Pub Date : 2024-07-01DOI: 10.1016/j.jcjq.2024.04.006
Benjamin D. Pollock PhD, MSPH (is Assistant Professor of Health Services Research and Senior Associate Consultant II–Research, Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida.), Leslie Carranza MD (is Quality Chair, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.), Elizabeth Braswell-Pickering MPH (is Senior Quality Informatics Analyst, Mayo Clinic, Rochester, Minnesota.), Christine M. Sing DPT, MBA (is Operations Manager, Quality & Value, Mayo Clinic, Rochester, Minnesota.), Lindsay L. Warner MD (is Anesthesiologist and Pediatric Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.), Regan N. Theiler MD, PHD (is Associate Professor, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota. Please address correspondence to Benjamin D. Pollock)
Background
The Joint Commission uses nulliparous, term, singleton, vertex, cesarean delivery (NTSV-CD) rates to assess hospitals’ perinatal care quality through the Cesarean Birth measurement (PC-02). However, these rates are not risk-adjusted for maternal health factors, putting this measure at odds with the risk adjustment paradigm of most publicly reported hospital quality measures. Here, the authors tested whether risk adjustment for readily documented maternal risk factors affected hospital-level NTSV-CD rates in a large health system.
Methods
Included were all consecutive NTSV pregnancies from January 2019 to April 2023 across 10 hospitals in one health system. Logistic regression, adjusting for age, obesity, diabetes, and hypertensive disorders. was used to calculate hospital-level risk-adjusted NTSV-CD rates by multiplying observed vs. expected ratios for each hospital by the systemwide unadjusted NTSV-CD rate. The authors calculated intrahospital risk differences between unadjusted and risk-adjusted rates and calculated the percentage of hospitals qualifying for different reporting status after risk adjustment using the 30% Joint Commission reporting threshold rate.
Results
Of 23,866 pregnancies, 6,550 (27.4%) had cesarean deliveries. Across 10 hospitals, the number of deliveries ranged from 393 to 7,671, with unadjusted NTSV-CD rates ranging from 21.0% to 30.5%. Risk-adjusted NTSV-CD rates ranged from 21.5% to 30.4%, with absolute intrahospital differences in risk-adjusted vs. unadjusted rates ranging from −1.33% (indicating lower rate after risk adjustment) to 3.37% (indicating higher rate after risk adjustment). Three of 10 (30.0%) hospitals qualified for different reporting statuses after risk adjustment.
Conclusion
Risk adjustment for age, obesity, diabetes, and hypertensive disorders is feasible and resulted in meaningful changes in hospital-level NTSV-CD rates with potentially impactful consequences for hospitals near The Joint Commission reporting threshold.
{"title":"A Simple Risk Adjustment for Hospital-Level Nulliparous, Term, Singleton, Vertex, Cesarean Delivery Rates and Its Implications for Public Reporting","authors":"Benjamin D. Pollock PhD, MSPH (is Assistant Professor of Health Services Research and Senior Associate Consultant II–Research, Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida.), Leslie Carranza MD (is Quality Chair, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.), Elizabeth Braswell-Pickering MPH (is Senior Quality Informatics Analyst, Mayo Clinic, Rochester, Minnesota.), Christine M. Sing DPT, MBA (is Operations Manager, Quality & Value, Mayo Clinic, Rochester, Minnesota.), Lindsay L. Warner MD (is Anesthesiologist and Pediatric Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.), Regan N. Theiler MD, PHD (is Associate Professor, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota. Please address correspondence to Benjamin D. Pollock)","doi":"10.1016/j.jcjq.2024.04.006","DOIUrl":"10.1016/j.jcjq.2024.04.006","url":null,"abstract":"<div><h3>Background</h3><p>The Joint Commission uses nulliparous, term, singleton, vertex, cesarean delivery (NTSV-CD) rates to assess hospitals’ perinatal care quality through the Cesarean Birth measurement (PC-02). However, these rates are not risk-adjusted for maternal health factors, putting this measure at odds with the risk adjustment paradigm of most publicly reported hospital quality measures. Here, the authors tested whether risk adjustment for readily documented maternal risk factors affected hospital-level NTSV-CD rates in a large health system.</p></div><div><h3>Methods</h3><p>Included were all consecutive NTSV pregnancies from January 2019 to April 2023 across 10 hospitals in one health system. Logistic regression, adjusting for age, obesity, diabetes, and hypertensive disorders. was used to calculate hospital-level risk-adjusted NTSV-CD rates by multiplying observed vs. expected ratios for each hospital by the systemwide unadjusted NTSV-CD rate. The authors calculated intrahospital risk differences between unadjusted and risk-adjusted rates and calculated the percentage of hospitals qualifying for different reporting status after risk adjustment using the 30% Joint Commission reporting threshold rate.</p></div><div><h3>Results</h3><p>Of 23,866 pregnancies, 6,550 (27.4%) had cesarean deliveries. Across 10 hospitals, the number of deliveries ranged from 393 to 7,671, with unadjusted NTSV-CD rates ranging from 21.0% to 30.5%. Risk-adjusted NTSV-CD rates ranged from 21.5% to 30.4%, with absolute intrahospital differences in risk-adjusted vs. unadjusted rates ranging from −1.33% (indicating lower rate after risk adjustment) to 3.37% (indicating higher rate after risk adjustment). Three of 10 (30.0%) hospitals qualified for different reporting statuses after risk adjustment.</p></div><div><h3>Conclusion</h3><p>Risk adjustment for age, obesity, diabetes, and hypertensive disorders is feasible and resulted in meaningful changes in hospital-level NTSV-CD rates with potentially impactful consequences for hospitals near The Joint Commission reporting threshold.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140780264","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}
Pub Date : 2024-07-01DOI: 10.1016/j.jcjq.2024.05.004
Michael S. Pulia MD, PhD (is Associate Professor, Departments of Emergency Medicine and Industrial and Systems Engineering University of Wisconsin-Madison.), Dimitrios Papanagnou MD, MPH (is Professor, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia.), Pat Croskerry MD, PhD (is Professor, Department of Emergency Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Please address correspondence to Michael S. Pulia)
{"title":"The Quest for Diagnostic Excellence in the Emergency Department","authors":"Michael S. Pulia MD, PhD (is Associate Professor, Departments of Emergency Medicine and Industrial and Systems Engineering University of Wisconsin-Madison.), Dimitrios Papanagnou MD, MPH (is Professor, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia.), Pat Croskerry MD, PhD (is Professor, Department of Emergency Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Please address correspondence to Michael S. Pulia)","doi":"10.1016/j.jcjq.2024.05.004","DOIUrl":"10.1016/j.jcjq.2024.05.004","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141035737","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}
Pub Date : 2024-06-28DOI: 10.1016/j.jcjq.2024.06.006
{"title":"Communication After Medical Error: The Need to Measure the Patient Experience","authors":"","doi":"10.1016/j.jcjq.2024.06.006","DOIUrl":"10.1016/j.jcjq.2024.06.006","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626824","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}
Pub Date : 2024-06-27DOI: 10.1016/j.jcjq.2024.06.005
Margaret V Darko, Robert White, Deirdre C Kelleher
{"title":"Letter to the Editor on \"Differences in the Receipt of Regional Anesthesia Based on Race and Ethnicity in Colorectal Surgery\".","authors":"Margaret V Darko, Robert White, Deirdre C Kelleher","doi":"10.1016/j.jcjq.2024.06.005","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.06.005","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734153","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}
Pub Date : 2024-06-25DOI: 10.1016/j.jcjq.2024.06.004
Lawrence Lurvey, Lyn Yasumura, Elena Martinez
{"title":"Will Ambulatory Safety Nets Go Viral?","authors":"Lawrence Lurvey, Lyn Yasumura, Elena Martinez","doi":"10.1016/j.jcjq.2024.06.004","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.06.004","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734154","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}
Pub Date : 2024-06-08DOI: 10.1016/j.jcjq.2024.06.002
Background
Human immunodeficiency virus (HIV) and hepatitis C (HCV) screening and human papillomavirus (HPV) vaccine uptake remain suboptimal. To improve HIV and HCV screening and HPV vaccination, the authors implemented a quality improvement project in three southwestern Pennsylvania family medicine residency practices.
Methods
From June 1 to November 30, 2021, participating practices used universal screening and vaccination guidelines and chose from multiple strategies at the office (for example, standing orders), provider (for example, multiple forms of provider reminders), and patient (for example, incentives) levels derived from published literature and tailored to local context. Age-eligible patients for each recommendation with at least one in-person office visit during the intervention period were included. To assess the interventions’ effect, the authors obtained testing and vaccination data from the electronic health record for the intervention period, contrasted it with identical data from June 1 to November 30, 2020, and used logistic regression controlling for patient age, sex, and race to determine differences in screening and vaccination between intervention and baseline periods.
Results
A total of 14,920 and 15,523 patients were eligible in the baseline and intervention periods, respectively. Following the intervention, HIV lifetime screening but not first-time screening for patients 13–64 years old was significantly higher (78.9% vs. 76.1%, p = 0.004, and 39.6% vs. 36.6%, p = 0.152, respectively, adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 1.06–1.38). HCV lifetime screening for patients 18–79 years old was significantly higher postintervention (62.5% vs. 53.5%, p < 0.001, aOR 1.51, 95% CI 1.4–1.64). For patients 9–26 years old, no change in HPV initiation was observed, but the percentage of patients who completed their HPV vaccinations in the observed period was significantly higher postintervention (7.0% vs 4.6%, p = 0.006, aOR 1.58, 95% CI 1.14–2.2). During the postintervention period, the researchers identified 0 new HIV diagnoses and 48 HCV diagnoses (19 eligible for treatment).
Conclusion
Family medicine residency office-based multistrategy efforts appear to successfully increase patient uptake of HIV and HCV screenings and maintain HPV vaccination rates.
{"title":"Going (Anti)Viral: Improving HIV and HCV Screening and HPV Vaccination in Primary Care","authors":"","doi":"10.1016/j.jcjq.2024.06.002","DOIUrl":"10.1016/j.jcjq.2024.06.002","url":null,"abstract":"<div><h3>Background</h3><p><span>Human immunodeficiency virus (HIV) and hepatitis C (HCV) screening and human papillomavirus (HPV) vaccine uptake remain suboptimal. To improve HIV and HCV<span> screening and HPV </span></span>vaccination<span>, the authors implemented a quality improvement project in three southwestern Pennsylvania family medicine residency practices.</span></p></div><div><h3>Methods</h3><p><span>From June 1 to November 30, 2021, participating practices used universal screening and vaccination guidelines and chose from multiple strategies at the office (for example, standing orders), provider (for example, multiple forms of provider reminders), and patient (for example, incentives) levels derived from published literature and tailored to local context. Age-eligible patients for each recommendation with at least one in-person office visit during the intervention period were included. To assess the interventions’ effect, the authors obtained testing and vaccination data from the electronic health record for the intervention period, contrasted it with identical data from June 1 to November 30, 2020, and used </span>logistic regression controlling for patient age, sex, and race to determine differences in screening and vaccination between intervention and baseline periods.</p></div><div><h3>Results</h3><p>A total of 14,920 and 15,523 patients were eligible in the baseline and intervention periods, respectively. Following the intervention, HIV lifetime screening but not first-time screening for patients 13–64 years old was significantly higher (78.9% vs. 76.1%, <em>p</em> = 0.004, and 39.6% vs. 36.6%, <em>p</em><span> = 0.152, respectively, adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 1.06–1.38). HCV lifetime screening for patients 18–79 years old was significantly higher postintervention (62.5% vs. 53.5%, </span><em>p</em><span> < 0.001, aOR 1.51, 95% CI 1.4–1.64). For patients 9–26 years old, no change in HPV initiation was observed, but the percentage of patients who completed their HPV vaccinations in the observed period was significantly higher postintervention (7.0% vs 4.6%, </span><em>p</em> = 0.006, aOR 1.58, 95% CI 1.14–2.2). During the postintervention period, the researchers identified 0 new HIV diagnoses and 48 HCV diagnoses (19 eligible for treatment).</p></div><div><h3>Conclusion</h3><p>Family medicine residency office-based multistrategy efforts appear to successfully increase patient uptake of HIV and HCV screenings and maintain HPV vaccination rates.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141413630","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}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.02.004
Kyle W. Blackburn (is Medical Student, School of Medicine, Baylor College of Medicine, Houston.), Lisa S. Brubaker MD (is General Surgery Resident, Department of Surgery, Baylor College of Medicine.), George Van Buren II MD (is Associate Professor, Department of Surgery, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center, Houston.), Emily Feng (is Clinical Research Coordinator at San Francisco Otolaryngology, Department of Surgery, Baylor College of Medicine.), Sadde Mohamed (is Medical Student, School of Medicine, Yale University.), Uma Ramamurthy PhD MBA (is Associate Professor Department of Pediatrics, Baylor College of Medicine.), Vivek Ramanathan MS (is Software Engineer, Office of Research IT, Baylor College of Medicine.), Amy L. Wood MPH (is Clinical Research Manager, Department of Surgery, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center.), Martha E. Navarro Cagigas MD (is Senior Research Coordinator, Department of Surgery, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center.), William E. Fisher MD (is Professor, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center. Please address correspondence to William E. Fisher)
Background
The surgical morbidity and mortality (M&M) conference is a vital part of a resident's surgical education, but methods to collect and store M&M data are often rudimentary and unreliable. The authors propose a Health Insurance Portability and Accountability Act (HIPAA)–compliant, electronic health record (EHR)–connected application and database to report and store complication data.
Methods
The app is linked to the patient's EHR, and as a result, basic data on each surgical case—including diagnosis, surgery type, and surgeon—are automatically uploaded to the app. In addition, all data are stored in a secure SQL database—with communications between the app and the database end-to-end encrypted for HIPAA compliance. The full surgical team has access to the app, democratizing complications reporting and allowing for reporting in both the inpatient and outpatient settings. This complication information can then be automatically pulled from the app with a premade presentation for the M&M conference. The data can also be accessed by a Power BI dashboard, allowing for easy quality improvement analyses.
Results
When implemented, the app improved data collection for the M&M conference while providing a database for institutional quality improvement use. The authors also identified additional utility of the app, including ensuring appropriate revenue capture. The general appearance of the app and the dashboard can be found in the article.
Conclusion
The app developed in this project significantly improves on more common methods for M&M conference complication reporting—transforming M&M data into a valuable resource for resident education and quality improvement.
背景外科发病率和死亡率（M&M）会议是住院医师外科教育的重要组成部分，但收集和存储 M&M 数据的方法往往非常简单且不可靠。作者提出了一种符合《健康保险可携性和责任法案》（HIPAA）、与电子病历（EHR）相连的应用程序和数据库，用于报告和存储并发症数据。此外，所有数据都存储在安全的 SQL 数据库中，应用程序与数据库之间的通信经过端到端加密，符合 HIPAA 标准。整个手术团队都可以访问该应用程序，实现了并发症报告的民主化，并允许在住院和门诊环境中进行报告。然后，这些并发症信息可自动从应用程序中提取，并预先制作成演示文稿，用于 M&M 会议。这些数据还可以通过 Power BI 仪表板访问，便于进行质量改进分析。结果该应用程序在实施后，改进了 M&M 会议的数据收集工作，同时为机构质量改进提供了一个数据库。作者还发现了该应用程序的其他效用，包括确保适当的收入获取。本项目开发的应用程序大大改进了医学并发症会议报告的常用方法，将医学并发症数据转化为住院医师教育和质量改进的宝贵资源。
{"title":"Real-Time Reporting of Complications in Hospitalized Surgical Patients by Surgical Team Members Using a Smartphone Application","authors":"Kyle W. Blackburn (is Medical Student, School of Medicine, Baylor College of Medicine, Houston.), Lisa S. Brubaker MD (is General Surgery Resident, Department of Surgery, Baylor College of Medicine.), George Van Buren II MD (is Associate Professor, Department of Surgery, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center, Houston.), Emily Feng (is Clinical Research Coordinator at San Francisco Otolaryngology, Department of Surgery, Baylor College of Medicine.), Sadde Mohamed (is Medical Student, School of Medicine, Yale University.), Uma Ramamurthy PhD MBA (is Associate Professor Department of Pediatrics, Baylor College of Medicine.), Vivek Ramanathan MS (is Software Engineer, Office of Research IT, Baylor College of Medicine.), Amy L. Wood MPH (is Clinical Research Manager, Department of Surgery, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center.), Martha E. Navarro Cagigas MD (is Senior Research Coordinator, Department of Surgery, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center.), William E. Fisher MD (is Professor, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center. Please address correspondence to William E. Fisher)","doi":"10.1016/j.jcjq.2024.02.004","DOIUrl":"10.1016/j.jcjq.2024.02.004","url":null,"abstract":"<div><h3>Background</h3><p>The surgical morbidity and mortality (M&M) conference is a vital part of a resident's surgical education, but methods to collect and store M&M data are often rudimentary and unreliable. The authors propose a Health Insurance Portability and Accountability Act (HIPAA)–compliant, electronic health record (EHR)–connected application and database to report and store complication data.</p></div><div><h3>Methods</h3><p>The app is linked to the patient's EHR, and as a result, basic data on each surgical case—including diagnosis, surgery type, and surgeon—are automatically uploaded to the app. In addition, all data are stored in a secure SQL database—with communications between the app and the database end-to-end encrypted for HIPAA compliance. The full surgical team has access to the app, democratizing complications reporting and allowing for reporting in both the inpatient and outpatient settings. This complication information can then be automatically pulled from the app with a premade presentation for the M&M conference. The data can also be accessed by a Power BI dashboard, allowing for easy quality improvement analyses.</p></div><div><h3>Results</h3><p>When implemented, the app improved data collection for the M&M conference while providing a database for institutional quality improvement use. The authors also identified additional utility of the app, including ensuring appropriate revenue capture. The general appearance of the app and the dashboard can be found in the article.</p></div><div><h3>Conclusion</h3><p>The app developed in this project significantly improves on more common methods for M&M conference complication reporting—transforming M&M data into a valuable resource for resident education and quality improvement.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140468120","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}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.02.007
Salome O. Chitavi PhD (is Research Scientist II, Department of Research, Division of Healthcare Quality Evaluation and Improvement, The Joint Commission, Oakbrook Terrace, Illinois.), Jamie Patrianakos PhD (is Research Scientist I, Department of Research, Division of Healthcare Quality Evaluation and Improvement. The Joint Commission.), Scott C. Williams PsyD (is Director, Department of Research, Division of Healthcare Quality Evaluation and Improvement, The Joint Commission.), Stephen P. Schmaltz PhD, MPH, MS (is Senior Biostatistician, Department of Research, Division of Healthcare Quality Evaluation and Improvement, The Joint Commission.), Brian K. Ahmedani PhD, LMSW (is Director, Center for Health Policy and Health Services Research, and Director of Research, Behavioral Health Services, Henry Ford Health, Detroit.), Kimberly Roaten PhD, ABPP (is Professor, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas.), Edwin D. Boudreaux PhD (is Professor, Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School.), Gregory K. Brown PhD (is Associate Professor of Clinical Psychology in Psychiatry, Perelman School of Medicine, University of Pennyslvania. Please address correspondence to Salome Chitavi)
Background
The Joint Commission's National Patient Safety Goal (NPSG) for suicide prevention (NPSG.15.01.01) requires that accredited hospitals maintain policies/procedures for follow-up care at discharge for patients identified as at risk for suicide. The proportion of hospitals meeting these requirements through use of recommended discharge practices is unknown.
Methods
This cross-sectional observational study explored the prevalence of suicide prevention activities among Joint Commission–accredited hospitals. A questionnaire was sent to 1,148 accredited hospitals. The authors calculated the percentage of hospitals reporting implementation of four recommended discharge practices for suicide prevention.
Results
Of 1,148 hospitals, 346 (30.1%) responded. The majority (n = 212 [61.3%]) of hospitals had implemented formal safety planning, but few of those (n = 41 [19.3%]) included all key components of safety planning. Approximately a third of hospitals provided a warm handoff to outpatient care (n = 128 [37.0%)] or made follow-up contact with patients (n = 105 [30.3%]), and approximately a quarter (n = 97 [28.0%]) developed a plan for lethal means safety. Very few (n = 14 [4.0%]) hospitals met full criteria for implementing recommended suicide prevention activities at time of discharge.
Conclusion
The study revealed a significant gap in implementation of recommended practices related to prevention of suicide postdischarge. Additional research is needed to identify factors contributing to this implementation gap.
{"title":"Evaluating the Prevalence of Four Recommended Practices for Suicide Prevention Following Hospital Discharge","authors":"Salome O. Chitavi PhD (is Research Scientist II, Department of Research, Division of Healthcare Quality Evaluation and Improvement, The Joint Commission, Oakbrook Terrace, Illinois.), Jamie Patrianakos PhD (is Research Scientist I, Department of Research, Division of Healthcare Quality Evaluation and Improvement. The Joint Commission.), Scott C. Williams PsyD (is Director, Department of Research, Division of Healthcare Quality Evaluation and Improvement, The Joint Commission.), Stephen P. Schmaltz PhD, MPH, MS (is Senior Biostatistician, Department of Research, Division of Healthcare Quality Evaluation and Improvement, The Joint Commission.), Brian K. Ahmedani PhD, LMSW (is Director, Center for Health Policy and Health Services Research, and Director of Research, Behavioral Health Services, Henry Ford Health, Detroit.), Kimberly Roaten PhD, ABPP (is Professor, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas.), Edwin D. Boudreaux PhD (is Professor, Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School.), Gregory K. Brown PhD (is Associate Professor of Clinical Psychology in Psychiatry, Perelman School of Medicine, University of Pennyslvania. Please address correspondence to Salome Chitavi)","doi":"10.1016/j.jcjq.2024.02.007","DOIUrl":"10.1016/j.jcjq.2024.02.007","url":null,"abstract":"<div><h3>Background</h3><p>The Joint Commission's National Patient Safety Goal (NPSG) for suicide prevention (NPSG.15.01.01) requires that accredited hospitals maintain policies/procedures for follow-up care at discharge for patients identified as at risk for suicide. The proportion of hospitals meeting these requirements through use of recommended discharge practices is unknown.</p></div><div><h3>Methods</h3><p>This cross-sectional observational study explored the prevalence of suicide prevention activities among Joint Commission–accredited hospitals. A questionnaire was sent to 1,148 accredited hospitals. The authors calculated the percentage of hospitals reporting implementation of four recommended discharge practices for suicide prevention.</p></div><div><h3>Results</h3><p>Of 1,148 hospitals, 346 (30.1%) responded. The majority (<em>n</em> = 212 [61.3%]) of hospitals had implemented formal safety planning, but few of those (<em>n</em> = 41 [19.3%]) included all key components of safety planning. Approximately a third of hospitals provided a warm handoff to outpatient care (<em>n</em> = 128 [37.0%)] or made follow-up contact with patients (<em>n</em> = 105 [30.3%]), and approximately a quarter (<em>n</em> = 97 [28.0%]) developed a plan for lethal means safety. Very few (<em>n</em> = 14 [4.0%]) hospitals met full criteria for implementing recommended suicide prevention activities at time of discharge.</p></div><div><h3>Conclusion</h3><p>The study revealed a significant gap in implementation of recommended practices related to prevention of suicide postdischarge. Additional research is needed to identify factors contributing to this implementation gap.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024000679/pdfft?md5=e6b6403241b88154c3809606c04f8ba4&pid=1-s2.0-S1553725024000679-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140305668","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}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.04.002
Sara E. Cosgrove MD, MS (is Professor of Medicine, Johns Hopkins University School of Medicine, and Director, Department of Antimicrobial Stewardship, The Johns Hopkins Hospital, Baltimore.), Roy Ahn ScM, ScD (is Vice President, Public Health, NORC at the University of Chicago.), Prashila Dullabh MD (is Vice President and Senior Fellow, Health Sciences, and Director, Health Implementation Science Center, NORC at the University of Chicago.), Janna Gordon PhD (is Research Scientist, Health Sciences, NORC at the University of Chicago.), Melissa A. Miller MD, MS (is Medical Officer, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland.), Pranita D. Tamma MD, MHS (is Associate Professor of Pediatrics, Johns Hopkins University School of Medicine. Please address correspondence to Pranita D. Tamma)
Background
The goal of antibiotic stewardship programs (ASPs) is to ensure that patients receive effective therapy while minimizing adverse events. To overcome barriers commonly faced in implementing successful ASPs, the Agency for Healthcare Research and Quality (AHRQ) established a multifaceted, nationwide Safety Program for Improving Antibiotic Use in 2018. This report summarizes the lessons learned from the implementation of this initiative based on structured interviews of personnel from participating sites.
Methods
At the completion of the one-year initiative, semistructured exit interviews were conducted with site leaders at 151 of the 402 hospitals that participated. These interviews consisted of open-ended questions about the perceived effectiveness of components of the Safety Program. Qualitative analyses incorporated both deductive coding themes (based on existing literature) and an iteratively developed inductive coding framework (based on salient themes that emerged from a subset of interviews).
Results
Several components of the Safety Program were identified as effective in expanding local stewardship activities, including techniques and strategies to implement sustainable ASPs, access to Implementation Advisors to keep sites engaged, provision of local benchmarked antibiotic use data to compare to similar hospitals, and Safety Program materials such as the antibiotic time-out tool to integrate stewardship techniques into daily work flows. The biggest challenges to greater effectiveness were suboptimal frontline staff engagement and difficulty changing antibiotic prescribing culture. Some approaches used to overcome these barriers (peer-to-peer communication and education through team huddles, identifying physician champions, informal rounds to enhance collegiality and buy-in, and engagement of hospital leadership) were identified.
Conclusion
Lessons learned from the Safety Program can be applied by other teams looking to promote an effective ASP at their hospital or system. The themes that emerged in this study likely also have relevance across a wide range of large-scale quality improvement initiatives.
{"title":"Lessons Learned from a National Hospital Antibiotic Stewardship Implementation Project","authors":"Sara E. Cosgrove MD, MS (is Professor of Medicine, Johns Hopkins University School of Medicine, and Director, Department of Antimicrobial Stewardship, The Johns Hopkins Hospital, Baltimore.), Roy Ahn ScM, ScD (is Vice President, Public Health, NORC at the University of Chicago.), Prashila Dullabh MD (is Vice President and Senior Fellow, Health Sciences, and Director, Health Implementation Science Center, NORC at the University of Chicago.), Janna Gordon PhD (is Research Scientist, Health Sciences, NORC at the University of Chicago.), Melissa A. Miller MD, MS (is Medical Officer, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland.), Pranita D. Tamma MD, MHS (is Associate Professor of Pediatrics, Johns Hopkins University School of Medicine. Please address correspondence to Pranita D. Tamma)","doi":"10.1016/j.jcjq.2024.04.002","DOIUrl":"10.1016/j.jcjq.2024.04.002","url":null,"abstract":"<div><h3>Background</h3><p>The goal of antibiotic stewardship programs (ASPs) is to ensure that patients receive effective therapy while minimizing adverse events. To overcome barriers commonly faced in implementing successful ASPs, the Agency for Healthcare Research and Quality (AHRQ) established a multifaceted, nationwide Safety Program for Improving Antibiotic Use in 2018. This report summarizes the lessons learned from the implementation of this initiative based on structured interviews of personnel from participating sites.</p></div><div><h3>Methods</h3><p>At the completion of the one-year initiative, semistructured exit interviews were conducted with site leaders at 151 of the 402 hospitals that participated. These interviews consisted of open-ended questions about the perceived effectiveness of components of the Safety Program. Qualitative analyses incorporated both deductive coding themes (based on existing literature) and an iteratively developed inductive coding framework (based on salient themes that emerged from a subset of interviews).</p></div><div><h3>Results</h3><p>Several components of the Safety Program were identified as effective in expanding local stewardship activities, including techniques and strategies to implement sustainable ASPs, access to Implementation Advisors to keep sites engaged, provision of local benchmarked antibiotic use data to compare to similar hospitals, and Safety Program materials such as the antibiotic time-out tool to integrate stewardship techniques into daily work flows. The biggest challenges to greater effectiveness were suboptimal frontline staff engagement and difficulty changing antibiotic prescribing culture. Some approaches used to overcome these barriers (peer-to-peer communication and education through team huddles, identifying physician champions, informal rounds to enhance collegiality and buy-in, and engagement of hospital leadership) were identified.</p></div><div><h3>Conclusion</h3><p>Lessons learned from the Safety Program can be applied by other teams looking to promote an effective ASP at their hospital or system. The themes that emerged in this study likely also have relevance across a wide range of large-scale quality improvement initiatives.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775572","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}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.03.006
Brenda Bursch PhD (is Professor, Department of Psychiatry and Biobehavioral Sciences, and Department of Pediatrics, David Geffen School of Medicine at UCLA.), Keren Ziv MD (is Clinical Professor, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA.), Shevaughn Marchese (is Faculty Development and Career Advancement Program Manager, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA.), Hilary Aralis PhD (is Professor, Department of Biostatistics, UCLA Fielding School of Public Health.), Teresa Bufford PhD (formerly Graduate Student Researcher and Biostatistician, Department of Biostatistics, UCLA Fielding School of Public Health, is Principal Statistician GSK, Wynnewood, Pennsylvania.), Patricia Lester MD (is Professor, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA. Please address correspondence to Brenda Bursch)
Background
Most anesthesia providers experience an adverse event during their training or career. Limited evidence suggests skilled peer support programs (SPSPs) reduce initial distress and support adaptive functioning and coping. This study evaluated second victim perceptions of a voluntary SPSP.
Methods
An SPSP was developed and implemented for all clinical and administrative personnel in the Department of Anesthesiology and Perioperative Medicine in three hospitals and six outpatient surgery centers in December 2017. The program incorporated the Scott Three-Tiered Interventional Model of Second Victim Support. Surveys were offered to clinicians in the department prior to implementation of the SPSP and again 18 months after implementation. Among the subset of respondents who experienced a serious adverse patient event, the authors used multiple logistic regression models that adjusted for role and number of night shifts per month to examine differences in perceived resource availability and post-event support received following implementation of the program.
Results
There were 94 surveys (83 complete; 11 partially complete) collected prior to implementation and 84 surveys (67 complete; 17 partially complete) collected after implementation. A total of 25 individuals took the survey at both pre and post (19 complete). After implementation, 62.5% of respondents indicated that institutional support had improved since the occurrence of their serious adverse patient event. Statistical models identified a significant improvement in the probability that a clinician agreed with the statement “I think that the organization learned from the event and took appropriate steps to reduce the chance of it happening again” at post vs. pre (adjusted odds ratio [aOR] 3.9, 95% confidence interval [CI] 1.01–15.1. A statistically significant increase from pre to post in the perceived availability of formal emotional support was identified (aOR 5.2, 95% CI 1.9–22.5).
Conclusion
Implementation of a skilled peer support program within a large department of anesthesiology can improve institutional-based emotional support.
{"title":"Department of Anesthesiology Skilled Peer Support Program Outcomes: Second Victim Perceptions","authors":"Brenda Bursch PhD (is Professor, Department of Psychiatry and Biobehavioral Sciences, and Department of Pediatrics, David Geffen School of Medicine at UCLA.), Keren Ziv MD (is Clinical Professor, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA.), Shevaughn Marchese (is Faculty Development and Career Advancement Program Manager, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA.), Hilary Aralis PhD (is Professor, Department of Biostatistics, UCLA Fielding School of Public Health.), Teresa Bufford PhD (formerly Graduate Student Researcher and Biostatistician, Department of Biostatistics, UCLA Fielding School of Public Health, is Principal Statistician GSK, Wynnewood, Pennsylvania.), Patricia Lester MD (is Professor, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA. Please address correspondence to Brenda Bursch)","doi":"10.1016/j.jcjq.2024.03.006","DOIUrl":"10.1016/j.jcjq.2024.03.006","url":null,"abstract":"<div><h3>Background</h3><p>Most anesthesia providers experience an adverse event during their training or career. Limited evidence suggests skilled peer support programs (SPSPs) reduce initial distress and support adaptive functioning and coping. This study evaluated second victim perceptions of a voluntary SPSP.</p></div><div><h3>Methods</h3><p>An SPSP was developed and implemented for all clinical and administrative personnel in the Department of Anesthesiology and Perioperative Medicine in three hospitals and six outpatient surgery centers in December 2017. The program incorporated the Scott Three-Tiered Interventional Model of Second Victim Support. Surveys were offered to clinicians in the department prior to implementation of the SPSP and again 18 months after implementation. Among the subset of respondents who experienced a serious adverse patient event, the authors used multiple logistic regression models that adjusted for role and number of night shifts per month to examine differences in perceived resource availability and post-event support received following implementation of the program.</p></div><div><h3>Results</h3><p>There were 94 surveys (83 complete; 11 partially complete) collected prior to implementation and 84 surveys (67 complete; 17 partially complete) collected after implementation. A total of 25 individuals took the survey at both pre and post (19 complete). After implementation, 62.5% of respondents indicated that institutional support had improved since the occurrence of their serious adverse patient event. Statistical models identified a significant improvement in the probability that a clinician agreed with the statement “I think that the organization learned from the event and took appropriate steps to reduce the chance of it happening again” at post vs. pre (adjusted odds ratio [aOR] 3.9, 95% confidence interval [CI] 1.01–15.1. A statistically significant increase from pre to post in the perceived availability of formal emotional support was identified (aOR 5.2, 95% CI 1.9–22.5).</p></div><div><h3>Conclusion</h3><p>Implementation of a skilled peer support program within a large department of anesthesiology can improve institutional-based emotional support.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024000746/pdfft?md5=c1cd74759868024f5c517009e4ebccbb&pid=1-s2.0-S1553725024000746-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140280918","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}
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