Pub Date : 2026-01-01Epub Date: 2025-10-21DOI: 10.1016/j.jcjq.2025.10.004
Bertie Geng MD (formerly Resident, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, is Fellow, Urogynecology, Department of Obstetrics & Gynecology, University of North Carolina School of Medicine), Nishita Pondugula MS, MD (formerly Medical Student, Yale School of Medicine, is Resident, Department of Obstetrics and Gynecology, Duke University Medical Center), Lisbet Lundsberg MPH, PhD (is Associate Research Scientist, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine), Holly Zurich MS (is Lead APP Performance Improvement, Yale New Haven Hospital.), Rohit B. Sangal MD, MBA (is Assistant Professor, Department of Emergency Medicine, Yale School of Medicine, and Associate Medical Director, Adult Emergency Department, Yale New Haven Hospital) , Linda Fan MD (is Assistant Professor, and Director of Gynecology Section, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine. Please address correspondence to Bertie Geng)
Objective
To determine if an electronic health record (EHR)–based quality improvement intervention can decrease the time to gynecologic evaluation for patients presenting to the emergency department (ED) within 30 days of gynecologic surgery.
Methods
Through a multidisciplinary approach, key drivers to delays of recognition of postoperative complications were delineated and change ideas explored. In April 2022 an EHR notification was implemented that alerted ED and gynecology providers when patients presented within 30 days postoperatively. For primary analysis, the authors compared patients who presented to the ED October 2021–April 2022 (preintervention) to those who presented April 2022–May 2023 (postintervention) who were admitted after gynecology evaluation. Secondary analysis included all postoperative patients presenting to the ED.
Results
A total of 93 patients were included in the primary analysis, 37 (39.8%) preintervention and 56 (60.2%) postintervention. Mean ages in the pre- and postintervention periods were 41.3 and 50.1 years, respectively, p = 0.01. Baseline characteristics did not otherwise differ. Average time between ED arrival and initial gynecologic evaluation was 6.08 ± 4.83 hours in the preintervention group and 4.25 ± 2.36 hours in the postintervention group. After adjusting for age, compared to the preintervention period, the postintervention period was associated with a 2.26 hour reduction (β = -2.26; 95% confidence interval [CI] -3.78 to -0.74) in the time between ED arrival and initial gynecologic evaluation, p < 0.01. The time between ED arrival and initial gynecologic evaluation also became a more predictable process postintervention. On secondary analysis, median minutes from patient rooming to gynecology first chart opening decreased from 57.1 preintervention to 11.9 postintervention, p = 0.001.
Conclusion
This process improvement project reduced the latency time from ED arrival to gynecologic evaluation.
{"title":"Reducing Delays in Postoperative Gynecologic Evaluations Through Automated Electronic Alerts","authors":"Bertie Geng MD (formerly Resident, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, is Fellow, Urogynecology, Department of Obstetrics & Gynecology, University of North Carolina School of Medicine), Nishita Pondugula MS, MD (formerly Medical Student, Yale School of Medicine, is Resident, Department of Obstetrics and Gynecology, Duke University Medical Center), Lisbet Lundsberg MPH, PhD (is Associate Research Scientist, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine), Holly Zurich MS (is Lead APP Performance Improvement, Yale New Haven Hospital.), Rohit B. Sangal MD, MBA (is Assistant Professor, Department of Emergency Medicine, Yale School of Medicine, and Associate Medical Director, Adult Emergency Department, Yale New Haven Hospital) , Linda Fan MD (is Assistant Professor, and Director of Gynecology Section, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine. Please address correspondence to Bertie Geng)","doi":"10.1016/j.jcjq.2025.10.004","DOIUrl":"10.1016/j.jcjq.2025.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>To determine if an electronic health record (EHR)–based quality improvement intervention can decrease the time to gynecologic evaluation for patients presenting to the emergency department (ED) within 30 days of gynecologic surgery.</div></div><div><h3>Methods</h3><div>Through a multidisciplinary approach, key drivers to delays of recognition of postoperative complications were delineated and change ideas explored. In April 2022 an EHR notification was implemented that alerted ED and gynecology providers when patients presented within 30 days postoperatively. For primary analysis, the authors compared patients who presented to the ED October 2021–April 2022 (preintervention) to those who presented April 2022–May 2023 (postintervention) who were admitted after gynecology evaluation. Secondary analysis included all postoperative patients presenting to the ED.</div></div><div><h3>Results</h3><div>A total of 93 patients were included in the primary analysis, 37 (39.8%) preintervention and 56 (60.2%) postintervention. Mean ages in the pre- and postintervention periods were 41.3 and 50.1 years, respectively, <em>p</em> = 0.01. Baseline characteristics did not otherwise differ. Average time between ED arrival and initial gynecologic evaluation was 6.08 ± 4.83 hours in the preintervention group and 4.25 ± 2.36 hours in the postintervention group. After adjusting for age, compared to the preintervention period, the postintervention period was associated with a 2.26 hour reduction (β = -2.26; 95% confidence interval [CI] -3.78 to -0.74) in the time between ED arrival and initial gynecologic evaluation, <em>p</em> < 0.01. The time between ED arrival and initial gynecologic evaluation also became a more predictable process postintervention. On secondary analysis, median minutes from patient rooming to gynecology first chart opening decreased from 57.1 preintervention to 11.9 postintervention, <em>p</em> = 0.001.</div></div><div><h3>Conclusion</h3><div>This process improvement project reduced the latency time from ED arrival to gynecologic evaluation.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"52 1","pages":"Pages 1-8"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556893","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 : 2026-01-01Epub Date: 2025-10-28DOI: 10.1016/j.jcjq.2025.10.006
Yash Bhanji Boricha MBBS, DGO, MS, DNB, MRCOG (is Senior Staff Physician, Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore.), Junzhe Zhao MA, MEng, PhD (is final year MD/PhD candidate, Duke-NUS Medical School, Singapore.), Felicia Yiqian Ang (is PSQ Lead, Department of Quality, Safety and Risk Management, KK Women’s & Children’s Hospital.), Kim Teng Tan MBBS, MMed, MRACOG, FAMS (is Senior Consultant, Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital. Please address correspondence to Junzhe Zhao)
Background
Mislabeling of endometrial vs. endocervical curettings was the most frequent specimen error in the Division of Obstetrics & Gynaecology at KK Women’s and Children’s Hospital, Singapore. These look-alike/sound-alike (LASA) errors can compromise patient safety and workflow efficiency. The authors aimed to reduce specimen labeling errors over a two-year quality improvement (QI) period.
Methods
Following root cause analysis, a multidisciplinary QI project was initiated in a single tertiary obstetrics & gynecology center using the Plan-Do-Study-Act (PDSA) methodology. Between 2020 and 2022, interventions were (1) a pilot system-level enhancement to the electronic ordering interface; (2) clinician education, training, and monthly feedback; (3) team-based process redesign emphasizing accountability and safety culture; and (4) a subsequent system-level enhancement to the electronic ordering interface during a second PDSA cycle. The primary outcome was the rate of endometrial vs. endocervical mislabeling events per 1,000 orders. The researchers plotted time-series run charts and u-charts and calculated pre- and postintervention incidence rate ratios (IRRs).
Results
Among 42,968 curettings from January 2020 to May 2025, 46 endometrial/endocervical mislabeling events occurred. Mislabeling rates were 3.79 per 1,000 orders at baseline (9/2,373; January–May 2020), 3.80 between two PDSA cycles (33/8,683; June 2020–April 2021), and 0.13 following the second PDSA cycle (4/31,912; from May 2021), corresponding to a 96.7% reduction vs. baseline (IRR 0.03, 95% confidence interval [CI] 0.01–0.11, p < 0.001). Time-series charts showed a sustained special cause shift since May 2021, with 30 consecutive zero-error months between January 2022 and June 2024.
Conclusion
A combination of education, feedback, process audits, and interface redesign effectively addressed mislabeling of endometrial/endocervical specimens, a high-impact patient safety concern. This approach may be transferable to other LASA error domains.
背景：在新加坡KK妇女儿童医院的妇产科中，子宫内膜与宫颈内膜刮痧的错误标记是最常见的标本错误。这些外观相似/声音相似（LASA）错误可能会危及患者安全和工作流程效率。作者的目的是在两年的质量改进（QI）期间减少标本标记错误。方法：在进行根本原因分析后，采用计划-做-研究-行动（PDSA）方法在某三级妇产科中心开展多学科质量评价项目。在2020年至2022年期间，干预措施包括：(1)试点系统级增强电子订购界面；(2)临床医师教育、培训，每月反馈；(3)基于团队的流程重新设计，强调问责制和安全文化；(4)在第二个PDSA循环期间对电子订购接口的后续系统级增强。主要结局是每1000个订单中子宫内膜与宫颈内膜错误标记事件的发生率。研究人员绘制了时序运行图和u形图，并计算了干预前和干预后的发病率比（IRRs）。结果：在2020年1月至2025年5月的42,968例子宫内膜/宫颈内膜错误标记事件中，发生了46例。基线时（9/2,373；2020年1月至5月）的误标率为3.79 / 1,000个订单，两个PDSA周期之间（33/8,683；2020年6月至2021年4月）的误标率为3.80，第二个PDSA周期后（4/31,912；2021年5月）的误标率为0.13，与基线相比降低了96.7% （IRR 0.03, 95%置信区间[CI] 0.01-0.11, p < 0.001）。时间序列图显示，自2021年5月以来，特殊原因持续变化，2022年1月至2024年6月期间连续30个月为零误差。结论：教育、反馈、流程审核和界面重新设计的结合有效地解决了子宫内膜/宫颈内膜标本标签错误的问题，这是一个影响患者安全的问题。这种方法可以转移到其他LASA错误域。
{"title":"Reducing Labeling Errors in Histopathology Specimens: A Quality Improvement Initiative on Endometrial vs. Endocervical Specimens to Promote Patient Safety in KK Women’s and Children’s Hospital","authors":"Yash Bhanji Boricha MBBS, DGO, MS, DNB, MRCOG (is Senior Staff Physician, Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore.), Junzhe Zhao MA, MEng, PhD (is final year MD/PhD candidate, Duke-NUS Medical School, Singapore.), Felicia Yiqian Ang (is PSQ Lead, Department of Quality, Safety and Risk Management, KK Women’s & Children’s Hospital.), Kim Teng Tan MBBS, MMed, MRACOG, FAMS (is Senior Consultant, Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital. Please address correspondence to Junzhe Zhao)","doi":"10.1016/j.jcjq.2025.10.006","DOIUrl":"10.1016/j.jcjq.2025.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Mislabeling of endometrial vs. endocervical curettings was the most frequent specimen error in the Division of Obstetrics & Gynaecology at KK Women’s and Children’s Hospital, Singapore. These look-alike/sound-alike (LASA) errors can compromise patient safety and workflow efficiency. The authors aimed to reduce specimen labeling errors over a two-year quality improvement (QI) period.</div></div><div><h3>Methods</h3><div>Following root cause analysis, a multidisciplinary QI project was initiated in a single tertiary obstetrics & gynecology center using the Plan-Do-Study-Act (PDSA) methodology. Between 2020 and 2022, interventions were (1) a pilot system-level enhancement to the electronic ordering interface; (2) clinician education, training, and monthly feedback; (3) team-based process redesign emphasizing accountability and safety culture; and (4) a subsequent system-level enhancement to the electronic ordering interface during a second PDSA cycle. The primary outcome was the rate of endometrial vs. endocervical mislabeling events per 1,000 orders. The researchers plotted time-series run charts and u-charts and calculated pre- and postintervention incidence rate ratios (IRRs).</div></div><div><h3>Results</h3><div>Among 42,968 curettings from January 2020 to May 2025, 46 endometrial/endocervical mislabeling events occurred. Mislabeling rates were 3.79 per 1,000 orders at baseline (9/2,373; January–May 2020), 3.80 between two PDSA cycles (33/8,683; June 2020–April 2021), and 0.13 following the second PDSA cycle (4/31,912; from May 2021), corresponding to a 96.7% reduction vs. baseline (IRR 0.03, 95% confidence interval [CI] 0.01–0.11, <em>p</em> < 0.001). Time-series charts showed a sustained special cause shift since May 2021, with 30 consecutive zero-error months between January 2022 and June 2024.</div></div><div><h3>Conclusion</h3><div>A combination of education, feedback, process audits, and interface redesign effectively addressed mislabeling of endometrial/endocervical specimens, a high-impact patient safety concern. This approach may be transferable to other LASA error domains.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"52 1","pages":"Pages 33-41"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668477","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 : 2026-01-01Epub Date: 2025-11-03DOI: 10.1016/j.jcjq.2025.10.008
Elizabeth Harry MD , Christine Sinsky MD , Lotte N. Dyrbye MD, MHPE , Maryam S. Makowski PhD , Mickey Trockel MD, PhD , Michael Tutty PhD , Lindsey E. Carlasare MBA , Colin P. West MD, PhD , Tait D. Shanafelt MD
{"title":"Corrigendum to Physician Task Load and the Risk of Burnout Among US Physicians in a National Survey [The Joint Commission Journal on Quality and Patient Safety 47, 2 (2021) 76-85]","authors":"Elizabeth Harry MD , Christine Sinsky MD , Lotte N. Dyrbye MD, MHPE , Maryam S. Makowski PhD , Mickey Trockel MD, PhD , Michael Tutty PhD , Lindsey E. Carlasare MBA , Colin P. West MD, PhD , Tait D. Shanafelt MD","doi":"10.1016/j.jcjq.2025.10.008","DOIUrl":"10.1016/j.jcjq.2025.10.008","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"52 1","pages":"Pages 54-55"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633661","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 : 2025-12-01DOI: 10.1016/j.jcjq.2025.09.005
Peter Pronovost MD, PhD, FCCM (is Chief Quality and Transformation Officer, University Hospitals Cleveland Medical Center, Cleveland, Ohio.), Leslie J. Pelton MPA (is Senior Program Officer, The John A. Hartford Foundation, New York, New York.), Hooman Azmi MD, FAANS (is Vice Chair of Neurosurgery for Quality and Safety, Hackensack University Medical Center, Hackensack, New Jersey.), Annie Brooks MSW (is Senior Director, Strategic Initiatives, Parkinson’s Foundation, Miami.), Eboné Carrington MPA (is Managing Director, Manatt Health Strategies, New York, New York.), Michael Siao Tick Chong MPH (is Senior Manager, Manatt Health Strategies.), Sheera Rosenfeld MHS (is Vice President, Chief Strategic Initiatives Officer, Parkinson’s Foundation. Please address correspondence to Sheera Rosenfeld)
{"title":"Advancing Parkinson’s Care and Patient Safety Through CMS’s Age-Friendly Hospital Measure","authors":"Peter Pronovost MD, PhD, FCCM (is Chief Quality and Transformation Officer, University Hospitals Cleveland Medical Center, Cleveland, Ohio.), Leslie J. Pelton MPA (is Senior Program Officer, The John A. Hartford Foundation, New York, New York.), Hooman Azmi MD, FAANS (is Vice Chair of Neurosurgery for Quality and Safety, Hackensack University Medical Center, Hackensack, New Jersey.), Annie Brooks MSW (is Senior Director, Strategic Initiatives, Parkinson’s Foundation, Miami.), Eboné Carrington MPA (is Managing Director, Manatt Health Strategies, New York, New York.), Michael Siao Tick Chong MPH (is Senior Manager, Manatt Health Strategies.), Sheera Rosenfeld MHS (is Vice President, Chief Strategic Initiatives Officer, Parkinson’s Foundation. Please address correspondence to Sheera Rosenfeld)","doi":"10.1016/j.jcjq.2025.09.005","DOIUrl":"10.1016/j.jcjq.2025.09.005","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 12","pages":"Pages 772-777"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623197","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 : 2025-12-01Epub Date: 2025-10-01DOI: 10.1016/j.jcjq.2025.09.004
Lucy Schulson MD, MPH (is Assistant Professor, Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine.), Mari-Lynn Drainoni PhD, MEd (is Research Professor, Section of Infectious Disease, Boston University Chobanian and Avedisian School of Medicine, and Department of Health Law, Policy & Management, Boston University School of Public Health, and Co-Director, Evans Center for Implementation and Improvement Sciences, Boston University.), Kirsten Austad MD, MPH (is Assistant Professor, Department of Family Medicine, Boston University Chobanian and Avedisian School of Medicine, and Co-Director, Evans Center for Implementation and Improvement Sciences. Please address correspondence to Lucy Schulson)
{"title":"Leveraging Implementation Science to Address Diagnostic Disparities and Promote Equity in Healthcare","authors":"Lucy Schulson MD, MPH (is Assistant Professor, Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine.), Mari-Lynn Drainoni PhD, MEd (is Research Professor, Section of Infectious Disease, Boston University Chobanian and Avedisian School of Medicine, and Department of Health Law, Policy & Management, Boston University School of Public Health, and Co-Director, Evans Center for Implementation and Improvement Sciences, Boston University.), Kirsten Austad MD, MPH (is Assistant Professor, Department of Family Medicine, Boston University Chobanian and Avedisian School of Medicine, and Co-Director, Evans Center for Implementation and Improvement Sciences. Please address correspondence to Lucy Schulson)","doi":"10.1016/j.jcjq.2025.09.004","DOIUrl":"10.1016/j.jcjq.2025.09.004","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 12","pages":"Pages 778-782"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145444730","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 : 2025-12-01Epub Date: 2025-09-05DOI: 10.1016/j.jcjq.2025.09.001
Daniel E. Hall MD, MDiv, MHSc, FACS , Carly A. Jacobs MPH , Katherine M. Reitz MD, MSc , Shipra Arya MD, SM, FACS , Michael A. Jacobs MS , John Cashy PhD , Jason M. Johanning MD, MS, FACS
{"title":"Corrigendum to: “Frailty Screening Using the Risk Analysis Index: A User Guide” [The Joint Commission Journal on Quality and Patient Safety Volume 51, Issue 3 (2025) Pages 178-191]","authors":"Daniel E. Hall MD, MDiv, MHSc, FACS , Carly A. Jacobs MPH , Katherine M. Reitz MD, MSc , Shipra Arya MD, SM, FACS , Michael A. Jacobs MS , John Cashy PhD , Jason M. Johanning MD, MS, FACS","doi":"10.1016/j.jcjq.2025.09.001","DOIUrl":"10.1016/j.jcjq.2025.09.001","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 12","pages":"Page 788"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206493","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 : 2025-12-01Epub Date: 2025-09-10DOI: 10.1016/j.jcjq.2025.09.002
Alison Lehane MD (is Pediatric Surgical Research Fellow, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, and Ann & Robert H. Lurie Children’s Hospital of Chicago.), Mallory Perez MD (is Pediatric Surgical Research Fellow, NQUIRES, Northwestern University Feinberg School of Medicine, and Ann & Robert H. Lurie Children’s Hospital of Chicago.), Gwyneth A. Sullivan MD, MS (is General Surgical Resident, Rush University Medical Center, Chicago.), Jennifer Dunn PhD, MSE (is Professor of Chemical and Biological Engineering, and Director, Center for Engineering Sustainability and Resilience, Northwestern University McCormick School of Engineering.), Timothy B. Lautz MD (is Associate Professor, Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, and Ann & Robert H. Lurie Children’s Hospital of Chicago.), Mehul V. Raval MD, MS (is Professor, Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, and Ann & Robert H. Lurie Children’s Hospital of Chicago. Please address correspondence to Alison Lehane)
Background
Operating rooms (ORs) generate substantial waste and greenhouse gas (GHG) emissions, in part due to common reliance on single-use disposable items widely used in prefabricated surgical kits. This study evaluates the environmental and economic benefits of streamlining surgical kits in a children’s hospital.
Method
Life cycle assessment (LCA) was used to assess the cradle-to-grave impact of surgical kits, quantifying GHG emissions from raw material extraction through disposal. GHG emissions were modeled using the Greenhouse gases, Regulated Emissions, and Energy use in Transportation (GREET) model and openLCA software, scaled to annual surgical volumes, and converted using the US Environmental Protection Agency’s (EPA) Greenhouse Gas Equivalencies Calculator. Iterative stakeholder consultation identified items for removal to minimize waste while maintaining operative needs. Cost savings were calculated from medical supplier data.
Results
Optimizing three surgical kits (Pediatric Major, Pediatric Minor, and Pediatric Minor–Outpatient) by removing select items (for example, large ring basins, preparation trays, suction tubing, extra gowns) resulted in annual cost savings of $8,608 and GHG reductions of 30,654 g across 2,676 pediatric surgical cases. GHG reductions ranged from 6.9 g to 13.0 g per pack. If applied across all surgical service lines (cases = 26,000), projected GHG reductions would be between 179,400 g and 338,000 g, with a median of 288,600 g, equivalent to 783 miles (1,260 kilometers) driven, or a journey between Chicago and New York City.
Conclusion
Streamlining pediatric surgical kits offers a scalable, cost-effective strategy for reducing the environmental impact of ORs. LCA provides a robust framework for evaluating sustainability in healthcare, supporting informed decision-making to enhance resource efficiency.
{"title":"Optimizing Pediatric Surgical Kits: A Cost-Effective Approach to Reducing Environmental Impact in Healthcare","authors":"Alison Lehane MD (is Pediatric Surgical Research Fellow, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, and Ann & Robert H. Lurie Children’s Hospital of Chicago.), Mallory Perez MD (is Pediatric Surgical Research Fellow, NQUIRES, Northwestern University Feinberg School of Medicine, and Ann & Robert H. Lurie Children’s Hospital of Chicago.), Gwyneth A. Sullivan MD, MS (is General Surgical Resident, Rush University Medical Center, Chicago.), Jennifer Dunn PhD, MSE (is Professor of Chemical and Biological Engineering, and Director, Center for Engineering Sustainability and Resilience, Northwestern University McCormick School of Engineering.), Timothy B. Lautz MD (is Associate Professor, Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, and Ann & Robert H. Lurie Children’s Hospital of Chicago.), Mehul V. Raval MD, MS (is Professor, Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, and Ann & Robert H. Lurie Children’s Hospital of Chicago. Please address correspondence to Alison Lehane)","doi":"10.1016/j.jcjq.2025.09.002","DOIUrl":"10.1016/j.jcjq.2025.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Operating rooms (ORs) generate substantial waste and greenhouse gas (GHG) emissions, in part due to common reliance on single-use disposable items widely used in prefabricated surgical kits. This study evaluates the environmental and economic benefits of streamlining surgical kits in a children’s hospital.</div></div><div><h3>Method</h3><div>Life cycle assessment (LCA) was used to assess the cradle-to-grave impact of surgical kits, quantifying GHG emissions from raw material extraction through disposal. GHG emissions were modeled using the Greenhouse gases, Regulated Emissions, and Energy use in Transportation (GREET) model and openLCA software, scaled to annual surgical volumes, and converted using the US Environmental Protection Agency’s (EPA) Greenhouse Gas Equivalencies Calculator. Iterative stakeholder consultation identified items for removal to minimize waste while maintaining operative needs. Cost savings were calculated from medical supplier data.</div></div><div><h3>Results</h3><div>Optimizing three surgical kits (Pediatric Major, Pediatric Minor, and Pediatric Minor–Outpatient) by removing select items (for example, large ring basins, preparation trays, suction tubing, extra gowns) resulted in annual cost savings of $8,608 and GHG reductions of 30,654 g across 2,676 pediatric surgical cases. GHG reductions ranged from 6.9 g to 13.0 g per pack. If applied across all surgical service lines (cases = 26,000), projected GHG reductions would be between 179,400 g and 338,000 g, with a median of 288,600 g, equivalent to 783 miles (1,260 kilometers) driven, or a journey between Chicago and New York City.</div></div><div><h3>Conclusion</h3><div>Streamlining pediatric surgical kits offers a scalable, cost-effective strategy for reducing the environmental impact of ORs. LCA provides a robust framework for evaluating sustainability in healthcare, supporting informed decision-making to enhance resource efficiency.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 12","pages":"Pages 753-757"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318316","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 : 2025-12-01Epub Date: 2025-09-21DOI: 10.1016/j.jcjq.2025.09.003
Dylan J. Parker MD (is Research Fellow, Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.), Iman M. Salem MD (is Resident, Department of Dermatology, Dartmouth Hitchcock Medical Center.), Dylan J. Badin MD (is Resident, Department of Dermatology, Dartmouth Hitchcock Medical Center.), Brian J. Simmons MD (is Assistant Professor, Department of Dermatology, Geisel School of Medicine at Dartmouth, and Director of Clinical Trials, Dartmouth Hitchcock Medical Center.), M. Shane Chapman MD, MBA (is Professor and Chair, Department of Dermatology, Geisel School of Medicine at Dartmouth, and Medical Director, Supply Chain Value Analysis, Dartmouth Hitchcock Medical Center. Please address correspondence to Dylan J. Parker)
Background
New patient waitlists across the United States continue to grow. This trend is exacerbated in rural areas. Dartmouth Dermatology is a unique tertiary care center serving approximately 50,000 patients annually. In September 2023 the center’s waitlist consisted of 3,654 unseen patients.
Methods
During Dartmouth Dermatology’s Big Access Week, which took place December 11–15, 2023, the center saw 1,532 patients (1,180 new patients) using a four-pronged approach: categorization, community sensitization, patient expectations, and operations.
Results
Patient ages ranged from 10 months to 98 years. Average referral to visit time was 98.7 days. Full skin exams were performed on 406 patients, and focused exams were performed on 607 patients. Primary diagnoses included malignant/premalignant lesions for 279 patients, autoimmune-related skin disease for 57 patients, inflammatory lesions for 396 patients, and infectious lesions for 82 patients. Notably, 124 malignancies were confirmed (67 basal cell carcinomas, 39 squamous cell carcinomas, and 18 melanomas). Mohs referrals totaled 87 cases. The average patient satisfaction rating was 3.8/4.
Conclusion
Dartmouth Dermatology’s workflow model in Big Access Week significantly shortened waitlist time while maintaining high-quality care. This model can be implemented by a wide array of medical and surgical subspecialties, contributing to a seemingly daunting task: improving vital access to healthcare.
{"title":"Big Access Week: Decreasing Dermatology Patient Wait Times in a Strained Healthcare System","authors":"Dylan J. Parker MD (is Research Fellow, Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.), Iman M. Salem MD (is Resident, Department of Dermatology, Dartmouth Hitchcock Medical Center.), Dylan J. Badin MD (is Resident, Department of Dermatology, Dartmouth Hitchcock Medical Center.), Brian J. Simmons MD (is Assistant Professor, Department of Dermatology, Geisel School of Medicine at Dartmouth, and Director of Clinical Trials, Dartmouth Hitchcock Medical Center.), M. Shane Chapman MD, MBA (is Professor and Chair, Department of Dermatology, Geisel School of Medicine at Dartmouth, and Medical Director, Supply Chain Value Analysis, Dartmouth Hitchcock Medical Center. Please address correspondence to Dylan J. Parker)","doi":"10.1016/j.jcjq.2025.09.003","DOIUrl":"10.1016/j.jcjq.2025.09.003","url":null,"abstract":"<div><h3>Background</h3><div>New patient waitlists across the United States continue to grow. This trend is exacerbated in rural areas. Dartmouth Dermatology is a unique tertiary care center serving approximately 50,000 patients annually. In September 2023 the center’s waitlist consisted of 3,654 unseen patients.</div></div><div><h3>Methods</h3><div>During Dartmouth Dermatology’s Big Access Week, which took place December 11–15, 2023, the center saw 1,532 patients (1,180 new patients) using a four-pronged approach: categorization, community sensitization, patient expectations, and operations.</div></div><div><h3>Results</h3><div>Patient ages ranged from 10 months to 98 years. Average referral to visit time was 98.7 days. Full skin exams were performed on 406 patients, and focused exams were performed on 607 patients. Primary diagnoses included malignant/premalignant lesions for 279 patients, autoimmune-related skin disease for 57 patients, inflammatory lesions for 396 patients, and infectious lesions for 82 patients. Notably, 124 malignancies were confirmed (67 basal cell carcinomas, 39 squamous cell carcinomas, and 18 melanomas). Mohs referrals totaled 87 cases. The average patient satisfaction rating was 3.8/4.</div></div><div><h3>Conclusion</h3><div>Dartmouth Dermatology’s workflow model in Big Access Week significantly shortened waitlist time while maintaining high-quality care. This model can be implemented by a wide array of medical and surgical subspecialties, contributing to a seemingly daunting task: improving vital access to healthcare.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 12","pages":"Pages 767-771"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345306","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 : 2025-12-01Epub Date: 2025-10-07DOI: 10.1016/j.jcjq.2025.09.006
Carole Lenz Hemmelgarn MS, MS (is Founding Member, Patients for Patient Safety US, and Senior Director of Education, MedStar Institute for Quality and Safety.), Margaret A. McManus MHS (is Co-Director, Got Transition®, and President, National Alliance to Advance Adolescent Health, Washington, DC.), Kiera Peoples MPH (is Policy Analyst, National Partnership for Women & Families, Washington, DC.), Rashmi Singh MBA, MS (is Senior Analyst, National Quality Forum.), Laura Blum Meisnere MA (is Program Director, Membership and Engagement, National Quality Forum. Please address correspondence to Laura Blum Meisnere)
{"title":"Patient Safety in Transition from Pediatric to Adult-Centered Care","authors":"Carole Lenz Hemmelgarn MS, MS (is Founding Member, Patients for Patient Safety US, and Senior Director of Education, MedStar Institute for Quality and Safety.), Margaret A. McManus MHS (is Co-Director, Got Transition®, and President, National Alliance to Advance Adolescent Health, Washington, DC.), Kiera Peoples MPH (is Policy Analyst, National Partnership for Women & Families, Washington, DC.), Rashmi Singh MBA, MS (is Senior Analyst, National Quality Forum.), Laura Blum Meisnere MA (is Program Director, Membership and Engagement, National Quality Forum. Please address correspondence to Laura Blum Meisnere)","doi":"10.1016/j.jcjq.2025.09.006","DOIUrl":"10.1016/j.jcjq.2025.09.006","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 12","pages":"Pages 783-787"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458737","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}
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