Joint Commission journal on quality and patient safety最新文献

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Response to: Medication-Related Safety Events. 对药物相关安全事件的回应。

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2025-12-27 DOI: 10.1016/j.jcjq.2025.12.005

Lauren R Bangerter

引用次数: 0

Evaluation of Declined Inter-ICU Transfer Requests to a Tertiary Care Hospital. 对被拒绝的三级护理医院icu间转院请求的评估。

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2025-12-26 DOI: 10.1016/j.jcjq.2025.12.003

Gabrielle Matias, Mengou Zhu, Nandita R Nadig, John M Coleman, Michelle Prickett, Lindsey Gradone, Susan R Russell

引用次数: 0

Impact of a Multifaceted Quality Improvement Initiative Aimed at Reducing Primary Cesarean Delivery Rates. 旨在降低初次剖宫产率的多方面质量改进倡议的影响。

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2025-12-08 DOI: 10.1016/j.jcjq.2025.12.001

Melissa Peskin, Brittany H Sanford, Celia A Muoser, Emma Chew Murphy, Amoli Kulkarni, Beatrice Lynch, Tess Nienaltowa, Marlena Gehret Plagianos, Peter Bernstein, Pe'er Dar

Introduction: The ideal approach to safely reduce the rising rates of cesarean deliveries (CDs) is unknown. The authors evaluated the impact of a multifaceted quality improvement (QI) initiative aimed at curbing the rising trend in the institutional nulliparous term singleton vertex (NTSV) CD rate at an urban, academic, safety-net hospital.

Methods: The primary intervention was a biweekly interdisciplinary educational meeting, wherein NTSV CD cases were reviewed and audited. In addition, an educational bulletin, NTSV score cards, labor position training, and efforts to promote guideline adherence were introduced. The research team examined the institutional NTSV CD rates by quarters and evaluated the trend, modeling the probability of a CD for the pre- and postintervention periods using logistic regression, with time as an ordinal variable. The authors also examined cesarean indications as well as maternal and neonatal complications before and after the QI implementation.

Results: There was a trend toward a decrease in CDs during the postintervention period, falling from 32.9% to 26.3% in the 12 months following implementation. Using an interrupted time series analysis to assess differences in trends, the trend before intervention was +2.63% per quarter (95% confidence interval [CI] 2.30-3.03, p < 0.001), while the change in trend postintervention was -3.78% per quarter (95% CI -4.74 to -2.81, p < 0.001, R² = 0.973). This suggests an increasing trend prior to intervention that was effectively reversed. Both maternal and neonatal complications rates remained comparable between pre- and postintervention periods for those who had NTSV CDs.

Conclusion: Multifaceted strategies incorporating interactive case review meetings can lead to practice change and may be a feasible strategy to reduce an institutional NTSV CD rate.

安全降低剖宫产率（cd）的理想方法尚不清楚。作者评估了多方面的质量改进（QI）倡议的影响，该倡议旨在遏制城市，学术，安全网医院机构无产期单胎顶点（NTSV） CD率的上升趋势。方法：主要干预措施是每两周一次的跨学科教育会议，对NTSV CD病例进行回顾和审核。此外，还介绍了教育公报、NTSV记分卡、劳动岗位培训和促进指南遵守的努力。研究小组按季度检查了机构NTSV CD率，并评估了趋势，使用逻辑回归对干预前后的CD概率进行建模，将时间作为序数变量。作者还检查了宫产指征以及QI实施前后的孕产妇和新生儿并发症。结果：干预后cd呈下降趋势，实施后12个月内从32.9%下降到26.3%。采用中断时间序列分析评估趋势差异，干预前的趋势为每季度+2.63%(95%可信区间[CI] 2.30-3.03, p < 0.001)，干预后的趋势变化为每季度-3.78% （95% CI -4.74至-2.81,p < 0.001, R2 = 0.973）。这表明，在干预之前，这种上升趋势已得到有效扭转。在NTSV cd患者的干预前后，产妇和新生儿并发症发生率保持可比性。结论：结合互动式病例审查会议的多方面策略可以导致实践变化，并且可能是降低机构NTSV CD率的可行策略。

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引用次数: 0

Global Health Impact: Sustainable Healthcare in Practice 全球健康影响：实践中的可持续医疗保健

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjq.2025.10.003

Kevin Zacharyasz M.En (is Global Director, Healthcare Sustainability, Joint Commission, Oakbrook Terrace, IL. Please address correspondence to)

引用次数: 0

Advancing Parkinson’s Care and Patient Safety Through CMS’s Age-Friendly Hospital Measure 通过CMS的老年友好医院措施推进帕金森护理和患者安全

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjq.2025.09.005

Peter Pronovost MD, PhD, FCCM (is Chief Quality and Transformation Officer, University Hospitals Cleveland Medical Center, Cleveland, Ohio.), Leslie J. Pelton MPA (is Senior Program Officer, The John A. Hartford Foundation, New York, New York.), Hooman Azmi MD, FAANS (is Vice Chair of Neurosurgery for Quality and Safety, Hackensack University Medical Center, Hackensack, New Jersey.), Annie Brooks MSW (is Senior Director, Strategic Initiatives, Parkinson’s Foundation, Miami.), Eboné Carrington MPA (is Managing Director, Manatt Health Strategies, New York, New York.), Michael Siao Tick Chong MPH (is Senior Manager, Manatt Health Strategies.), Sheera Rosenfeld MHS (is Vice President, Chief Strategic Initiatives Officer, Parkinson’s Foundation. Please address correspondence to Sheera Rosenfeld)

引用次数: 0

Corrigendum to: “Frailty Screening Using the Risk Analysis Index: A User Guide” [The Joint Commission Journal on Quality and Patient Safety Volume 51, Issue 3 (2025) Pages 178-191] “使用风险分析指数进行虚弱筛查：用户指南”的更正[质量和患者安全联合委员会杂志第51卷，第3期（2025）页178-191]。

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjq.2025.09.001

Daniel E. Hall MD, MDiv, MHSc, FACS , Carly A. Jacobs MPH , Katherine M. Reitz MD, MSc , Shipra Arya MD, SM, FACS , Michael A. Jacobs MS , John Cashy PhD , Jason M. Johanning MD, MS, FACS

引用次数: 0

Leveraging Implementation Science to Address Diagnostic Disparities and Promote Equity in Healthcare 利用实施科学解决诊断差异并促进医疗公平。

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjq.2025.09.004

Lucy Schulson MD, MPH (is Assistant Professor, Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine.), Mari-Lynn Drainoni PhD, MEd (is Research Professor, Section of Infectious Disease, Boston University Chobanian and Avedisian School of Medicine, and Department of Health Law, Policy & Management, Boston University School of Public Health, and Co-Director, Evans Center for Implementation and Improvement Sciences, Boston University.), Kirsten Austad MD, MPH (is Assistant Professor, Department of Family Medicine, Boston University Chobanian and Avedisian School of Medicine, and Co-Director, Evans Center for Implementation and Improvement Sciences. Please address correspondence to Lucy Schulson)

引用次数: 0

Optimizing Pediatric Surgical Kits: A Cost-Effective Approach to Reducing Environmental Impact in Healthcare 优化儿科手术包：降低医疗保健环境影响的成本效益方法。

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjq.2025.09.002

Alison Lehane MD (is Pediatric Surgical Research Fellow, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, and Ann & Robert H. Lurie Children’s Hospital of Chicago.), Mallory Perez MD (is Pediatric Surgical Research Fellow, NQUIRES, Northwestern University Feinberg School of Medicine, and Ann & Robert H. Lurie Children’s Hospital of Chicago.), Gwyneth A. Sullivan MD, MS (is General Surgical Resident, Rush University Medical Center, Chicago.), Jennifer Dunn PhD, MSE (is Professor of Chemical and Biological Engineering, and Director, Center for Engineering Sustainability and Resilience, Northwestern University McCormick School of Engineering.), Timothy B. Lautz MD (is Associate Professor, Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, and Ann & Robert H. Lurie Children’s Hospital of Chicago.), Mehul V. Raval MD, MS (is Professor, Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, and Ann & Robert H. Lurie Children’s Hospital of Chicago. Please address correspondence to Alison Lehane)

Background

Operating rooms (ORs) generate substantial waste and greenhouse gas (GHG) emissions, in part due to common reliance on single-use disposable items widely used in prefabricated surgical kits. This study evaluates the environmental and economic benefits of streamlining surgical kits in a children’s hospital.

Method

Life cycle assessment (LCA) was used to assess the cradle-to-grave impact of surgical kits, quantifying GHG emissions from raw material extraction through disposal. GHG emissions were modeled using the Greenhouse gases, Regulated Emissions, and Energy use in Transportation (GREET) model and openLCA software, scaled to annual surgical volumes, and converted using the US Environmental Protection Agency’s (EPA) Greenhouse Gas Equivalencies Calculator. Iterative stakeholder consultation identified items for removal to minimize waste while maintaining operative needs. Cost savings were calculated from medical supplier data.

Results

Optimizing three surgical kits (Pediatric Major, Pediatric Minor, and Pediatric Minor–Outpatient) by removing select items (for example, large ring basins, preparation trays, suction tubing, extra gowns) resulted in annual cost savings of $8,608 and GHG reductions of 30,654 g across 2,676 pediatric surgical cases. GHG reductions ranged from 6.9 g to 13.0 g per pack. If applied across all surgical service lines (cases = 26,000), projected GHG reductions would be between 179,400 g and 338,000 g, with a median of 288,600 g, equivalent to 783 miles (1,260 kilometers) driven, or a journey between Chicago and New York City.

Conclusion

Streamlining pediatric surgical kits offers a scalable, cost-effective strategy for reducing the environmental impact of ORs. LCA provides a robust framework for evaluating sustainability in healthcare, supporting informed decision-making to enhance resource efficiency.

背景：手术室（or）产生大量废物和温室气体（GHG）排放，部分原因是普遍依赖于广泛用于预制手术包的一次性用品。本研究评估了儿童医院简化手术包的环境和经济效益。方法：采用生命周期评估法（LCA）评估手术包从摇篮到坟墓的影响，量化原料提取到处置过程中的温室气体排放。使用温室气体、管制排放和运输能源使用（GREET）模型和openLCA软件对温室气体排放进行建模，按年手术量进行缩放，并使用美国环境保护署（EPA）温室气体当量计算器进行转换。迭代的利益相关者咨询确定了需要移除的项目，以在保持运行需求的同时最大限度地减少浪费。根据医疗供应商的数据计算成本节约。结果：通过优化三种手术包（儿科大手术包、儿科小手术包和儿科小门诊手术包），取消了一些特定项目（例如，大环盆、准备托盘、吸引管、额外的长袍），在2,676例儿科手术中每年节省了8,608美元的成本，减少了30,654克的温室气体排放。每包减少的温室气体从6.9克到13.0克不等。如果应用于所有外科手术服务项目（病例数为26000例），预计温室气体减排量将在179400克至338000克之间，中位数为288600克，相当于行驶783英里（1260公里），或从芝加哥到纽约的旅程。结论：简化儿科手术包为减少手术室对环境的影响提供了一种可扩展的、具有成本效益的策略。LCA为评估医疗保健的可持续性提供了一个强大的框架，支持明智的决策以提高资源效率。

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引用次数: 0

Big Access Week: Decreasing Dermatology Patient Wait Times in a Strained Healthcare System 大访问周：减少皮肤科病人的等待时间在紧张的医疗保健系统。

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjq.2025.09.003

Dylan J. Parker MD (is Research Fellow, Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.), Iman M. Salem MD (is Resident, Department of Dermatology, Dartmouth Hitchcock Medical Center.), Dylan J. Badin MD (is Resident, Department of Dermatology, Dartmouth Hitchcock Medical Center.), Brian J. Simmons MD (is Assistant Professor, Department of Dermatology, Geisel School of Medicine at Dartmouth, and Director of Clinical Trials, Dartmouth Hitchcock Medical Center.), M. Shane Chapman MD, MBA (is Professor and Chair, Department of Dermatology, Geisel School of Medicine at Dartmouth, and Medical Director, Supply Chain Value Analysis, Dartmouth Hitchcock Medical Center. Please address correspondence to Dylan J. Parker)

Background

New patient waitlists across the United States continue to grow. This trend is exacerbated in rural areas. Dartmouth Dermatology is a unique tertiary care center serving approximately 50,000 patients annually. In September 2023 the center’s waitlist consisted of 3,654 unseen patients.

Methods

During Dartmouth Dermatology’s Big Access Week, which took place December 11–15, 2023, the center saw 1,532 patients (1,180 new patients) using a four-pronged approach: categorization, community sensitization, patient expectations, and operations.

Results

Patient ages ranged from 10 months to 98 years. Average referral to visit time was 98.7 days. Full skin exams were performed on 406 patients, and focused exams were performed on 607 patients. Primary diagnoses included malignant/premalignant lesions for 279 patients, autoimmune-related skin disease for 57 patients, inflammatory lesions for 396 patients, and infectious lesions for 82 patients. Notably, 124 malignancies were confirmed (67 basal cell carcinomas, 39 squamous cell carcinomas, and 18 melanomas). Mohs referrals totaled 87 cases. The average patient satisfaction rating was 3.8/4.

Conclusion

Dartmouth Dermatology’s workflow model in Big Access Week significantly shortened waitlist time while maintaining high-quality care. This model can be implemented by a wide array of medical and surgical subspecialties, contributing to a seemingly daunting task: improving vital access to healthcare.

背景：美国各地的新患者等待名单继续增长。这一趋势在农村地区更为严重。达特茅斯皮肤科是一个独特的三级护理中心，每年为大约50,000名患者提供服务。2023年9月，该中心的等待名单上有3654名未见过的患者。方法：在2023年12月11日至15日举行的达特茅斯皮肤科大访问周期间，该中心使用四管齐下的方法治疗了1532名患者（1180名新患者）：分类、社区敏化、患者期望和手术。结果：患者年龄从10个月到98岁不等。平均转诊时间为98.7天。对406例患者进行了全面皮肤检查，对607例患者进行了重点检查。初步诊断包括279例恶性/癌前病变，57例自身免疫相关皮肤病，396例炎性病变，82例感染性病变。值得注意的是，124例恶性肿瘤被确诊（67例基底细胞癌、39例鳞状细胞癌和18例黑色素瘤）。Mohs共转诊87例。患者平均满意度为3.8/4。结论：达特茅斯皮肤科在大访问周的工作流程模型显著缩短了等候时间，同时保持了高质量的护理。这种模式可以在广泛的医学和外科专科实施，有助于完成一项看似艰巨的任务：改善至关重要的医疗保健服务。

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引用次数: 0

The Impact of Semistructured Safety-Focused Site Visits Between Children’s Hospitals 儿童医院间半结构化以安全为重点的实地考察的影响。

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjq.2025.08.003

Sarah Kandil MD (is Associate Professor of Pediatrics, Section of Critical Care Medicine, Yale School of Medicine, and Deputy Quality and Safety Officer, Yale New Haven Hospital.), Michelle Vonderhaar (is Project Manager, Children’s Hospitals’ Solutions for Patient Safety, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center.), Patsy Sisson MS (is Senior Analyst, Children’s Hospitals’ Solutions for Patient Safety, Cincinnati Children’s Hospital Medical Center.), Lara Wood MN, RN, CPN, CPPS (is Associate Clinical Director, Children’s Hospitals’ Solutions for Patient Safety, Cincinnati Children’s Hospital Medical Center.), Patrick W. Brady MD, MSc (is Co-Director, Division of Hospital Medicine, Children’s Hospitals’ Solutions for Patient Safety, Cincinnati Children’s Hospital Medical Center, and Professor, Department of Pediatrics, University of Cincinnati College of Medicine.), Anne Lyren MD, MSc (is Chief Medical and Strategy Officer, and Clinical Director, Children’s Hospitals’ Solutions for Patient Safety, Cincinnati Children’s Hospital Medical Center. Please address correspondence to Sarah Kandil)

Background

Site visits are commonly used for accreditation and regulatory purposes, but little is known about how hospitals use them for safety improvement or their impact on clinical processes and outcomes.

Methods

This mixed methods study describes the key components of safety-focused site visits between hospitals and their impact on hospital safety outcomes, particularly for the visiting hospital. Hospitals were recruited via the Children’s Hospitals’ Solutions for Patient Safety (SPS) Network. A site visit guide was developed, covering pre-visit planning, visit execution, and post-visit debriefing. A post-visit survey and follow-up interviews (6 to 12 months later) were conducted. Themes were identified using a constant comparative approach, and statistical analysis compared rates of hospital-acquired conditions (HACs) between hospitals that participated in site visits and those that did not.

Results

From 2019 to 2021, 27 hospitals (19.6%) participated in site visits, with 14 in-person and 13 virtual. Key themes to drive a successful and useful visit highlighted the importance of peer rapport, interaction with frontline staff, structured planning, clear agendas, and thorough debriefing. Among hospitals that completed a follow-up interview, 76.5% completed at least one action item, with 56.8% of pre-determined SMART aims achieved. However, no significant difference in HAC rates, specifically central line–associated bloodstream infections (CLABSIs) and unplanned extubations (UEs), was found between site visit and non–site visit hospitals.

Conclusion

Safety-focused site visits between hospitals provide a valuable learning experience, fostering the development of improvement strategies and high rates of action item completion. However, no significant differences in safety outcomes were observed, likely due to the small sample size.

背景：实地考察通常用于认证和监管目的，但很少有人知道医院如何利用它们来提高安全性或它们对临床过程和结果的影响。方法：该混合方法研究描述了医院之间以安全为重点的现场访问的关键组成部分及其对医院安全结果的影响，特别是对访问医院而言。医院是通过儿童医院病人安全解决方案网络招募的。制定了一份实地考察指南，内容包括考察前规划、考察执行和考察后汇报。随访6 ~ 12个月，进行随访调查和随访访谈。使用持续比较方法确定主题，并通过统计分析比较参加和未参加实地考察的医院之间的医院获得性疾病（HACs）发生率。结果：2019 - 2021年，共有27家医院（19.6%）参加了现场访问，其中14家医院亲自访问，13家医院虚拟访问。成功和有用的访问重点是同事间的融洽关系、与前线员工的互动、有条理的计划、清晰的议程和详尽的汇报。在完成随访访谈的医院中，76.5%的医院至少完成了一项行动项目，达到了预定SMART目标的56.8%。然而，在现场访问医院和非现场访问医院之间，HAC率，特别是中心线相关血流感染（CLABSIs）和计划外拔管（ue）没有显著差异。结论：医院间以安全为重点的实地考察提供了宝贵的学习经验，促进了改进策略的制定和行动项目的高完成率。然而，没有观察到安全结果的显著差异，可能是由于样本量小。

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