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Huang WJ, Zhang MW, Li BY, Wang XH, Zhang CH, Yu JG. 5S management improves the service quality in the outpatient-emergency pharmacy: from management process optimisation to staff capacity enhancement. Eur J Hosp Pharm 2024; 31:259-266. [PMID: 36424124 DOI: 10.1136/ejhpharm-2022-003449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE As a high-efficiency demanding department in a hospital, the outpatient pharmacy has a great need for quality improvement to provide superior medical service for patients. Little is known about the application of 5S management in a hospital pharmacy department. The aim of this study was to evaluate the impacts of 5S management on pharmaceutical service quality and staff capacity in the outpatient-emergency pharmacy. METHODS We carried out a 5S project in the outpatient-emergency pharmacy at a local hospital that involved processes including waste elimination, workplace standardisation, and optimisation of workflow and staff quality, and then evaluated the effects of the project. RESULTS The equipment and items in the outpatient-emergency pharmacy were sorted. All the drugs were categorised and put in order. The redesigned workspace and standardised workflow during the project improved the accuracy and efficiency of drug dispensing. The satisfaction rate of patients regarding the pharmaceutical service quality in the outpatient-emergency pharmacy was elevated, as well as the satisfaction rate of pharmacists about their work experiences. The optimisation of objective conditions also stimulated a positive working attitude and professional ability promotion of pharmacists in the outpatient-emergency pharmacy. CONCLUSIONS In this study, the 5S management method has proven useful for quality and efficiency improvement in the outpatient-emergency pharmacy, and could be generalised to other departments in a hospital, which provides further evidence of the advantages of the Lean tool in healthcare system management.
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Affiliation(s)
- Wen-Jing Huang
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Meng-Wan Zhang
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Bei-Yi Li
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Xiao-Hui Wang
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Chu-Han Zhang
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Jian-Guang Yu
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
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Saraswathula A, Merck SJ, Bai G, Weston CM, Skinner EA, Taylor A, Kachalia A, Demski R, Wu AW, Berry SA. The Volume and Cost of Quality Metric Reporting. JAMA 2023; 329:1840-1847. [PMID: 37278813 PMCID: PMC10245189 DOI: 10.1001/jama.2023.7271] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/14/2023] [Indexed: 06/07/2023]
Abstract
Importance US hospitals report data on many health care quality metrics to government and independent health care rating organizations, but the annual cost to acute care hospitals of measuring and reporting quality metric data, independent of resources spent on quality interventions, is not well known. Objective To evaluate externally reported inpatient quality metrics for adult patients and estimate the cost of data collection and reporting, independent of quality-improvement efforts. Design, Setting, and Participants Retrospective time-driven activity-based costing study at the Johns Hopkins Hospital (Baltimore, Maryland) with hospital personnel involved in quality metric reporting processes interviewed between January 1, 2019, and June 30, 2019, about quality reporting activities in the 2018 calendar year. Main Outcomes and Measures Outcomes included the number of metrics, annual person-hours per metric type, and annual personnel cost per metric type. Results A total of 162 unique metrics were identified, of which 96 (59.3%) were claims-based, 107 (66.0%) were outcome metrics, and 101 (62.3%) were related to patient safety. Preparing and reporting data for these metrics required an estimated 108 478 person-hours, with an estimated personnel cost of $5 038 218.28 (2022 USD) plus an additional $602 730.66 in vendor fees. Claims-based (96 metrics; $37 553.58 per metric per year) and chart-abstracted (26 metrics; $33 871.30 per metric per year) metrics used the most resources per metric, while electronic metrics consumed far less (4 metrics; $1901.58 per metric per year). Conclusions and Relevance Significant resources are expended exclusively for quality reporting, and some methods of quality assessment are far more expensive than others. Claims-based metrics were unexpectedly found to be the most resource intensive of all metric types. Policy makers should consider reducing the number of metrics and shifting to electronic metrics, when possible, to optimize resources spent in the overall pursuit of higher quality.
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Affiliation(s)
- Anirudh Saraswathula
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland
| | - Samantha J. Merck
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ge Bai
- Carey Business School, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Allen Kachalia
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Albert W. Wu
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephen A. Berry
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ryan AM, Shashikumar SA, Chopra Z, Joynt Maddox KE, Buxbaum JD. Reconciliation Payments in the Bundled Payments for Care Improvement Advanced Program and Reductions in Clinical Spending Needed for CMS to Avoid Financial Losses. JAMA 2023; 329:1221-1223. [PMID: 37039798 PMCID: PMC10091160 DOI: 10.1001/jama.2023.1435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/30/2023] [Indexed: 04/12/2023]
Abstract
This study examines the magnitude of reconciliation payments and clinical spending reductions necessary for the Centers for Medicare & Medicaid Services to break even in the first 4 performance periods of the BPCI-A (Bundled Payments for Care Improvement Advanced) program.
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Affiliation(s)
- Andrew M. Ryan
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | | | - Zoey Chopra
- Department of Economics, University of Michigan, Ann Arbor
| | - Karen E. Joynt Maddox
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Jason D. Buxbaum
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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4
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Eldridge N. Improvements in Adverse Event Rates Among Hospitalized Patients. JAMA 2023; 329:343. [PMID: 36692568 DOI: 10.1001/jama.2022.21465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abstract
This Viewpoint discusses 3 areas in need of progress regarding societal approaches to pandemics and other health threats: a renaissance in public health; robustness of primary health care; and resilience of individuals and communities, with higher levels of trust in government and society.
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Shashikumar SA, Gulseren B, Berlin NL, Hollingsworth JM, Joynt Maddox KE, Ryan AM. Association of Hospital Participation in Bundled Payments for Care Improvement Advanced With Medicare Spending and Hospital Incentive Payments. JAMA 2022; 328:1616-1623. [PMID: 36282256 PMCID: PMC9597389 DOI: 10.1001/jama.2022.18529] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022]
Abstract
Importance Bundled Payments for Care Improvement Advanced (BPCI-A) is a Centers for Medicare & Medicaid Services (CMS) initiative that aims to produce financial savings by incentivizing decreases in clinical spending. Incentives consist of financial bonuses from CMS to hospitals or penalties paid by hospitals to CMS. Objective To investigate the association of hospital participation in BPCI-A with spending, and to characterize hospitals receiving financial bonuses vs penalties. Design, Setting, and Participants Difference-in-differences and cross-sectional analyses of 4 754 139 patient episodes using 2013-2019 US Medicare claims at 694 participating and 2852 nonparticipating hospitals merged with hospital and market characteristics. Exposures BPCI-A model years 1 and 2 (October 1, 2018, through December 31, 2019). Main Outcomes and Measures Hospitals' per-episode spending, CMS gross and net spending, and the incentive allocated to each hospital. Results The study identified 694 participating hospitals. The analysis observed a -$175 change in mean per-episode spending (95% CI, -$378 to $28) and an aggregate spending change of -$75.1 million (95% CI, -$162.1 million to $12.0 million) across the 428 670 episodes in BPCI-A model years 1 and 2. However, CMS disbursed $354.3 million (95% CI, $212.0 million to $496.0 million) more in bonuses than it received in penalties. Hospital participation in BPCI-A was associated with a net loss to CMS of $279.2 million (95% CI, $135.0 million to $423.0 million). Hospitals in the lowest quartile of Medicaid days received a mean penalty of $0.41 million; (95% CI, $0.09 million to $0.72 million), while those in the highest quartile received a mean bonus of $1.57 million; (95% CI, $1.09 million to $2.08 million). Similar patterns were observed for hospitals across increasing quartiles of Disproportionate Share Hospital percentage and of patients from racial and ethnic minority groups. Conclusions and Relevance Among US hospitals measured between 2013 and 2019, participation in BPCI-A was significantly associated with an increase in net CMS spending. Bonuses accrued disproportionately to hospitals providing care for marginalized communities.
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Affiliation(s)
- Sukruth A Shashikumar
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Baris Gulseren
- School of Public Health, University of Michigan, Ann Arbor
- Center for Evaluating Health Reform, University of Michigan, Ann Arbor
| | - Nicholas L Berlin
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor
| | | | - Karen E Joynt Maddox
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
- Center for Health Economics and Policy, Institute for Public Health, Washington University in St Louis, St Louis, Missouri
- Associate Editor, JAMA
| | - Andrew M Ryan
- School of Public Health, Brown University, Providence, Rhode Island
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Abstract
This Viewpoint discusses the potential benefits and harms of prior authorization in Medicare Advantage and the health policy implications and opportunities for improvement.
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Affiliation(s)
- Kelly E Anderson
- Anschutz Medical Campus, University of Colorado, Aurora
- Hopkins Business of Health Initiative, Johns Hopkins University, Baltimore, Maryland
| | - Michael Darden
- Carey Business School, Johns Hopkins University, Baltimore, Maryland
- National Bureau of Economic Research, Cambridge, Massachusetts
| | - Amit Jain
- Hopkins Business of Health Initiative, Johns Hopkins University, Baltimore, Maryland
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Ruder K. Physicians and EMS Who Responded to Mass Shootings Develop Consensus Recommendations for Improving Care. JAMA 2022; 328:1166-1167. [PMID: 36166032 DOI: 10.1001/jama.2022.13671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This Medical News article discusses new guidance for health care system responses to mass shooting incidents.
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Gottlieb ER, Mendu M. Clinical Decision Support to Prevent Acute Kidney Injury After Cardiac Catheterization: Moving Beyond Process to Improving Clinical Outcomes. JAMA 2022; 328:831-832. [PMID: 36066539 DOI: 10.1001/jama.2022.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Eric R Gottlieb
- Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge
| | - Mallika Mendu
- Harvard Medical School, Boston, Massachusetts
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Office of the Chief Medical Officer, Brigham and Women's Hospital, Boston, Massachusetts
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Leonard MB, Grimm PC. Improving Quality of Care and Outcomes for Pediatric Patients With End-stage Kidney Disease: The Importance of Pediatric Nephrology Expertise. JAMA 2022; 328:427-429. [PMID: 35916864 DOI: 10.1001/jama.2022.11603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mary B Leonard
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Paul C Grimm
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Affiliation(s)
- William V Padula
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
| | - Peter J Pronovost
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Wilson E, Gannon H, Chimhini G, Fitzgerald F, Khan N, Lorencatto F, Kesler E, Nkhoma D, Chiyaka T, Haghparast-Bidgoli H, Lakhanpaul M, Cortina Borja M, Stevenson AG, Crehan C, Sassoon Y, Hull-Bailey T, Curtis K, Chiume M, Chimhuya S, Heys M. Protocol for an intervention development and pilot implementation evaluation study of an e-health solution to improve newborn care quality and survival in two low-resource settings, Malawi and Zimbabwe: Neotree. BMJ Open 2022; 12:e056605. [PMID: 35790332 PMCID: PMC9258512 DOI: 10.1136/bmjopen-2021-056605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Every year 2.4 million deaths occur worldwide in babies younger than 28 days. Approximately 70% of these deaths occur in low-resource settings because of failure to implement evidence-based interventions. Digital health technologies may offer an implementation solution. Since 2014, we have worked in Bangladesh, Malawi, Zimbabwe and the UK to develop and pilot Neotree: an android app with accompanying data visualisation, linkage and export. Its low-cost hardware and state-of-the-art software are used to improve bedside postnatal care and to provide insights into population health trends, to impact wider policy and practice. METHODS AND ANALYSIS This is a mixed methods (1) intervention codevelopment and optimisation and (2) pilot implementation evaluation (including economic evaluation) study. Neotree will be implemented in two hospitals in Zimbabwe, and one in Malawi. Over the 2-year study period clinical and demographic newborn data will be collected via Neotree, in addition to behavioural science informed qualitative and quantitative implementation evaluation and measures of cost, newborn care quality and usability. Neotree clinical decision support algorithms will be optimised according to best available evidence and clinical validation studies. ETHICS AND DISSEMINATION This is a Wellcome Trust funded project (215742_Z_19_Z). Research ethics approvals have been obtained: Malawi College of Medicine Research and Ethics Committee (P.01/20/2909; P.02/19/2613); UCL (17123/001, 6681/001, 5019/004); Medical Research Council Zimbabwe (MRCZ/A/2570), BRTI and JREC institutional review boards (AP155/2020; JREC/327/19), Sally Mugabe Hospital Ethics Committee (071119/64; 250418/48). Results will be disseminated via academic publications and public and policy engagement activities. In this study, the care for an estimated 15 000 babies across three sites will be impacted. TRIAL REGISTRATION NUMBER NCT0512707; Pre-results.
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Affiliation(s)
- Emma Wilson
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Hannah Gannon
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Gwendoline Chimhini
- Unit of Child and Adolescent Health, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Felicity Fitzgerald
- Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, London, UK
| | - Nushrat Khan
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Erin Kesler
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Deliwe Nkhoma
- Parent and Child Health Initiative Trust, Lilongwe, Central Region, Malawi
| | - Tarisai Chiyaka
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Monica Lakhanpaul
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Mario Cortina Borja
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Caroline Crehan
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Tim Hull-Bailey
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Msandeni Chiume
- Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Simbarashe Chimhuya
- Unit of Child and Adolescent Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Michelle Heys
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
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McDonough JE, Adashi EY. The Center for Medicare and Medicaid Innovation-Toward Value-Based Care. JAMA 2022; 327:1957-1958. [PMID: 35532947 DOI: 10.1001/jama.2022.6927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- John E McDonough
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Eli Y Adashi
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Oprea AD, Keshock MC, O'Glasser AY, Cummings KC, Edwards AF, Hunderfund AL, Urman RD, Mauck KF. Preoperative Management of Medications for Neurologic Diseases: Society for Perioperative Assessment and Quality Improvement Consensus Statement. Mayo Clin Proc 2022; 97:375-396. [PMID: 35120701 DOI: 10.1016/j.mayocp.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 10/14/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
Neurologic diseases are prevalent in patients undergoing invasive procedures; yet, no societal guidelines exist as to best practice in management of perioperative medications prescribed to treat these disorders. The Society for Perioperative Assessment and Quality Improvement tasked experts in internal medicine, anesthesiology, perioperative medicine, and neurology to provide evidence-based recommendations for preoperative management of these medications. The aim of this review is not only to provide consensus recommendations for preoperative management of patients on medications for neurologic disorders, but also to serve as an educational guide to perioperative clinicians. While, in general, medications for neurologic disorders should be continued preoperatively, an individualized approach may be needed in certain situations (eg, holding anticonvulsants on day of surgery if electroencephalographic mapping is planned during epilepsy surgery). Pertinent interactions with commonly used drugs in anesthesia practice, as well as considerations for targeted laboratory testing or perioperative drug substitutions, are addressed as well.
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Affiliation(s)
- Adriana D Oprea
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT.
| | - Maureen C Keshock
- Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Avital Y O'Glasser
- Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR
| | | | - Angela F Edwards
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | | | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Karen F Mauck
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
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15
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Oprea AD, Keshock MC, O'Glasser AY, Cummings KC, Edwards AF, Zimbrean PC, Urman RD, Mauck KF. Preoperative Management of Medications for Psychiatric Diseases: Society for Perioperative Assessment and Quality Improvement Consensus Statement. Mayo Clin Proc 2022; 97:397-416. [PMID: 35120702 DOI: 10.1016/j.mayocp.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/15/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
There is a lack of guidelines for preoperative management of psychiatric medications leading to variation in care and the potential for perioperative complications and surgical procedure cancellations on the day of surgery. The Society for Perioperative Assessment and Quality Improvement identified preoperative psychiatric medication management as an area in which consensus could improve patient care. The aim of this consensus statement is to provide recommendations to clinicians regarding preoperative psychiatric medication management. Several categories of drugs were identified including antidepressants, mood stabilizers, anxiolytics, antipsychotics, and attention deficit hyperactivity disorder medications. Literature searches and review of primary and secondary data sources were performed for each medication/medication class. We used a modified Delphi process to develop consensus recommendations for preoperative management of individual medications in each of these drug categories. While most medications should be continued perioperatively to avoid risk of relapse of the psychiatric condition, adjustments may need to be made on a case-by-case basis for certain drugs.
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Affiliation(s)
- Adriana D Oprea
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT.
| | - Maureen C Keshock
- Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Avital Y O'Glasser
- Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR
| | | | - Angela F Edwards
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Paula C Zimbrean
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Karen F Mauck
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
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Scarpis E, Brunelli L, Tricarico P, Poletto M, Panzera A, Londero C, Castriotta L, Brusaferro S. How to assure the quality of clinical records? A 7-year experience in a large academic hospital. PLoS One 2021; 16:e0261018. [PMID: 34882705 PMCID: PMC8659650 DOI: 10.1371/journal.pone.0261018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Clinical record (CR) is the primary tool used by healthcare workers (HCWs) to record clinical information and its completeness can help achieve safer practices. CR is the most appropriate source in order to measure and evaluate the quality of care. In order to achieve a safety climate is fundamental to involve a responsive healthcare workforce thorough peer-review and feedbacks. This study aims to develop a peer-review tool for clinical records quality assurance, presenting the seven-year experience in the evolution of it; secondary aims are to describe the CR completeness and HCWs' diligence toward recording information in it. METHODS To assess the completeness of CRs a peer-review tool was developed in a large Academic Hospital of Northern Italy. This tool included measurable items that examined different themes, moments and levels of the clinical process. Data were collected every three months between 2010 and 2016 by appointed and trained HCWs from 42 Units; the hospital Quality Unit was responsible for of processing and validating them. Variations in the proportion of CR completeness were assessed using Cochran-Armitage test for trends. RESULTS A total of 9,408 CRs were evaluated. Overall CR completeness improved significantly from 79.6% in 2010 to 86.5% in 2016 (p<0.001). Doctors' attitude showed a trend similar to the overall completeness, while nurses improved more consistently (p<0.001). Most items exploring themes, moments and levels registered a significant improvement in the early years, then flattened in last years. Results of the validation process were always above the cut-off of 75%. CONCLUSIONS This peer-review tool enabled the Quality Unit and hospital leadership to obtain a reliable picture of CRs completeness, while involving the HCWs in the quality evaluation. The completeness of CR showed an overall positive and significant trend during these seven years.
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Affiliation(s)
- Enrico Scarpis
- Department of Medicine, University of Udine, Udine, Italy
| | - Laura Brunelli
- Department of Medicine, University of Udine, Udine, Italy
| | | | - Marco Poletto
- Department of Medicine, University of Udine, Udine, Italy
| | - Angela Panzera
- Health District of Udine, Friuli Centrale Healthcare and University Integrated Trust, ASUFC, Udine, Italy
| | - Carla Londero
- Accreditation, Clinical Risk Management and Performance Assessment Unit, Friuli Centrale Healthcare and University Integrated Trust, ASUFC, Udine, Italy
| | - Luigi Castriotta
- Hygiene and Clinical Epidemiology Institute, Friuli Centrale Healthcare and University Integrated Trust, ASUFC, Udine, Italy
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Pfeifer KJ, Selzer A, Whinney CM, Rogers B, Naik AS, Regan D, Mendez CE, Urman RD, Mauck K. Preoperative Management of Gastrointestinal and Pulmonary Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement. Mayo Clin Proc 2021; 96:3158-3177. [PMID: 34736777 DOI: 10.1016/j.mayocp.2021.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/17/2021] [Accepted: 08/20/2021] [Indexed: 01/20/2023]
Abstract
Perioperative medication management is integral to preoperative optimization but remains challenging because of a paucity of literature guidance. Published recommendations are based on the expert opinion of a small number of authors without collaboration from multiple specialties. The Society for Perioperative Assessment and Quality Improvement (SPAQI) recognized the need for consensus recommendations in this area as well as the unique opportunity for its multidisciplinary membership to fill this void. In a series of articles within this journal, SPAQI provides preoperative medication management guidance based on available literature and expert multidisciplinary consensus. The aim of this consensus statement is to provide practical guidance on the preoperative management of gastrointestinal and pulmonary medications. A panel of experts with anesthesiology, perioperative medicine, hospital medicine, general internal medicine, and medical specialty experience was drawn together and identified the common medications in each of these categories. The authors then used a modified Delphi approach to review the literature and to generate consensus recommendations.
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Affiliation(s)
- Kurt J Pfeifer
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
| | - Angela Selzer
- Department of Anesthesiology, University of Colorado, Boulder, CO
| | - Christopher M Whinney
- Department of Hospital Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Barbara Rogers
- Department of Anesthesiology, The Ohio State Wexner Medical Center, Columbus, OH
| | - Amar S Naik
- Division of Gastroenterology, Loyola University Medical Center, Chicago, IL
| | - Dennis Regan
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Carlos E Mendez
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Karen Mauck
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
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18
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Kaplan LC, Ichsan I, Diba F, Marthoenis M, Muhsin M, Samadi S, Richert K, Susanti SS, Sofyan H, Vollmer S. Effects of the World Health Organization Safe Childbirth Checklist on Quality of Care and Birth Outcomes in Aceh, Indonesia: A Cluster-Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2137168. [PMID: 34860241 PMCID: PMC8642783 DOI: 10.1001/jamanetworkopen.2021.37168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/01/2021] [Indexed: 11/14/2022] Open
Abstract
Importance To address major causes of perinatal and maternal mortality, the World Health Organization developed the Safe Childbirth Checklist (SCC), which to our knowledge has been rigorously evaluated only in combination with high-intensity coaching. Objective To evaluate the effect of the SCC with medium-intensity coaching on health care workers' performance of essential birth practices. Design, Setting, and Participants This cluster randomized clinical trial without blinding included 32 hospitals and community health centers in the province of Aceh, Indonesia (a medium-resource setting) that met the criterion of providing at least basic emergency obstetric and newborn care. Baseline data were collected from August to October 2016, and outcomes were measured from March to April 2017. Data were analyzed from January 2020 to October 2021. Interventions After applying an optimization method, facilities were randomly assigned to the treatment or control group (16 facilities each). The SCC with 11 coaching visits was implemented during a 6-month period. Main Outcomes and Measures For the primary outcome, clinical observers documented whether 36 essential birth practices were applied at treatment and control facilities at 1 or more of 4 pause points during the birthing process (admission to the hospital, just before pushing or cesarean delivery, soon after birth, and before hospital discharge). Probability models for binary outcome measures were estimated using ordinary least-squares regressions, complemented by Firth logit and complier average causal effect estimations. Results Among the 32 facilities that participated in the trial, a significant increase of up to 41 percentage points was observed in the application of 5 of 36 essential birth practices in the 16 treatment facilities compared with the 16 control facilities, including communication of danger signs at admission (treatment: 136 of 155 births [88%]; control: 79 of 107 births [74%]), measurement of neonatal temperature (treatment: 9 of 31 births [29%]; control: 1 of 20 births [5%]), newborn feeding checks (treatment: 22 of 34 births [65%]; control: 5 of 21 births [24%]), and the rate of communication of danger signs to mothers and birth companions verbally (treatment: 30 of 36 births [83%]; control: 14 of 22 births [64%]) and in a written format (treatment: 3 of 24 births [13%]; control: 0 of 16 births [0%]). Conclusions and Relevance In this cluster randomized clinical trial, health facilities that implemented the SCC with medium-intensity coaching had an increased rate of application for 5 of 36 essential birth practices compared with the control facilities. Medium-intensity coaching may not be sufficient to increase uptake of the SCC to a satisfying extent, but it may be worthwhile to assess a redesigned coaching approach prompting long-term behavioral change and, therefore, effectiveness. Trial Registration isrctn.org Identifier: ISRCTN11041580.
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Affiliation(s)
- Lennart Christian Kaplan
- Department of Economics, University of Göttingen, Göttingen, Germany
- German Development Institute, Bonn, Germany
| | | | - Farah Diba
- Syiah Kuala University, Banda Aceh, Indonesia
| | | | | | | | | | | | | | - Sebastian Vollmer
- Department of Economics, University of Göttingen, Göttingen, Germany
- Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
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19
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Trout LJ, Weisman A, Miller JS, Kramer C, Keshavjee S, Kleinman AM, Kulkarni S, Baldwin T, Tobey ML, Buffey T, Harris NS. Siamit: A Novel Academic-Tribal Health Partnership in Northwest Alaska. Acad Med 2021; 96:1560-1563. [PMID: 34261866 DOI: 10.1097/acm.0000000000004239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PROBLEM American Indians and Alaska Natives hold a state-conferred right to health, yet significant health and health care disparities persist. Academic medical centers are resource-rich institutions committed to public service, yet few are engaged in responsive, equitable, and lasting tribal health partnerships to address these challenges. APPROACH Maniilaq Association, a rural and remote tribal health organization in Northwest Alaska, partnered with Massachusetts General Hospital and Harvard Medical School to address health care needs through physician staffing, training, and quality improvement initiatives. This partnership, called Siamit, falls under tribal governance, focuses on supporting community health leaders, addresses challenges shaped by extreme geographic remoteness, and advances the mission of academic medicine in the context of tribal health priorities. OUTCOMES Throughout the 2019-2020 academic year, Siamit augmented local physician staffing, mentored health professions trainees, provided continuing medical education courses, implemented quality improvement initiatives, and provided clinical care and operational support during the COVID-19 pandemic. Siamit began with a small budget and limited human resources, demonstrating that relatively small investments in academic-tribal health partnerships can support meaningful and positive outcomes. NEXT STEPS During the 2020-2021 academic year, the authors plan to expand Siamit's efforts with a broader social medicine curriculum, additional attending staff, more frequent trainee rotations, an increasingly robust mentorship network for Indigenous health professions trainees, and further study of the impact of these efforts. Such partnerships may be replicable in other settings and represent a significant opportunity to advance community health priorities, strengthen tribal health systems, support the next generation of Indigenous health leaders, and carry out the academic medicine mission of teaching, research, and service.
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Affiliation(s)
- Lucas J Trout
- L.J. Trout is managing partner, Siamit, Sayaqagvik director, Maniilaq Social Medicine, and lecturer on global health and social medicine, Harvard Medical School, Kotzebue, Alaska; ORCID: https://orcid.org/0000-0002-5074-6092
| | - Ashley Weisman
- A. Weisman is emergency medicine faculty, Siamit, and assistant professor of emergency medicine, Department of Surgery, University of Vermont Medical Center, Burlington, Vermont
| | - James S Miller
- J.S. Miller is internal medicine faculty, Siamit, and a fellow in global medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Corina Kramer
- C. Kramer is social medicine faculty and community director, Della Keats Fellowship in Indigenous Health Equity, Siamit, and lead Qargi facilitator, Maniilaq Social Medicine, Kotzebue, Alaska
| | - Salmaan Keshavjee
- S. Keshavjee is faculty advisor, Siamit, director, Harvard Medical School Center for Global Health Delivery, and professor of global health and social medicine, Harvard Medical School, Boston, Massachusetts
| | - Arthur M Kleinman
- A.M. Kleinman is faculty advisor, Siamit, Esther and Sidney Rabb Professor of Anthropology, Harvard University, professor of medical anthropology in global health and social medicine, and professor of psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Suchitra Kulkarni
- S. Kulkarni is senior program coordinator, Siamit and Harvard Medical School Center for Global Health Delivery, Boston, Massachusetts
| | - Teressa Baldwin
- T. Baldwin is Sayaqagvik youth counselor, Maniilaq Social Medicine, and a Della Keats Fellow in Indigenous Health Equity, Siamit, Kotzebue, Alaska
| | - Matthew L Tobey
- M.L. Tobey is rural medicine faculty, Siamit, and rural health leadership fellowship director, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Timothy Buffey
- T. Buffey is medical director, Department of Medicine, Maniilaq Health Services, Kotzebue, Alaska
| | - N Stuart Harris
- N.S. Harris is emergency medicine faculty, Siamit, associate professor of emergency medicine, Harvard Medical School, and chief, Division of Wilderness Medicine, Massachusetts General Hospital, Boston, Massachusetts
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20
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Carr MJ, Badiee J, Benham DA, Diaz JA, Calvo RY, Sise CB, Sise MJ, Bansal V, Martin MJ. Fragmentation of care in the blunt abdominal trauma patient: Capturing our true outcomes and impact on care. J Trauma Acute Care Surg 2021; 91:829-833. [PMID: 34695059 DOI: 10.1097/ta.0000000000003217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma care is associated with unplanned readmissions, which may occur at facilities other than the index treatment facility. This "fragmentation of care" may be associated with adverse outcomes. We evaluated a statewide database that includes readmissions to analyze the incidence and impact of FC. METHODS The California Office of Statewide Health Planning and Development patient discharge data set was evaluated for calendar years 2016 to 2018. Patients 15 years or older diagnosed with blunt abdominal solid organ injury during the index admission were identified. Readmissions were evaluated postdischarge at 1, 3, and 6 months. Patients readmitted within 6 months to a facility other than the index admission facility (fragmented care [FC]) were compared with those readmitted to their index admission facility (non-FC). Logistic regression modeling was used to evaluate risk of FC. RESULTS Of the total 1,580 patients, there were 752 FC (47.6%) and 828 (52.4%) non-FC. Readmissions representing FC at months 1, 3, and 6 were 40.3%, 49.3%, and 53.4%, respectively. At index admission, the groups were demographically and clinically similar, with similar rates of abdominal operations and complications. Non-FC patients had a higher rate of abdominal reoperation at readmission (5.8% non-FC vs. 2.9% FC, p = 0.006). In an adjusted model, multiple readmissions (odds ratio [OR] 1.11, p = 0.014), readmission >30 days after index facility discharge (OR, 1.98; p < 0.001), and discharge to a nonmedical facility (OR, 2.46; p < 0.0001) were associated with increased odds of FC. Operative intervention at index admission was associated with lower odds of FC (OR, 0.77; p = 0.039). However, FC was not independently associated with demographic or insurance characteristics. CONCLUSION The rate of FC among patients with blunt abdominal injury is high. The risk of FC is mitigated when patients are managed operatively during the index admission. Trauma systems should implement measures to ensure that these patients are followed postdischarge. LEVEL OF EVIDENCE Prognostic and epidemiological, level III; Care management, level IV.
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Affiliation(s)
- Matthew J Carr
- From the Trauma Service, Scripps Mercy Hospital, San Diego, California
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21
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Affiliation(s)
- R Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- James J. Peters VA Medical Center, Bronx, New York
| | - Diane E Meier
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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22
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Wongyikul P, Thongyot N, Tantrakoolcharoen P, Seephueng P, Khumrin P. High alert drugs screening using gradient boosting classifier. Sci Rep 2021; 11:20132. [PMID: 34635694 PMCID: PMC8505501 DOI: 10.1038/s41598-021-99505-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
Prescription errors in high alert drugs (HAD), a group of drugs that have a high risk of complications and potential negative consequences, are a major and serious problem in medicine. Standardized hospital interventions, protocols, or guidelines were implemented to reduce the errors but were not found to be highly effective. Machine learning driven clinical decision support systems (CDSS) show a potential solution to address this problem. We developed a HAD screening protocol with a machine learning model using Gradient Boosting Classifier and screening parameters to identify the events of HAD prescription errors from the drug prescriptions of out and inpatients at Maharaj Nakhon Chiang Mai hospital in 2018. The machine learning algorithm was able to screen drug prescription events with a risk of HAD inappropriate use and identify over 98% of actual HAD mismatches in the test set and 99% in the evaluation set. This study demonstrates that machine learning plays an important role and has potential benefit to screen and reduce errors in HAD prescriptions.
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Affiliation(s)
- Pakpoom Wongyikul
- Department of Family Medicine, Faculty of Medicine, Biomedical Informatics Center, Chiang Mai University, Chiang Mai, Thailand
| | - Nuttamon Thongyot
- Department of Family Medicine, Faculty of Medicine, Biomedical Informatics Center, Chiang Mai University, Chiang Mai, Thailand
| | - Pannika Tantrakoolcharoen
- Department of Family Medicine, Faculty of Medicine, Biomedical Informatics Center, Chiang Mai University, Chiang Mai, Thailand
| | - Pusit Seephueng
- Department of Family Medicine, Faculty of Medicine, Biomedical Informatics Center, Chiang Mai University, Chiang Mai, Thailand
| | - Piyapong Khumrin
- Department of Family Medicine, Faculty of Medicine, Biomedical Informatics Center, Chiang Mai University, Chiang Mai, Thailand.
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23
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Taher J, Randell EW, Arnoldo S, Bailey D, De Guire V, Kaur S, Knauer M, Petryayeva E, Poutanen SM, Shaw JLV, Uddayasankar U, White-Al Habeeb N, Konforte D. Canadian Society of Clinical Chemists (CSCC) consensus guidance for testing, selection and quality management of SARS-CoV-2 point-of-care tests. Clin Biochem 2021; 95:1-12. [PMID: 34048776 PMCID: PMC8144094 DOI: 10.1016/j.clinbiochem.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/02/2021] [Accepted: 05/22/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES A consensus guidance is provided for testing, utility and verification of SARS-CoV-2 point-of-care test (POCT) performance and implementation of a quality management program, focusing on nucleic acid and antigen targeted technologies. DESIGN AND METHODS The recommendations are based on current literature and expert opinion from the members of Canadian Society of Clinical Chemists (CSCC), and are intended for use inside or outside of healthcare settings that have varied levels of expertise and experience with POCT. RESULTS AND CONCLUSIONS Here we discuss sampling requirements, biosafety, SARS-CoV-2 point-of-care testing methodologies (with focus on Health Canada approved tests), test performance and limitations, test selection, testing utility, development and implementation of quality management systems, quality improvement, and medical and scientific oversight.
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Affiliation(s)
- Jennifer Taher
- Pathology and Laboratory Medicine, Sinai Health System, Toronto, Canada; University of Toronto, Laboratory Medicine and Pathobiology, Toronto, Canada
| | - Edward W Randell
- Department of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, Newfoundland, Canada
| | - Saranya Arnoldo
- University of Toronto, Laboratory Medicine and Pathobiology, Toronto, Canada; William Osler Health System, Brampton, Canada
| | | | - Vincent De Guire
- Clinical Biochemistry, Maisonneuve-Rosemont Hospital, Optilab-CHUM Laboratory Network, Montreal, Canada; Biochemistry, Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montreal, Canada
| | - Sukhbir Kaur
- Fraser Health Authority, Vancouver, Canada; Pathology and Laboratory Medicine, University of British Columbia, Canada
| | - Michael Knauer
- Pathology and Laboratory Medicine, London Health Sciences Center, London, Canada; Pathology and Laboratory Medicine, University of Western Ontario, London, Canada
| | - Eleonora Petryayeva
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Susan M Poutanen
- University of Toronto, Laboratory Medicine and Pathobiology, Toronto, Canada; University of Toronto, Medicine, Toronto, Canada; University Health Network/Sinai Health Department of Microbiology, Toronto, Canada
| | - Julie L V Shaw
- Eastern Ontario Regional Laboratory Association, Canada; Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
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24
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Nelson G, Wang X, Nelson A, Faris P, Lagendyk L, Wasylak T, Bathe OF, Bigam D, Bruce E, Buie WD, Chong M, Fairey A, Hyndman ME, MacLean A, McCall M, Pin S, Wang H, Gramlich L. Evaluation of the Implementation of Multiple Enhanced Recovery After Surgery Pathways Across a Provincial Health Care System in Alberta, Canada. JAMA Netw Open 2021; 4:e2119769. [PMID: 34357394 PMCID: PMC8346943 DOI: 10.1001/jamanetworkopen.2021.19769] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Engaging multidisciplinary care teams in surgical practice is important for the improvement of surgical outcomes. OBJECTIVE To evaluate the association of multiple Enhanced Recovery After Surgery (ERAS) pathways with ERAS guideline adherence and outcomes. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study compared a pre-ERAS cohort (2013-2017) with a post-ERAS cohort (2014-2018). All patients were from Alberta Health Services in Alberta, Canada, and had available ERAS and up to 1-year postsurgery administrative data. Data collected included age, sex, body mass index, tobacco and alcohol use, diabetes, comorbidity index, and surgical characteristics. Data analysis was performed from May 7, 2020, to February 1, 2021. INTERVENTIONS Implementation of 5 ERAS pathways (colorectal, liver, pancreas, gynecologic oncology, and radical cystectomy) across 9 sites. MAIN OUTCOMES AND MEASURES Adherence to ERAS guidelines was measured by the percentage of patients whose care met the common ERAS pathway care element criteria. Surgical procedures were grouped by complexity; complications were classified by severity. Outcome measures for the pre-post-ERAS cohorts included length of stay (LOS), readmission, complications, and mortality. RESULTS A total of 7757 patients participated in the study, including 984 in the pre-ERAS cohort (median [interquartile range] age, 62 [53-71] years; 526 [53.5%] female) and 6773 in the post-ERAS cohort (median [interquartile range] age, 62 [53-71] years; 3470 [51.2%] male). In the total cohort, care-element adherence improved from 52% to 76% (P < .001), no significant differences were found in serious complications (from 6.2% to 4.9%; P = .08) or 30-day mortality (from 0.71% to 0.93%; P = .50), 1-year mortality decreased from 7.1% to 4.6% (P < .001), mean (SD) LOS decreased from 9.4 (7.0) to 7.8 (5.0) days (P < .001), and 30-day readmission rates were unchanged (from 13.4% to 11.7%; P = .12). After adjustment for patient characteristics, the LOS mean difference decreased 0.71 days (95% CI, -1.13 to -0.29 days; P < .001), with no significant differences in adjusted 30-day readmission (-3.5%; 95% CI, -22.7% to 20.4%; P = .75), serious complications (1.3%; 95% CI, -26.2% to 39.0%; P = .94), or mortality (30-day mortality: 42% [95% CI, -35.4% to 212.3%]; P = .38; 1-year mortality: 8% [95% CI, -20.5% to 46.8%]; P = .62). The adjusted 1-year readmission rate was -15.6% (95% CI, -27.7% to -1.5%; P = .03) in favor of ERAS, and readmission LOS was shorter by 1.7 days (95% CI, -3.3 to -0.1 days; P = .04). CONCLUSIONS AND RELEVANCE The results of this quality improvement study suggest that implementation of ERAS across multiple pathways may improve health care practitioner adherence to ERAS guidelines, LOS, and readmission rates at a system level.
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Affiliation(s)
- Gregg Nelson
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Xiaoming Wang
- Analytics, Data Integration, Measurement, and Reporting, Alberta Health Services, Calgary, Alberta, Canada
| | - Alison Nelson
- Surgery Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter Faris
- Analytics, Data Integration, Measurement, and Reporting, Alberta Health Services, Calgary, Alberta, Canada
| | | | - Tracy Wasylak
- Strategic Clinical Networks, Alberta Health Services, Calgary, Alberta, Canada
| | - Oliver F. Bathe
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - David Bigam
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Erin Bruce
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta, Canada
| | - W. Donald Buie
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Michael Chong
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adrian Fairey
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - M. Eric Hyndman
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Anthony MacLean
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Michael McCall
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sophia Pin
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Haili Wang
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Abstract
BACKGROUND There is growing interest in paying for performance (P4P) as a means to align the incentives of healthcare providers with public health goals. Rigorous evidence on the effectiveness of these strategies in improving health care and health in low- and middle-income countries (LMICs) is lacking; this is an update of the 2012 review on this topic. OBJECTIVES To assess the effects of paying for performance on the provision of health care and health outcomes in low- and middle-income countries. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and 10 other databases between April and June 2018. We also searched two trial registries, websites, online resources of international agencies, organizations and universities, and contacted experts in the field. Studies identified from rerunning searches in 2020 are under 'Studies awaiting classification.' SELECTION CRITERIA We included randomized or non-randomized trials, controlled before-after studies, or interrupted time series studies conducted in LMICs (as defined by the World Bank in 2018). P4P refers to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. To be included, a study had to report at least one of the following outcomes: patient health outcomes, changes in targeted measures of provider performance (such as the delivery of healthcare services), unintended effects, or changes in resource use. DATA COLLECTION AND ANALYSIS We extracted data as per original review protocol and narratively synthesised findings. We used standard methodological procedures expected by Cochrane. Given diversity and variability in intervention types, patient populations, analyses and outcome reporting, we deemed meta-analysis inappropriate. We noted the range of effects associated with P4P against each outcome of interest. Based on intervention descriptions provided in documents, we classified design schemes and explored variation in effect by scheme design. MAIN RESULTS We included 59 studies: controlled before-after studies (19), non-randomized (16) or cluster randomized trials (14); and interrupted time-series studies (9). One study included both an interrupted time series and a controlled before-after study. Studies focused on a wide range of P4P interventions, including target payments and payment for outputs as modified by quality (or quality and equity assessments). Only one study assessed results-based aid. Many schemes were funded by national governments (23 studies) with the World Bank funding most externally funded schemes (11 studies). Targeted services varied; however, most interventions focused on reproductive, maternal and child health indicators. Participants were predominantly located in public or in a mix of public, non-governmental and faith-based facilities (54 studies). P4P was assessed predominantly at health facility level, though districts and other levels were also involved. Most studies assessed the effects of P4P against a status quo control (49 studies); however, some studies assessed effects against comparator interventions (predominantly enhanced financing intended to match P4P funds (17 studies)). Four studies reported intervention effects against both comparator and status quo. Controlled before-after studies were at higher risk of bias than other study designs. However, some randomised trials were also downgraded due to risk of bias. The interrupted time-series studies provided insufficient information on other concurrent changes in the study context. P4P compared to a status quo control For health services that are specifically targeted, P4P may slightly improve health outcomes (low certainty evidence), but few studies assessed this. P4P may also improve service quality overall (low certainty evidence); and probably increases the availability of health workers, medicines and well-functioning infrastructure and equipment (moderate certainty evidence). P4P may have mixed effects on the delivery and use of services (low certainty evidence) and may have few or no distorting unintended effects on outcomes that were not targeted (low-certainty evidence), but few studies assessed these. For secondary outcomes, P4P may make little or no difference to provider absenteeism, motivation or satisfaction (low certainty evidence); but may improve patient satisfaction and acceptability (low certainty evidence); and may positively affect facility managerial autonomy (low certainty evidence). P4P probably makes little to no difference to management quality or facility governance (low certainty evidence). Impacts on equity were mixed (low certainty evidence). For health services that are untargeted, P4P probably improves some health outcomes (moderate certainty evidence); may improve the delivery, use and quality of some health services but may make little or no difference to others (low certainty evidence); and may have few or no distorting unintended effects (low certainty evidence). The effects of P4P on the availability of medicines and other resources are uncertain (very low certainty evidence). P4P compared to other strategies For health outcomes and services that are specifically targeted, P4P may make little or no difference to health outcomes (low certainty evidence), but few studies assessed this. P4P may improve service quality (low certainty evidence); and may have mixed effects on the delivery and use of health services and on the availability of equipment and medicines (low certainty evidence). For health outcomes and services that are untargeted, P4P may make little or no difference to health outcomes and to the delivery and use of health services (low certainty evidence). The effects of P4P on service quality, resource availability and unintended effects are uncertain (very low certainty evidence). Findings of subgroup analyses Results-based aid, and schemes using payment per output adjusted for service quality, appeared to yield the greatest positive effects on outcomes. However, only one study evaluated results-based aid, so the effects may be spurious. Overall, schemes adjusting both for quality of service and rewarding equitable delivery of services appeared to perform best in relation to service utilization outcomes. AUTHORS' CONCLUSIONS The evidence base on the impacts of P4P schemes has grown considerably, with study quality gradually increasing. P4P schemes may have mixed effects on outcomes of interest, and there is high heterogeneity in the types of schemes implemented and evaluations conducted. P4P is not a uniform intervention, but rather a range of approaches. Its effects depend on the interaction of several variables, including the design of the intervention (e.g., who receives payments ), the amount of additional funding, ancillary components (such as technical support) and contextual factors (including organizational context).
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Affiliation(s)
- Karin Diaconu
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Jennifer Falconer
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Adrian Verbel
- Research Group for Evidence Based Public Health, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Atle Fretheim
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Fischer CP, Hu QL, Wescott AB, Maggard-Gibbons M, Hoyt DB, Ko CY. Evidence Review for the American College of Surgeons Quality Verification Part II: Processes for Reliable Quality Improvement. J Am Coll Surg 2021; 233:294-311.e1. [PMID: 33940183 DOI: 10.1016/j.jamcollsurg.2021.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 12/21/2022]
Abstract
After decades of experience supporting surgical quality and safety by the American College of Surgeons, the American College of Surgeons Quality Verification Program was developed to help hospitals improve surgical quality, safety, and reliability. This review is the second of a 3-part review aiming to synthesize the evidence supporting the main principles of the American College of Surgeons Quality Verification Program. Evidence was systematically reviewed for 5 principles: case review, peer review, credentialing and privileging, data for surveillance, and continuous quality improvement using data. MEDLINE was searched for articles published from inception to January 2019 and 2 reviewers independently screened studies for inclusion in a hierarchical fashion, extracted data, and summarized results in a narrative fashion. A total of 9,098 studies across the 5 principles were identified. After exclusion criteria, a total of 184 studies in systematic reviews and primary studies were included for assessment. The identified literature supports the importance of standardized processes and systems to identify problems and improve quality of care.
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Affiliation(s)
- Chelsea P Fischer
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago; Department of Surgery, Loyola University Medical Center, Maywood, IL.
| | - Q Lina Hu
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Annie B Wescott
- Galter Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - David B Hoyt
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago
| | - Clifford Y Ko
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; THIS Institute, University of Cambridge, UK
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Garcia RA, Spertus JA. Using Patient-Reported Outcomes toAssess Healthcare Quality: Toward Better Measurement of Patient-Centered Care in Cardiovascular Disease. Methodist Debakey Cardiovasc J 2021; 17:e1-e9. [PMID: 34104328 PMCID: PMC8158443 DOI: 10.14797/vuwd7697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Patient-reported outcomes (PROs) are elicited directly from patients so they can describe their overall health status, including their symptoms, function, and quality of life. While commonly used as end points in clinical trials, PROs can play an important role in routine clinical care, population health management, and as a means for quantifying the quality of patient care. In this review, we propose that PROs be used to improve patient-centered care in the treatment of cardiovascular diseases given their importance to patients and society and their ability to improve doctor- provider communication. Furthermore, given the current variability in patients' health status across different clinics and the fact that PROs can be improved by titrating therapy, we contend that PROs have a key opportunity to serve as measures of healthcare quality.
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Affiliation(s)
- Raul Angel Garcia
- Saint Luke’s Mid America Heart Institute, University of Missouri Kansas City,Kansas City, Missouri
| | - John A Spertus
- Saint Luke’s Mid America Heart Institute, University of Missouri Kansas City,Kansas City, Missouri
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Abstract
OBJECTIVES The aim of this study was to explore if, and in what ways, there has been changes in the supervisory approach toward Norwegian hospitals due to the implementation of a new management and quality improvement regulation (Regulation on Management and Quality Improvement in the Healthcare Services, hereinafter referred to as "Quality Improvement Regulation"). Moreover, we aimed to understand how inspectors' work promotes or hampers resilience potentials of adaptive capacity and learning in hospitals. METHODS The study design is a case study of implementation and impact of the Quality Improvement Regulation. We performed a document analysis, and conducted and analyzed 3 focus groups and 2 individual interviews with regulatory inspectors, recruited from 3 county governor offices who are responsible for implementation and supervision of the Quality Improvement Regulation in Norwegian regions. RESULTS Data analysis resulted in 5 themes. Informants described no substantial change in their approach owing to the Quality Improvement Regulation. Regardless, data pointed to a development in their practices and expectations. Although the Norwegian Board of Health Supervision, at the national level, occasionally provides guidance, supervision is adapted to specific contexts and inspectors balance trade-offs. Informants expressed concern about the impact of supervision on hospital performance. Benefits and disadvantage with positive feedback from inspectors were debated. Inspectors could nurture learning by improving their follow-up and add more hospital self-assessment. CONCLUSIONS A nondetailed regulatory framework such as the Quality Improvement Regulation provides hospitals with room to maneuver, and self-assessment might reduce resource demands. The impact of supervision is scarce with an unfulfilled potential to learn from supervision. The Government could contribute to a shift in focus by instructing the county governors to actively reflect on and communicate positive experiences from, and smart adaptations in, hospital practice.
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Affiliation(s)
- Sina Furnes Øyri
- From the Faculty of Health Sciences, SHARE—Centre for Resilience in Healthcare, University of Stavanger
| | - Geir Sverre Braut
- From the Faculty of Health Sciences, SHARE—Centre for Resilience in Healthcare, University of Stavanger
- Stavanger University Hospital, Stavanger, Norway
| | - Carl Macrae
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, United Kingdom
| | - Siri Wiig
- From the Faculty of Health Sciences, SHARE—Centre for Resilience in Healthcare, University of Stavanger
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Grover P, Volshteyn O, Carr DB. Physical Medicine and Rehabilitation Residency Quality Improvement and Research Curriculum: Design and Implementation. Am J Phys Med Rehabil 2021; 100:S23-S29. [PMID: 32740055 DOI: 10.1097/phm.0000000000001550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Physical medicine and rehabilitation residency programs do not demonstrate a uniform level of training and mentorship for resident scholarly activities related in part to variable utilization of standardized curricula. The aim of this study was to design, develop, implement, and evaluate a structured Quality Improvement and Research Curriculum for a physical medicine and rehabilitation residency program in academic year 2015 using standardized methodology. A combination of five-phase project-lifecycle and six-step medical-curriculum development methodologies was used to integrate existing resources into five institutional domains: (1) Patient Safety and Quality Improvement Program; (2) Research Mentorship Program; (3) Rehab in Review; (4) Publication and Presentation Resources, and (5) Research and QI Lecture Series. Dedicated resident-faculty teams were created for individual domains and for the overall curriculum. Written materials developed included scope documents, reporting forms, and tracking tables. A dedicated webpage on the department website served as an accessible resource. A bimonthly Updates newsletter highlighted ongoing resident achievements. Program and resident outcome metrics were evaluated at the mid and end of academic year 2015. Excellent resident and good faculty participation in the curriculum was observed. Resident publication and presentation productivity improved. Time was the biggest barrier to success. Key factors for success included phased implementation, dedicated teams, scope clarity, accessible resources, personnel support, resident champions, and faculty mentorship.
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Affiliation(s)
- Prateek Grover
- From the Division of Neurorehabilitation, Washington University School of Medicine, St. Louis, Missouri (PG, OV); The Rehabilitation Institute of St Louis, St Louis, Missouri (PG); and Washington University School of Medicine, St. Louis, Missouri (DBC)
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DiSciullo B, Calfin D, Hickerson KA, Kubis SE, Patton AM, Simpson CJ, Figueroa-Altmann A. Strategies for Success in Regulatory Readiness. J Nurs Adm 2021; 51:6-8. [PMID: 33278194 DOI: 10.1097/nna.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article describes the formation of a Regulatory Advisory Council to address regulatory preparedness. The council used quality improvement methods to address data and findings from previous mock surveys and created 2 categories of work, an environment of care and clinical standards group, with checklists and work streams to improve organizational success with regulatory readiness.
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Affiliation(s)
- Brigid DiSciullo
- Author Affiliations: Safety Quality Specialist Officer (Ms DiSciullo); Manager, Cardiac Preparation and Recovery Unit (Ms Calfin); Vice President and Associate Chief Nursing Officer (Dr Hickerson); Director, Cardiac Care (Ms Kubis); Manager, Operating Room (Mss Patton and Simpson); and Director of Nursing Safety, Regulatory and Performance (Dr Figueroa-Altmann), Nursing and Clinical Care Service, Children's Hospital of Philadelphia, Pennsylvania
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Stifter J, Sermersheim E, Ellsworth M, Dowding E, Day E, Silvestri K, Margwarth J, Korkmaz K, Walkowiak N, Boudreau L, Hernandez L, Harbert B, Ambutas S, Abraham A, Shaw P. COVID-19 and Nurse-Sensitive Indicators: Using Performance Improvement Teams to Address Quality Indicators During a Pandemic. J Nurs Care Qual 2021; 36:1-6. [PMID: 33079815 DOI: 10.1097/ncq.0000000000000523] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nurse-sensitive quality indicators have historically been used as a metric of nursing care quality in health care organizations. PROBLEM At our academic medical center, critically ill COVID-19 patients led to a dramatic change in the organizational standard of care resulting in an increase in nurse-sensitive health care-associated infections. APPROACH Nursing performance improvement teams provided the structure for development of innovative strategies implemented in real time by our frontline clinicians to address the quality and safety issues found with these elevated health care-associated infections. OUTCOMES A new COVID-19 CLABSI (central line-associated bloodstream infection) Tip Sheet and a Prone Positioning Kit for HAPI Prevention are strategies developed to address quality of care issues experienced with the COVID-19 patients. CONCLUSIONS Deployment of these innovative practice strategies has led to a decline in health care-associated infections and instituted a new care standard for the COVID-19 patients.
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Affiliation(s)
- Janet Stifter
- Perioperative and Interventional Services and Professional Nursing Practice (Dr Stifter), Professional Nursing Practice (Dr Sermersheim and Mss Ellsworth and Silvestri), Hematology/Oncology/Stem Cell Transplant, Department of Medicine (Ms Dowding), Department of Medicine (Ms Day), Departments of Adult General Surgery and Medicine (Ms Margwarth), Patient Care Services (Mr Korkmaz and Dr Abraham), Wound/Ostomy Continence Service (Mss Walkowiak, Boudreau, and Hernandez), Rehabilitation Services (Mr Harbert and Dr Ambutas), and Guest Relations (Mr Shaw), Rush University Medical Center, Chicago, Illinois
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Esteves SC, Conforti A, Sunkara SK, Carbone L, Picarelli S, Vaiarelli A, Cimadomo D, Rienzi L, Ubaldi FM, Zullo F, Andersen CY, Orvieto R, Humaidan P, Alviggi C. Improving Reporting of Clinical Studies Using the POSEIDON Criteria: POSORT Guidelines. Front Endocrinol (Lausanne) 2021; 12:587051. [PMID: 33815269 PMCID: PMC8017440 DOI: 10.3389/fendo.2021.587051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/19/2021] [Indexed: 12/19/2022] Open
Abstract
The POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) criteria were developed to help clinicians identify and classify low-prognosis patients undergoing assisted reproductive technology (ART) and provide guidance for possible therapeutic strategies to overcome infertility. Since its introduction, the number of published studies using the POSEIDON criteria has increased steadily. However, a critical analysis of existing evidence indicates inconsistent and incomplete reporting of critical outcomes. Therefore, we developed guidelines to help researchers improve the quality of reporting in studies applying the POSEIDON criteria. We also discuss the advantages of using the POSEIDON criteria in ART clinical studies and elaborate on possible study designs and critical endpoints. Our ultimate goal is to advance the knowledge concerning the clinical use of the POSEIDON criteria to patients, clinicians, and the infertility community.
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Affiliation(s)
- Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
- Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
- *Correspondence: Sandro C. Esteves, ; orcid.org/0000-0002-1313-9680
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | - Sesh K. Sunkara
- Department of Women’s Health, Faculty of Life Sciences, King’s College London, London, United Kingdom
| | - Luigi Carbone
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | - Silvia Picarelli
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | | | | | - Laura Rienzi
- Center for Reproductive Medicine, GENERA, Rome, Italy
| | | | - Fulvio Zullo
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Faculty of Health and Medical Sciences, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Peter Humaidan
- Faculty of Health, Aarhus University, Aarhus, Denmark
- Fertility Clinic Skive, Skive Regional Hospital, Skive, Denmark
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
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Chen A, Wolpaw BJ, Vande Vusse LK, Wu C, Meo N, Staub MB, Hicks KG, Carr SA, Schleyer AM, Harrington RD, Klein JW. Creating a Framework to Integrate Residency Program and Medical Center Approaches to Quality Improvement and Patient Safety Training. Acad Med 2021; 96:75-82. [PMID: 32909995 DOI: 10.1097/acm.0000000000003725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Quality improvement and patient safety (QIPS) are core components of graduate medical education (GME). Training programs and affiliated medical centers must partner to create an environment in which trainees can learn while meaningfully contributing to QIPS efforts, to further the shared goal of improving patient care. Numerous challenges have been identified in the literature, including lack of resources, lack of faculty expertise, and siloed QIPS programs. In this article, the authors describe a framework for integrated QIPS training for residents in the University of Washington Internal Medicine Residency Program, beginning in 2014 with the creation of a dedicated QIPS chief resident position and assistant program director for health systems position, the building of a formal curriculum, and integration with medical center QIPS efforts. The postgraduate year (PGY) 1 curriculum focused on the culture of patient safety and entering traditional patient safety event (PSE) reports. The PGY-2 curriculum highlighted QIPS methodology and how to conduct mentored PSE reviews of cases that were of educational value to trainees and a clinical priority to the medical center. Additional PGY-2/PGY-3 training focused on the active report, presentation, and evaluation of cases during morbidity and mortality conferences while on clinical services, as well as how to lead longitudinal QIPS work. Select residents led mentored QI projects as part of an additional elective. The hallmark feature of this framework was the depth of integration with medical center priorities, which maximized educational and operational value. Evaluation of the program demonstrated improved attitudes, knowledge, and behavior changes in trainees, and significant contributions to medical center QIPS work. This specialty-agnostic framework allowed for training program and medical center integration, as well as horizontal integration across GME specialties, and can be a model for other institutions.
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Affiliation(s)
- Anders Chen
- A. Chen was assistant program director, Health Systems and Quality Improvement, Internal Medicine Residency Program, University of Washington School of Medicine, Seattle, Washington, at the time this work was completed. He is curriculum and pathway director, Health Systems and Quality Improvement, Internal Medicine Residency Program, and assistant professor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Benjamin J Wolpaw
- B.J. Wolpaw was chief resident for quality and safety, Harborview Medical Center, Seattle, Washington, at the time this work was completed. He is clinical instructor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Lisa K Vande Vusse
- L.K. Vande Vusse is associate program director, Research and Scholarship, Internal Medicine Residency Program, and assistant professor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Chenwei Wu
- C. Wu was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. He is director, Office of Transformation in the Quality, Safety and Values service line, Puget Sound VA Medical Center, and clinical instructor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Nicholas Meo
- N. Meo was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. He is associate director of Graduate Medical Education Quality and Safety and clinical instructor, University of Washington School of Medicine, Seattle, Washington
| | - Milner B Staub
- M.B. Staub was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. She is VA quality scholar, VA Tennessee Valley Healthcare System, and clinical instructor, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine G Hicks
- K.G. Hicks was chief resident for quality and safety, Harborview Medical Center, Seattle, Washington, at the time this work was completed. She is acting instructor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Stephanie A Carr
- S.A. Carr was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. She is staff physician, Family Care Network, Bellingham, Washington
| | - Anneliese M Schleyer
- A.M. Schleyer is associate medical director, Hospital Quality and Safety, Harborview Medical Center, and associate professor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Robert D Harrington
- R.D. Harrington is chief of medicine, Harborview Medical Center, and vice chair, Department of Medicine and professor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Jared W Klein
- J.W. Klein is internal medicine representative, Medical Quality Improvement Committee, Harborview Medical Center, and assistant professor of medicine, University of Washington School of Medicine, Seattle, Washington
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Masood MQ, Singh K, Kondal D, Ali MK, Mawani M, Devarajan R, Menon U, Varthakavi P, Viswanathan V, Dharmalingam M, Bantwal G, Sahay R, Khadgawat R, Desai A, Prabhakaran D, Narayan KMV, Tandon N. Factors affecting achievement of glycemic targets among type 2 diabetes patients in South Asia: Analysis of the CARRS trial. Diabetes Res Clin Pract 2021; 171:108555. [PMID: 33242515 PMCID: PMC7854496 DOI: 10.1016/j.diabres.2020.108555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/12/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the predictors of achieving and maintaining guideline-recommended glycemic control in people with poorly controlled type 2 diabetes. METHODS We analyzed data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) Trial (n = 1146), to identify groups that achieved guideline-recommended glycemic control (HbA1c < 7%) and those that remained persistently poorly controlled (HbA1c > 9%) over a median of 28 months of follow-up. We used generalized estimation equations (GEE) analysis for each outcome i.e. achieving guideline-recommended control and persistently poorly controlled and constructed four regression models (demographics, disease-related, self-care, and other risk factors) separately to identify predictors of HbA1c < 7% and HbA1c > 9% at the end of the trial, adjusting for trial group assignment and site. RESULTS In the final multivariate model, adherence to prescribed medications (RR: 1.46, 95%CI: 1.09, 1.95), adherence to diet plans (RR: 1.79, 95% CI: 1.43, 2.23) and middle-aged: 50-64 years (RR: 1.32; 95% CI: 1.02-1.71) were associated with achieving guideline-recommended control (HbA1c < 7%). Presence of microvascular complications (RR: 0.70; 95%CI: 0.53-0.92) reduced the probability of achieving guideline-recommended glycemic control (HbA1c 7%). Further, longer duration of diabetes (>15 years), RR: 1.41; 95% CI: 1.15, 1.72, hyperlipidemia, RR: 1.19; 95% CI: 1.06, 1.34 and younger age group (35-49 years vs. >64 years: RR: 0.61; 95% CI: 0.47-0.79) were associated with persistently poor glycemic control (HbA1c > 9%). CONCLUSION To achieve and maintain guideline-recommended glycemic control, care delivery models must put additional emphasis and effort on patients with longer disease duration, younger people and those having microvascular complications and hyperlipidemia.
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Affiliation(s)
- Muhammad Q Masood
- Aga Khan University, Department of Medicine, Section of Endocrinology and Diabetes, Stadium Road, Karachi 74800, Pakistan.
| | - Kavita Singh
- Public Health Foundation of India, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon 122 002, Haryana, India.
| | - Dimple Kondal
- Public Health Foundation of India, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon 122 002, Haryana, India.
| | - Mohammed K Ali
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Rm CNR 701, Atlanta, GA 30322, USA.
| | - Minaz Mawani
- Aga Khan University, Department of Medicine, Section of Endocrinology and Diabetes, Stadium Road, Karachi 74800, Pakistan.
| | - Raji Devarajan
- Center of Excellence - Center for CArdio-metabolic Risk Reduction in South Asia, Public Health Foundation of India, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon 122 002, Haryana, USA.
| | - Usha Menon
- Amrita Institute of Medical Sciences, Department of Endocrinology & Diabetes, AIMS Ponekkara P.O., Kochi 682 041, Kerala, India.
| | - Premlata Varthakavi
- TNM College & BYL Nair Charity Hospital, Department of Endocrinology, Dr. A. L. Nair Road, Mumbai Central, Mumbai 400 008, Maharashtra, India.
| | - Vijay Viswanathan
- MV Hospital for Diabetes & Diabetes Research Centre, No 4, West Madha Church Street, Royapuram, Chennai 600 013, Tamil Nadu, India.
| | - Mala Dharmalingam
- Bangalore Endocrinology & Diabetes Research Centre, #35, 5th Cross, Malleswaram Circle, Bangalore 560 003, Karantaka, India.
| | - Ganapathi Bantwal
- St. John's Medical College & Hospital, Department of Endocrinology, Sarjapur Road, Koramangala, Bangalore 560 034, Karantaka, India.
| | - Rakesh Sahay
- Osmania General Hospital, Department of Endocrinology, 2nd Floor, Golden Jubilee Block, Afzalgunj, Hyderabad 500 012, Telangana, India.
| | - Rajesh Khadgawat
- All India Institute of Medical Sciences, Department of Endocrinology & Metabolism, Biotechnology Block, 3rd Floor, Ansari Nagar, New Delhi 110 029, India.
| | - Ankush Desai
- Goa Medical College, Endocrine Unit, Department of Medicine, Bambolim, Goa 403202, India.
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon 122 002, Haryana, India.
| | - K M Venkat Narayan
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Rm CNR 7049, Atlanta, GA 30322, USA.
| | - Nikhil Tandon
- All India Institute of Medical Sciences, Department of Endocrinology & Metabolism, Biotechnology Block, 3rd Floor, Rm #312, Ansari Nagar, New Delhi 110 029, India.
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Abstract
To address the global mental health crisis exacerbated by the COVID-19 pandemic, an urgent need has emerged to transform the accessibility, efficiency, and quality of mental health care. The next suite of efforts to transform mental health care must foster the implementation of "learning organizations," that is, organizations that continuously improve patient-centered care through ongoing data collection. The concept of learning organizations is highly regarded, but the key features of such organizations, particularly those providing mental health care, are less well defined. Using telepsychiatry care as an example, the authors of this Open Forum concretely describe the key building blocks for operationalizing a learning organization in mental health care to set a research agenda for services transformation.
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Affiliation(s)
- Rinad Beidas
- Departments of Psychiatry, Medical Ethics & Health Policy, Medicine, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3015, Philadelphia, PA 19104
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Shannon Wiltsey Stirman
- National Center for PTSD, Menlo Park, CA
- Department of Psychiatry and Biobehavioral Sciences, Stanford University, Stanford, CA
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Anderson R, Rosenberg A, Garg S, Nahass J, Nenos A, Egorova N, Rowland J, Mari J, LoPachin V. Establishing the Foundation to Support Health System Quality Improvement: Using a Hand Hygiene Initiative to Define the Process. J Patient Saf 2021; 17:23-29. [PMID: 30844890 PMCID: PMC7781088 DOI: 10.1097/pts.0000000000000578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES As hospitals are increasingly consolidating into larger health systems, they are becoming better positioned to have far reaching and material impacts on safety and quality of care. When the Mount Sinai Health System (MSHS) was formed in 2013, it sought to ensure the delivery of safe, high-quality care to every patient. In 2014, the MSHS addressed hand hygiene as the first major system-wide process improvement project focused on quality and safety. The goals of this study were to evaluate a system-wide hand hygiene program and to create a foundation for future process improvement projects. METHODS The MSHS implemented the Joint Commission's Targeted Solutions Tool as a way to improve hand hygiene compliance and reduce harm from hospital-acquired infections, specifically Clostridium difficile infections. A multifaceted approach was used to improve hand hygiene and promote a culture of patient safety. RESULTS The MSHS improved hand hygiene compliance by approximately 20% from a baseline compliance of 63.3% to an intervention compliance of 82.8% (P < 0.001). Additional correlation analysis revealed a significant correlation between increasing hand hygiene compliance and reduction in C. difficile infections. CONCLUSIONS Through a focus on leadership engagement, data transparency, data and observer management, and system-wide communication of best practices, the MSHS was able to improve hand hygiene compliance, reduce infection rates, and build an effective foundation for future process improvement programs.
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Affiliation(s)
| | | | | | | | | | | | - John Rowland
- Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract
In summarizing the proceedings of a longitudinal meeting of experts in substance use disorders (SUDs) among adolescents and young adults, in this special article, we review principles of care related to SUD treatment of young adults. SUDs are most commonly diagnosed during young adulthood, but most of the evidence guiding the treatment of this population has been obtained from older adult study participants. Extrapolating evidence from older populations, the expert group asserted the following principles for SUD treatment: It is important that clinicians who work with young adults effectively identify and address SUD to avert long-term addiction and its associated adverse health outcomes. Young adults receiving addiction treatment should have access to a broad range of evidence-based assessment, psychosocial and pharmacologic treatments, harm reduction interventions, and recovery services. These evidence-based approaches should be tailored to young adults' needs and provided in the least restrictive environment possible. Young adults should enter care voluntarily; civil commitment to treatment should be a last resort. In many settings, compulsory treatment does not use evidence-based approaches; thus, when treatment is involuntary, it should reflect recognized standards of care. Continuous engagement with young adults, particularly during periods of relapse, should be considered a goal of treatment and can be supported by care that is patient-centered and focused on the young adult's goals. Lastly, substance use treatments for young adults should be held to the same evidence and quality standards as those for other chronic health conditions.
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Affiliation(s)
- Scott E Hadland
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts;
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Amy M Yule
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Departments of Psychiatry and Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Sharon J Levy
- Departments of Psychiatry and Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
- Adolescent Substance Use and Addiction Program and Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; and
| | - Eliza Hallett
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Michael Silverstein
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Sarah M Bagley
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
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Iannello J, Levitt MP, Poetter D, Bromberg D, James L, Cruz M, Jean-Baptiste M, Henry M, Parissis EI, King ED, Antwi C, Johnson D, Skjerve P, Kothari AJ, Schweighardt C, Reynolds E, Wood K, Reiss A. Improving Inpatient Tobacco Treatment Measures: Outcomes Through Standardized Treatment, Care Coordination, and Electronic Health Record Optimization. J Healthc Qual 2021; 43:48-58. [PMID: 33394840 DOI: 10.1097/jhq.0000000000000251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Centers for Disease Control and Prevention states that tobacco use is the largest and most preventable cause of disease and mortality in the United States. The Joint Commission implemented inpatient tobacco treatment measures (TTMs) in 2012 to encourage healthcare systems to create processes that help patients quit tobacco use through evidence-based care. METHODS A tobacco cessation care delivery system was implemented at James A. Haley Veterans' Hospital and Clinics, which included: standardized pathways within the Veterans Health Administration (VHA) electronic health record system to improve nicotine replacement therapy ordering; evidence-based tobacco cessation counseling; and improved care coordination for tobacco cessation treatment through the use of technological innovation. RESULTS Outcomes were obtained from the VHA quality metric reporting system known as Strategic Analytics for Improvement and Learning (SAIL). TOB-2 and TOB-3 (two Joint Commission inpatient TTMs) equivalent to tob20 and tob40 within SAIL improved by greater than 300% after implementation at James A. Haley Veterans' Hospital and Clinics. CONCLUSION Implementation of a tobacco cessation care system at James A. Haley Veterans' Hospital and Clinics enhanced interdisciplinary coordination of tobacco cessation care and resulted in improvements of The Joint Commission inpatient TTMs by greater than threefold.
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Shamash J, Ansell W, Alifrangis C, Thomas B, Wilson P, Stoneham S, Mazhar D, Warren A, Barrett T, Alexander S, Rudman S, Lockley M, Berney D, Sahdev A. The impact of a supranetwork multidisciplinary team (SMDT) on decision-making in testicular cancers: a 10-year overview of the Anglian Germ Cell Cancer Collaborative Group (AGCCCG). Br J Cancer 2021; 124:368-374. [PMID: 32989229 PMCID: PMC7853071 DOI: 10.1038/s41416-020-01075-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 07/25/2020] [Accepted: 08/17/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The germ cell supranetwork multidisciplinary team (SMDT) for the Anglian Network covers a population of 7.5 million. METHODS We reviewed 10 years of SMDT discussion and categorised them into five domains ((1) overall outcome, (2) chemotherapy regimens-untreated disease and salvage therapy, (3) radiology, (4) pathology and (5) complex cases) to assess the impact of the SMDT. RESULTS A total of 2892 new cases were reviewed. In the first 5 years, patients with good prognosis disease had poorer survival in low-volume vs high-volume centres (87.8 vs 95.3, p = 0.02), but the difference was no longer significant in the last 5 years (93.3 vs 95.1, p = 0.30). Radiology review of 3206 scans led to rejection of the diagnosis of progression in 26 cases and a further 10 cases were down-staged. There were 790 pathology reviews by two specialised uropathologists, which lead to changes in 75 cases. 18F-fluorodeoxyglucose (18FDG) PET-CT was undertaken during this time period but did not help to predict who would have viable cancer. A total of 26 patients with significant mental health issues who were unable to give informed consent were discussed. CONCLUSION SMDT working has led to an improvement in outcomes and refining of treatment in patients with germ cell tumours.
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Affiliation(s)
| | | | | | - Benjamin Thomas
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Danish Mazhar
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anne Warren
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tristan Barrett
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Susanna Alexander
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Sarah Rudman
- Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Michelle Lockley
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
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Abstract
OBJECTIVES Hospitals can reduce labor costs by hiring lowest skill possible for the job, stretching clinical hours, and reducing staff not at bedside. However, these labor constraints designed to reduce costs may paradoxically increase costs. Specialty staff, such as board-certified clinicians, can redesign health systems to evaluate the needs of complex patients and prevent complications. The aim of the study was to evaluate whether investing in skilled specialists for supporting hospital quality infrastructure improves value and performance. METHODS We evaluated pressure injury rates as an indicator of performance in a retrospective observational cohort of 55 U.S. academic hospitals from the Vizient clinical database between 2007 and 2012. Pressure injuries were defined by U.S. Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator 3 (PSI-03) for stage 3, 4, and unstageable pressure injuries not present on admission in hospitalized adults. We compared ratios of board-certified wound care nurses per 1000 hospital beds to hospital-acquired pressure injury rates in these hospitals using mixed-effects regression of hospital quarters. RESULTS High-performing hospitals invested in prevention infrastructure with skilled specialists and observed performance improvements. Regression indicated that by adding one board-certified wound care nurse per 1000 hospital beds, hospitals had associated decreases in pressure injury rates by -17.7% relative to previous quarters, controlling for other interruptions. Highest performers supplied fewer skilled specialists and achieve improved outcomes. CONCLUSIONS Skilled specialists bring important value to health systems as a representation of investment in infrastructure, and the proportion of these specialists could be scaled relative to the hospital's patient capacity. Policy should support hospitals to make investments in infrastructure to drive down patient costs and improve quality.
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Affiliation(s)
- William V. Padula
- From the Department of Pharmaceutical and Health Economics, School of Pharmacy
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California
- Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University
| | - Madhuram Nagarajan
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Patricia M. Davidson
- Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University
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Abstract
ABSTRACT Lean has gained recognition in healthcare as a quality improvement tool. The purpose of this research was to examine the extent to which quality improvement projects in healthcare adhered to Lean's eight-step process. We analyzed 605 publications identified through a systematic literature review following PRISMA guidelines. Each publication was coded using a structured coding sheet. The most frequent type of publication reported empirical research (48.6%) and most of these (80.3%) shared the results of the Lean projects. Of the 237 publications reporting Lean projects, more than half (71.3%) used an experimental, one-site, pre/postdesign. The impact of the project was most often measured using a single metric (59.1%) that was operational (e.g., waiting time). Although most Lean project publications reported the use of tools to "break down the problem" (84.4%, Step 2) and "see countermeasures through" (70.0%, Step 6), fewer than half described using tools associated with each of the other steps. Projects completed an average of 2.77 steps and none of the projects completed all steps. Although some may perceive low adherence to the tenets of Lean as a deficiency, it may be that Lean approaches are evolving to better meet the needs of healthcare.
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Horstman MJ, Miltner RS, Wallhagen MI, Patrician PA, Oliver BJ, Roumie CL, Dolansky MA, Perez F, Naik AD, Godwin KM. Developing Leaders and Scholars in Health Care Improvement: The VA Quality Scholars Program Competencies. Acad Med 2021; 96:68-74. [PMID: 32769476 DOI: 10.1097/acm.0000000000003658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite the need for leaders in health care improvement across health professions, there are no standards for the knowledge and skills that should be achieved through advanced interprofessional health care improvement training. Existing health care improvement training competencies focus on foundational knowledge expected of all trainees or for specific career pathways. Health care improvement leaders fill multiple roles within organizations and promote interprofessional improvement practice. The diverse skill set required of modern health care improvement leaders necessitates the development of training competencies specifically for fellowships in applied health care improvement. The authors describe the development of the revised national Veterans Affairs Quality Scholars (VAQS) Program competencies. The VAQS Program is an interprofessional, postdoctoral training program whose mission is to develop leaders and scholars to improve health care. An interprofessional committee of VAQS faculty reviewed and revised the competencies over 4 months beginning in fall 2018. The first draft was developed using 111 competencies submitted by 11 VAQS training sites and a review of published competencies. The final version included 22 competencies spanning 5 domains: interprofessional collaboration and teamwork, improvement and implementation science, organization and system leadership, methodological skills and analytic techniques for improvement and research, and teaching and coaching. Once attained, the VAQS competencies will guide the skill development that interprofessional health care improvement leaders need to participate in and lead health care improvement scholarship and implementation. These broad competencies are relevant to advanced training programs that develop health care improvement leaders and scholars and may be used by employers to understand the knowledge and skills expected of individuals who complete advanced fellowships in applied health care improvement.
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Affiliation(s)
- Molly J Horstman
- M.J. Horstman is assistant professor, Department of Medicine, Section of Health Services Research, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, investigator, Center for Innovations in Quality, Effectiveness, and Safety, and core faculty, VA Quality Scholars Coordinating Center, Houston, Texas
| | - Rebecca S Miltner
- R.S. Miltner is associate professor, University of Alabama at Birmingham School of Nursing, and associate faculty scholar, VA Quality Scholars Fellowship Program, Birmingham VA Medical Center site, Birmingham, Alabama
| | - Margaret I Wallhagen
- M.I. Wallhagen is professor, Department of Physiological Nursing, director, UCSF Hartford Center of Gerontological Nursing Excellence, and senior nurse faculty scholar, VA Quality Scholars Fellowship Program, San Francisco VA Medical Center site, San Francisco, California
| | - Patricia A Patrician
- P.A. Patrician is professor and Rachel Z. Booth Endowed Chair in Nursing, University of Alabama at Birmingham School of Nursing, and senior faculty scholar, VA Quality Scholars Fellowship Program, Birmingham VA Medical Center site, Birmingham, Alabama
| | - Brant J Oliver
- B.J. Oliver is associate professor, Departments of Community and Family Medicine, Psychiatry, and Dartmouth Institute at Dartmouth-Hitchcock Medical Center, and Geisel School of Medicine at Dartmouth, adjunct associate professor, MGH Institute of Health Professions School of Nursing, Hanover, New Hampshire, and faculty senior scholar, VA Quality Scholars Fellowship Program, White River Junction VAMC site, White River Junction, Vermont
| | - Christianne L Roumie
- C.L. Roumie is associate professor of internal medicine and pediatrics, Vanderbilt University Medical Center and VA Tennessee Valley Healthcare System, Geriatrics Research and Education Clinical Center, Nashville, Tennessee
| | - Mary A Dolansky
- M.A. Dolansky is associate professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, associate director, VA Quality Scholars Fellowship Program, senior nurse faculty, Cleveland VA Quality Scholars Fellowship Program site, and director, Quality and Safety Education for Nurses Institute, Cleveland, Ohio
| | - Federico Perez
- F. Perez is associate professor, Department of Medicine, Case Western Reserve University School of Medicine, faculty scholar, VA Quality Scholars Fellowship Program, Cleveland VA Medical Center site, and investigator, VISN-10 Geriatrics Research, Education, and Clinical Center, Cleveland, Ohio
| | - Aanand D Naik
- A.D. Naik is investigator, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, senior advisor for the VA Quality Scholars Coordinating Center, and associate professor, Department of Medicine, Sections of Health Services Research and Geriatrics, Baylor College of Medicine, Houston, Texas
| | - Kyler M Godwin
- K.M. Godwin is assistant professor, Department of Medicine, Section of Health Services Research, Baylor College of Medicine, investigator, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, and director, VA Quality Scholars Coordinating Center, Houston, Texas
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Abstract
Residency training represents a unique period when learners begin to personally experience the patient safety and quality-of-care issues that affect health care systems and increasingly take responsibility to address them. Their integration into the clinical workflow in clinics, wards, and operating rooms positions them perfectly to observe and characterize the underlying processes that contribute to patient safety and health care quality problems. Residents' practices and perspectives are less entrenched than those of their faculty counterparts, which enables them to offer fresh ideas on the quality improvement (QI) process. Their creativity and ingenuity serve as assets when coming up with new and innovative changes to test using rapid change cycles. As such, they are ideally suited to serve as health systems change agents. Training programs and clinical institutions typically see residents as frontline care providers whose primary role is to treat the patient in front of them. Yet, by enabling residents to "treat the system" through QI work, they can take on the role of residents as change agents, which has the potential to have long-lasting effects on patient care on a much wider scale. However, training programs must do more than simply harness residents' enthusiasm and root them on from the sidelines. Instead, they must create an environment that is conducive to successfully implementing changes at the curricular, institutional, and health systems levels.
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Affiliation(s)
- Philip W Lam
- P.W. Lam is assistant professor, Department of Medicine, University of Toronto, and staff physician, Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brian M Wong
- B.M. Wong is associate professor, Department of Medicine, and director, Centre for Quality Improvement and Patient Safety, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Puppala M, Ezeana CF, Alvarado MVY, Goode KN, Danforth RL, Wong SS, Vassallo ML, Wong ST. A multifaceted study of hospital variables and interventions to improve inpatient satisfaction in a multi-hospital system. Medicine (Baltimore) 2020; 99:e23669. [PMID: 33371105 PMCID: PMC7748194 DOI: 10.1097/md.0000000000023669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022] Open
Abstract
Knowing the areas of service, actions, and parameters that can influence patient perception about a service provided can help hospital executives and healthcare workers to devise improvement plans, leading to higher patient satisfaction. To identify inpatient satisfaction determinants, assess their relationships with hospital variables, and improve patient satisfaction through interventions. We studied the inpatient population of an eight-hospital tertiary medical center in 2015. The satisfaction determinants were based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey answers and included clinical and organizational variables. Interventions began at the end of 2016 included bedside care coordination rounds (BCCR), medications best practices alert (BPA), connect transitions post-discharge calls (CONNECT Transitions) and a framework for provider-patient interactions called AIDET (Acknowledge, Introduce, Duration, Explain, and Thank). Substantial impact upon patient satisfaction was observed after the introduction of these interventions. Three groups were identified: 1. high satisfaction, which correlated with race, surgery, and cancer care; 2. low satisfaction, correlated with elderly, emergency room, intensive care unit, chronic obstructive pulmonary disease, and vascular diseases; and 3. neutral, correlated with hospital-acquired complications, several diagnostic procedures, and medical care delay. Significant improvements in the 3 groups were achieved with interventions that optimize care provider interactions with patients and their families. Based on the HCAHPS-based analysis, we implemented new measures and programs for addressing coordination of care, improving patient safety, reducing the length of stay, and ultimately improving patient satisfaction.
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Affiliation(s)
| | | | | | | | | | - Solomon S.Y. Wong
- Department of Systems Medicine and Bioengineering
- Present address: Baylor University School of Law, Waco, TX
| | - Mark L. Vassallo
- Department of Quality Operations, Houston Methodist Hospital, Houston, Texas
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Malik AO, Nallamothu BK, Trumpower B, Kennedy M, Krein SL, Chinnakondepalli KM, Hejjaji V, Chan PS. Association Between Hospital Debriefing Practices With Adherence to Resuscitation Process Measures and Outcomes for In-Hospital Cardiac Arrest. Circ Cardiovasc Qual Outcomes 2020; 13:e006695. [PMID: 33201736 DOI: 10.1161/circoutcomes.120.006695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Identifying actionable resuscitation practices that vary across hospitals could improve adherence to process measures or outcomes after in-hospital cardiac arrest (IHCA). We sought to examine whether hospital debriefing frequency after IHCA varies across hospitals and whether hospitals which routinely perform debriefing have higher rates of process-of-care compliance or survival. Methods We conducted a nationwide survey of hospital resuscitation practices in April of 2018, which were then linked to data from the Get With The Guidelines-Resuscitation national registry for IHCA. Hospitals were categorized according to their reported frequency of debriefing immediately after IHCA; rarely (0%-20% of all IHCA cases), occasionally (21%-80%), and frequently (81%-100%). Hospital-level rates of timely defibrillation (≤2 minutes), epinephrine administration (≤5 minutes), survival to discharge, return of spontaneous circulation, and neurologically intact survival were comparted for patients with IHCA from 2015 to 2017. Results Overall, there were 193 hospitals comprising 44 477 IHCA events. Mean patient age was 65±16, 41% were females, and 68% were of White race. Across hospitals, 84 (43.5%) rarely performed debriefings immediately after an IHCA, 82 (42.5%) performed debriefing sessions occasionally, and 27 (14.0%) performed debriefing frequently. There was no association between higher reported debriefing frequency and hospital rates of timely defibrillation and epinephrine administration. Mean hospital rates of risk-standardized survival to discharge were similar across debriefing frequency groups (rarely 25.6%; occasionally 26.0%; frequently 25.2%, P=0.72), as were hospital rates of risk-adjusted return of spontaneous circulation (rarely 72.2%; occasionally 73.0%; frequently 70.0%, P=0.06) and neurologically intact survival (rarely 21.9%, occasionally 22.2%, frequently 21.1%, P=0.75). Conclusions In a large contemporary nationwide quality improvement registry, hospitals varied widely in how often they conducted debriefings immediately after IHCA. However, hospital debriefing frequency was not associated with better adherence to timely delivery of epinephrine or defibrillation or higher rates of IHCA survival.
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Affiliation(s)
- Ali O Malik
- University of Missouri Kansas City (A.O.M., M.K., V.H., P.S.C.)
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., K.M.C., V.H., P.S.C.)
| | | | - Brad Trumpower
- University of Missouri Kansas City (A.O.M., M.K., V.H., P.S.C.)
- University of Michigan, Ann Arbor (B.K.N., B.T., S.L.K.)
| | | | - Sarah L Krein
- University of Michigan, Ann Arbor (B.K.N., B.T., S.L.K.)
- VA Ann Arbor Healthcare System, MI (S.L.K.)
| | | | - Vittal Hejjaji
- University of Missouri Kansas City (A.O.M., M.K., V.H., P.S.C.)
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., K.M.C., V.H., P.S.C.)
| | - Paul S Chan
- University of Missouri Kansas City (A.O.M., M.K., V.H., P.S.C.)
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., K.M.C., V.H., P.S.C.)
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De Bie AJR, Mestrom E, Compagner W, Nan S, van Genugten L, Dellimore K, Eerden J, van Leeuwen S, van de Pol H, Schuling F, Lu X, Bindels AJGH, Bouwman ARA, Korsten EHHM. Intelligent checklists improve checklist compliance in the intensive care unit: a prospective before-and-after mixed-method study. Br J Anaesth 2020; 126:404-414. [PMID: 33213832 DOI: 10.1016/j.bja.2020.09.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We examined whether a context and process-sensitive 'intelligent' checklist increases compliance with best practice compared with a paper checklist during intensive care ward rounds. METHODS We conducted a single-centre prospective before-and-after mixed-method trial in a 35 bed medical and surgical ICU. Daily ICU ward rounds were observed during two periods of 8 weeks. We compared paper checklists (control) with a dynamic (digital) clinical checklist (DCC, intervention). The primary outcome was compliance with best clinical practice, measured as the percentages of checked items and unchecked critical items. Secondary outcomes included ICU stay and the usability of digital checklists. Data are presented as median (interquartile range). RESULTS Clinical characteristics and severity of critical illness were similar during both control and intervention periods of study. A total of 36 clinicians visited 197 patients during 352 ward rounds using the paper checklist, compared with 211 patients during 366 ward rounds using the DCC. Per ICU round, a median of 100% of items (94.4-100.0) were completed by DCC, compared with 75.1% (66.7-86.4) by paper checklist (P=0.03). No critical items remained unchecked by the DCC, compared with 15.4% (8.3-27.3) by the paper checklist (P=0.01). The DCC was associated with reduced ICU stay (1 day [1-3]), compared with the paper checklist (2 days [1-4]; P=0.05). Usability of the DCC was judged by clinicians to require further improvement. CONCLUSIONS A digital checklist improved compliance with best clinical practice, compared with a paper checklist, during ward rounds on a mixed ICU. CLINICAL TRIAL REGISTRATION NCT03599856.
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Affiliation(s)
- Ashley J R De Bie
- Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Eveline Mestrom
- Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Wilma Compagner
- Healthcare Intelligence, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Shan Nan
- Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; College of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
| | - Lenneke van Genugten
- Department of Brain, Behaviour and Cognition, Philips Research, Eindhoven, The Netherlands
| | - Kiran Dellimore
- Department of Patient Care and Measurements, Philips Research, Eindhoven, The Netherlands
| | - Jacco Eerden
- Department of Philips Design, Eindhoven, The Netherlands
| | | | - Harald van de Pol
- Healthcare Intelligence, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | | | - Xudong Lu
- College of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
| | | | - Arthur R A Bouwman
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Anaesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Erik H H M Korsten
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Healthcare Intelligence, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Oktay O, Nanavati J, Schwaighofer A, Carter D, Bristow M, Tanno R, Jena R, Barnett G, Noble D, Rimmer Y, Glocker B, O’Hara K, Bishop C, Alvarez-Valle J, Nori A. Evaluation of Deep Learning to Augment Image-Guided Radiotherapy for Head and Neck and Prostate Cancers. JAMA Netw Open 2020; 3:e2027426. [PMID: 33252691 PMCID: PMC7705593 DOI: 10.1001/jamanetworkopen.2020.27426] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Personalized radiotherapy planning depends on high-quality delineation of target tumors and surrounding organs at risk (OARs). This process puts additional time burdens on oncologists and introduces variability among both experts and institutions. OBJECTIVE To explore clinically acceptable autocontouring solutions that can be integrated into existing workflows and used in different domains of radiotherapy. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study used a multicenter imaging data set comprising 519 pelvic and 242 head and neck computed tomography (CT) scans from 8 distinct clinical sites and patients diagnosed either with prostate or head and neck cancer. The scans were acquired as part of treatment dose planning from patients who received intensity-modulated radiation therapy between October 2013 and February 2020. Fifteen different OARs were manually annotated by expert readers and radiation oncologists. The models were trained on a subset of the data set to automatically delineate OARs and evaluated on both internal and external data sets. Data analysis was conducted October 2019 to September 2020. MAIN OUTCOMES AND MEASURES The autocontouring solution was evaluated on external data sets, and its accuracy was quantified with volumetric agreement and surface distance measures. Models were benchmarked against expert annotations in an interobserver variability (IOV) study. Clinical utility was evaluated by measuring time spent on manual corrections and annotations from scratch. RESULTS A total of 519 participants' (519 [100%] men; 390 [75%] aged 62-75 years) pelvic CT images and 242 participants' (184 [76%] men; 194 [80%] aged 50-73 years) head and neck CT images were included. The models achieved levels of clinical accuracy within the bounds of expert IOV for 13 of 15 structures (eg, left femur, κ = 0.982; brainstem, κ = 0.806) and performed consistently well across both external and internal data sets (eg, mean [SD] Dice score for left femur, internal vs external data sets: 98.52% [0.50] vs 98.04% [1.02]; P = .04). The correction time of autogenerated contours on 10 head and neck and 10 prostate scans was measured as a mean of 4.98 (95% CI, 4.44-5.52) min/scan and 3.40 (95% CI, 1.60-5.20) min/scan, respectively, to ensure clinically accepted accuracy. Manual segmentation of the head and neck took a mean 86.75 (95% CI, 75.21-92.29) min/scan for an expert reader and 73.25 (95% CI, 68.68-77.82) min/scan for a radiation oncologist. The autogenerated contours represented a 93% reduction in time. CONCLUSIONS AND RELEVANCE In this study, the models achieved levels of clinical accuracy within expert IOV while reducing manual contouring time and performing consistently well across previously unseen heterogeneous data sets. With the availability of open-source libraries and reliable performance, this creates significant opportunities for the transformation of radiation treatment planning.
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Affiliation(s)
- Ozan Oktay
- Health Intelligence, Microsoft Research, Cambridge, United Kingdom
| | - Jay Nanavati
- Health Intelligence, Microsoft Research, Cambridge, United Kingdom
| | | | - David Carter
- Health Intelligence, Microsoft Research, Cambridge, United Kingdom
| | - Melissa Bristow
- Health Intelligence, Microsoft Research, Cambridge, United Kingdom
| | - Ryutaro Tanno
- Health Intelligence, Microsoft Research, Cambridge, United Kingdom
| | - Rajesh Jena
- Health Intelligence, Microsoft Research, Cambridge, United Kingdom
| | - Gill Barnett
- Health Intelligence, Microsoft Research, Cambridge, United Kingdom
| | - David Noble
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
- now with Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Yvonne Rimmer
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Ben Glocker
- Health Intelligence, Microsoft Research, Cambridge, United Kingdom
| | - Kenton O’Hara
- Health Intelligence, Microsoft Research, Cambridge, United Kingdom
| | | | | | - Aditya Nori
- Health Intelligence, Microsoft Research, Cambridge, United Kingdom
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48
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Levy N, Zucco L, Ehrlichman RJ, Hirschberg RE, Hutton Johnson S, Yaffe MB, Ramachandran SK, Bose S, Leibowitz A. Development of Rapid Response Capabilities in a Large COVID-19 Alternate Care Site Using Failure Modes and Effect Analysis with In Situ Simulation. Anesthesiology 2020; 133:985-996. [PMID: 32773686 PMCID: PMC7434018 DOI: 10.1097/aln.0000000000003521] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022]
Abstract
Preparedness measures for the anticipated surge of coronavirus disease 2019 (COVID-19) cases within eastern Massachusetts included the establishment of alternate care sites (field hospitals). Boston Hope hospital was set up within the Boston Convention and Exhibition Center to provide low-acuity care for COVID-19 patients and to support local healthcare systems. However, early recognition of the need to provide higher levels of care, or critical care for the potential deterioration of patients recovering from COVID-19, prompted the development of a hybrid acute care-intensive care unit. We describe our experience of implementing rapid response capabilities of this innovative ad hoc unit. Combining quality improvement tools for hazards detection and testing through in situ simulation successfully identified several operational hurdles. Through rapid continuous analysis and iterative change, we implemented appropriate mitigation strategies and established rapid response and rescue capabilities. This study provides a framework for future planning of high-acuity services within a unique field hospital setting.
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Barclay C, Viswanathan M, Ratner S, Tompkins J, Jonas DE. Implementing Evidence-Based Screening and Counseling for Unhealthy Alcohol Use with Epic-Based Electronic Health Record Tools. Jt Comm J Qual Patient Saf 2020; 45:566-574. [PMID: 31378277 DOI: 10.1016/j.jcjq.2019.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple national organizations recommend screening and counseling adults for unhealthy alcohol use. METHODS An evidence-based approach to screening and counseling using Epic electronic health record (EHR) tools was implemented in a general medicine clinic. A dissemination package with actionable steps for clinics and systems wishing to implement similar processes was then produced. To evaluate the initial implementation and quality improvement project, run charts were created to track patients screened, patients counseled, and fidelity to protocols, and members of the original project team were interviewed to assess facilitators and barriers. The draft dissemination package was revised after feedback from health system representatives (key informants). RESULTS More than 9,000 patients (73.9% of those eligible) were screened in 20 months. Sixty-four percent of patients with positive initial screens had documented screening-related assessment; 39.7% (141/355) were offered counseling when indicated. Initial project team members identified EHR tools, clinic leadership, quality improvement culture, a multidisciplinary team, and training for providers and nurses as facilitators; and competing demands, patient population size, and nursing staff/resident turnover as barriers. Six key informants evaluated the dissemination package. Most rated 10 of the 12 sections as very useful; all rated components specific to implementing alcohol screening and counseling as very useful. Ratings for general guidance on implementing evidence-based services in primary care were more mixed. CONCLUSION Evidence-based screening and counseling for unhealthy alcohol use can be implemented with EHR tools. A dissemination guide was viewed favorably by key informants and can serve as a guide for other clinics and systems.
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50
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Dufraing K, Fenizia F, Torlakovic E, Wolstenholme N, Deans ZC, Rouleau E, Vyberg M, Parry S, Schuuring E, Dequeker EMC. Biomarker testing in oncology - Requirements for organizing external quality assessment programs to improve the performance of laboratory testing: revision of an expert opinion paper on behalf of IQNPath ABSL. Virchows Arch 2020; 478:553-565. [PMID: 33047156 PMCID: PMC7550230 DOI: 10.1007/s00428-020-02928-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/16/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022]
Abstract
In personalized medicine, predictive biomarker testing is the basis for an appropriate choice of therapy for patients with cancer. An important tool for laboratories to ensure accurate results is participation in external quality assurance (EQA) programs. Several providers offer predictive EQA programs for different cancer types, test methods, and sample types. In 2013, a guideline was published on the requirements for organizing high-quality EQA programs in molecular pathology. Now, after six years, steps were taken to further harmonize these EQA programs as an initiative by IQNPath ABSL, an umbrella organization founded by various EQA providers. This revision is based on current knowledge, adds recommendations for programs developed for predictive biomarkers by in situ methodologies (immunohistochemistry and in situ hybridization), and emphasized transparency and an evidence-based approach. In addition, this updated version also has the aim to give an overview of current practices from various EQA providers.
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Affiliation(s)
- K Dufraing
- Biomedical Quality Assurance Research Unit, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 blok d, 3000, Leuven, Belgium
| | - F Fenizia
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - E Torlakovic
- Department of Pathology and Laboratory Medicine, Royal University Hospital, College of Medicine, University of Saskatchewan and Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - N Wolstenholme
- European Molecular Quality Network (EMQN), Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester, M13 9WL, UK
| | - Z C Deans
- UK NEQAS for Molecular Genetics, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK
| | - E Rouleau
- Department of Medical Biology and Pathology, Gustave Roussy, Cancer Genetics Laboratory, Gustave Roussy, Villejuif, France
| | - M Vyberg
- NordiQC, Institute of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - S Parry
- UK NEQAS ICC & ISH, University College London Cancer Institute, London, UK
| | - E Schuuring
- Department of Pathology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700, RB, Groningen, The Netherlands
| | - Elisabeth M C Dequeker
- Biomedical Quality Assurance Research Unit, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 blok d, 3000, Leuven, Belgium.
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