Program's Assessment System. Am J Med 2017; 130:750-755. [PMID: 28285071 DOI: 10.1016/j.amjmed.2017.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 02/22/2017] [Indexed: 11/22/2022]
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Al-Kuwaiti A, Homa K, Maruthamuthu T. A New Performance Improvement Model: Adding Benchmarking to the Analysis of Performance Indicator Data. Jt Comm J Qual Patient Saf 2016; 42:462-465. [DOI: 10.1016/s1553-7250(16)42062-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Køster B, Søndergaard J, Nielsen JB, Allen M, Bjerregaard M, Olsen A, Bentzen J. Effects of smartphone diaries and personal dosimeters on behavior in a randomized study of methods to document sunlight exposure. Prev Med Rep 2016; 3:367-72. [PMID: 27419038 PMCID: PMC4929184 DOI: 10.1016/j.pmedr.2016.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 04/09/2016] [Accepted: 04/20/2016] [Indexed: 11/20/2022] Open
Abstract
Dosimeters and diaries have previously been used to evaluate sun-related behavior and UV exposure in local samples. However, wearing a dosimeter or filling in a diary may cause a behavioral change. The aim of this study was to examine possible confounding factors for a questionnaire validation study. We examined the effects of wearing dosimeters and filling out diaries, measurement period and recall effect on the sun-related behavior in Denmark in 2012. Our sample included 240 participants eligible by smartphone status and who took a vacation during weeks 26–32 in 2012, randomized by gender, age, education and skin type to six groups: 1) Control + diary, 2) Control, 3) 1-week dosimetry measurement, 4) 1-week dosimetry measurement + diary, 5) 3-week dosimetry measurement and 6) 1-week dosimetry measurement with 4 week delayed questionnaire. Correlation coefficients between reported outdoor time and registered outdoor time for groups 3–6 were 0.39, 0.45, 0.43 and 0.09, respectively. Group 6 was the only group not significantly correlated. Questionnaire reported outdoor exposure time was shorter in the dosimeter measurement groups (3–6) than in their respective controls. We showed that using a dosimeter or keeping a diary seems to increase attention towards the behavior examined and therefore may influence this behavior. Receiving the questionnaire with 4 week delay had a significant negative influence on correlation and recall of sunburn. When planning future UV behavior questionnaire validations, we suggest to use a 1-week interval for dosimetry measurements, no diary, and to minimize the time from end of measurement to filling out questionnaires. Personal UV dosimeters and diaries were previously applied in studies of UV radiation. Effects of using UV dosimeters and diaries on participants' behavior were not previously examined. Correlation between objective and subjective measures of outdoor exposure time was shown. Their correlation coefficient depends on length of recall (bias). The use of dosimeters and diaries increases attention towards the examined behavior.
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Affiliation(s)
- Brian Køster
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
- Research Unit of General Practice, University of Southern, Denmark
- Corresponding author at: Strandboulevarden 49, DK-2100, Denmark.Strandboulevarden 49DK-2100Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, University of Southern, Denmark
| | | | - Martin Allen
- Electrical and Computer Engineering, University of Canterbury, New Zealand
| | - Mette Bjerregaard
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
| | - Anja Olsen
- Research Centre, Danish Cancer Society, Denmark
| | - Joan Bentzen
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
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Kruskal JB, Eisenberg RL, Brook O, Siewert B. Transitioning from peer review to peer learning for abdominal radiologists. Abdom Radiol (NY) 2016; 41:416-28. [PMID: 26940330 DOI: 10.1007/s00261-016-0675-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hingorani R, Mahmood M, Alweis R. Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process. J Community Hosp Intern Med Perspect 2015; 5:27472. [PMID: 26091659 PMCID: PMC4475260 DOI: 10.3402/jchimp.v5.27472] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/14/2015] [Accepted: 04/21/2015] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Approximately 25 million people in the United States visit their primary care physician each year for acute respiratory infections (ARI). They are a common cause of unnecessary prescription of antibiotics; despite well-validated national treatment guidelines, around 73% of adults with ARI are prescribed antibiotics in the United States. Inappropriate use of antibiotics has profound implications. METHODS Our aim was to increase adherence to antibiotic guidelines for treatment of ARI in an internal medicine outpatient practice. We used a package of active and passive interventions to improve physician awareness of treatment guidelines; these included short sessions of didactic teaching, antibiotic guidelines posters in patient examination rooms and staff areas, clinical decision support (CDS) tools integrated into the electronic medical record system, guideline adherence report cards for providers, and reiteration of CDS tool use and guideline adherence at monthly group meetings. Process measures were the rate of use of CDS tools for the management of ARI and patient callbacks within 72 h for the same issue. Outcome measures were compliance with antibiotic prescribing guidelines. RESULTS Our low-cost interventions led to a significant improvement in ARI treatment guideline adherence. There was improvement in compliance with treatment guidelines for sinusitis (90.90% vs. 57.58%, p<0.001), pharyngitis (64.28% vs. 25.00%, p=0.003), upper respiratory infection (96.18% vs. 73.68%, p=0.008), and the aggregated measure of ARI (91.25% vs. 78.6%, p<0.001). Rate of CDS tool usage was 40.5% with a 72-h callback rate of 0.05%. CONCLUSION Simple, low-cost interventions can improve appropriate antibiotic use for ARI and change the prescribing habits of providers in an outpatient setting. Provider and patient education is a vital component of antibiotic stewardship. Simple interventions for common outpatient conditions can have a positive impact on patient outcomes and reduce unnecessary healthcare costs.
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Affiliation(s)
- Rittu Hingorani
- Internal Medicine Department, Reading Health System, West Reading PA, USA; ;
| | - Maryam Mahmood
- Internal Medicine Department, Reading Health System, West Reading PA, USA
| | - Richard Alweis
- Internal Medicine Department, Reading Health System, West Reading PA, USA
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Profit J, Goldstein BA, Tamaresis J, Kan P, Lee HC. Regional variation in antenatal corticosteroid use: a network-level quality improvement study. Pediatrics 2015; 135:e397-404. [PMID: 25601974 PMCID: PMC4306799 DOI: 10.1542/peds.2014-2177] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Examination of regional care patterns in antenatal corticosteroid use (ACU) rates may be salient for the development of targeted interventions. Our objective was to assess network-level variation using California perinatal care regions as a proxy. We hypothesized that (1) significant variation in ACU exists within and between California perinatal care regions, and (2) lower performing regions exhibit greater NICU-level variability in ACU than higher performing regions. METHODS We undertook cross-sectional analysis of 33,610 very low birth weight infants cared for at 120 hospitals in 11 California perinatal care regions from 2005 to 2011. We computed risk-adjusted median ACU rates and interquartile ranges (IQR) for each perinatal care region. The degree of variation was assessed using hierarchical multivariate regression analysis with NICU as a random effect and region as a fixed effect. RESULTS From 2005 to 2011, mean ACU rates across California increased from 82% to 87.9%. Regional median (IQR) ACU rates ranged from 68.4% (24.3) to 92.9% (4.8). We found significant variation in ACU rates among regions (P < .0001). Compared with Level IV NICUs, care in a lower level of care was a strongly significant predictor of lower odds of receiving antenatal corticosteroids in a multilevel model (Level III, 0.65 [0.45-0.95]; Level II, 0.39 [0.24-0.64]; P < .001). Regions with lower performance in ACU exhibited greater variability in performance. CONCLUSIONS We found significant variation in ACU rates among California perinatal regions. Regional quality improvement approaches may offer a new avenue to spread best practice.
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Affiliation(s)
- J Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California; California Perinatal Quality Care Collaborative, Palo Alto, California;
| | - B A Goldstein
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina; and
| | - J Tamaresis
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - P Kan
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California
| | - H C Lee
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California; California Perinatal Quality Care Collaborative, Palo Alto, California
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McAlearney AS, Hefner JL, Sieck C, Rizer M, Huerta TR. Evidence-based management of ambulatory electronic health record system implementation: an assessment of conceptual support and qualitative evidence. Int J Med Inform 2014; 83:484-94. [PMID: 24862893 DOI: 10.1016/j.ijmedinf.2014.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 01/30/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES While electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies. METHODS We held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes. RESULTS We suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation. CONCLUSIONS Organizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating new evidence through the PDSA model is a key element of evidence-based management and a crucial way for organizations to position themselves to proactively address implementation and use challenges before they are exacerbated.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, Ohio State University, United States; Division of Health Services Management and Policy, College of Public Health, Ohio State University, United States; Department of Corporate Strategy and Innovation, École Polytechnique Fédérale de Lausanne, Switzerland.
| | - Jennifer L Hefner
- Department of Family Medicine, College of Medicine, Ohio State University, United States
| | - Cynthia Sieck
- Department of Family Medicine, College of Medicine, Ohio State University, United States
| | - Milisa Rizer
- Department of Family Medicine, College of Medicine, Ohio State University, United States; Department of Biomedical Informatics, College of Medicine, Ohio State University, United States
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, Ohio State University, United States; Department of Biomedical Informatics, College of Medicine, Ohio State University, United States
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Flicker LS, Rose SL, Eves MM, Flamm AL, Sanghani R, Smith ML. Developing and testing a checklist to enhance quality in clinical ethics consultation. THE JOURNAL OF CLINICAL ETHICS 2014; 25:281-90. [PMID: 25517564 PMCID: PMC4552192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Checklists have been used to improve quality in many industries, including healthcare. The use of checklists, however, has not been extensively evaluated in clinical ethics consultation. This article seeks to fill this gap by exploring the efficacy of using a checklist in ethics consultation, as tested by an empirical investigation of the use of the checklist at a large academic medical system (Cleveland Clinic). The specific aims of this project are as follows: (1) to improve the quality of ethics consultations by providing reminders to ethics consultants about process steps that are important for most patient-centered ethics consultations, (2) to create consistency in the ethics consultation process across the medical system, and (3) to establish an effective educational tool for trainers and trainees in clinical ethics consultation. The checklist was developed after a thorough literature review and an iterative process of revising and testing by a group of experienced ethics consultants. To pilot test the checklist, it was distributed to 46 ethics consultants. After a six-month pilot period in which ethics professionals used the checklist during their clinical activities, a survey was distributed to all of those who used the checklist. The 10-item survey examined consultants' perceptions regarding the three aims listed above. Of the 25 survey respondents, 11 self-reported as experts in ethics consultation, nine perceived themselves to have mid-level expertise, and five self-reported as novices. The majority (68 percent) of all respondents, regardless of expertise, believed that the checklist could be a "helpful" or "very helpful" tool in the consultation process generally. Novices were more likely than experts to believe that the checklist would be useful in conducting consultations. The limitations of this study include: reduced generalizability given that this project was conducted at one medical system, utilized a small sample size, and used self-reported quality outcome measures. Despite these limitations, to the authors' knowledge this is the first investigation of the use of a checklist systematically to improve quality in ethics consultation. Importantly, our findings shed light on ways this checklist can be used to improve ethics consultation, including its use as an educational tool. The authors hope to test the checklist with consultants in other healthcare systems to explore its usefulness in different healthcare environments.
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Affiliation(s)
| | - Susannah L. Rose
- the Cleveland Clinic Department of Bioethics and ---- at Case Western Reserve University
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Crofts J, Moyo J, Ndebele W, Mhlanga S, Draycott T, Sibanda T. Adaptation and implementation of local maternity dashboards in a Zimbabwean hospital to drive clinical improvement. Bull World Health Organ 2013; 92:146-52. [PMID: 24623908 DOI: 10.2471/blt.13.124347] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 10/17/2013] [Accepted: 10/20/2013] [Indexed: 11/27/2022] Open
Abstract
PROBLEM The Commission on Information and Accountability for Women's and Children's Health of the World Health Organization (WHO) reported that national health outcome data were often of questionable quality and "not timely enough for practical use by health planners and administrators". Delayed reporting of poor-quality data limits the ability of front-line staff to identify problems rapidly and make improvements. APPROACH Clinical "dashboards" based on locally available data offer a way of providing accurate and timely information. A dashboard is a simple computerized tool that presents a health facility's clinical data graphically using a traffic-light coding system to alert front-line staff about changes in the frequency of clinical outcomes. It provides rapid feedback on local outcomes in an accessible form and enables problems to be detected early. Until now, dashboards have been used only in high-resource settings. LOCAL SETTING An overview maternity dashboard and a maternal mortality dashboard were designed for, and introduced at, a public hospital in Zimbabwe. A midwife at the hospital was trained to collect and input data monthly. RELEVANT CHANGES Implementation of the maternity dashboards was feasible and 28 months of clinical outcome data were summarized using common computer software. Presentation of these data to staff led to the rapid identification of adverse trends in outcomes and to suggestions for actions to improve health-care quality. LESSONS LEARNT Implementation of maternity dashboards was feasible in a low-resource setting and resulted in actions that improved health-care quality locally. Active participation of hospital management and midwifery staff was crucial to their success.
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Affiliation(s)
- J Crofts
- School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, BS10 5NB, England
| | - J Moyo
- Mpilo Central Hospital, Bulawayo, Zimbabwe
| | - W Ndebele
- Mpilo Central Hospital, Bulawayo, Zimbabwe
| | - S Mhlanga
- Mpilo Central Hospital, Bulawayo, Zimbabwe
| | - T Draycott
- School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, BS10 5NB, England
| | - T Sibanda
- Whanganui Hospital, Whanganui District Health Board, Whanganui, New Zealand
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Kazmierczak SC. Contributions of CCLM to advances in quality control. Clin Chem Lab Med 2012; 51:75-81. [PMID: 23152419 DOI: 10.1515/cclm-2012-0649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 09/29/2012] [Indexed: 11/15/2022]
Abstract
Abstract The discipline of laboratory medicine is relatively young when considered in the context of the history of medicine itself. The history of quality control, within the context of laboratory medicine, also enjoys a relatively brief, but rich history. Laboratory quality control continues to evolve along with advances in automation, measurement techniques and information technology. Clinical Chemistry and Laboratory Medicine (CCLM) has played a key role in helping disseminate information about the proper use and utility of quality control. Publication of important advances in quality control techniques and dissemination of guidelines concerned with laboratory quality control has undoubtedly helped readers of this journal keep up to date on the most recent developments in this field.
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Affiliation(s)
- Steven C Kazmierczak
- Department of Pathology, Oregon Health and Science University, Portland, OR 97239, USA.
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Formal quality improvement curriculum and DMAIC method results in interdisciplinary collaboration and process improvement in renal transplant patients. J Surg Res 2012; 177:7-13. [DOI: 10.1016/j.jss.2012.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 02/25/2012] [Accepted: 03/08/2012] [Indexed: 11/23/2022]
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Affiliation(s)
- Reuben Arasaratnam
- Department of Internal Medicine, University of North Carolina, Chapel Hill, NC 27514, United States
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Oh HC, Toh HG, Giap Cheong ES. Realization of Process Improvement at a Diagnostic Radiology Department with Aid of Simulation Modeling. J Healthc Qual 2011; 33:40-7. [DOI: 10.1111/j.1945-1474.2011.00133.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Duclos A, Touzet S, Soardo P, Colin C, Peix JL, Lifante JC. Quality monitoring in thyroid surgery using the Shewhart control chart. Br J Surg 2009; 96:171-4. [DOI: 10.1002/bjs.6418] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Background
A control chart can help to interpret and reduce sources of variability in patient safety by continuously monitoring indicators. The aim of this study was to monitor the outcome of thyroid surgery using control charts.
Methods
Patients who had thyroid surgery during 2006–2007 were included in the study. Safety was monitored based on postoperative complications of recurrent laryngeal nerve palsy and hypocalcaemia. Indicators were extracted prospectively from the hospital information system and plotted each month on a P-control chart. Performance of the surgical team was also measured retrospectively for 2004–2005 (baseline period) to compare surgical outcomes before and after control chart implementation. Electromyographic monitoring of recurrent laryngeal nerves was not used, nor was calcium or vitamin D given routinely.
Results
The outcomes of 1114 thyroid procedures were monitored. Although the proportion of patients with recurrent laryngeal nerve palsy was similar for baseline and monitored periods (6·4 and 7·2 per cent respectively), there was a 35·3 per cent decrease in hypocalcaemia after implementation of control charts (P < 0·001). Complications almost doubled during a period when one surgeon was away and operating room renovations took place.
Conclusion
Outcome monitoring in thyroid surgery using control charts is useful for identifying potential issues in patient safety.
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Affiliation(s)
- A Duclos
- Pôle d'Information Médicale Evaluation Recherche, Hospices Civils de Lyon, and Université Lyon 1, Hôtel Dieu, Lyon, France
| | - S Touzet
- Pôle d'Information Médicale Evaluation Recherche, Hospices Civils de Lyon, and Université Lyon 1, Hôtel Dieu, Lyon, France
| | - P Soardo
- Hospices Civils de Lyon, Department of General and Endocrine Surgery, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - C Colin
- Pôle d'Information Médicale Evaluation Recherche, Hospices Civils de Lyon, and Université Lyon 1, Hôtel Dieu, Lyon, France
| | - J L Peix
- Hospices Civils de Lyon, Department of General and Endocrine Surgery, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - J C Lifante
- Hospices Civils de Lyon, Department of General and Endocrine Surgery, Centre Hospitalier Lyon Sud, Pierre Bénite, France
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Duclos A, Bouhour D, Baptiste C, Launay O, Guiso N. Assessment of individual vaccine status in a vaccinology experts' group. J Eval Clin Pract 2008; 14:610-4. [PMID: 19126179 DOI: 10.1111/j.1365-2753.2008.00946.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE Worldwide, experts in vaccinology have promoted the broad annual coverage of health care workers with the influenza vaccine. Furthermore, pertussis vaccination is now recommended for young adults and health care workers working with newborns. AIM To analyse the compliance with these guidelines among experts responsible for the development or dissemination of national immunization schedules. METHOD A cross-sectional survey was conducted in a vaccinology workshop group of French experts, using a self-administered questionnaire. RESULTS Among 44 experts, the average rate of influenza vaccination was 69.5% (95% confidence interval, 61.6% to 77.3%) between the 2003/04 and 2005/06 flu seasons, whereas the rate of pertussis vaccination during this period was only 30%. The main reasons that the experts gave for not being vaccinated were a lack of time or simply not remembering to do so. CONCLUSION Experts had low coverage rates for influenza and pertussis vaccination. To improve these rates, a multifaceted intervention combining audit and feedback strategy with a vaccine day is planned.
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Affiliation(s)
- Antoine Duclos
- Département d'Information Médicale des Hospices Civils de Lyon, Pôle IMER, Lyon, France.
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Pawlicki T, Whitaker M. Variation and Control of Process Behavior. Int J Radiat Oncol Biol Phys 2008; 71:S210-4. [DOI: 10.1016/j.ijrobp.2007.05.096] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 05/21/2007] [Indexed: 11/24/2022]
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Attof Y, Hachemi M, Cannesson M, Souza Neto EP, Rosamel P, Chambrier C, Bastien O, Lehot JJ. [From the creation to the appreciation of a personal digital assistant-based clinical decision-support system for the management of artificial nutrition]. ACTA ACUST UNITED AC 2007; 26:1031-6. [PMID: 17977688 DOI: 10.1016/j.annfar.2007.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 09/25/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of our study was to assess the effect of NutriPDA, a personal digital assistant (PDA)-based clinical decision-support system (CDSS) for the management of artificial nutrition. A CDSS was developed and implemented on a handheld computer for use in the ICU after cardiovascular and thoracic surgery. STUDY DESIGN System impact was assessed in a prospective "before/after" cohort trial. METHODS After informed consent we studied 61 patients in the postcardiovascular and thoracic surgery ICU (age > 17 years, duration of artificial nutrition > 3 days, length of stay > 8 days). Patients were divided into two groups (before and after the use of NutriPDA: Group A: 32 patients (4-month period in 2005); group B: 29 patients (4-month period in 2006). RESULTS There were no significant differences in anthropometric and clinical parameters between the 2 groups. Energetic intakes were < 80% of basal energetic expenditures in 21% and 1% of patients, respectively (P < 0.01). Caloric and nitrogen intakes were below international recommendation in Group A: 20+/-4 kcal/kg/d (mean+/-SD), 104+/-30 mg/kg/d, but not in Group B: 26+/-5 kcal/kg/d, 196+/-41 mg/kg/d (P < 0.01). CONCLUSION NutriPDA was found to be able to optimize artificial nutrition by improving caloric intake in ICU. This new software has potential clinical applications.
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Affiliation(s)
- Y Attof
- Service d'anesthésie-réanimation, hôpital cardiovasculaire et pneumologique Louis-Pradel, hospices civils de Lyon, BP Lyon-Monchat, 69394 Lyon cedex 03, France; ERI 22, université Claude-Bernard Lyon-I, France.
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Abstract
A modern approach to quality was developed in the United States at Bell Telephone Laboratories during the first part of the 20th century. Over the years, those quality techniques have been adopted and extended by almost every industry. Medicine in general and radiation oncology in particular have been slow to adopt modern quality techniques. This work contains a brief description of the history of research on quality that led to the development of organization-wide quality programs such as Six Sigma. The aim is to discuss the current approach to quality in radiation oncology as well as where quality should be in the future. A strategy is suggested with the goal to provide a threshold improvement in quality over the next 10 years.
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Affiliation(s)
- Todd Pawlicki
- Department of Radiation Oncology, University of California, San Diego, La Jolla, California 92093, USA.
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Affiliation(s)
- Mark Best
- Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA.
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