Pub 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":"2025-06-22","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 : 2025-06-20DOI: 10.1016/j.jcjq.2025.06.009
Autumn Fiester PhD (is Director, Penn Program in Clinical Conflict Management, and Associate Professor, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania. Please address correspondence to Autumn Fiester)
{"title":"Mediating Clinical Conflict: An Expanded Role for Patient Relations Offices","authors":"Autumn Fiester PhD (is Director, Penn Program in Clinical Conflict Management, and Associate Professor, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania. Please address correspondence to Autumn Fiester)","doi":"10.1016/j.jcjq.2025.06.009","DOIUrl":"10.1016/j.jcjq.2025.06.009","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 11","pages":"Pages 733-736"},"PeriodicalIF":2.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717926","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 : 2025-06-20DOI: 10.1016/j.jcjq.2025.06.002
Lynn Shesser MBA, MSN, RN (is Quality Improvement Coordinator, Children’s Hospital of Philadelphia Home Care.), John Tamasitis RRT, NPS (is Former Clinical Manager, Respiratory Services, Children’s Hospital of Philadelphia Home Care.), John Chuo MD, MS, IA (is Professor of Clinical Pediatrics, Perelman School of Medicine, University of Pennsylvania, and Quality Officer for Neonatal Network, Children’s Hospital of Philadelphia. Please address correspondence to Lynn Shesser)
Background
Children’s Hospital of Philadelphia’s Home Care respiratory therapy patient population becomes more acute and resource-intense each year. The organization's trach/vent patients have numerous clinical and equipment needs requiring complex home respiratory management. To conserve respiratory therapy resources, a remote patient management (RPM) program was integrated into the current respiratory services care model by introducing innovative technology to monitor patient data remotely. The authors expected this to reduce the number of home visits defined in the established program while maintaining safe, high-quality care. The goal was a reduction of 20%.
Methods
Biweekly, respiratory therapists (RTs) reviewed electronic health records and equipment downloads for specific patients and contacted them to assess their clinical status. RTs documented findings, planned interventions, communicated with interdisciplinary teams, and determined follow-up. Home and video contacts remained options for concerns. At minimum, RTs assessed patients in homes every three months. Chart reviews and safety rounds supported quality assessment.
Results
Results revealed a 38.7% reduction in home visits compared to the prior year and 59.6% reduction in home visits from pre–COVID-19 baseline data, with several instances of special cause variation observed on statistical process control analysis (p < 0.05). The authors found a 21.01% reduction in on-call volume for ventilator-related issues (p = 0.2) and a 5.8% increase in patient’s status changing to lower acuity (p = 0.2); neither was statistically significant due to low sample size. Results showed time and mileage savings, improved communication with interdisciplinary teams and families, improved RT quality of life, active ventilator weaning for relevant patients, and potential prevention of hospital admissions.
Conclusion
The program delivered innovation to an established care model, providing resource conservation, financial savings, and patient and staff satisfaction, and exceeded its goal.
{"title":"A Remote Patient Management Care Model for Pediatric Home Care Ventilator Patients Conserves Resources: A Quality Improvement Initiative","authors":"Lynn Shesser MBA, MSN, RN (is Quality Improvement Coordinator, Children’s Hospital of Philadelphia Home Care.), John Tamasitis RRT, NPS (is Former Clinical Manager, Respiratory Services, Children’s Hospital of Philadelphia Home Care.), John Chuo MD, MS, IA (is Professor of Clinical Pediatrics, Perelman School of Medicine, University of Pennsylvania, and Quality Officer for Neonatal Network, Children’s Hospital of Philadelphia. Please address correspondence to Lynn Shesser)","doi":"10.1016/j.jcjq.2025.06.002","DOIUrl":"10.1016/j.jcjq.2025.06.002","url":null,"abstract":"<div><h3>Background</h3><div>Children’s Hospital of Philadelphia’s Home Care respiratory therapy patient population becomes more acute and resource-intense each year. The organization's trach/vent patients have numerous clinical and equipment needs requiring complex home respiratory management. To conserve respiratory therapy resources, a remote patient management (RPM) program was integrated into the current respiratory services care model by introducing innovative technology to monitor patient data remotely. The authors expected this to reduce the number of home visits defined in the established program while maintaining safe, high-quality care. The goal was a reduction of 20%.</div></div><div><h3>Methods</h3><div>Biweekly, respiratory therapists (RTs) reviewed electronic health records and equipment downloads for specific patients and contacted them to assess their clinical status. RTs documented findings, planned interventions, communicated with interdisciplinary teams, and determined follow-up. Home and video contacts remained options for concerns. At minimum, RTs assessed patients in homes every three months. Chart reviews and safety rounds supported quality assessment.</div></div><div><h3>Results</h3><div>Results revealed a 38.7% reduction in home visits compared to the prior year and 59.6% reduction in home visits from pre–COVID-19 baseline data, with several instances of special cause variation observed on statistical process control analysis (<em>p</em> < 0.05). The authors found a 21.01% reduction in on-call volume for ventilator-related issues (<em>p</em> = 0.2) and a 5.8% increase in patient’s status changing to lower acuity (<em>p</em> = 0.2); neither was statistically significant due to low sample size. Results showed time and mileage savings, improved communication with interdisciplinary teams and families, improved RT quality of life, active ventilator weaning for relevant patients, and potential prevention of hospital admissions.</div></div><div><h3>Conclusion</h3><div>The program delivered innovation to an established care model, providing resource conservation, financial savings, and patient and staff satisfaction, and exceeded its goal.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 9","pages":"Pages 566-573"},"PeriodicalIF":2.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768662","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 : 2025-06-18DOI: 10.1016/j.jcjq.2025.06.008
Julie Dickinson JM, MBA, BSN, RN, LNCC, CPHRM (is System Director, Risk Management, Hartford HealthCare, Hartford, Connecticut.), Sebastian Placide MD (was Chief Resident in Quality Improvement and Patient Safety for Internal Medicine, Academic Year 2023–2024, VA [US Department of Veterans Affairs] Connecticut Healthcare System and Yale School of Medicine, and is Fellow in Cardiovascular Medicine, NewYork Presbyterian / Weill Cornell Medical Center.), Samantha Magier MD, MEng (was Chief Resident in Quality Improvement and Patient Safety for Internal Medicine, Academic Year 2022–2023, VA Connecticut Healthcare System and Yale School of Medicine, and is Clinical Research Fellow PGY6, Division of Gastroenterology, Hepatology and Endoscopy, Brigham & Women’s Hospital / Harvard Medical School.), Naseema B. Merchant MD (is Associate Professor, Department of Medicine, Yale School of Medicine, and Program Director, Chief Residency in Quality Improvement and Patient Safety in Internal Medicine, VA Connecticut Healthcare System. Please address correspondence to Julie Dickinson)
Background
While providing learning from adverse events, traditional morbidity and mortality conferences may not consistently discuss systems, action items, and execution plans, or engage interprofessional audiences to address adverse events. The aim of this study was to design a space to learn from adverse events and, through engaging diverse staff, develop systems-oriented action items, establish mechanisms to follow through on these items, and close the loop with staff on system improvements.
Methods
A planning group designed a quarterly conference in which involved staff review an adverse event with an interdisciplinary, interdepartmental audience. Through interactive discussion, attendees identify root causes and potential system-level solutions. Actionable solutions are implemented and communicated at the next conference. Attendee surveys were conducted to gauge the perceived impact of the conference series on safety culture. The monthly average of submitted safety reports was evaluated as a surrogate safety culture marker.
Results
Conference attendance grew by 157.5%. Participants reported increased comfort in raising concerns (from 84.0% to 100.0%), improved interprofessional teamwork (from 84.0% to 100.0%), unit-based shifts to a learning culture (from 64.0% to 93.4%), positive clinical area changes (from 52.0% to 90.0%), and positive health system changes (from 84.0% to 96.7%). The average number of monthly safety reports increased by 17.0%.
Conclusion
The morbidity, mortality, and improvement conference demonstrated improvements in reported safety attitudes, interdisciplinary collaboration, system design, learning culture, psychological safety, and safety reporting. This interdisciplinary, interdepartmental, system-focused, interactive conference with closed-loop communication is an effective tool for cultivating trust in safety culture and transforming staff into safety ambassadors and change agents.
{"title":"The Morbidity, Mortality, and Improvement Conference: An Innovative, Action-Oriented Learning Space","authors":"Julie Dickinson JM, MBA, BSN, RN, LNCC, CPHRM (is System Director, Risk Management, Hartford HealthCare, Hartford, Connecticut.), Sebastian Placide MD (was Chief Resident in Quality Improvement and Patient Safety for Internal Medicine, Academic Year 2023–2024, VA [US Department of Veterans Affairs] Connecticut Healthcare System and Yale School of Medicine, and is Fellow in Cardiovascular Medicine, NewYork Presbyterian / Weill Cornell Medical Center.), Samantha Magier MD, MEng (was Chief Resident in Quality Improvement and Patient Safety for Internal Medicine, Academic Year 2022–2023, VA Connecticut Healthcare System and Yale School of Medicine, and is Clinical Research Fellow PGY6, Division of Gastroenterology, Hepatology and Endoscopy, Brigham & Women’s Hospital / Harvard Medical School.), Naseema B. Merchant MD (is Associate Professor, Department of Medicine, Yale School of Medicine, and Program Director, Chief Residency in Quality Improvement and Patient Safety in Internal Medicine, VA Connecticut Healthcare System. Please address correspondence to Julie Dickinson)","doi":"10.1016/j.jcjq.2025.06.008","DOIUrl":"10.1016/j.jcjq.2025.06.008","url":null,"abstract":"<div><h3>Background</h3><div>While providing learning from adverse events, traditional morbidity and mortality conferences may not consistently discuss systems, action items, and execution plans, or engage interprofessional audiences to address adverse events. The aim of this study was to design a space to learn from adverse events and, through engaging diverse staff, develop systems-oriented action items, establish mechanisms to follow through on these items, and close the loop with staff on system improvements.</div></div><div><h3>Methods</h3><div>A planning group designed a quarterly conference in which involved staff review an adverse event with an interdisciplinary, interdepartmental audience. Through interactive discussion, attendees identify root causes and potential system-level solutions. Actionable solutions are implemented and communicated at the next conference. Attendee surveys were conducted to gauge the perceived impact of the conference series on safety culture. The monthly average of submitted safety reports was evaluated as a surrogate safety culture marker.</div></div><div><h3>Results</h3><div>Conference attendance grew by 157.5%. Participants reported increased comfort in raising concerns (from 84.0% to 100.0%), improved interprofessional teamwork (from 84.0% to 100.0%), unit-based shifts to a learning culture (from 64.0% to 93.4%), positive clinical area changes (from 52.0% to 90.0%), and positive health system changes (from 84.0% to 96.7%). The average number of monthly safety reports increased by 17.0%.</div></div><div><h3>Conclusion</h3><div>The morbidity, mortality, and improvement conference demonstrated improvements in reported safety attitudes, interdisciplinary collaboration, system design, learning culture, psychological safety, and safety reporting. This interdisciplinary, interdepartmental, system-focused, interactive conference with closed-loop communication is an effective tool for cultivating trust in safety culture and transforming staff into safety ambassadors and change agents.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 11","pages":"Pages 719-726"},"PeriodicalIF":2.4,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717867","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 : 2025-06-17DOI: 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":"2025-06-17","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 : 2025-06-13DOI: 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":"2025-06-13","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 : 2025-06-12DOI: 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":"2025-06-12","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 : 2025-06-10DOI: 10.1016/j.jcjq.2025.06.003
Hanne Irene Jensen PhD, MHSc, CCN (is Professor, Departments of Anesthesiology and Intensive Care, Lillebaelt Hospital (Vejle and Kolding), University Hospital of Southern Denmark, and Department of Regional Health Research, University of Southern Denmark.), Hanne Andersen MPG, RN (is Nursing Director, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark.), Helen Bruun MHSc, RN (is Quality Coordinator, Department of Medicine, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark. Please address correspondence to Hanne Irene Jensen)
Background
Do not resuscitate (DNR) orders are not always documented at transitions of care, which may lead to inappropriate resuscitation attempts. The objectives of this study were (1) to investigate the challenges in ensuring that all staff are aware of patients’ DNR orders, (2) to examine documentation of DNR orders at transitions of care, and (3) to improve knowledge about DNR orders in institutions and at transitions of care.
Methods
This intervention initiative with pre- and post-measurements (2020 and 2023) involved hospital departments and nursing homes in Denmark. The intervention consisted of a practical instruction brochure and an end-of-life presentation. The measurements included audits of resuscitation attempts and of DNR order documentation at transitions of care. Furthermore, the participating institutions completed an electronic survey on perceived challenges.
Results
Thirty nursing homes and eight hospital departments participated in pre-measurement, 20 nursing homes and seven hospital departments participated in post-measurement, and 17 to 20 sites were included in paired analyses. The number of inappropriate resuscitation attempts was identical at pre- and post-measurements (none in nursing homes and five at the hospital). Correct documentation in nursing reports at hospital discharge increased from 32% to 53% (p = 0.003). Participating units that did not perceive challenges in ensuring knowledge of DNR orders increased from 10% to 48% (p < 0.001). At post-measurement, more than 80% of participating units had worked with models to ensure awareness of DNR orders and inclusion of DNR orders at transitions of care.
Conclusion
Participants experienced a significant increased focus on DNR orders in their own departments. Likewise, a significant increase in communication of DNR orders at transitions of care was found.
{"title":"Improving Awareness and Communication of Do Not Resuscitate Orders During Transitions of Care","authors":"Hanne Irene Jensen PhD, MHSc, CCN (is Professor, Departments of Anesthesiology and Intensive Care, Lillebaelt Hospital (Vejle and Kolding), University Hospital of Southern Denmark, and Department of Regional Health Research, University of Southern Denmark.), Hanne Andersen MPG, RN (is Nursing Director, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark.), Helen Bruun MHSc, RN (is Quality Coordinator, Department of Medicine, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark. Please address correspondence to Hanne Irene Jensen)","doi":"10.1016/j.jcjq.2025.06.003","DOIUrl":"10.1016/j.jcjq.2025.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Do not resuscitate (DNR) orders are not always documented at transitions of care, which may lead to inappropriate resuscitation attempts. The objectives of this study were (1) to investigate the challenges in ensuring that all staff are aware of patients’ DNR orders, (2) to examine documentation of DNR orders at transitions of care, and (3) to improve knowledge about DNR orders in institutions and at transitions of care.</div></div><div><h3>Methods</h3><div>This intervention initiative with pre- and post-measurements (2020 and 2023) involved hospital departments and nursing homes in Denmark. The intervention consisted of a practical instruction brochure and an end-of-life presentation. The measurements included audits of resuscitation attempts and of DNR order documentation at transitions of care. Furthermore, the participating institutions completed an electronic survey on perceived challenges.</div></div><div><h3>Results</h3><div>Thirty nursing homes and eight hospital departments participated in pre-measurement, 20 nursing homes and seven hospital departments participated in post-measurement, and 17 to 20 sites were included in paired analyses. The number of inappropriate resuscitation attempts was identical at pre- and post-measurements (none in nursing homes and five at the hospital). Correct documentation in nursing reports at hospital discharge increased from 32% to 53% (<em>p</em> = 0.003). Participating units that did not perceive challenges in ensuring knowledge of DNR orders increased from 10% to 48% (<em>p</em> < 0.001). At post-measurement, more than 80% of participating units had worked with models to ensure awareness of DNR orders and inclusion of DNR orders at transitions of care.</div></div><div><h3>Conclusion</h3><div>Participants experienced a significant increased focus on DNR orders in their own departments. Likewise, a significant increase in communication of DNR orders at transitions of care was found.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 9","pages":"Pages 574-581"},"PeriodicalIF":2.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649498","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 : 2025-06-10DOI: 10.1016/j.jcjq.2025.06.004
Nkiru Ogbuefi (is MD Candidate, Tufts University School of Medicine.), Alexandra Forauer MPH (is Director, Destination Services, Memorial Sloan Kettering Cancer Center, New York.), Maryana Kovalchuk MA (is Senior Manager, Patient Support Services, Memorial Sloan Kettering Cancer Center.), Javier Gonzalez MFA (is Language Initiatives Lead, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center.), Catalina Gomez Luna (is Language Program Coordinator and Trainer, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center.), Yunshan Niu MA (is Project Manager, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center.), Francesca Gany MD, MS (is Attending Physician, and Chief, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, and Professor of Medicine and Population Health Sciences, Weill Cornell Medical College.), Lisa C. Diamond MD, MPH (is Associate Attending Physician, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Assistant Professor of Population Health Sciences, Weill Cornell Medical College. Please address correspondence to Lisa C. Diamond)
Background
Language proficiency among health care professionals is essential for delivering equitable, high-quality care to patients with a non-English language preference (NELP). This study examines how implementing a Bilingual Competency Program (BCP) for diverse clinical staff enhances patient-centered care and improves the health care experience for NELP patients.
Methods
This quality improvement initiative describes implementation of the BCP at an urban cancer center. Staff self-assessed their language skills using the adapted Interagency Language Roundtable Scale for Healthcare (ILR-H) and recorded this in the organization’s human resources platform. Those self-rating as excellent attested to their proficiency and enrolled by signing an electronic statement. Those rating themselves as very good or good took an oral proficiency test. Those who passed joined the BCP, while those self-assessing as fair or poor were not included.
Results
A total of 935 employees joined the program, representing 1,087 unique language entries across 67 languages, with Spanish, Mandarin, Russian, and Hindi being most common. Out of 1,087 unique entries, 641 (59.0%) self-assessed as excellent, 269 (24.7%) as very good (75.0% of whom [60/80] passed the proficiency test), and 130 (12.0%) as good (58.8% of whom [20/34] passed). Most participants (71.8%) were in patient-facing roles, and 68.7% held clinical positions. Of 1,087 unique entries, 721 (66.3%) were verified for language proficiency, 641 through self-assessment and 80 through formal testing.
Conclusion
The BCP enhances linguistic competency by integrating validated assessments and evidence-based methods, addressing prior program limitations, and setting a new standard for improving health equity, care quality, and outcomes for NELP patients.
{"title":"Language-Concordant Health Care: Implementation of a Bilingual Competency Program","authors":"Nkiru Ogbuefi (is MD Candidate, Tufts University School of Medicine.), Alexandra Forauer MPH (is Director, Destination Services, Memorial Sloan Kettering Cancer Center, New York.), Maryana Kovalchuk MA (is Senior Manager, Patient Support Services, Memorial Sloan Kettering Cancer Center.), Javier Gonzalez MFA (is Language Initiatives Lead, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center.), Catalina Gomez Luna (is Language Program Coordinator and Trainer, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center.), Yunshan Niu MA (is Project Manager, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center.), Francesca Gany MD, MS (is Attending Physician, and Chief, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, and Professor of Medicine and Population Health Sciences, Weill Cornell Medical College.), Lisa C. Diamond MD, MPH (is Associate Attending Physician, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Assistant Professor of Population Health Sciences, Weill Cornell Medical College. Please address correspondence to Lisa C. Diamond)","doi":"10.1016/j.jcjq.2025.06.004","DOIUrl":"10.1016/j.jcjq.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Language proficiency among health care professionals is essential for delivering equitable, high-quality care to patients with a non-English language preference (NELP). This study examines how implementing a Bilingual Competency Program (BCP) for diverse clinical staff enhances patient-centered care and improves the health care experience for NELP patients.</div></div><div><h3>Methods</h3><div>This quality improvement initiative describes implementation of the BCP at an urban cancer center. Staff self-assessed their language skills using the adapted Interagency Language Roundtable Scale for Healthcare (ILR-H) and recorded this in the organization’s human resources platform. Those self-rating as excellent attested to their proficiency and enrolled by signing an electronic statement. Those rating themselves as very good or good took an oral proficiency test. Those who passed joined the BCP, while those self-assessing as fair or poor were not included.</div></div><div><h3>Results</h3><div>A total of 935 employees joined the program, representing 1,087 unique language entries across 67 languages, with Spanish, Mandarin, Russian, and Hindi being most common. Out of 1,087 unique entries, 641 (59.0%) self-assessed as excellent, 269 (24.7%) as very good (75.0% of whom [60/80] passed the proficiency test), and 130 (12.0%) as good (58.8% of whom [20/34] passed). Most participants (71.8%) were in patient-facing roles, and 68.7% held clinical positions. Of 1,087 unique entries, 721 (66.3%) were verified for language proficiency, 641 through self-assessment and 80 through formal testing.</div></div><div><h3>Conclusion</h3><div>The BCP enhances linguistic competency by integrating validated assessments and evidence-based methods, addressing prior program limitations, and setting a new standard for improving health equity, care quality, and outcomes for NELP patients.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 9","pages":"Pages 526-533"},"PeriodicalIF":2.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649499","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 : 2025-06-07DOI: 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":"2025-06-07","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号