American journal of medical quality : the official journal of the American College of Medical Quality最新文献

Hypoglycemia (defined as blood glucose < 70 mg/dL) is a common medication-related harm event in the inpatient setting. In this study, an electronic-based trigger was developed to identify hypoglycemic cases and subsequently analyze reasons for insulin-mediated hypoglycemic events in hospitalized patients. After a multistep validation approach, the trigger identified 111 hypoglycemic events between January 1 and December 31, 2023. Qualitative analysis of these events revealed that the most common reason for hypoglycemia was related to insulin orders, particularly starting or adjusting insulin at too high of a dose and failing to discontinue insulin despite falling glucose levels. Other emerging themes that provided short-term areas for improvement included changes in dietary status and hyperkalemia treatment. Overall, given that multiple causative etiologies emerged during analysis, prevention of hypoglycemia in hospitalized patients will require multifaceted solutions, including the formation of educational groups for providers who prescribe insulin.

Evidence-based guidance for the evaluation of unintentional weight loss (UWL) is lacking. Using electronic health record data, common diagnostic tests ordered among patients with UWL were identified, as well as their usefulness, by comparing rates of abnormalities to patients without UWL and reviewing reports. Only 38% of cases of UWL were recognized by physicians. Among 1471 patients with recognized UWL, a wide variety of laboratory tests (eg, thyroid-stimulating hormone, complete blood count, prostate specific antigen) potentially related to UWL evaluation were ordered. None of these was more likely to be abnormal in patients with recognized UWL compared with patients without UWL. Neither upper or lower endoscopy nor imaging was found to be useful in identifying a cause. With a stakeholder panel, we developed a conservative approach to UWL. Routine diagnostic evaluation of patients with UWL is not recommended. Patients should monitor their weight weekly as a useful indicator of overall health and undergo recommended routine cancer screening.

Although effective physician-nurse communication has been associated with improved healthcare quality and patient safety outcomes, few studies have explored physician practices that foster high-quality communication. In this study, we aimed to identify physician behaviors that promote effective communication with bedside nurses in the inpatient setting. Using purposeful sampling, we recruited physicians who were identified as excellent communicators by bedside nurses to participate in semi-structured interviews exploring workflows, communication methods, and attitudes toward interprofessional collaboration. Data were analyzed using inductive content analysis. Interviews identified that physicians prioritized communication with bedside nurses in their daily workflows and employed specific techniques to enhance communication quality. Three key themes emerged: (1) consistent daily communication workflows; (2) intentional communication; and (3) deliberate relationship-building. Results highlight opportunities to improve communication through physician- and system-level interventions to integrate structured communication practices into daily workflows and promote relationship-building between physicians and nurses.

In high-reliability organizations, early detection and escalation of safety risks are critical to averting harm. Tiered safety huddles are forums for surfacing weak signals and escalating risk concerns from the frontline unit to executive leadership. We assessed the effect of a tier 4 safety huddle format redesign on reporting within a multihospital system. We conducted a retrospective observational study using 120 paired tier 4 huddle reports (60 pre-redesign and 60 postredesign). Huddle reports were evaluated using a red/green framework, where items were tagged red when they signaled an urgent safety concern. The tier 4 huddle format was redesigned in April 2024 to include: high-reliability organization principles, standardized electronic reporting, and leader accountability. Red look-back (retrospective) and red look-ahead (prospective) items were compared. Red items were identified in 100% of reports. After the redesign, red look-back reports more than doubled (mean 9.02 versus 4.15; P < 0.001), and red look-ahead reports significantly increased (mean 5.40 versus 4.12; P < 0.001). In conclusion, a structured, system-wide tier 4 safety huddle format resulted in increased reporting of urgent safety concerns. Findings suggest improved escalation of both retrospective and prospective concerns, supporting situational awareness and proactive risk management in complex health care systems, and strengthening safety culture.

Cardiovascular programs are often high-cost, high-volume service lines plagued by fragmentation and inconsistent governance. This article presents a structured framework for developing a cardiovascular center of excellence (CVCOE) to enhance care quality and strategic integration. A CVCOE is a purpose-built program defined by three interdependent layers-foundational infrastructure, clinical pillars, and governance-unified through a physician-led clinical model that drives the business and operating models. Drawing on implementation experience across diverse hospital settings, the framework provides a roadmap for aligning structural investments with evidence-based care delivery and organizational capacity. It introduces a two-stage lifecycle: an initial implementation stage to achieve clinical and financial viability, followed by a maintenance stage focused on iterative quality improvement and potential scope expansion. By embedding leadership and quality systems at the structural level, this model offers hospitals and health systems a replicable approach to optimizing cardiovascular services and creating the conditions needed for better outcomes.

Despite a longstanding connection of quality improvement methodology to health care, challenges related to training physicians in this area continue, and knowledge about downstream results is limited. To address these gaps, a team of local educators, including physicians, began by developing a novel quality improvement training experience, the Faculty Quality Collaborative. Content was delivered over a full day, book-ended by a total of 3 hours of independent study. The training was delivered to over 100 physicians between 2021 and 2024, and this group was then surveyed about the effects on their professional roles. The survey aimed to capture overall experience, subsequent participation in quality improvement efforts, dissemination of learnings, and enhancement of educational, clinical, and administrative responsibilities. Survey respondents cited impacts in all these areas. The findings suggest this type of physician-targeted training can lead to meaningful engagement in related activities and help support broader educational and clinical goals.