Joint Commission journal on quality and patient safety最新文献

The Joint Commission Journal on Quality and Patient Safety 50th Anniversary Article Collections: 50 Most Cited 联合委员会《质量与患者安全杂志》50周年文章集：50篇被引用次数最多的文章

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2024-08-22 DOI: 10.1016/j.jcjq.2024.07.006

引用次数: 0

Enhancing Implementation of the I-PASS Handoff Tool Using a Provider Handoff Task Force at a Comprehensive Cancer Center 利用综合癌症中心的医疗服务提供者移交工作组，加强 I-PASS 移交工具的实施。

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjq.2024.03.004

Background

Communication failures are among the most common causes of harmful medical errors. At one Comprehensive Cancer Center, patient handoffs varied among services. The authors describe the implementation and results of an organization-wide project to improve handoffs and implement an evidence-based handoff tool across all inpatient services.

Methods

The research team created a task force composed of members from 22 hospital services—advanced practice providers (APPs), trainees, some faculty members, electronic health record (EHR) staff, education and training specialists, and nocturnal providers. Over two years, the task force expanded to include consulting services and Anesthesiology. Factors contributing to ineffective handoffs were identified and organized into categories. The EHR I-PASS tool was used to standardize handoff documentation. Training was provided to staff on its use, and compliance was monitored using a customized dashboard. I-PASS champions in each service were responsible for the rollout of I-PASS in their respective services. The data were reported quarterly to the Quality Assessment and Performance Improvement (QAPI) governing committee. Provider handoff perception was assessed through the biennial Institution-wide safety culture survey.

Results

All fellows, residents, APPs, and physician assistants were trained in the use of I-PASS, either online or in person. Adherence to the I-PASS written tool improved from 41.6% in 2019 to 70.5% in 2022 (p < 0.05), with improvements seen in most services. The frequency of updating I-PASS elements and the action list in the handoff tool also increased over time. The handoff favorability score on the safety culture survey improved from 38% in 2018 to 59% in 2022.

Conclusion

The implementation approach developed by the Provider Handoff Task Force led to increased use of the I-PASS EHR tool and improved safety culture survey handoff favorability.

背景：沟通失败是造成有害医疗事故的最常见原因之一。在一家综合癌症中心，各服务部门之间的患者交接工作各不相同。作者介绍了一个全组织项目的实施情况和结果，该项目旨在改善交接工作，并在所有住院服务部门实施循证交接工具：研究小组成立了一个特别工作组，由来自 22 个医院服务部门的成员组成，包括高级医疗服务提供者 (APP)、受训人员、部分教职员工、电子健康记录 (EHR) 工作人员、教育和培训专家以及夜班医疗服务提供者。两年后，工作组扩大到咨询服务和麻醉科。工作小组确定了导致交接无效的因素，并将这些因素分门别类。电子病历 I-PASS 工具被用来规范交接记录。对工作人员进行了使用培训，并使用定制的仪表板对合规情况进行监测。各服务部门的 I-PASS 倡导者负责在各自服务部门推广 I-PASS。每季度向质量评估和绩效改进 (QAPI) 管理委员会报告数据。通过两年一次的全机构安全文化调查，对医疗服务提供者的交接感知进行评估：所有研究员、住院医师、APP 和医生助理都接受了使用 I-PASS 的在线或面授培训。对 I-PASS 书面工具的坚持率从 2019 年的 41.6% 提高到了 2022 年的 70.5%（p < 0.05），大多数服务都有所改善。随着时间的推移，更新 I-PASS 要素和移交工具中的行动清单的频率也在增加。安全文化调查中的移交支持率得分从 2018 年的 38% 提高到 2022 年的 59%：医疗服务提供者移交工作组开发的实施方法提高了 I-PASS EHR 工具的使用率，并改善了安全文化调查中的移交支持率。

{"title":"Enhancing Implementation of the I-PASS Handoff Tool Using a Provider Handoff Task Force at a Comprehensive Cancer Center","authors":"","doi":"10.1016/j.jcjq.2024.03.004","DOIUrl":"10.1016/j.jcjq.2024.03.004","url":null,"abstract":"<div><h3>Background</h3><p>Communication failures are among the most common causes of harmful medical errors. At one Comprehensive Cancer Center, patient handoffs varied among services. The authors describe the implementation and results of an organization-wide project to improve handoffs and implement an evidence-based handoff tool across all inpatient services.</p></div><div><h3>Methods</h3><p>The research team created a task force composed of members from 22 hospital services—advanced practice providers (APPs), trainees, some faculty members, electronic health record (EHR) staff, education and training specialists, and nocturnal providers. Over two years, the task force expanded to include consulting services and Anesthesiology. Factors contributing to ineffective handoffs were identified and organized into categories. The EHR I-PASS tool was used to standardize handoff documentation. Training was provided to staff on its use, and compliance was monitored using a customized dashboard. I-PASS champions in each service were responsible for the rollout of I-PASS in their respective services. The data were reported quarterly to the Quality Assessment and Performance Improvement (QAPI) governing committee. Provider handoff perception was assessed through the biennial Institution-wide safety culture survey.</p></div><div><h3>Results</h3><p>All fellows, residents, APPs, and physician assistants were trained in the use of I-PASS, either online or in person. Adherence to the I-PASS written tool improved from 41.6% in 2019 to 70.5% in 2022 (<em>p</em> < 0.05), with improvements seen in most services. The frequency of updating I-PASS elements and the action list in the handoff tool also increased over time. The handoff favorability score on the safety culture survey improved from 38% in 2018 to 59% in 2022.</p></div><div><h3>Conclusion</h3><p>The implementation approach developed by the Provider Handoff Task Force led to increased use of the I-PASS EHR tool and improved safety culture survey handoff favorability.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024000734/pdfft?md5=2308c60ab04c20b7faee74dd13dee6aa&pid=1-s2.0-S1553725024000734-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Standardizing the Dosage and Timing of Dexamethasone for Postoperative Nausea and Vomiting Prophylaxis at a Safety-Net Hospital System 在安全网医院系统中规范地塞米松用于术后恶心呕吐预防的剂量和时机

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjq.2024.03.014

Background

A single dose of dexamethasone is routinely given during general anesthesia for postoperative nausea and vomiting (PONV) prophylaxis, although the exact dosage and timing of administration may vary between practitioners. The authors aimed to standardize the dosage and timing of this medication when given to adult patients undergoing general anesthesia for elective surgery.

Methods

Baseline data for 7,483 preintervention cases were analyzed. The researchers attempted to use a standard dose of 8 to 10 mg induction of anesthesia, which, based on a literature review, was effective for PONV prophylaxis, had a similar safety profile as a 4 to 5 mg dose (including in diabetic patients), and may confer additional benefits such as improved prophylaxis and quality of recovery. The interventions included standardizing the medication concentration vials, altering electronic health record quick-select button options, simplifying the intraoperative charting process, and educating the anesthesia providers. The research team then tracked compliance with the standard of care for 2,167 cases after the interventions.

Results

Overall compliance with the standard of care increased from 21.2% preintervention to 53.7% postintervention. The number of patients not receiving dexamethasone was reduced from 29.7% to 19.4%. Patients receiving a compliant dose at a noncompliant time increased from 16.3% to 23.8%. Postanesthesia care unit antiemetic administration also decreased after the interventions.

Conclusion

This study showed improvements in compliance with the dosage of medication with the interventions. However, compliance with the timing of administration remains challenging.

背景在全身麻醉期间常规给予单剂量地塞米松以预防术后恶心和呕吐 (PONV)，但不同医师给药的确切剂量和时间可能会有所不同。作者旨在对接受全身麻醉进行择期手术的成年患者使用这种药物的剂量和时间进行标准化。研究人员尝试使用 8 至 10 毫克的标准剂量进行麻醉诱导，根据文献综述，该剂量对预防 PONV 有效，其安全性与 4 至 5 毫克的剂量相似（包括糖尿病患者），并可能带来额外的益处，如改善预防和恢复质量。干预措施包括将药物浓度瓶标准化、更改电子健康记录快速选择按钮选项、简化术中制表流程以及对麻醉提供者进行教育。研究小组随后跟踪了干预后 2,167 个病例的护理标准遵守情况。结果护理标准的总体遵守率从干预前的 21.2% 提高到干预后的 53.7%。未接受地塞米松治疗的患者人数从 29.7% 降至 19.4%。在不符合规定的时间接受符合规定剂量的患者从 16.3% 增加到 23.8%。结论本研究显示，干预措施改善了患者对药物剂量的依从性。然而，遵守给药时间仍是一项挑战。

{"title":"Standardizing the Dosage and Timing of Dexamethasone for Postoperative Nausea and Vomiting Prophylaxis at a Safety-Net Hospital System","authors":"","doi":"10.1016/j.jcjq.2024.03.014","DOIUrl":"10.1016/j.jcjq.2024.03.014","url":null,"abstract":"<div><h3>Background</h3><p>A single dose of dexamethasone is routinely given during general anesthesia for postoperative nausea and vomiting (PONV) prophylaxis, although the exact dosage and timing of administration may vary between practitioners. The authors aimed to standardize the dosage and timing of this medication when given to adult patients undergoing general anesthesia for elective surgery.</p></div><div><h3>Methods</h3><p>Baseline data for 7,483 preintervention cases were analyzed. The researchers attempted to use a standard dose of 8 to 10 mg induction of anesthesia, which, based on a literature review, was effective for PONV prophylaxis, had a similar safety profile as a 4 to 5 mg dose (including in diabetic patients), and may confer additional benefits such as improved prophylaxis and quality of recovery. The interventions included standardizing the medication concentration vials, altering electronic health record quick-select button options, simplifying the intraoperative charting process, and educating the anesthesia providers. The research team then tracked compliance with the standard of care for 2,167 cases after the interventions.</p></div><div><h3>Results</h3><p>Overall compliance with the standard of care increased from 21.2% preintervention to 53.7% postintervention. The number of patients not receiving dexamethasone was reduced from 29.7% to 19.4%. Patients receiving a compliant dose at a noncompliant time increased from 16.3% to 23.8%. Postanesthesia care unit antiemetic administration also decreased after the interventions.</p></div><div><h3>Conclusion</h3><p>This study showed improvements in compliance with the dosage of medication with the interventions. However, compliance with the timing of administration remains challenging.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024000989/pdfft?md5=3d73540b49a5ee104118d56bf2122222&pid=1-s2.0-S1553725024000989-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140793611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Joint Commission Journal on Quality and Patient Safety 50th Anniversary Article Collections: John M. Eisenberg Patient Safety and Quality Awards 联合委员会《质量与患者安全杂志》50周年文章集：约翰-艾森伯格患者安全与质量奖

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjq.2024.06.003

引用次数: 0

Screening and Intervention to Prevent Violence Against Health Professionals from Hospitalized Patients: A Pilot Study 筛查和干预，防止住院病人暴力侵害医务人员：试点研究

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjq.2024.03.015

Background

Health care providers, particularly nursing staff, are at risk of physical or emotional abuse from patients. This abuse has been associated with increased use of physical and pharmacological restraints on patients, poor patient outcomes, high staff turnover, and reduced job satisfaction.

Methods

In this study, a multidisciplinary team at Tufts Medical Center implemented the Brøset Violence Checklist (BVC), a screening tool administered by nurses to identify patients displaying agitated behavior. Patients who scored high on the BVC received a psychiatry consultation, followed by assessments and recommendations. This tool was implemented in an inpatient medical setting in conjunction with a one-hour de-escalation training led by nursing and Public Safety. The intervention design was executed through a series of three distinct Plan-Do-Study-Act cycles.

Results

This study measured the number of BVCs completed and their scores, the number of psychiatric consults placed, the number of calls to Public Safety, the number of staff assaults, nursing restraint use, and staff satisfaction. During the study period, restraint use decreased 17.6% from baseline mean and calls to Public Safety decreased 60.0% from baseline mean. In the staff survey, nursing staff reported feeling safer at work and feeling better equipped to care for agitated patients.

Conclusion

The BVC is an effective, low-cost tool to proactively identify patients displaying agitated or aggressive behavior. Simple algorithms for next steps in interventions and training help to mitigate risk and increase feelings of safety among staff. Regular psychiatric rounding and the identification of champions were key components in a successful implementation.

背景医疗服务提供者，尤其是护理人员，有可能受到患者的身体或精神虐待。在这项研究中，塔夫茨医疗中心的一个多学科团队实施了布勒塞特暴力检查表（BVC），这是一种由护士实施的筛查工具，用于识别有激动行为的患者。在 BVC 中得分较高的患者会接受精神科会诊，随后进行评估并提出建议。在住院医疗环境中实施这一工具的同时，护理人员和公共安全人员还主持了一个小时的降级培训。结果这项研究测量了完成 BVC 的数量及其得分、精神科咨询的数量、呼叫公共安全部门的数量、员工攻击的数量、护理约束的使用以及员工的满意度。在研究期间，束缚措施的使用比基线平均值减少了 17.6%，公共安全呼叫比基线平均值减少了 60.0%。在员工调查中，护理人员表示在工作中感觉更安全，并觉得自己更有能力护理情绪激动的病人。下一步干预和培训的简单算法有助于降低风险，提高员工的安全感。定期精神科查房和确定倡导者是成功实施的关键因素。

{"title":"Screening and Intervention to Prevent Violence Against Health Professionals from Hospitalized Patients: A Pilot Study","authors":"","doi":"10.1016/j.jcjq.2024.03.015","DOIUrl":"10.1016/j.jcjq.2024.03.015","url":null,"abstract":"<div><h3>Background</h3><p>Health care providers, particularly nursing staff, are at risk of physical or emotional abuse from patients. This abuse has been associated with increased use of physical and pharmacological restraints on patients, poor patient outcomes, high staff turnover, and reduced job satisfaction.</p></div><div><h3>Methods</h3><p>In this study, a multidisciplinary team at Tufts Medical Center implemented the Brøset Violence Checklist (BVC), a screening tool administered by nurses to identify patients displaying agitated behavior. Patients who scored high on the BVC received a psychiatry consultation, followed by assessments and recommendations. This tool was implemented in an inpatient medical setting in conjunction with a one-hour de-escalation training led by nursing and Public Safety. The intervention design was executed through a series of three distinct Plan-Do-Study-Act cycles.</p></div><div><h3>Results</h3><p>This study measured the number of BVCs completed and their scores, the number of psychiatric consults placed, the number of calls to Public Safety, the number of staff assaults, nursing restraint use, and staff satisfaction. During the study period, restraint use decreased 17.6% from baseline mean and calls to Public Safety decreased 60.0% from baseline mean. In the staff survey, nursing staff reported feeling safer at work and feeling better equipped to care for agitated patients.</p></div><div><h3>Conclusion</h3><p>The BVC is an effective, low-cost tool to proactively identify patients displaying agitated or aggressive behavior. Simple algorithms for next steps in interventions and training help to mitigate risk and increase feelings of safety among staff. Regular psychiatric rounding and the identification of champions were key components in a successful implementation.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140769560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Systemwide Strategy to Embed Equity into Patient Safety Event Analysis 将公平纳入患者安全事件分析的全系统战略

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjq.2024.04.004

Background

There is a lack of framework to incorporate equity into event analysis. This quality improvement initiative involved the development of equity tools that were introduced in a two-hour interactive, case-based training across 11 acute care facilities at the largest municipal health care system in the United States. A pre and post survey (which included analysis of a clinical vignette) was also conducted to assess for knowledge and comfort embedding equity in patient safety event analysis, and to measure discomfort or distress during the training. A separate assessment was used to evaluate the tools.

Equity Tools

A visual aid, the Patient Equity Wheel, was created to facilitate more comprehensive and robust health equity discussions by compiling a comprehensive list of equity categories, including internal, external, and organizational dimensions of equity. The Wheel was designed for use during each phase of event analysis. An Embedding Equity in Root Cause Analysis Worksheet was developed to aid in assessing considerations of equitable care in the investigation process and includes questions to ask staff to further assess bias or equitable care factors.

Initiative Outcome and Key Insights

Participant knowledge and level of comfort increased after training. The most commonly unrecognized categories of bias were Training/Competencies, Structural Workflow, and Culture/Norms. Most participants responded that they had no discomfort or distress during the training. Post-training feedback noted that the tools were being used across the system in various stages of event analysis and have been reported to improve health equity conversations.

背景缺乏将公平纳入事件分析的框架。这项质量改进计划包括开发公平工具，并在美国最大的市级医疗保健系统的 11 家急症护理机构开展的两小时基于案例的互动培训中介绍这些工具。此外，还进行了一项前后调查（包括对临床小故事的分析），以评估将公平纳入患者安全事件分析的知识和舒适度，并测量培训期间的不适或困扰。患者公平轮（Patient Equity Wheel）是一种可视化辅助工具，旨在通过汇编一份全面的公平类别清单，包括公平的内部、外部和组织层面，促进更全面、更有力的健康公平讨论。该工具可在事件分析的各个阶段使用。开发了 "将公平纳入根本原因分析工作表"，以帮助评估调查过程中对公平护理的考虑，其中包括向工作人员提出的问题，以进一步评估偏见或公平护理因素。最常见的未认识到的偏见类别是培训/能力、结构性工作流程和文化/规范。大多数参与者都表示在培训过程中没有任何不适或困扰。培训后的反馈意见指出，这些工具正在整个系统中用于不同阶段的事件分析，并被报告用于改善健康公平对话。

{"title":"A Systemwide Strategy to Embed Equity into Patient Safety Event Analysis","authors":"","doi":"10.1016/j.jcjq.2024.04.004","DOIUrl":"10.1016/j.jcjq.2024.04.004","url":null,"abstract":"<div><h3>Background</h3><p>There is a lack of framework to incorporate equity into event analysis. This quality improvement initiative involved the development of equity tools that were introduced in a two-hour interactive, case-based training across 11 acute care facilities at the largest municipal health care system in the United States. A pre and post survey (which included analysis of a clinical vignette) was also conducted to assess for knowledge and comfort embedding equity in patient safety event analysis, and to measure discomfort or distress during the training. A separate assessment was used to evaluate the tools.</p></div><div><h3>Equity Tools</h3><p>A visual aid, the Patient Equity Wheel, was created to facilitate more comprehensive and robust health equity discussions by compiling a comprehensive list of equity categories, including internal, external, and organizational dimensions of equity. The Wheel was designed for use during each phase of event analysis. An Embedding Equity in Root Cause Analysis Worksheet was developed to aid in assessing considerations of equitable care in the investigation process and includes questions to ask staff to further assess bias or equitable care factors.</p></div><div><h3>Initiative Outcome and Key Insights</h3><p>Participant knowledge and level of comfort increased after training. The most commonly unrecognized categories of bias were Training/Competencies, Structural Workflow, and Culture/Norms. Most participants responded that they had no discomfort or distress during the training. Post-training feedback noted that the tools were being used across the system in various stages of event analysis and have been reported to improve health equity conversations.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140790909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluating Real-World Implementation of INFORM (Improving Nursing Home Care through Feedback on Performance Data): An Improvement Initiative in Canadian Nursing Homes 评估 INFORM（通过绩效数据反馈改善疗养院护理）在现实世界中的实施情况：加拿大疗养院改进计划》。

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjq.2024.04.009

Background

INFORM (Improving Nursing Home Care through Feedback on Performance Data) was a research intervention that equipped nursing home managers with skills to conduct local improvement projects and supported them in improving performance through modifiable elements in their units. Prior reports have found positive and sustained outcomes from INFORM intervention. In this article, the authors report findings from a formative service evaluation of INFORM as modified for implementation in real-world settings.

Methods

INFORM was transformed for real-world implementation with an initial cohort of 26 nursing homes in British Columbia, Canada (INFORM BC). Three stakeholder groups were involved: nursing home teams, an academic team that modified INFORM for implementation, and a BC team that implemented INFORM and coached participating nursing home teams in applying it locally. Service evaluation was conducted drawing on participants from all three stakeholder groups, using convenience sampling, with numbers varying by data source. Using a mixed methods design, outcome data included qualitative and quantitative assessment of surveys, discussions, observations, and a review of documents and resources.

Results

The majority of nursing home teams reported positive outcomes relative to the usefulness and relevance of the initiative for local needs despite a number of operational challenges during implementation. A key factor in their success was combining targeted external support with the opportunity to set goals and measure success locally. Challenges included a lack of time at the nursing home level, COVID-19–related disruptions, and issues with role clarity and alignment of expectations among the academic and BC teams.

Conclusion

INFORM BC advanced the processes of change planning and transferable learning among nursing home managers and their local teams. Success was facilitated externally but defined and achieved locally. Future iterations should probe outcome sustainability and how nursing home teams adapt the INFORM approach in practice.

背景：INFORM（通过绩效数据反馈改善疗养院护理）是一项研究性干预措施，它使疗养院管理人员掌握了开展本地改进项目的技能，并支持他们通过单位中的可修改要素来提高绩效。先前的报告发现，INFORM 干预措施取得了积极而持久的成果。在这篇文章中，作者报告了对 INFORM 的形成性服务评估结果，INFORM 已针对实际环境的实施进行了修改：对 INFORM 进行了改造，以便在加拿大不列颠哥伦比亚省（INFORM BC）的 26 家养老院中实施。三个利益相关群体参与其中：疗养院团队、负责修改 INFORM 以供实施的学术团队，以及负责实施 INFORM 并指导参与疗养院团队在当地应用 INFORM 的不列颠哥伦比亚团队。服务评估采用便利抽样法，从所有三个利益相关者小组中抽取参与者，人数因数据来源而异。采用混合方法设计，结果数据包括定性和定量评估调查、讨论、观察以及文件和资源审查：结果：尽管在实施过程中遇到了一些操作上的挑战，但大多数疗养院团队都报告了与该倡议对当地需求的实用性和相关性有关的积极成果。他们取得成功的一个关键因素是将有针对性的外部支持与制定目标和衡量本地成功的机会相结合。面临的挑战包括疗养院缺乏时间、与 COVID-19 相关的干扰，以及学术团队和业连团队之间的角色明确性和期望一致性问题：INFORM BC 推动了养老院管理人员及其当地团队的变革规划和可迁移学习进程。成功是在外部推动下取得的，但也是在当地定义和实现的。未来的迭代应探究成果的可持续性以及养老院团队如何在实践中调整 INFORM 方法。

{"title":"Evaluating Real-World Implementation of INFORM (Improving Nursing Home Care through Feedback on Performance Data): An Improvement Initiative in Canadian Nursing Homes","authors":"","doi":"10.1016/j.jcjq.2024.04.009","DOIUrl":"10.1016/j.jcjq.2024.04.009","url":null,"abstract":"<div><h3>Background</h3><p>INFORM (Improving Nursing Home Care through Feedback on Performance Data) was a research intervention that equipped nursing home managers with skills to conduct local improvement projects and supported them in improving performance through modifiable elements in their units. Prior reports have found positive and sustained outcomes from INFORM intervention. In this article, the authors report findings from a formative service evaluation of INFORM as modified for implementation in real-world settings.</p></div><div><h3>Methods</h3><p>INFORM was transformed for real-world implementation with an initial cohort of 26 nursing homes in British Columbia, Canada (INFORM BC). Three stakeholder groups were involved: nursing home teams, an academic team that modified INFORM for implementation, and a BC team that implemented INFORM and coached participating nursing home teams in applying it locally. Service evaluation was conducted drawing on participants from all three stakeholder groups, using convenience sampling, with numbers varying by data source. Using a mixed methods design, outcome data included qualitative and quantitative assessment of surveys, discussions, observations, and a review of documents and resources.</p></div><div><h3>Results</h3><p>The majority of nursing home teams reported positive outcomes relative to the usefulness and relevance of the initiative for local needs despite a number of operational challenges during implementation. A key factor in their success was combining targeted external support with the opportunity to set goals and measure success locally. Challenges included a lack of time at the nursing home level, COVID-19–related disruptions, and issues with role clarity and alignment of expectations among the academic and BC teams.</p></div><div><h3>Conclusion</h3><p>INFORM BC advanced the processes of change planning and transferable learning among nursing home managers and their local teams. Success was facilitated externally but defined and achieved locally. Future iterations should probe outcome sustainability and how nursing home teams adapt the INFORM approach in practice.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024001223/pdfft?md5=57536e6e6dec894838eb39457f26e932&pid=1-s2.0-S1553725024001223-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Racial/Ethnic Disparities in Peripartum Pain Assessment and Management 围产期疼痛评估和管理中的种族/族裔差异

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjq.2024.03.009

Objective

This study was conducted to determine if there were racial/ethnic disparities in pain assessment and management from labor throughout the postpartum period.

Methods

This was a retrospective cohort study of all births from January 2019 to December 2021 in a single urban, quaternary care hospital, excluding patients with hysterectomy, ICU stay, transfusion of more than 3 units of packed red blood cells, general anesthesia, or evidence of a substance abuse disorder. We characterized and compared patterns of antepartum and postpartum pain assessments, epidural use, pain scores, and postpartum pain management by racial/ethnic group with bivariable analyses. Multivariable regression was performed to test for an association between race/ethnicity and amount of opioid pain medication in milligram equivalent units, stratified by delivery mode.

Results

There were 18,085 births between 2019 and 2021 with available race/ethnicity data. Of these, 58.3% were white, 15.0% were Hispanic, 11.9% were Asian, 7.4% were Black, and the remaining 7.4% were classified as Other/Declined. There were no significant differences by race/ethnicity in the number of antepartum or postpartum pain assessments or the proportion of patients who received epidural analgesia. Black and Hispanic patients reported the highest maximum postpartum pain scores after vaginal and cesarean birth compared to white and Asian patients. However, Black and Hispanic patients received lower daily doses of opioid medications than white patients, regardless of delivery mode. After adjusting for patient factors and non-opioid medication dosages, all other racial/ethnic groups received less opioid medication than white patients.

Conclusion

Inequities were found in postpartum pain treatment, including among patients reporting the highest pain levels.

方法这是一项回顾性队列研究，研究对象是一家城市四级护理医院 2019 年 1 月至 2021 年 12 月期间的所有新生儿，排除了子宫切除术、重症监护室住院、输注超过 3 个单位的包装红细胞、全身麻醉或有药物滥用障碍证据的患者。我们根据种族/人种组别对产前和产后疼痛评估、硬膜外麻醉使用、疼痛评分和产后疼痛管理的模式进行了特征描述和比较，并进行了二变量分析。进行了多变量回归，以检验种族/人种与按分娩方式分层的以毫克当量单位计算的阿片类止痛药物用量之间的关联。结果2019年至2021年期间，有18085名新生儿提供了种族/人种数据。其中，白人占 58.3%，西班牙裔占 15.0%，亚裔占 11.9%，黑人占 7.4%，其余 7.4% 被归类为其他/拒绝归类。在产前或产后疼痛评估次数或接受硬膜外镇痛的患者比例方面，不同种族/族裔之间没有明显差异。与白人和亚裔患者相比，黑人和西班牙裔患者在阴道分娩和剖宫产后的产后疼痛评分最高。然而，无论分娩方式如何，黑人和西班牙裔患者每天接受的阿片类药物剂量均低于白人患者。在对患者因素和非阿片类药物剂量进行调整后，所有其他种族/族裔群体接受的阿片类药物治疗均少于白人患者。

{"title":"Racial/Ethnic Disparities in Peripartum Pain Assessment and Management","authors":"","doi":"10.1016/j.jcjq.2024.03.009","DOIUrl":"10.1016/j.jcjq.2024.03.009","url":null,"abstract":"<div><h3>Objective</h3><p>This study was conducted to determine if there were racial/ethnic disparities in pain assessment and management from labor throughout the postpartum period.</p></div><div><h3>Methods</h3><p>This was a retrospective cohort study of all births from January 2019 to December 2021 in a single urban, quaternary care hospital, excluding patients with hysterectomy, ICU stay, transfusion of more than 3 units of packed red blood cells, general anesthesia, or evidence of a substance abuse disorder. We characterized and compared patterns of antepartum and postpartum pain assessments, epidural use, pain scores, and postpartum pain management by racial/ethnic group with bivariable analyses. Multivariable regression was performed to test for an association between race/ethnicity and amount of opioid pain medication in milligram equivalent units, stratified by delivery mode.</p></div><div><h3>Results</h3><p>There were 18,085 births between 2019 and 2021 with available race/ethnicity data. Of these, 58.3% were white, 15.0% were Hispanic, 11.9% were Asian, 7.4% were Black, and the remaining 7.4% were classified as Other/Declined. There were no significant differences by race/ethnicity in the number of antepartum or postpartum pain assessments or the proportion of patients who received epidural analgesia. Black and Hispanic patients reported the highest maximum postpartum pain scores after vaginal and cesarean birth compared to white and Asian patients. However, Black and Hispanic patients received lower daily doses of opioid medications than white patients, regardless of delivery mode. After adjusting for patient factors and non-opioid medication dosages, all other racial/ethnic groups received less opioid medication than white patients.</p></div><div><h3>Conclusion</h3><p>Inequities were found in postpartum pain treatment, including among patients reporting the highest pain levels.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Improving Appropriate Use of Peripherally Inserted Central Catheters Through a Statewide Collaborative Hospital Initiative: A Cost-Effectiveness Analysis 通过全州医院协作计划改善外周置入中心导管的合理使用：成本效益分析

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjq.2024.04.003

Background

Quality improvement (QI) programs require significant financial investment. The authors evaluated the cost-effectiveness of a physician-led, performance-incentivized, QI intervention that increased appropriate peripherally inserted central catheter (PICC) use.

Methods

The authors used an economic evaluation from a health care sector perspective. Implementation costs included incentive payments to hospitals and costs for data abstractors and the coordinating center. Effectiveness was calculated from propensity score-matched observations across two time periods for complications (venous thromboembolism [VTE], central line–associated bloodstream infection [CLABSI], and catheter occlusion): preintervention period (January 2015 through December 2016) and intervention period (January 2017 through December 2021). Cost-effectiveness was presented as the cost-offset per averted complication, reflecting the health care costs avoided due to having lower complication rates.

Results

Across 35 hospitals, this study sampled 17,418 PICCs placed preintervention and 26,004 placed during the intervention period. PICC complications decreased significantly following the intervention. CLABSIs decreased from 2.1% to 1.5%, VTEs from 3.2% to 2.3%, and catheter occlusions from 10.8% to 7.0% (all p < 0.01). Estimated number of complications prevented included 871 CLABSIs, 2,535 VTEs, and 8,743 catheter occlusions. Project implementation costs were $31.8 million, and the cost-offset related to avoided complications was $64.4 million. Each participating hospital averaged $932,073 in cost-offset over seven years, and the average cost-offset per complication averted was $2,614 (95% CI [confidence interval] $2,314–$3,003).

Conclusion

A large-scale, multihospital QI initiative to improve appropriate PICC use yielded substantial return on investment from cost-offset of prevented complications.

背景质量改进（QI）项目需要大量的资金投入。作者评估了一项由医生主导、绩效激励的 QI 干预项目的成本效益，该项目旨在提高外周置入中心导管 (PICC) 的合理使用率。实施成本包括向医院支付的激励费用以及数据抽取者和协调中心的费用。根据两个时间段内并发症（静脉血栓栓塞[VTE]、中心静脉相关血流感染[CLABSI]和导管闭塞）的倾向得分匹配观察结果计算效果：干预前时间段（2015 年 1 月至 2016 年 12 月）和干预时间段（2017 年 1 月至 2021 年 12 月）。成本效益以每避免一次并发症的成本抵消来表示，反映了因并发症发生率降低而避免的医疗成本。结果在 35 家医院中，本研究对干预前放置的 17,418 例 PICC 和干预期间放置的 26,004 例 PICC 进行了采样。干预后，PICC 并发症明显减少。CLABSI从2.1%降至1.5%，VTE从3.2%降至2.3%，导管堵塞从10.8%降至7.0%（所有P均为0.01）。估计预防的并发症包括 871 例 CLABSI、2,535 例 VTE 和 8,743 例导管堵塞。项目实施成本为 3180 万美元，与避免并发症相关的成本抵消为 6440 万美元。每家参与医院在 7 年内的平均成本抵消额为 932,073 美元，每避免一起并发症的平均成本抵消额为 2,614 美元（95% CI [置信区间] 为 2,314 美元至 3,003 美元）。

{"title":"Improving Appropriate Use of Peripherally Inserted Central Catheters Through a Statewide Collaborative Hospital Initiative: A Cost-Effectiveness Analysis","authors":"","doi":"10.1016/j.jcjq.2024.04.003","DOIUrl":"10.1016/j.jcjq.2024.04.003","url":null,"abstract":"<div><h3>Background</h3><p>Quality improvement (QI) programs require significant financial investment. The authors evaluated the cost-effectiveness of a physician-led, performance-incentivized, QI intervention that increased appropriate peripherally inserted central catheter (PICC) use.</p></div><div><h3>Methods</h3><p>The authors used an economic evaluation from a health care sector perspective. Implementation costs included incentive payments to hospitals and costs for data abstractors and the coordinating center. Effectiveness was calculated from propensity score-matched observations across two time periods for complications (venous thromboembolism [VTE], central line–associated bloodstream infection [CLABSI], and catheter occlusion): preintervention period (January 2015 through December 2016) and intervention period (January 2017 through December 2021). Cost-effectiveness was presented as the cost-offset per averted complication, reflecting the health care costs avoided due to having lower complication rates.</p></div><div><h3>Results</h3><p>Across 35 hospitals, this study sampled 17,418 PICCs placed preintervention and 26,004 placed during the intervention period. PICC complications decreased significantly following the intervention. CLABSIs decreased from 2.1% to 1.5%, VTEs from 3.2% to 2.3%, and catheter occlusions from 10.8% to 7.0% (all <em>p</em> < 0.01). Estimated number of complications prevented included 871 CLABSIs, 2,535 VTEs, and 8,743 catheter occlusions. Project implementation costs were $31.8 million, and the cost-offset related to avoided complications was $64.4 million. Each participating hospital averaged $932,073 in cost-offset over seven years, and the average cost-offset per complication averted was $2,614 (95% CI [confidence interval] $2,314–$3,003).</p></div><div><h3>Conclusion</h3><p>A large-scale, multihospital QI initiative to improve appropriate PICC use yielded substantial return on investment from cost-offset of prevented complications.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140796408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An Interview with Eduardo Salas, PhD 采访爱德华多-萨拉斯博士

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2024-08-01 DOI: 10.1016/j.jcjq.2024.05.010

引用次数: 0