Pub Date : 2025-10-01Epub Date: 2025-06-07DOI: 10.1016/j.jcjq.2025.06.001
Salome O. Chitavi PhD (is Research Scientist II, Department of Research, The Joint Commission, Oakbrook Terrace, Illinois), Michael Kohut PhD (is Qualitative Data Analyst, Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Westbrook, Maine), Barbara I. Braun PhD (is Associate Director, Department of Research, The Joint Commission), David Y. Hyun MD (is Project Director, Antibiotic Resistance Project, The Pew Charitable Trust, Washington, D.C. Please address correspondence to Salome Chitavi)
Background
Most hospitals have a basic infrastructure in place for their antimicrobial stewardship programs (ASPs). However, up to 50% of hospital-administered antimicrobials are prescribed inappropriately. To explore challenges and facilitators for effective implementation of leading practices (LPs), the authors conducted in-depth semistructured interviews with a sample of ASP leaders in Joint Commission–accredited hospitals across the United States.
Methods
In this qualitative study, the reserarchers conducted 30 in-depth interviews with a purposive sample of hospital ASP leaders from a cross section of hospitals of varied size and system membership. The framework approach was used to analyze and organize data. Factors that were critical for implementing multiple LPs across hospitals of different characteristics were termed super-facilitators.
Results
Of 46 hospitals invited, 30 (10 large, 10 medium, 10 small) agreed to be interviewed. Of these, 22 hospitals were general medical/surgical, 6 were critical access hospitals (CAHs), and 2 were children’s hospitals. The authors identified five super-facilitators: (1) having optimal electronic health records (EHRs), (2) dedicated staffing, (3) infectious diseases expertise, (4) hospital leadership commitment, and (5) physician champions that enhanced buy-in from clinicians.
Conclusion
Each of the five super-facilitators affect implementation of multiple leading antimicrobial stewardship practices. Given their inter-relationships, collective application of all five super-facilitators can support more effective and sustainable antimicrobial stewardship.
{"title":"Super-Facilitators for Implementation of Leading Antimicrobial Stewardship Practices in Hospitals: A Qualitative Study","authors":"Salome O. Chitavi PhD (is Research Scientist II, Department of Research, The Joint Commission, Oakbrook Terrace, Illinois), Michael Kohut PhD (is Qualitative Data Analyst, Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Westbrook, Maine), Barbara I. Braun PhD (is Associate Director, Department of Research, The Joint Commission), David Y. Hyun MD (is Project Director, Antibiotic Resistance Project, The Pew Charitable Trust, Washington, D.C. Please address correspondence to Salome Chitavi)","doi":"10.1016/j.jcjq.2025.06.001","DOIUrl":"10.1016/j.jcjq.2025.06.001","url":null,"abstract":"<div><h3>Background</h3><div>Most hospitals have a basic infrastructure in place for their antimicrobial stewardship programs (ASPs). However, up to 50% of hospital-administered antimicrobials are prescribed inappropriately. To explore challenges and facilitators for effective implementation of leading practices (LPs), the authors conducted in-depth semistructured interviews with a sample of ASP leaders in Joint Commission–accredited hospitals across the United States.</div></div><div><h3>Methods</h3><div>In this qualitative study, the reserarchers conducted 30 in-depth interviews with a purposive sample of hospital ASP leaders from a cross section of hospitals of varied size and system membership. The framework approach was used to analyze and organize data. Factors that were critical for implementing multiple LPs across hospitals of different characteristics were termed <em>super-facilitators</em>.</div></div><div><h3>Results</h3><div>Of 46 hospitals invited, 30 (10 large, 10 medium, 10 small) agreed to be interviewed. Of these, 22 hospitals were general medical/surgical, 6 were critical access hospitals (CAHs), and 2 were children’s hospitals. The authors identified five super-facilitators: (1) having optimal electronic health records (EHRs), (2) dedicated staffing, (3) infectious diseases expertise, (4) hospital leadership commitment, and (5) physician champions that enhanced buy-in from clinicians.</div></div><div><h3>Conclusion</h3><div>Each of the five super-facilitators affect implementation of multiple leading antimicrobial stewardship practices. Given their inter-relationships, collective application of all five super-facilitators can support more effective and sustainable antimicrobial stewardship.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 10","pages":"Pages 621-631"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649500","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 : 2025-10-01Epub Date: 2025-06-22DOI: 10.1016/j.jcjq.2025.06.011
Maja Ahlberg MSc (is Podiatrist, Department of Prosthetics and Orthotics, Ottobock Care, Malmö, Sweden), Ulla Hellstrand Tang Associate Professor (Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden, and Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg), Christina Petersson PhD (is Associate Professor, Department of Quality Improvement and Leadership, School of Health and Welfare, Jönköping University, and Director, Jönköping Academy for Improvement of Health and Welfare, Jönköping University. Please address correspondence to Maja Ahlberg)
Background
Diabetic foot ulcers (DFUs) are common and serious complications in diabetes. To avoid DFUs, identification of at-risk patients through a structured foot assessment leading to appropriate risk classification is essential. However, this is often lacking in clinical practice. This study aimed to identify barriers and facilitators to guideline adherence in diabetic care and to increase the proportion of diabetic patients who receive a foot risk classification.
Methods
This quantitative evaluation of improvement interventions was conducted at a department of prosthetics and orthotics (DPO) in the south of Sweden. To identify barriers and facilitators to guideline adherence and identify potential interventions, the authors used the COM-B (Capability, Opportunity, Motivation, and Behaviour) framework and qualitative interviews designed as one pilot interview and two focus group sessions with practitioners at the DPO. To improve guideline adherence, the research team implemented several interventions targeting behaviour over multiple Plan-Do-Study-Act cycles where training, education, and easily accessible material were incorporated. Eligible patients at risk of DFUs were identified by means of their medical journal. The candidates were referred to the DPO to be provided with preventive offloading devices.
Results
The frequency of patients receiving a foot examination and risk classification increased from 32.0% to 61.9%. Practitioners described the perception of increased patient safety as a facilitator of adherence to the clinical guidelines, while time limitation and insufficient knowledge were perceived as barriers.
Conclusion
To ease implementation of evidence-based guidelines in diabetes, clinics must address behavioural mechanisms related to adherence. The result adds further knowledge about enablers and barriers in clinical practice. Future research should focus on the clinical outcomes of improvement efforts in diabetes care in DPOs to avoid DFUs.
{"title":"Enhancing Clinical Guideline Adherence in Diabetic Foot Ulcer Prevention: A Case Study on Quality Improvement Interventions","authors":"Maja Ahlberg MSc (is Podiatrist, Department of Prosthetics and Orthotics, Ottobock Care, Malmö, Sweden), Ulla Hellstrand Tang Associate Professor (Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden, and Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg), Christina Petersson PhD (is Associate Professor, Department of Quality Improvement and Leadership, School of Health and Welfare, Jönköping University, and Director, Jönköping Academy for Improvement of Health and Welfare, Jönköping University. Please address correspondence to Maja Ahlberg)","doi":"10.1016/j.jcjq.2025.06.011","DOIUrl":"10.1016/j.jcjq.2025.06.011","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic foot ulcers (DFUs) are common and serious complications in diabetes. To avoid DFUs, identification of at-risk patients through a structured foot assessment leading to appropriate risk classification is essential. However, this is often lacking in clinical practice. This study aimed to identify barriers and facilitators to guideline adherence in diabetic care and to increase the proportion of diabetic patients who receive a foot risk classification.</div></div><div><h3>Methods</h3><div>This quantitative evaluation of improvement interventions was conducted at a department of prosthetics and orthotics (DPO) in the south of Sweden. To identify barriers and facilitators to guideline adherence and identify potential interventions, the authors used the COM-B (Capability, Opportunity, Motivation, and Behaviour) framework and qualitative interviews designed as one pilot interview and two focus group sessions with practitioners at the DPO. To improve guideline adherence, the research team implemented several interventions targeting behaviour over multiple Plan-Do-Study-Act cycles where training, education, and easily accessible material were incorporated. Eligible patients at risk of DFUs were identified by means of their medical journal. The candidates were referred to the DPO to be provided with preventive offloading devices.</div></div><div><h3>Results</h3><div>The frequency of patients receiving a foot examination and risk classification increased from 32.0% to 61.9%. Practitioners described the perception of increased patient safety as a facilitator of adherence to the clinical guidelines, while time limitation and insufficient knowledge were perceived as barriers.</div></div><div><h3>Conclusion</h3><div>To ease implementation of evidence-based guidelines in diabetes, clinics must address behavioural mechanisms related to adherence. The result adds further knowledge about enablers and barriers in clinical practice. Future research should focus on the clinical outcomes of improvement efforts in diabetes care in DPOs to avoid DFUs.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 10","pages":"Pages 642-651"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812019","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 : 2025-10-01Epub Date: 2025-06-12DOI: 10.1016/j.jcjq.2025.06.006
Jeffrey J. Geppert EdM, JD (is Senior Research Leader, Battelle Memorial Institute, Columbus, Ohio.), Peta M.A. Alexander MBBS, FRACP, FCICM (is Senior Associate Cardiologist, Boston Children's Hospital, and Associate Professor of Pediatrics, Harvard Medical School.), Nicole Brennan DrPH, MPH (is Director, Healthcare Quality Improvement and Population Health, Battelle Memorial Institute.), Kedar S. Mate MD (is Founder and Chief Medical Officer, Qualified Health, and Assistant Professor of Medicine, Weill Cornell Medical College.), Kathy J. Jenkins MD, MPH (is Senior Associate Cardiologist, Boston Children's Hospital, and Professor of Pediatrics, Harvard Medical School. Please address correspondence to Jeffrey J. Geppert)
{"title":"Generating Value Through Structural Investment: Rebalancing Value-Based Payment, Pay for Transformation, and Fee-for-Service","authors":"Jeffrey J. Geppert EdM, JD (is Senior Research Leader, Battelle Memorial Institute, Columbus, Ohio.), Peta M.A. Alexander MBBS, FRACP, FCICM (is Senior Associate Cardiologist, Boston Children's Hospital, and Associate Professor of Pediatrics, Harvard Medical School.), Nicole Brennan DrPH, MPH (is Director, Healthcare Quality Improvement and Population Health, Battelle Memorial Institute.), Kedar S. Mate MD (is Founder and Chief Medical Officer, Qualified Health, and Assistant Professor of Medicine, Weill Cornell Medical College.), Kathy J. Jenkins MD, MPH (is Senior Associate Cardiologist, Boston Children's Hospital, and Professor of Pediatrics, Harvard Medical School. Please address correspondence to Jeffrey J. Geppert)","doi":"10.1016/j.jcjq.2025.06.006","DOIUrl":"10.1016/j.jcjq.2025.06.006","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 10","pages":"Pages 673-678"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707512","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 : 2025-10-01Epub Date: 2025-06-13DOI: 10.1016/j.jcjq.2025.06.005
Jessica C. Schoen MD, MS (is Emergency Medicine Physician, Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, and Mayo Clinic Health System, Minnesota), Janee M. Klipfel RN, MS (is Patient Safety Manager, Department of Nursing, Mayo Clinic, Rochester), Shelley M. Wolfe EdD, RN, CHSE, NPD-BC (is Nursing Education Specialist, Department of Nursing, Mayo Clinic, Rochester), Valerie D. Willis MSN, RN, CHSE (is Nursing Education Specialist, Department of Nursing, Mayo Clinic, Rochester), Vanessa E. Torbenson MD (is Obstetrician/Gynecologist, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester), Jason J. DeWitt MD (is Obstetrician/Gynecologist, Department of Obstetrics and Gynecology, Mayo Clinic Health System, Minnesota), Jennifer L. Fang MD, MS (is Neonatologist, Division of Neonatal Medicine, Mayo Clinic, Rochester), Regan N. Theiler MD, PhD (is Obstetrician/Gynecologist, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester. Please address correspondence to Jessica C. Schoen)
Background
To meet Joint Commission maternal safety standards and facilitate the implementation of acute care obstetrics telemedicine (TeleOB) consultation services throughout one health system, the authors developed a novel in situ simulation framework called STEPS: Simulation for Targeted Education, Process improvement, and Systems integration. STEPS addresses education, process improvement, and systems integration objectives within each simulation scenario, a three-in-one approach to in situ simulation that has not been previously described.
Methods
The STEPS framework was used to design and implement multidisciplinary in situ simulations in six emergency departments and four labor and delivery units in two states. Simulations and debriefs were facilitated by simulation education–trained faculty. Opportunities for improvement (OFIs) were addressed by appropriate leadership teams. Participants provided feedback via a voluntary survey after each simulation session.
Results
A total of 136 OFIs were identified. Many OFIs were observed in more than one simulation session or across multiple sites, but 33 were distinct (9 distinct educational OFIs, 16 distinct process improvement OFIs, and 8 distinct systems integration OFIs). OFIs were assigned to appropriate personnel to design and implement mitigation strategies. Simulation faculty followed up with site leadership about two weeks after each simulation session to provide feedback and review the status of mitigation efforts. Of 162 participants, 91 (56.2%) completed the post-session survey. Of those who responded, 96.7% reported increased confidence in managing similar cases in their own practice. Many also noted improved familiarity with telemedicine resources and workflows.
Conclusion
The STEPS approach is a novel and effective way to simultaneously meet education, process improvement, and systems integration objectives in each simulation scenario and across a large health system.
{"title":"Simulation for Targeted Education, Process Improvement, and Systems Integration (STEPS): A Novel Approach to Health Care Quality Improvement Using In Situ Simulation","authors":"Jessica C. Schoen MD, MS (is Emergency Medicine Physician, Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, and Mayo Clinic Health System, Minnesota), Janee M. Klipfel RN, MS (is Patient Safety Manager, Department of Nursing, Mayo Clinic, Rochester), Shelley M. Wolfe EdD, RN, CHSE, NPD-BC (is Nursing Education Specialist, Department of Nursing, Mayo Clinic, Rochester), Valerie D. Willis MSN, RN, CHSE (is Nursing Education Specialist, Department of Nursing, Mayo Clinic, Rochester), Vanessa E. Torbenson MD (is Obstetrician/Gynecologist, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester), Jason J. DeWitt MD (is Obstetrician/Gynecologist, Department of Obstetrics and Gynecology, Mayo Clinic Health System, Minnesota), Jennifer L. Fang MD, MS (is Neonatologist, Division of Neonatal Medicine, Mayo Clinic, Rochester), Regan N. Theiler MD, PhD (is Obstetrician/Gynecologist, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester. Please address correspondence to Jessica C. Schoen)","doi":"10.1016/j.jcjq.2025.06.005","DOIUrl":"10.1016/j.jcjq.2025.06.005","url":null,"abstract":"<div><h3>Background</h3><div>To meet Joint Commission maternal safety standards and facilitate the implementation of acute care obstetrics telemedicine (TeleOB) consultation services throughout one health system, the authors developed a novel in situ simulation framework called STEPS: Simulation for Targeted Education, Process improvement, and Systems integration. STEPS addresses education, process improvement, and systems integration objectives within each simulation scenario, a three-in-one approach to in situ simulation that has not been previously described.</div></div><div><h3>Methods</h3><div>The STEPS framework was used to design and implement multidisciplinary in situ simulations in six emergency departments and four labor and delivery units in two states. Simulations and debriefs were facilitated by simulation education–trained faculty. Opportunities for improvement (OFIs) were addressed by appropriate leadership teams. Participants provided feedback via a voluntary survey after each simulation session.</div></div><div><h3>Results</h3><div>A total of 136 OFIs were identified. Many OFIs were observed in more than one simulation session or across multiple sites, but 33 were distinct (9 distinct educational OFIs, 16 distinct process improvement OFIs, and 8 distinct systems integration OFIs). OFIs were assigned to appropriate personnel to design and implement mitigation strategies. Simulation faculty followed up with site leadership about two weeks after each simulation session to provide feedback and review the status of mitigation efforts. Of 162 participants, 91 (56.2%) completed the post-session survey. Of those who responded, 96.7% reported increased confidence in managing similar cases in their own practice. Many also noted improved familiarity with telemedicine resources and workflows.</div></div><div><h3>Conclusion</h3><div>The STEPS approach is a novel and effective way to simultaneously meet education, process improvement, and systems integration objectives in each simulation scenario and across a large health system.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 10","pages":"Pages 609-620"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717866","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 : 2025-10-01Epub Date: 2025-07-20DOI: 10.1016/j.jcjq.2025.07.006
Courtney Sump MD, MSc (Assistant Professor, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine.), Hadley Sauers-Ford MPH, CCRP (is Senior Clinical Research Coordinator, Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center.), Sinem Toraman Turk PhD (is Associate Research Scientist, Yale Global Health Leadership Initiative, Department of Health Policy and Management, Yale School of Public Health.), Kylee Denker MSN, RN, NE-BC (is Clinical Director, Home Care Agency and Remote Patient Monitoring, Cincinnati Children’s Hospital Medical Center.), Carlos Casillas MD, MPH (is Assistant Professor, Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine.), Joanna Thomson MD, MPH (is Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, and Professor, Department of Pediatrics, University of Cincinnati College of Medicine. Please send correspondence to Courtney Sump)
Background
Although telehealth has potential to improve access to care by eliminating barriers such as transportation and childcare, it also may result in disparate access for certain populations. The aim of this study was to gain an in-depth understanding of telehealth access at a large quaternary care children’s hospital.
Methods
This qualitative study employed purposive sampling and semistructured interviews of key personnel across our institution, including caregivers, clinical providers, and telehealth operational leads and staff. Interviews targeting access to telehealth were recorded and transcribed verbatim. Using an inductive, thematic approach, each interview was coded independently by two study team members. The authors identified preliminary themes and iteratively reviewed interviews and codes to finalize themes with illustrative quotes.
Results
The authors interviewed 25 participants and identified four themes: (1) Telehealth may perpetuate health disparities, including provider reluctance to offer telehealth to patients with a preferred language other than English; (2) Telehealth can help patients receive the right care, at the right place and time; (3) There are numerous facilitators to telehealth’s uptake, including provider and caregiver buy-in and optimal physical workspace; and (4) There are challenges in its execution that lead to decreased uptake.
Conclusion
Telehealth has many challenges to successful execution but is an integral component to providing the right care at the right place and time. This study was unique in capturing perspectives of multidisciplinary members of the healthcare team in addition to patient caregivers to provide a wide variety of perspectives on access to telehealth. The findings in this single-site, qualitative study identify that real and perceived assumptions about who is best suited for telehealth care may perpetuate health disparities and exacerbate gaps in access to care.
{"title":"Telehealth for Pediatric Patients: Facilitators, Barriers, and Impact on Disparities","authors":"Courtney Sump MD, MSc (Assistant Professor, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine.), Hadley Sauers-Ford MPH, CCRP (is Senior Clinical Research Coordinator, Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center.), Sinem Toraman Turk PhD (is Associate Research Scientist, Yale Global Health Leadership Initiative, Department of Health Policy and Management, Yale School of Public Health.), Kylee Denker MSN, RN, NE-BC (is Clinical Director, Home Care Agency and Remote Patient Monitoring, Cincinnati Children’s Hospital Medical Center.), Carlos Casillas MD, MPH (is Assistant Professor, Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine.), Joanna Thomson MD, MPH (is Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, and Professor, Department of Pediatrics, University of Cincinnati College of Medicine. Please send correspondence to Courtney Sump)","doi":"10.1016/j.jcjq.2025.07.006","DOIUrl":"10.1016/j.jcjq.2025.07.006","url":null,"abstract":"<div><h3>Background</h3><div>Although telehealth has potential to improve access to care by eliminating barriers such as transportation and childcare, it also may result in disparate access for certain populations. The aim of this study was to gain an in-depth understanding of telehealth access at a large quaternary care children’s hospital.</div></div><div><h3>Methods</h3><div>This qualitative study employed purposive sampling and semistructured interviews of key personnel across our institution, including caregivers, clinical providers, and telehealth operational leads and staff. Interviews targeting access to telehealth were recorded and transcribed verbatim. Using an inductive, thematic approach, each interview was coded independently by two study team members. The authors identified preliminary themes and iteratively reviewed interviews and codes to finalize themes with illustrative quotes.</div></div><div><h3>Results</h3><div>The authors interviewed 25 participants and identified four themes: (1) Telehealth may perpetuate health disparities, including provider reluctance to offer telehealth to patients with a preferred language other than English; (2) Telehealth can help patients receive the right care, at the right place and time; (3) There are numerous facilitators to telehealth’s uptake, including provider and caregiver buy-in and optimal physical workspace; and (4) There are challenges in its execution that lead to decreased uptake.</div></div><div><h3>Conclusion</h3><div>Telehealth has many challenges to successful execution but is an integral component to providing the right care at the right place and time. This study was unique in capturing perspectives of multidisciplinary members of the healthcare team in addition to patient caregivers to provide a wide variety of perspectives on access to telehealth. The findings in this single-site, qualitative study identify that real and perceived assumptions about who is best suited for telehealth care may perpetuate health disparities and exacerbate gaps in access to care.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 10","pages":"Pages 632-641"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955012","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 : 2025-10-01Epub Date: 2025-06-29DOI: 10.1016/j.jcjq.2025.06.012
Nick May (is Nurse Educator, Innovation and Education Directorate, Royal Perth Bentley Group, Perth, Australia.), Lucia Gillman PhD (is Coordinator of Nursing, Innovation and Education Directorate, Royal Perth Bentley Group. Please address correspondence to Nicholas May)
Background
Patient harm attributed to invasive devices is a global concern. Around 18% to 54% of all catheter-related hospital-acquired bloodstream infections (HABSIs) are attributable to peripheral intravenous cannulas (PIVCs). Between 4% and 28% of PIVCs placed in hospitalized patients and up to 50% of emergency department (ED) PIVCs are not used. Avoiding insertion of the “just in case” PIVC where safe to do so has potential to reduce patient risk.
Tool Development
The DRIP mnemonic (Deterioration, Rehydration, Intravenous medications, Procedure) was designed around four simple questions to guide clinicians’ decision-making relating to PIVC insertion. DRIP can also be used to support the daily review of existing cannulas to confirm ongoing need. Both applications align to daily workflows to promote a culture of safety.
Results
DRIP has assisted in reducing the number of idle PIVCs reported in monthly quality and safety audits from 8.3% to 1.8%. Removal of these PIVCs was possible after confirmation with treating teams that the device was not clinically indicated. This has reduced patient exposure to HABSI. During a 15-month period, independent assessment of PIVC insertion requests by the Vascular Access Team found that 3,103 PIVC requests (10.1%) were deemed not clinically indicated and were not inserted. None met DRIP criteria, which suggests independent expert clinician assessment aligns well to the DRIP criteria in practice.
Conclusion
DRIP has shown that elimination of cannulation where not clinically indicated is achievable. Use of the DRIP tool can support safe organizational culture by encouraging staff to question the need for a PIVC to reduce or eliminate the “just in case” or idle cannula. Formal validation of DRIP across multiple settings would strengthen the evidence base underpinning PIVC decision-making.
{"title":"The DRIP Criteria: Reducing the Frequency of Peripheral Intravenous Catheter Insertion in Hospitalized Patients","authors":"Nick May (is Nurse Educator, Innovation and Education Directorate, Royal Perth Bentley Group, Perth, Australia.), Lucia Gillman PhD (is Coordinator of Nursing, Innovation and Education Directorate, Royal Perth Bentley Group. Please address correspondence to Nicholas May)","doi":"10.1016/j.jcjq.2025.06.012","DOIUrl":"10.1016/j.jcjq.2025.06.012","url":null,"abstract":"<div><h3>Background</h3><div>Patient harm attributed to invasive devices is a global concern. Around 18% to 54% of all catheter-related hospital-acquired bloodstream infections (HABSIs) are attributable to peripheral intravenous cannulas (PIVCs). Between 4% and 28% of PIVCs placed in hospitalized patients and up to 50% of emergency department (ED) PIVCs are not used. Avoiding insertion of the “just in case” PIVC where safe to do so has potential to reduce patient risk.</div></div><div><h3>Tool Development</h3><div>The DRIP mnemonic (Deterioration, Rehydration, Intravenous medications, Procedure) was designed around four simple questions to guide clinicians’ decision-making relating to PIVC insertion. DRIP can also be used to support the daily review of existing cannulas to confirm ongoing need. Both applications align to daily workflows to promote a culture of safety.</div></div><div><h3>Results</h3><div>DRIP has assisted in reducing the number of idle PIVCs reported in monthly quality and safety audits from 8.3% to 1.8%. Removal of these PIVCs was possible after confirmation with treating teams that the device was not clinically indicated. This has reduced patient exposure to HABSI. During a 15-month period, independent assessment of PIVC insertion requests by the Vascular Access Team found that 3,103 PIVC requests (10.1%) were deemed not clinically indicated and were not inserted. None met DRIP criteria, which suggests independent expert clinician assessment aligns well to the DRIP criteria in practice.</div></div><div><h3>Conclusion</h3><div>DRIP has shown that elimination of cannulation where not clinically indicated is achievable. Use of the DRIP tool can support safe organizational culture by encouraging staff to question the need for a PIVC to reduce or eliminate the “just in case” or idle cannula. Formal validation of DRIP across multiple settings would strengthen the evidence base underpinning PIVC decision-making.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 10","pages":"Pages 666-672"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731051","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 : 2025-10-01Epub Date: 2025-07-11DOI: 10.1016/j.jcjq.2025.07.002
Margery Dell Smith DNP, FNP-C (is a Nurse Practitioner at Onvida Health Transitional Care Clinic in Yuma, Arizona), Kimberly A. Couch DNP, CNM, FNP-BC (is a Clinical Faculty Member at Frontier Nursing University in Versailles, Kentucky. Please address correspondence to Margery Dell Smith, DNP, FNP-C)
Background
Alpha-1 antitrypsin deficiency (AATD) is an underrecognized hereditary condition affecting approximately 2% of patients with chronic obstructive pulmonary disease (COPD) in the United States. Studies show a correlation between AATD and COPD progression, with a five-year mortality rate of 19% in severe AATD. National costs attributed to COPD were approximately $32.1 billion in 2010 and an estimated $49 billion in 2020. Chart audits at Onvida Health revealed that only 2.0% of patients diagnosed with COPD were tested for AATD. The authors aimed to improve effective care through AATD testing in adult patients with COPD in the primary care setting to 75% in an eight-week time frame.
Methods
Baseline data were obtained from chart audits for patients with COPD and patient/staff surveys. The implementation spanned eight weeks using a Plan-Do-Study-Act (PDSA) process consisting of four cycles and two core interventions analyzed every two weeks. A shared decision-making checklist was developed for AATD screening and testing. A standard of care log constructed from current evidence was implemented for all patients with COPD.
Results
Testing rates improved to 38.1% from a baseline of 2.0%. Although there was a 0.0% positivity rate for the diagnosis of AATD (two abnormal alleles), 19.7% (n = 12 of 61) of patients were identified as AATD carriers (one abnormal and one normal allele).
Conclusion
Utilizing standard of care can aid in disease prevention and prevent progression with early identification of patients with AATD. Suggested next steps include lengthier studies to evaluate the carriers and their offspring.
{"title":"Improving Screening for Alpha-1 Antitrypsin Deficiency in Adults with COPD","authors":"Margery Dell Smith DNP, FNP-C (is a Nurse Practitioner at Onvida Health Transitional Care Clinic in Yuma, Arizona), Kimberly A. Couch DNP, CNM, FNP-BC (is a Clinical Faculty Member at Frontier Nursing University in Versailles, Kentucky. Please address correspondence to Margery Dell Smith, DNP, FNP-C)","doi":"10.1016/j.jcjq.2025.07.002","DOIUrl":"10.1016/j.jcjq.2025.07.002","url":null,"abstract":"<div><h3>Background</h3><div>Alpha-1 antitrypsin deficiency (AATD) is an underrecognized hereditary condition affecting approximately 2% of patients with chronic obstructive pulmonary disease (COPD) in the United States. Studies show a correlation between AATD and COPD progression, with a five-year mortality rate of 19% in severe AATD. National costs attributed to COPD were approximately $32.1 billion in 2010 and an estimated $49 billion in 2020. Chart audits at Onvida Health revealed that only 2.0% of patients diagnosed with COPD were tested for AATD. The authors aimed to improve effective care through AATD testing in adult patients with COPD in the primary care setting to 75% in an eight-week time frame.</div></div><div><h3>Methods</h3><div>Baseline data were obtained from chart audits for patients with COPD and patient/staff surveys. The implementation spanned eight weeks using a Plan-Do-Study-Act (PDSA) process consisting of four cycles and two core interventions analyzed every two weeks. A shared decision-making checklist was developed for AATD screening and testing. A standard of care log constructed from current evidence was implemented for all patients with COPD.</div></div><div><h3>Results</h3><div>Testing rates improved to 38.1% from a baseline of 2.0%. Although there was a 0.0% positivity rate for the diagnosis of AATD (two abnormal alleles), 19.7% (<em>n</em> = 12 of 61) of patients were identified as AATD carriers (one abnormal and one normal allele).</div></div><div><h3>Conclusion</h3><div>Utilizing standard of care can aid in disease prevention and prevent progression with early identification of patients with AATD. Suggested next steps include lengthier studies to evaluate the carriers and their offspring.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 10","pages":"Pages 659-665"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804109","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 : 2025-10-01Epub Date: 2025-06-17DOI: 10.1016/j.jcjq.2025.06.007
Helen Jingshu Jin MSc (is Medical Student, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada), Tsan-Hua Tung PhD (is Department of Surgery, London Health Sciences Centre, London, Ontario), Sydney Selznick MD (is Resident Physician, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery, London Health Sciences Centre), Christine Cotton RN (is Patient Blood Management Program Coordinator, Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre), Madeline Lemke MD, MSc (is General Surgery Resident, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery, London Health Sciences Centre), Lily J. Park MD, MSc (is General Surgery Resident, Department of Surgery, McMaster University), Christopher C. Harle FRCA, FRCP (is Associate Professor, Schulich School of Medicine and Dentistry, and Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre), Bradley Moffat MD, MSc, MSc(QI), FRCSC, FACS (is Assistant Professor, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery, London Health Sciences Centre), Patrick Colquhoun MD, MSc, FRCSC, FACS, FASCRS (is Professor, Schulich School of Medicine and Dentistry, Western University, and Departments of Surgery and Oncology, London Health Sciences Centre), Terry Murray Zwiep MD, MSc, FRCSC (is Assistant Professor, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery London Health Sciences Centre. Please address correspondence to Terry Murray Zwiep)
Introduction
Preoperative anemia for patients undergoing major surgery is associated with increased postoperative morbidity and mortality, including increased requirement for perioperative blood transfusion, length of hospital stay, in-hospital mortality, and ICU admissions. In this quality improvement initiative, the authors describe measures implemented to promote preoperative anemia screening rates and increase uptake in hemoglobin optimizing interventions, with the goal of decreasing perioperative blood transfusion rates.
Methods
Change ideas implemented included establishing a new relationship between the Division of General Surgery and the center’s established Patient Blood Management (PBM) program; amending the center’s electronic health record to include prebuilt order sets for anemia screening bloodwork, PBM referrals, and oral iron prescriptions; modifying surgical consent packages to include anemia screening questions; and providing education to relevant care team members.
Results
A total of 1,444 patients were included. PBM referrals for anemic patients were increased to 24.6% from 0%. In patients with anemia (n = 754), preoperative treatment was independently associated with a decrease in perioperative blood transfusion (odds ratio 0.42, p = 0.007). Patients connected with the PBM program had decreased lengths of hospital stay (6.6 vs 9.7 days, p = 0.01), admissions to the ICU (1.1% vs 6.7%, p = 0.03), and in-hospital mortality (0% vs 4.3%, p = 0.04) compared to unreferred anemic patients.
Conclusion
The interventions described were successful in decreasing the perioperative blood transfusion rates and improving postoperative outcomes for anemic patients undergoing major surgery. The initiatives were easily incorporated into the existing surgical workflow and can be expanded into other centers and surgical fields.
{"title":"Improving the Treatment of Preoperative Anemia in Colorectal and Hepato-Pancreato-Biliary Patients: A Quality Improvement Initiative","authors":"Helen Jingshu Jin MSc (is Medical Student, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada), Tsan-Hua Tung PhD (is Department of Surgery, London Health Sciences Centre, London, Ontario), Sydney Selznick MD (is Resident Physician, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery, London Health Sciences Centre), Christine Cotton RN (is Patient Blood Management Program Coordinator, Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre), Madeline Lemke MD, MSc (is General Surgery Resident, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery, London Health Sciences Centre), Lily J. Park MD, MSc (is General Surgery Resident, Department of Surgery, McMaster University), Christopher C. Harle FRCA, FRCP (is Associate Professor, Schulich School of Medicine and Dentistry, and Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre), Bradley Moffat MD, MSc, MSc(QI), FRCSC, FACS (is Assistant Professor, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery, London Health Sciences Centre), Patrick Colquhoun MD, MSc, FRCSC, FACS, FASCRS (is Professor, Schulich School of Medicine and Dentistry, Western University, and Departments of Surgery and Oncology, London Health Sciences Centre), Terry Murray Zwiep MD, MSc, FRCSC (is Assistant Professor, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery London Health Sciences Centre. Please address correspondence to Terry Murray Zwiep)","doi":"10.1016/j.jcjq.2025.06.007","DOIUrl":"10.1016/j.jcjq.2025.06.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Preoperative anemia for patients undergoing major surgery is associated with increased postoperative morbidity and mortality, including increased requirement for perioperative blood transfusion, length of hospital stay, in-hospital mortality, and ICU admissions. In this quality improvement initiative, the authors describe measures implemented to promote preoperative anemia screening rates and increase uptake in hemoglobin optimizing interventions, with the goal of decreasing perioperative blood transfusion rates.</div></div><div><h3>Methods</h3><div>Change ideas implemented included establishing a new relationship between the Division of General Surgery and the center’s established Patient Blood Management (PBM) program; amending the center’s electronic health record to include prebuilt order sets for anemia screening bloodwork, PBM referrals, and oral iron prescriptions; modifying surgical consent packages to include anemia screening questions; and providing education to relevant care team members.</div></div><div><h3>Results</h3><div>A total of 1,444 patients were included. PBM referrals for anemic patients were increased to 24.6% from 0%. In patients with anemia (<em>n</em> = 754), preoperative treatment was independently associated with a decrease in perioperative blood transfusion (odds ratio 0.42, <em>p</em> = 0.007). Patients connected with the PBM program had decreased lengths of hospital stay (6.6 vs 9.7 days, <em>p</em> = 0.01), admissions to the ICU (1.1% vs 6.7%, p = 0.03), and in-hospital mortality (0% vs 4.3%, <em>p</em> = 0.04) compared to unreferred anemic patients.</div></div><div><h3>Conclusion</h3><div>The interventions described were successful in decreasing the perioperative blood transfusion rates and improving postoperative outcomes for anemic patients undergoing major surgery. The initiatives were easily incorporated into the existing surgical workflow and can be expanded into other centers and surgical fields.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 10","pages":"Pages 652-658"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731050","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 : 2025-09-01Epub Date: 2025-07-18DOI: 10.1016/j.jcjq.2025.07.004
Elizabeth Mort MD, MPH (is Editor-in-Chief, The Joint Commission Journal on Quality and Patient Safety, and Vice President and Chief Medical Officer, Joint Commission, Oakbrook Terrace, Illinois. Please address correspondence to Dr. Elizabeth Mort)
{"title":"Remembering Lucian Leape","authors":"Elizabeth Mort MD, MPH (is Editor-in-Chief, The Joint Commission Journal on Quality and Patient Safety, and Vice President and Chief Medical Officer, Joint Commission, Oakbrook Terrace, Illinois. Please address correspondence to Dr. Elizabeth Mort)","doi":"10.1016/j.jcjq.2025.07.004","DOIUrl":"10.1016/j.jcjq.2025.07.004","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 9","pages":"Page 514"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768663","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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