Pub Date : 2024-11-08DOI: 10.1016/j.jcjq.2024.11.002
Roma A Vasa, Vamsi K Kalari, Christopher A Kitchen, Hadi Kharrazi, John V Campo, Holly C Wilcox
Background: Youth with autism spectrum disorder (ASD) are over three times more likely to experience suicidal thoughts and behaviors (STB) than children in the general population. Screening to detect suicide risk is therefore critical for youth with ASD. This study examines the capacity of the Ask Suicide-Screening Questions (ASQ), a standard suicide screening tool, to detect suicide risk in children and adolescents with ASD who present to the pediatric emergency department (PED).
Methods: This is a retrospective chart review of 393 (2.1%) youth with ASD and 17,964 (97.9%) youth without ASD, aged 8 to 21 years, who presented to the PED of a large urban academic medical center between 2017 and 2020. During the study period, the ASQ was universally administered to children and adolescents who presented to the PED for any reason. Data extracted from the electronic health record included demographic information, presenting concerns, ASD diagnosis, and ASQ results.
Results: Autistic children and adolescents were more likely to present to the PED with STB at the first PED visit compared to non-autistic children (12.7% vs. 4.4%, p < 0.001). In both autistic and non-autistic groups, presenting concerns about STB were significantly associated with a positive ASQ screen. More autistic youth were found to have a positive ASQ without STB as their chief presenting complaint as compared to non-autistic youth (22.6% vs. 11.6%, p < 0.001). Youth with ASD endorsed each item of the ASQ at roughly twice the rate of those without ASD.
Conclusion: This preliminary descriptive study indicates that the ASQ may be a promising screening tool to assess suicide risk in autistic individuals. Further research on the predictive validity and overall reliability of the ASQ in youth with ASD is recommended.
{"title":"Suicide Risk Screening in Children and Adolescents with Autism Spectrum Disorder Presenting to the Emergency Department.","authors":"Roma A Vasa, Vamsi K Kalari, Christopher A Kitchen, Hadi Kharrazi, John V Campo, Holly C Wilcox","doi":"10.1016/j.jcjq.2024.11.002","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.11.002","url":null,"abstract":"<p><strong>Background: </strong>Youth with autism spectrum disorder (ASD) are over three times more likely to experience suicidal thoughts and behaviors (STB) than children in the general population. Screening to detect suicide risk is therefore critical for youth with ASD. This study examines the capacity of the Ask Suicide-Screening Questions (ASQ), a standard suicide screening tool, to detect suicide risk in children and adolescents with ASD who present to the pediatric emergency department (PED).</p><p><strong>Methods: </strong>This is a retrospective chart review of 393 (2.1%) youth with ASD and 17,964 (97.9%) youth without ASD, aged 8 to 21 years, who presented to the PED of a large urban academic medical center between 2017 and 2020. During the study period, the ASQ was universally administered to children and adolescents who presented to the PED for any reason. Data extracted from the electronic health record included demographic information, presenting concerns, ASD diagnosis, and ASQ results.</p><p><strong>Results: </strong>Autistic children and adolescents were more likely to present to the PED with STB at the first PED visit compared to non-autistic children (12.7% vs. 4.4%, p < 0.001). In both autistic and non-autistic groups, presenting concerns about STB were significantly associated with a positive ASQ screen. More autistic youth were found to have a positive ASQ without STB as their chief presenting complaint as compared to non-autistic youth (22.6% vs. 11.6%, p < 0.001). Youth with ASD endorsed each item of the ASQ at roughly twice the rate of those without ASD.</p><p><strong>Conclusion: </strong>This preliminary descriptive study indicates that the ASQ may be a promising screening tool to assess suicide risk in autistic individuals. Further research on the predictive validity and overall reliability of the ASQ in youth with ASD is recommended.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876461","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 : 2024-11-08DOI: 10.1016/j.jcjq.2024.10.011
Melissa H Chouinard, Natalie L Nguyen, Joshua A Young, Benjamin M Hester, Denise M Reilly, Michael C Kontos, William D Cahoon, Cassandra R Baker, Kylie M Weigel, Gonzalo M Bearman
In a landscape of increasingly frequent and severe drug shortages, this article describes an interdisciplinary strategy for managing a nationwide shortage of dobutamine in an academic health system. The authors outline an approach that centers on leveraging information technology resources, minimizing waste, conserving supply, and centralizing supply. These efforts, which enabled the organization to consistently supply dobutamine to those patients who needed it most, could form a model for health systems to follow during future drug shortages.
{"title":"Reflections on a Dobutamine Shortage in an Academic Health System: A Roadmap for Risk Reduction.","authors":"Melissa H Chouinard, Natalie L Nguyen, Joshua A Young, Benjamin M Hester, Denise M Reilly, Michael C Kontos, William D Cahoon, Cassandra R Baker, Kylie M Weigel, Gonzalo M Bearman","doi":"10.1016/j.jcjq.2024.10.011","DOIUrl":"https://doi.org/10.1016/j.jcjq.2024.10.011","url":null,"abstract":"<p><p>In a landscape of increasingly frequent and severe drug shortages, this article describes an interdisciplinary strategy for managing a nationwide shortage of dobutamine in an academic health system. The authors outline an approach that centers on leveraging information technology resources, minimizing waste, conserving supply, and centralizing supply. These efforts, which enabled the organization to consistently supply dobutamine to those patients who needed it most, could form a model for health systems to follow during future drug shortages.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005627","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 : 2024-10-22DOI: 10.1016/j.jcjq.2024.10.007
Gerald B. Hickson MD (is Joseph C. Ross Chair in Medical Education and Administration and| Professor of Pediatrics, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville. Please address correspondence to Gerald B. Hickson)
{"title":"Supporting Professionalism in a Crisis Requires Leadership and a Well-Developed Plan","authors":"Gerald B. Hickson MD (is Joseph C. Ross Chair in Medical Education and Administration and| Professor of Pediatrics, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville. Please address correspondence to Gerald B. Hickson)","doi":"10.1016/j.jcjq.2024.10.007","DOIUrl":"10.1016/j.jcjq.2024.10.007","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 12","pages":"Pages 823-826"},"PeriodicalIF":2.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590582","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 : 2024-10-19DOI: 10.1016/j.jcjq.2024.10.001
Amy Lu MD, MPH (UCSF Health and Anesthesia and Perioperative Care, UCSF School of Medicine, San Francisco, CA) , May C.M. Pian-Smith MD, MS (Enterprise Anesthesiology Quality and Safety, Mass General Brigham, Harvard Medical School, Massachusetts General Hospital, Boston, MA) , Amanda Burden MD (Clinical Skills and Simulation Education, Cooper Medical School of Rowan University and Cooper University Healthcare, Camden, NJ), Gladys L. Fernandez MD (Surgery UMMS- Chan-Baystate, Baystate Health, Springfield, MA), Sally A. Fortner MD, MS, FACH (Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM), Robert V. Rege MD (Surgery, Undergraduate Medical Education, University of Texas Southwestern Medical Center, Dallas, TX), Douglas P. Slakey MD (Department of Surgery, University of Illinois at Chicago, Chicago, IL), Jose M. Velasco MD, FACS (Surgery, Surgical Innovation, Rush University, Chicago, IL), Jeffrey B. Cooper PhD (Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA), Randolph H. Steadman MD, MS (Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, TX)
Simulation is underutilized as a tool to improve healthcare quality and safety despite many examples of its effectiveness to identify and remedy quality and safety problems, improve teamwork, and improve various measures of quality and safety that are important to healthcare organizations, eg, patient safety indicators. We urge quality and safety and simulation professionals to collaborate with their counterparts in their organizations to employ simulation in ways that improve the quality and safety of care of their patients. These collaborations could begin through initiating conversations among the quality and safety and simulation professionals, perhaps using this article as a prompt for discussion, identifying one area in need of quality and safety improvement for which simulation can be helpful, and beginning that work.
{"title":"Quality and Simulation Professionals Should Collaborate","authors":"Amy Lu MD, MPH (UCSF Health and Anesthesia and Perioperative Care, UCSF School of Medicine, San Francisco, CA) , May C.M. Pian-Smith MD, MS (Enterprise Anesthesiology Quality and Safety, Mass General Brigham, Harvard Medical School, Massachusetts General Hospital, Boston, MA) , Amanda Burden MD (Clinical Skills and Simulation Education, Cooper Medical School of Rowan University and Cooper University Healthcare, Camden, NJ), Gladys L. Fernandez MD (Surgery UMMS- Chan-Baystate, Baystate Health, Springfield, MA), Sally A. Fortner MD, MS, FACH (Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM), Robert V. Rege MD (Surgery, Undergraduate Medical Education, University of Texas Southwestern Medical Center, Dallas, TX), Douglas P. Slakey MD (Department of Surgery, University of Illinois at Chicago, Chicago, IL), Jose M. Velasco MD, FACS (Surgery, Surgical Innovation, Rush University, Chicago, IL), Jeffrey B. Cooper PhD (Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA), Randolph H. Steadman MD, MS (Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, TX)","doi":"10.1016/j.jcjq.2024.10.001","DOIUrl":"10.1016/j.jcjq.2024.10.001","url":null,"abstract":"<div><div>Simulation is underutilized as a tool to improve healthcare quality and safety despite many examples of its effectiveness to identify and remedy quality and safety problems, improve teamwork, and improve various measures of quality and safety that are important to healthcare organizations, eg, patient safety indicators. We urge quality and safety and simulation professionals to collaborate with their counterparts in their organizations to employ simulation in ways that improve the quality and safety of care of their patients. These collaborations could begin through initiating conversations among the quality and safety and simulation professionals, perhaps using this article as a prompt for discussion, identifying one area in need of quality and safety improvement for which simulation can be helpful, and beginning that work.</div><div>(<em>Sim Healthcare</em> 19(5):319–325, 2024)</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 12","pages":"Pages 882-889"},"PeriodicalIF":2.3,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557876","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 : 2024-09-20DOI: 10.1016/j.jcjq.2024.09.004
Crystal C. Wright MD, FASA (is Professor, Department of Anesthesiology & Perioperative Medicine, and Director, Center for Professionalism, Support, and Success (CPSS), University of Texas MD Anderson Cancer Center, Houston.), Maureen D. Triller DrPH, PMP, PHR, CMQ (is Administrative Director, CPSS, University of Texas MD Anderson Cancer Center.), Anne S. Tsao MD, MBA (is Professor, Department of Thoracic/Head & Neck Medical Oncology, and Vice President, Academic Affairs, University of Texas MD Anderson Cancer Center.), Stephanie A. Zajac PhD (is Senior Leadership Practitioner, University of Texas MD Anderson Cancer Center.), Cindy Segal PhD, MSN, RN (is Associate Director of Operating Room, Department of Perioperative Services, University of Texas MD Anderson Cancer Center.), Elizabeth P. Ninan PA, MBA (is Associate Vice President, Division of Procedures and Therapeutics, University of Texas MD Anderson Cancer Center.), Jenise B. Rice MSN, RN-CPAN (is Director, Nursing Perioperative Services PACU, Department of Perioperative Services, University of Texas MD Anderson Cancer Center.), William O. Cooper MD, MPH (is Professor, Pediatrics and Health Policy, and President, Vanderbilt Center for Patient and Professional Advocacy, Vanderbilt University Medical Center.), Carin A. Hagberg MD, FASA (is Professor, Department of Anesthesiology & Perioperative Medicine, and Chief Academic Officer, University of Texas MD Anderson Cancer Center.), Mark W. Clemens MD, MBA, FACS (is Associate Vice President of Perioperative Services, and Associate Professor, Department of Plastic Surgery, University of Texas MD Anderson Cancer Center. Please address correspondence to Crystal C. Wright)
Background
This retrospective comparative cohort study aimed to evaluate the effects of COVID-19 on professionalism within the perioperative environment of a tertiary cancer center across three periods: pre-pandemic, pandemic, and an interventional endemic phase.
Methods
A retrospective observational review of a prospectively maintained safety event report (SER) database at MD Anderson Cancer Center, with an intervention during the COVID-19 endemic phase, was conducted. This was performed to compare the incidence of professionalism-related events (PRE), which are included in the SER database, during the COVID-19 pandemic period (March 2020 to May 2022), with a pre-pandemic period (September 2011 to February 2020) and a postintervention endemic phase (June 2022 to March 2023). Study interventions included the application of the Vanderbilt Professionalism Escalation Model with broad staff and surgical team education.
Results
During the study period, 17,425 SERs were reviewed. Of these, 11,731 (mean 115.0 SERs/month) were reported in the pre-pandemic period, 4,004 SERs (mean 148.3 SERs/month) in the pandemic period, and 1,690 SERs (mean 169.0 SERs/month) in the endemic phase (p = 0.001). There was a statistically significant increase in the incidence of PRE during the pandemic compared to the pre-pandemic and endemic periods. Specifically, 264 PRE (1.5%) were identified during the study period: 114 PRE (mean 1.1 PRE/month) in the pre-pandemic period, 121 PRE (mean 4.5 PRE/month) in the pandemic period, and 29 PRE (mean 2.9 PRE/month) in the endemic phase (p = 0.001). The increase in PRE during the pandemic period corresponded to a concomitant increase in staff turnover rates (15.5%) compared to the pre-pandemic period (8.3%). However, a time shift of four months into the postintervention endemic phase demonstrated a successful reduction to less than pre-pandemic levels of staff turnover (6.7%, p = 0.001).
Conclusion
The COVID-19 pandemic was associated with a significant increase in SERs describing professionalism lapses among health care providers in the perioperative environment. Hospital organizations must recognize the impact of professionalism on morale and turnover and seek to mitigate its effects. Education, promoting individual accountability, confidential reporting, addressing wellness concerns, and providing modes of resilience can enhance workplace culture and potentially cultivate better employee retention rates.
{"title":"Strategies to Mitigate the Pandemic Aftermath on Perioperative Professionalism","authors":"Crystal C. Wright MD, FASA (is Professor, Department of Anesthesiology & Perioperative Medicine, and Director, Center for Professionalism, Support, and Success (CPSS), University of Texas MD Anderson Cancer Center, Houston.), Maureen D. Triller DrPH, PMP, PHR, CMQ (is Administrative Director, CPSS, University of Texas MD Anderson Cancer Center.), Anne S. Tsao MD, MBA (is Professor, Department of Thoracic/Head & Neck Medical Oncology, and Vice President, Academic Affairs, University of Texas MD Anderson Cancer Center.), Stephanie A. Zajac PhD (is Senior Leadership Practitioner, University of Texas MD Anderson Cancer Center.), Cindy Segal PhD, MSN, RN (is Associate Director of Operating Room, Department of Perioperative Services, University of Texas MD Anderson Cancer Center.), Elizabeth P. Ninan PA, MBA (is Associate Vice President, Division of Procedures and Therapeutics, University of Texas MD Anderson Cancer Center.), Jenise B. Rice MSN, RN-CPAN (is Director, Nursing Perioperative Services PACU, Department of Perioperative Services, University of Texas MD Anderson Cancer Center.), William O. Cooper MD, MPH (is Professor, Pediatrics and Health Policy, and President, Vanderbilt Center for Patient and Professional Advocacy, Vanderbilt University Medical Center.), Carin A. Hagberg MD, FASA (is Professor, Department of Anesthesiology & Perioperative Medicine, and Chief Academic Officer, University of Texas MD Anderson Cancer Center.), Mark W. Clemens MD, MBA, FACS (is Associate Vice President of Perioperative Services, and Associate Professor, Department of Plastic Surgery, University of Texas MD Anderson Cancer Center. Please address correspondence to Crystal C. Wright)","doi":"10.1016/j.jcjq.2024.09.004","DOIUrl":"10.1016/j.jcjq.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>This retrospective comparative cohort study aimed to evaluate the effects of COVID-19 on professionalism within the perioperative environment of a tertiary cancer center across three periods: pre-pandemic, pandemic, and an interventional endemic phase.</div></div><div><h3>Methods</h3><div>A retrospective observational review of a prospectively maintained safety event report (SER) database at MD Anderson Cancer Center, with an intervention during the COVID-19 endemic phase, was conducted. This was performed to compare the incidence of professionalism-related events (PRE), which are included in the SER database, during the COVID-19 pandemic period (March 2020 to May 2022), with a pre-pandemic period (September 2011 to February 2020) and a postintervention endemic phase (June 2022 to March 2023). Study interventions included the application of the Vanderbilt Professionalism Escalation Model with broad staff and surgical team education.</div></div><div><h3>Results</h3><div>During the study period, 17,425 SERs were reviewed. Of these, 11,731 (mean 115.0 SERs/month) were reported in the pre-pandemic period, 4,004 SERs (mean 148.3 SERs/month) in the pandemic period, and 1,690 SERs (mean 169.0 SERs/month) in the endemic phase (<em>p</em> = 0.001). There was a statistically significant increase in the incidence of PRE during the pandemic compared to the pre-pandemic and endemic periods. Specifically, 264 PRE (1.5%) were identified during the study period: 114 PRE (mean 1.1 PRE/month) in the pre-pandemic period, 121 PRE (mean 4.5 PRE/month) in the pandemic period, and 29 PRE (mean 2.9 PRE/month) in the endemic phase (<em>p</em> = 0.001). The increase in PRE during the pandemic period corresponded to a concomitant increase in staff turnover rates (15.5%) compared to the pre-pandemic period (8.3%). However, a time shift of four months into the postintervention endemic phase demonstrated a successful reduction to less than pre-pandemic levels of staff turnover (6.7%, <em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>The COVID-19 pandemic was associated with a significant increase in SERs describing professionalism lapses among health care providers in the perioperative environment. Hospital organizations must recognize the impact of professionalism on morale and turnover and seek to mitigate its effects. Education, promoting individual accountability, confidential reporting, addressing wellness concerns, and providing modes of resilience can enhance workplace culture and potentially cultivate better employee retention rates.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 12","pages":"Pages 827-833"},"PeriodicalIF":2.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590577","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 : 2024-09-20DOI: 10.1016/j.jcjq.2024.09.001
Teena Nelson MHA (is Manager, ABMS Portfolio Program, American Board of Medical Specialties, Chicago.), Spencer Walter (is Program Manager, ABMS Portfolio Program, American Board of Medical Specialties.), Ann Williamson RN, CCRC (is Performance Improvement Program Manager, American Board of Family Medicine, Lexington, Kentucky.), Kevin Graves MBA (is Strategic Project Manager, American Board of Family Medicine.), Peggy Paulson MA (is Operations Manager–Education, Mayo Clinic, Rochester, Minnesota.), Greg Ogrinc MD, MS (is Senior Vice President, American Board of Medical Specialties, and Clinical Professor of Medicine, University of Illinois College of Medicine at Chicago. Please address all correspondence to Teena Nelson)
Background
Physician involvement in quality improvement and patient safety (QIPS) work is critical for success. It is often difficult to engage physicians in this work given competing priorities and lack of individual benefits for participation.
Program Inception and Development
The American Board of Medical Specialties (ABMS) Portfolio Program was created to establish a systematic process for review and approval of health care organizations’ implementation of QIPS work and that allows organizations to offer continuing certification credit to physicians who meaningfully engage in that same work. What started as a pilot program in 2010 between Mayo Clinic and the American Boards of Family Medicine, Internal Medicine, and Pediatrics has grown to include more than 100 organizations in 2024.
Evolution of the Program
The Portfolio Program has expanded from academic medical centers and medical schools to include government agencies, hospital groups, associations, and other types of health organizations. It has provided credit for more than 5,000 activities, and credit has been issued to physicians more than 60,000 times. To make QIPS submissions easier, standardized templates were created for certain types of quality improvement work; for example, the COVID-19 template facilitated the awarding of continuing certification credit to more than 10,000 physicians.
Conclusion
The ABMS Portfolio Program helps organizations establish a framework around QIPS work so physicians can receive continuing certification credit for their engagement. It also provides structure to establish processes and procedures for awarding credit and is flexible enough to meet the needs of each organization.
{"title":"Engaging Physicians in Improvement Priorities Through the American Board of Medical Specialties Portfolio Program","authors":"Teena Nelson MHA (is Manager, ABMS Portfolio Program, American Board of Medical Specialties, Chicago.), Spencer Walter (is Program Manager, ABMS Portfolio Program, American Board of Medical Specialties.), Ann Williamson RN, CCRC (is Performance Improvement Program Manager, American Board of Family Medicine, Lexington, Kentucky.), Kevin Graves MBA (is Strategic Project Manager, American Board of Family Medicine.), Peggy Paulson MA (is Operations Manager–Education, Mayo Clinic, Rochester, Minnesota.), Greg Ogrinc MD, MS (is Senior Vice President, American Board of Medical Specialties, and Clinical Professor of Medicine, University of Illinois College of Medicine at Chicago. Please address all correspondence to Teena Nelson)","doi":"10.1016/j.jcjq.2024.09.001","DOIUrl":"10.1016/j.jcjq.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>Physician involvement in quality improvement and patient safety (QIPS) work is critical for success. It is often difficult to engage physicians in this work given competing priorities and lack of individual benefits for participation.</div></div><div><h3>Program Inception and Development</h3><div>The American Board of Medical Specialties (ABMS) Portfolio Program was created to establish a systematic process for review and approval of health care organizations’ implementation of QIPS work and that allows organizations to offer continuing certification credit to physicians who meaningfully engage in that same work. What started as a pilot program in 2010 between Mayo Clinic and the American Boards of Family Medicine, Internal Medicine, and Pediatrics has grown to include more than 100 organizations in 2024.</div></div><div><h3>Evolution of the Program</h3><div>The Portfolio Program has expanded from academic medical centers and medical schools to include government agencies, hospital groups, associations, and other types of health organizations. It has provided credit for more than 5,000 activities, and credit has been issued to physicians more than 60,000 times. To make QIPS submissions easier, standardized templates were created for certain types of quality improvement work; for example, the COVID-19 template facilitated the awarding of continuing certification credit to more than 10,000 physicians.</div></div><div><h3>Conclusion</h3><div>The ABMS Portfolio Program helps organizations establish a framework around QIPS work so physicians can receive continuing certification credit for their engagement. It also provides structure to establish processes and procedures for awarding credit and is flexible enough to meet the needs of each organization.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 12","pages":"Pages 849-856"},"PeriodicalIF":2.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500818","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 : 2024-08-24DOI: 10.1016/j.jcjq.2024.08.006
Christine D. Franciscovich MSN, CRNP, NNP-BC (is the Patient Safety and Improvement Advanced Practice Provider, Children's Hospital of Philadelphia.), Anna Bieniek BS, PharmD, MS (is the Pharmacy Regulatory Compliance, Quality Assurance, and Medication Safety Program Manager, Children's Hospital of Philadelphia.), Katie Dunn BSN, RN, CPN (is a Certified Pediatric Nurse, Children's Hospital of Philadelphia.), Ursula Nawab MD (formerly Senior Medical Director of Patient Safety, Children's Hospital of Philadelphia, is Chief Patient Safety and Quality Officer, Johns Hopkins All Children's Hospital. Please address correspondence to Christine D. Franciscovich)
Background
Automated dispensing cabinets (ADCs) are used to store and dispense medications at the point of care. Medications accessed from an ADC before pharmacist order verification are removed using override functionality. Bypassing pharmacist verification can lead to medication errors; therefore, The Joint Commission considers overrides acceptable only in limited scenarios. During an 18-month period, the override rate in our perianesthesia care unit (PACU) was 17%, with oral midazolam accounting for roughly 40% of overrides. A multidisciplinary quality improvement (QI) project was initiated with a goal to reduce overrides by 10% (17% to 15%) by December 31, 2021.
Methods
Key drivers for reducing overrides included timely medication order entry, nursing practice to wait for verification, and timely pharmacist medication order verification. Interventions related to the latter two drivers included nursing education, individual interviews, and a workflow change involving nurse-to-pharmacy communication prior to medication overrides. Interventions were implemented in three Plan-Do-Study-Act cycles beginning in July 2021. Outcome metrics were average monthly percentage of total medication overrides and overrides for oral midazolam, which were analyzed using statistical process control charts.
Results
Following interventions, the average monthly percentage of total medication overrides decreased from 17% to 8% in July 2021, and further to 4% in February 2022. Oral midazolam overrides decreased from 22% to 9% in July 2021, and further to 3% in February 2022.
Conclusion
Both total and oral midazolam overrides were reduced by changing nursing and pharmacy workflow. Reducing ADC overrides is a complex process balancing operational flow and safety efforts.
{"title":"Reducing Automated Dispensing Cabinet Overrides in the Perianesthesia Care Unit: A Quality Improvement Project","authors":"Christine D. Franciscovich MSN, CRNP, NNP-BC (is the Patient Safety and Improvement Advanced Practice Provider, Children's Hospital of Philadelphia.), Anna Bieniek BS, PharmD, MS (is the Pharmacy Regulatory Compliance, Quality Assurance, and Medication Safety Program Manager, Children's Hospital of Philadelphia.), Katie Dunn BSN, RN, CPN (is a Certified Pediatric Nurse, Children's Hospital of Philadelphia.), Ursula Nawab MD (formerly Senior Medical Director of Patient Safety, Children's Hospital of Philadelphia, is Chief Patient Safety and Quality Officer, Johns Hopkins All Children's Hospital. Please address correspondence to Christine D. Franciscovich)","doi":"10.1016/j.jcjq.2024.08.006","DOIUrl":"10.1016/j.jcjq.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Automated dispensing cabinets (ADCs) are used to store and dispense medications at the point of care. Medications accessed from an ADC before pharmacist order verification are removed using override functionality. Bypassing pharmacist verification can lead to medication errors; therefore, The Joint Commission considers overrides acceptable only in limited scenarios. During an 18-month period, the override rate in our perianesthesia care unit (PACU) was 17%, with oral midazolam accounting for roughly 40% of overrides. A multidisciplinary quality improvement (QI) project was initiated with a goal to reduce overrides by 10% (17% to 15%) by December 31, 2021.</div></div><div><h3>Methods</h3><div>Key drivers for reducing overrides included timely medication order entry, nursing practice to wait for verification, and timely pharmacist medication order verification. Interventions related to the latter two drivers included nursing education, individual interviews, and a workflow change involving nurse-to-pharmacy communication prior to medication overrides. Interventions were implemented in three Plan-Do-Study-Act cycles beginning in July 2021. Outcome metrics were average monthly percentage of total medication overrides and overrides for oral midazolam, which were analyzed using statistical process control charts.</div></div><div><h3>Results</h3><div>Following interventions, the average monthly percentage of total medication overrides decreased from 17% to 8% in July 2021, and further to 4% in February 2022. Oral midazolam overrides decreased from 22% to 9% in July 2021, and further to 3% in February 2022.</div></div><div><h3>Conclusion</h3><div>Both total and oral midazolam overrides were reduced by changing nursing and pharmacy workflow. Reducing ADC overrides is a complex process balancing operational flow and safety efforts.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 12","pages":"Pages 867-876"},"PeriodicalIF":2.3,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390713","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 : 2024-08-24DOI: 10.1016/j.jcjq.2024.08.005
Sonali Shambhu MPH (formerly Senior Researcher, Elevance Health Public Policy Institute, is Senior Researcher, Pfizer.) , Aliza S. Gordon MPH (is Director, Health Services Research, Elevance Health Public Policy Institute.) , Ying Liu PhD (formerly Senior Researcher, Elevance Health Public Policy Institute, is Senior Manager, CORDS Oncology, Bristol Myers Squibb.), Maximilian Pany PhD (is Researcher, Elevance Health, Medicare Clinical Operations, and MD Candidate, Harvard Medical School.), William V. Padula PhD (is Assistant Professor, Department of Pharmaceutical and Health Economnics, Schaeffer Center, University of Southern California.), Peter J. Pronovost MD, PhD (is Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center.), Eugene Hsu MD, MBA (is Chief Medical Officer and Regional Vice President, Elevance Health, Medicare Clinical Operations, and Adjunct Faculty, Stanford University School of Medicine. Please address correspondence to Aliza S. Gordon)
Objective
To assess the additional health care utilization, cost, and mortality resulting from three surgical site infections (SSIs): mediastinitis/SSI after coronary artery bypass graft, SSI after bariatric surgery for obesity, and SSI after certain orthopedic procedures.
Methods
This retrospective observational cohort study used commercial and Medicare Advantage/Supplement claims from 2016 to 2021. Patients with one of three SSIs were compared to a 1:1 propensity score-matched group of patients with the same surgeries but without SSI on outcomes up to one year postdischarge.
Results
The total sample size was 4,620. Compared to their matched cohorts, the three SSI cohorts had longer mean index inpatient length of stay (LOS; adjusted days difference ranged from 1.73 to 6.27 days, all p < 0.001) and higher 30-day readmission rates (adjusted odds ratio ranged from 2.83 to 25.07, all p ≤ 0.001). The SSI cohort for orthopedic procedures had higher 12-month mortality (hazard ratio 1.56, p = 0.01), though other cohorts did not have significant differences. Total medical costs were higher in all three SSI cohorts vs. matched comparison cohorts for the index episode and 6 months and 1 year postdischarge. Average adjusted 1-year total medical cost differences ranged from $40,606 to $68,101 per person, depending on the cohort (p < 0.001), with out-of-pocket cost differences ranging from $330 to $860 (p < 0.05).
Conclusion
Patients with SSIs experienced higher LOS, readmission rates, and total medical costs, and higher mortality for some populations, compared to their matched comparison cohorts during the first year postdischarge. Identifying strategies to reduce SSIs is important both for patient outcomes and affordability of care.
{"title":"The Burden of Health Care Utilization, Cost, and Mortality Associated with Select Surgical Site Infections","authors":"Sonali Shambhu MPH (formerly Senior Researcher, Elevance Health Public Policy Institute, is Senior Researcher, Pfizer.) , Aliza S. Gordon MPH (is Director, Health Services Research, Elevance Health Public Policy Institute.) , Ying Liu PhD (formerly Senior Researcher, Elevance Health Public Policy Institute, is Senior Manager, CORDS Oncology, Bristol Myers Squibb.), Maximilian Pany PhD (is Researcher, Elevance Health, Medicare Clinical Operations, and MD Candidate, Harvard Medical School.), William V. Padula PhD (is Assistant Professor, Department of Pharmaceutical and Health Economnics, Schaeffer Center, University of Southern California.), Peter J. Pronovost MD, PhD (is Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center.), Eugene Hsu MD, MBA (is Chief Medical Officer and Regional Vice President, Elevance Health, Medicare Clinical Operations, and Adjunct Faculty, Stanford University School of Medicine. Please address correspondence to Aliza S. Gordon)","doi":"10.1016/j.jcjq.2024.08.005","DOIUrl":"10.1016/j.jcjq.2024.08.005","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the additional health care utilization, cost, and mortality resulting from three surgical site infections (SSIs): mediastinitis/SSI after coronary artery bypass graft, SSI after bariatric surgery for obesity, and SSI after certain orthopedic procedures.</div></div><div><h3>Methods</h3><div>This retrospective observational cohort study used commercial and Medicare Advantage/Supplement claims from 2016 to 2021. Patients with one of three SSIs were compared to a 1:1 propensity score-matched group of patients with the same surgeries but without SSI on outcomes up to one year postdischarge.</div></div><div><h3>Results</h3><div>The total sample size was 4,620. Compared to their matched cohorts, the three SSI cohorts had longer mean index inpatient length of stay (LOS; adjusted days difference ranged from 1.73 to 6.27 days, all <em>p</em> < 0.001) and higher 30-day readmission rates (adjusted odds ratio ranged from 2.83 to 25.07, all <em>p</em> ≤ 0.001). The SSI cohort for orthopedic procedures had higher 12-month mortality (hazard ratio 1.56, <em>p</em> = 0.01), though other cohorts did not have significant differences. Total medical costs were higher in all three SSI cohorts vs. matched comparison cohorts for the index episode and 6 months and 1 year postdischarge. Average adjusted 1-year total medical cost differences ranged from $40,606 to $68,101 per person, depending on the cohort (<em>p</em> < 0.001), with out-of-pocket cost differences ranging from $330 to $860 (<em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>Patients with SSIs experienced higher LOS, readmission rates, and total medical costs, and higher mortality for some populations, compared to their matched comparison cohorts during the first year postdischarge. Identifying strategies to reduce SSIs is important both for patient outcomes and affordability of care.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 12","pages":"Pages 857-866"},"PeriodicalIF":2.3,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390714","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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