Joint Commission journal on quality and patient safety最新文献

Background: Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, are common causes of preventable hospital death. Most VTEs diagnosed in the outpatient setting are directly linked to a recent hospitalization or surgery.

Methods: A type 2 effectiveness-implementation hybrid study was conducted to develop and implement targeted interventions to improve care for patients with VTE in six US health systems. Primary outcomes included (1) 7-day follow-up after VTE diagnosis (phone calls, office visits); (2) VTE-related hospitalizations or emergency department (ED) visits within 45 days of acute VTE diagnosis; and (3) anticoagulant-associated adverse drug events (ADEs). Qualitative comparative analysis (QCA) identified interventions associated with improved care for patients with VTE.

Results: Among 1,265 patients, follow-up within 7 days of an index VTE diagnosis improved from 25.2% to 33.6% (p < 0.0001); among 2,002 patients, hospitalizations/ED visits within 45 days of VTE diagnosis decreased across settings from 7.8% to 6.3% (p = 0.033), and the rate of anticoagulant-associated ADEs remained low (3.1% to 3.4%, p = 0.528). Factors characteristic of improving 7-day follow-up included combinations of (1) safer prescribing and management of anticoagulants and standardized protocols with centralized care processes or (2) safer prescribing and management of anticoagulants with improved care team communication and expanded anticoagulation clinic access for patients prescribed direct oral anticoagulants. Factors associated with 45-day hospitalization/ED visits improvement included high baseline rates of 7-day follow-up, high rates of baseline 45-day hospitalization/ED visits (larger opportunity), improved care team communication, and improved standardization and centralization of protocols.

Conclusion: Combinations of interventions, tailored to local context and team dynamics, improved ambulatory follow-up rates and reduced VTE-related utilization. Health systems may benefit from considering novel, implementation science-informed strategies to foster improvement.

Background: The cardiac operating room is a complex, high-risk, sociotechnical system. Risks in cardiac surgery and anesthesiology have been extensively categorized, but less is known about effective risk reduction strategies. A comprehensive understanding of effective, evidence-based risk reduction strategies is necessary to improve patient safety in cardiac anesthesia.

Methods: An advanced literature search of MEDLINE, CINAHL, Embase, and Web of Science databases was conducted to identify studies involving the introduction of a tool or intervention to improve patient safety and human factors in cardiac anesthesia. Studies were screened independently by two authors applying prespecified inclusion and exclusion criteria. Risk reduction strategies and safety initiatives identified were classified according to the Systems Engineering Initiative for Patient Safety model. Data were extracted using a standardized form and were narratively synthesized.

Results: A total of 18 studies were identified for inclusion using preoperative briefing tools, intraoperative checklists, and postoperative handover tools. Preoperative briefing tools were associated with a significant reduction in patient mortality and length of hospital stay and also led to adaptations to planned operation. Intraoperative checklists demonstrated decreased bleeding, mortality, and blood transfusion requirements. Postoperative handover tools were associated with improved information transfer and teamwork.

Conclusion: This review identified three categories of tools that may be used to improve patient and organizational outcomes. Many of these tools are simple to introduce and sustainable in the long term and can be readily adapted to different centers.

Background: Telehealth involves providing health care remotely using communication tools such as telephone, video, and remote patient monitoring. Research on telehealth has shown many benefits, including improved access to care and reduced costs, and drawbacks, including delays in care, breakdowns in communication, and missed diagnoses. The use of telehealth nationally, including in the Veterans Health Administration (VHA), expanded dramatically during the COVID-19 pandemic. Despite its increased use, few studies have described adverse events or the role of patient safety in the provision of telehealth.

Methods: The authors looked at all reports of adverse events and close calls in the VHA involving the use of telehealth between October 1, 2022, and February 2, 2023, and coded each case for the location of the event, type of event, and causes.

Results: A total of 145 reports met criteria for review. Most events occurred in primary care, outpatient behavioral health, and radiology, with delays in care, medication errors, and equipment problems being common types. Most reported events did not cause harm; 45 cases were identified as an unsafe condition, 37 as a close call, and 15 as causing some harm to the patient. There were 3,609,105 telehealth episodes of care during this time, resulting in a reporting rate of 4.02 per 100,000 episodes of care and 0.42 reports of harm per 100,000 episodes of care.

Conclusion: The most frequent telehealth-related events were delays in care, medication errors, and equipment issues, and most events were not unique to this modality. Further research is needed to characterize safety events unique to telehealth to better define parameters for patient safety activities. Recommendations to reduce errors include ongoing provider training, human factors analysis of telehealth processes, simplifying processes and procedures for providers and patients to get help for technical or knowledge deficits in real time, and examining the business rules for telehealth care.

Background: Medical-legal partnerships (MLPs) are a hospital-based resource for patients and families to address health-related legal needs, which often align closely with health-related social needs (HRSNs). For instance, patients and their families with housing insecurity or education, immigration, family law, or other legal needs, or who are having trouble accessing government benefits programs are referred by their health care provider to the MLP. Next, an intake process determines eligibility for MLP services that will result in connecting the patients and their families with resources or legal assistance to address the HRSNs. The Joint Commission's health equity requirements were established as a quality and safety imperative and focus on obtaining patient-specific data for HRSNs in the populations a hospital serves to address the root causes of disparities in patients' health outcomes. The authors examined data for pediatric patients referred to the hospital's MLP as an example of using legal referral data to obtain HRSNs data to comply with these requirements.

Methods: The researchers collected and analyzed data on sociodemographic factors, clinical characteristics, and reason for referral of pediatric patients to a hospital-based MLP. Data were collected from January 1, 2019, to December 31, 2021, spanning the duration of the COVID-19 pandemic. The legal matters from January 1, 2019, to March 9, 2020, were classified as pre-COVID-19 pandemic legal matters, and the legal matters from March 10, 2020, to December 31, 2021, were classified as having occurred during the COVID-19 pandemic. These two time periods were analyzed to account for any pandemic-related effects.

Results: A total of 628 patients (median age 9.0 years; male 48.2%) were referred for 611 legal matters (referrals including more than 1 patient from a single household were counted once). Patients were more likely to be Hispanic/Latino, Black/African American, English-speaking, and publicly insured. Many had at least one complex chronic condition (44.4%). More than half of referrals were for housing insecurity (52.1%). This was consistent in the pre-COVID-19 pandemic period and during the COVID-19 period (52.0% vs. 52.2%, p = 0.95).

Conclusion: Most MLP referrals were for housing insecurity in children from medically underserved or marginalized populations. Aligning The Joint Commission's health equity requirements with legal referral data is a generalizable approach to improve the collection of HRSNs data for addressing disparities in health outcomes in the populations the hospital serves.