Pub Date : 2024-06-08DOI: 10.1016/j.jcjq.2024.06.002
Background
Human immunodeficiency virus (HIV) and hepatitis C (HCV) screening and human papillomavirus (HPV) vaccine uptake remain suboptimal. To improve HIV and HCV screening and HPV vaccination, the authors implemented a quality improvement project in three southwestern Pennsylvania family medicine residency practices.
Methods
From June 1 to November 30, 2021, participating practices used universal screening and vaccination guidelines and chose from multiple strategies at the office (for example, standing orders), provider (for example, multiple forms of provider reminders), and patient (for example, incentives) levels derived from published literature and tailored to local context. Age-eligible patients for each recommendation with at least one in-person office visit during the intervention period were included. To assess the interventions’ effect, the authors obtained testing and vaccination data from the electronic health record for the intervention period, contrasted it with identical data from June 1 to November 30, 2020, and used logistic regression controlling for patient age, sex, and race to determine differences in screening and vaccination between intervention and baseline periods.
Results
A total of 14,920 and 15,523 patients were eligible in the baseline and intervention periods, respectively. Following the intervention, HIV lifetime screening but not first-time screening for patients 13–64 years old was significantly higher (78.9% vs. 76.1%, p = 0.004, and 39.6% vs. 36.6%, p = 0.152, respectively, adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 1.06–1.38). HCV lifetime screening for patients 18–79 years old was significantly higher postintervention (62.5% vs. 53.5%, p < 0.001, aOR 1.51, 95% CI 1.4–1.64). For patients 9–26 years old, no change in HPV initiation was observed, but the percentage of patients who completed their HPV vaccinations in the observed period was significantly higher postintervention (7.0% vs 4.6%, p = 0.006, aOR 1.58, 95% CI 1.14–2.2). During the postintervention period, the researchers identified 0 new HIV diagnoses and 48 HCV diagnoses (19 eligible for treatment).
Conclusion
Family medicine residency office-based multistrategy efforts appear to successfully increase patient uptake of HIV and HCV screenings and maintain HPV vaccination rates.
{"title":"Going (Anti)Viral: Improving HIV and HCV Screening and HPV Vaccination in Primary Care","authors":"","doi":"10.1016/j.jcjq.2024.06.002","DOIUrl":"10.1016/j.jcjq.2024.06.002","url":null,"abstract":"<div><h3>Background</h3><p><span>Human immunodeficiency virus (HIV) and hepatitis C (HCV) screening and human papillomavirus (HPV) vaccine uptake remain suboptimal. To improve HIV and HCV<span> screening and HPV </span></span>vaccination<span>, the authors implemented a quality improvement project in three southwestern Pennsylvania family medicine residency practices.</span></p></div><div><h3>Methods</h3><p><span>From June 1 to November 30, 2021, participating practices used universal screening and vaccination guidelines and chose from multiple strategies at the office (for example, standing orders), provider (for example, multiple forms of provider reminders), and patient (for example, incentives) levels derived from published literature and tailored to local context. Age-eligible patients for each recommendation with at least one in-person office visit during the intervention period were included. To assess the interventions’ effect, the authors obtained testing and vaccination data from the electronic health record for the intervention period, contrasted it with identical data from June 1 to November 30, 2020, and used </span>logistic regression controlling for patient age, sex, and race to determine differences in screening and vaccination between intervention and baseline periods.</p></div><div><h3>Results</h3><p>A total of 14,920 and 15,523 patients were eligible in the baseline and intervention periods, respectively. Following the intervention, HIV lifetime screening but not first-time screening for patients 13–64 years old was significantly higher (78.9% vs. 76.1%, <em>p</em> = 0.004, and 39.6% vs. 36.6%, <em>p</em><span> = 0.152, respectively, adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 1.06–1.38). HCV lifetime screening for patients 18–79 years old was significantly higher postintervention (62.5% vs. 53.5%, </span><em>p</em><span> < 0.001, aOR 1.51, 95% CI 1.4–1.64). For patients 9–26 years old, no change in HPV initiation was observed, but the percentage of patients who completed their HPV vaccinations in the observed period was significantly higher postintervention (7.0% vs 4.6%, </span><em>p</em> = 0.006, aOR 1.58, 95% CI 1.14–2.2). During the postintervention period, the researchers identified 0 new HIV diagnoses and 48 HCV diagnoses (19 eligible for treatment).</p></div><div><h3>Conclusion</h3><p>Family medicine residency office-based multistrategy efforts appear to successfully increase patient uptake of HIV and HCV screenings and maintain HPV vaccination rates.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 9","pages":"Pages 645-654"},"PeriodicalIF":2.3,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141413630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-03DOI: 10.1016/j.jcjq.2024.05.012
Care transitions among high-intensity units caring for patients with complex needs are a critical yet undeveloped area of patient safety research. In addition, effective communication and coordination across disciplines remain elusive. This study introduces and tests the Multi-Team Shared Expectations Tool (MT-SET), an exercise that aims to engage health care teams in eliciting needs and establishing agreed-upon expectations teams and individuals within a multi-team system have of one another. We piloted the exercise within hospital-based workflows for oncology inpatients and later adopted it to elicit data on mutual needs and expectations of teams across units involved in patient transitions in two patient safety projects. Our studies demonstrated that the exercise identified common cross-unit coordination problems of delays in care, unwanted variations in care, and lack of standardized communication among units. It also revealed mismatched prioritization of each of these problems between specific unit types. The participants reported that the MT-SET helped establish positive relationships for building better cross-unit and cross-disciplinary teamwork and coordination. There is a need for systematic approaches to understand and facilitate cross-unit communication and coordination in care delivery and transitions. Future studies should broaden the application of the exercise to additional types of multi-unit and multidisciplinary teams and observe intervention ideas generated from the exercise, as well as their implementation.
{"title":"Multi‐Team Shared Expectations Tool (MT‐SET): An Exercise to Improve Teamwork Across Health Care Teams","authors":"","doi":"10.1016/j.jcjq.2024.05.012","DOIUrl":"10.1016/j.jcjq.2024.05.012","url":null,"abstract":"<div><div><span>Care transitions among high-intensity units caring for patients with complex needs are a critical yet undeveloped area of patient safety<span> research. In addition, effective communication and coordination across disciplines remain elusive. This study introduces and tests the Multi-Team Shared Expectations Tool (MT-SET), an exercise that aims to engage health care teams in eliciting needs and establishing agreed-upon expectations teams and individuals within a multi-team system have of one another. We piloted the exercise within hospital-based workflows for </span></span>oncology<span> inpatients and later adopted it to elicit data on mutual needs and expectations of teams across units involved in patient transitions in two patient safety projects. Our studies demonstrated that the exercise identified common cross-unit coordination problems of delays in care, unwanted variations in care, and lack of standardized communication among units. It also revealed mismatched prioritization of each of these problems between specific unit types. The participants reported that the MT-SET helped establish positive relationships for building better cross-unit and cross-disciplinary teamwork and coordination. There is a need for systematic approaches to understand and facilitate cross-unit communication and coordination in care delivery and transitions. Future studies should broaden the application of the exercise to additional types of multi-unit and multidisciplinary teams and observe intervention ideas generated from the exercise, as well as their implementation.</span></div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 10","pages":"Pages 737-744"},"PeriodicalIF":2.3,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141277273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.02.004
Kyle W. Blackburn (is Medical Student, School of Medicine, Baylor College of Medicine, Houston.), Lisa S. Brubaker MD (is General Surgery Resident, Department of Surgery, Baylor College of Medicine.), George Van Buren II MD (is Associate Professor, Department of Surgery, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center, Houston.), Emily Feng (is Clinical Research Coordinator at San Francisco Otolaryngology, Department of Surgery, Baylor College of Medicine.), Sadde Mohamed (is Medical Student, School of Medicine, Yale University.), Uma Ramamurthy PhD MBA (is Associate Professor Department of Pediatrics, Baylor College of Medicine.), Vivek Ramanathan MS (is Software Engineer, Office of Research IT, Baylor College of Medicine.), Amy L. Wood MPH (is Clinical Research Manager, Department of Surgery, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center.), Martha E. Navarro Cagigas MD (is Senior Research Coordinator, Department of Surgery, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center.), William E. Fisher MD (is Professor, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center. Please address correspondence to William E. Fisher)
Background
The surgical morbidity and mortality (M&M) conference is a vital part of a resident's surgical education, but methods to collect and store M&M data are often rudimentary and unreliable. The authors propose a Health Insurance Portability and Accountability Act (HIPAA)–compliant, electronic health record (EHR)–connected application and database to report and store complication data.
Methods
The app is linked to the patient's EHR, and as a result, basic data on each surgical case—including diagnosis, surgery type, and surgeon—are automatically uploaded to the app. In addition, all data are stored in a secure SQL database—with communications between the app and the database end-to-end encrypted for HIPAA compliance. The full surgical team has access to the app, democratizing complications reporting and allowing for reporting in both the inpatient and outpatient settings. This complication information can then be automatically pulled from the app with a premade presentation for the M&M conference. The data can also be accessed by a Power BI dashboard, allowing for easy quality improvement analyses.
Results
When implemented, the app improved data collection for the M&M conference while providing a database for institutional quality improvement use. The authors also identified additional utility of the app, including ensuring appropriate revenue capture. The general appearance of the app and the dashboard can be found in the article.
Conclusion
The app developed in this project significantly improves on more common methods for M&M conference complication reporting—transforming M&M data into a valuable resource for resident education and quality improvement.
背景外科发病率和死亡率（M&M）会议是住院医师外科教育的重要组成部分，但收集和存储 M&M 数据的方法往往非常简单且不可靠。作者提出了一种符合《健康保险可携性和责任法案》（HIPAA）、与电子病历（EHR）相连的应用程序和数据库，用于报告和存储并发症数据。此外，所有数据都存储在安全的 SQL 数据库中，应用程序与数据库之间的通信经过端到端加密，符合 HIPAA 标准。整个手术团队都可以访问该应用程序，实现了并发症报告的民主化，并允许在住院和门诊环境中进行报告。然后，这些并发症信息可自动从应用程序中提取，并预先制作成演示文稿，用于 M&M 会议。这些数据还可以通过 Power BI 仪表板访问，便于进行质量改进分析。结果该应用程序在实施后，改进了 M&M 会议的数据收集工作，同时为机构质量改进提供了一个数据库。作者还发现了该应用程序的其他效用，包括确保适当的收入获取。本项目开发的应用程序大大改进了医学并发症会议报告的常用方法，将医学并发症数据转化为住院医师教育和质量改进的宝贵资源。
{"title":"Real-Time Reporting of Complications in Hospitalized Surgical Patients by Surgical Team Members Using a Smartphone Application","authors":"Kyle W. Blackburn (is Medical Student, School of Medicine, Baylor College of Medicine, Houston.), Lisa S. Brubaker MD (is General Surgery Resident, Department of Surgery, Baylor College of Medicine.), George Van Buren II MD (is Associate Professor, Department of Surgery, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center, Houston.), Emily Feng (is Clinical Research Coordinator at San Francisco Otolaryngology, Department of Surgery, Baylor College of Medicine.), Sadde Mohamed (is Medical Student, School of Medicine, Yale University.), Uma Ramamurthy PhD MBA (is Associate Professor Department of Pediatrics, Baylor College of Medicine.), Vivek Ramanathan MS (is Software Engineer, Office of Research IT, Baylor College of Medicine.), Amy L. Wood MPH (is Clinical Research Manager, Department of Surgery, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center.), Martha E. Navarro Cagigas MD (is Senior Research Coordinator, Department of Surgery, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center.), William E. Fisher MD (is Professor, Baylor College of Medicine and Dan L. Duncan Comprehensive Cancer Center. Please address correspondence to William E. Fisher)","doi":"10.1016/j.jcjq.2024.02.004","DOIUrl":"10.1016/j.jcjq.2024.02.004","url":null,"abstract":"<div><h3>Background</h3><p>The surgical morbidity and mortality (M&M) conference is a vital part of a resident's surgical education, but methods to collect and store M&M data are often rudimentary and unreliable. The authors propose a Health Insurance Portability and Accountability Act (HIPAA)–compliant, electronic health record (EHR)–connected application and database to report and store complication data.</p></div><div><h3>Methods</h3><p>The app is linked to the patient's EHR, and as a result, basic data on each surgical case—including diagnosis, surgery type, and surgeon—are automatically uploaded to the app. In addition, all data are stored in a secure SQL database—with communications between the app and the database end-to-end encrypted for HIPAA compliance. The full surgical team has access to the app, democratizing complications reporting and allowing for reporting in both the inpatient and outpatient settings. This complication information can then be automatically pulled from the app with a premade presentation for the M&M conference. The data can also be accessed by a Power BI dashboard, allowing for easy quality improvement analyses.</p></div><div><h3>Results</h3><p>When implemented, the app improved data collection for the M&M conference while providing a database for institutional quality improvement use. The authors also identified additional utility of the app, including ensuring appropriate revenue capture. The general appearance of the app and the dashboard can be found in the article.</p></div><div><h3>Conclusion</h3><p>The app developed in this project significantly improves on more common methods for M&M conference complication reporting—transforming M&M data into a valuable resource for resident education and quality improvement.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 449-455"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140468120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.02.007
Salome O. Chitavi PhD (is Research Scientist II, Department of Research, Division of Healthcare Quality Evaluation and Improvement, The Joint Commission, Oakbrook Terrace, Illinois.), Jamie Patrianakos PhD (is Research Scientist I, Department of Research, Division of Healthcare Quality Evaluation and Improvement. The Joint Commission.), Scott C. Williams PsyD (is Director, Department of Research, Division of Healthcare Quality Evaluation and Improvement, The Joint Commission.), Stephen P. Schmaltz PhD, MPH, MS (is Senior Biostatistician, Department of Research, Division of Healthcare Quality Evaluation and Improvement, The Joint Commission.), Brian K. Ahmedani PhD, LMSW (is Director, Center for Health Policy and Health Services Research, and Director of Research, Behavioral Health Services, Henry Ford Health, Detroit.), Kimberly Roaten PhD, ABPP (is Professor, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas.), Edwin D. Boudreaux PhD (is Professor, Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School.), Gregory K. Brown PhD (is Associate Professor of Clinical Psychology in Psychiatry, Perelman School of Medicine, University of Pennyslvania. Please address correspondence to Salome Chitavi)
Background
The Joint Commission's National Patient Safety Goal (NPSG) for suicide prevention (NPSG.15.01.01) requires that accredited hospitals maintain policies/procedures for follow-up care at discharge for patients identified as at risk for suicide. The proportion of hospitals meeting these requirements through use of recommended discharge practices is unknown.
Methods
This cross-sectional observational study explored the prevalence of suicide prevention activities among Joint Commission–accredited hospitals. A questionnaire was sent to 1,148 accredited hospitals. The authors calculated the percentage of hospitals reporting implementation of four recommended discharge practices for suicide prevention.
Results
Of 1,148 hospitals, 346 (30.1%) responded. The majority (n = 212 [61.3%]) of hospitals had implemented formal safety planning, but few of those (n = 41 [19.3%]) included all key components of safety planning. Approximately a third of hospitals provided a warm handoff to outpatient care (n = 128 [37.0%)] or made follow-up contact with patients (n = 105 [30.3%]), and approximately a quarter (n = 97 [28.0%]) developed a plan for lethal means safety. Very few (n = 14 [4.0%]) hospitals met full criteria for implementing recommended suicide prevention activities at time of discharge.
Conclusion
The study revealed a significant gap in implementation of recommended practices related to prevention of suicide postdischarge. Additional research is needed to identify factors contributing to this implementation gap.
{"title":"Evaluating the Prevalence of Four Recommended Practices for Suicide Prevention Following Hospital Discharge","authors":"Salome O. Chitavi PhD (is Research Scientist II, Department of Research, Division of Healthcare Quality Evaluation and Improvement, The Joint Commission, Oakbrook Terrace, Illinois.), Jamie Patrianakos PhD (is Research Scientist I, Department of Research, Division of Healthcare Quality Evaluation and Improvement. The Joint Commission.), Scott C. Williams PsyD (is Director, Department of Research, Division of Healthcare Quality Evaluation and Improvement, The Joint Commission.), Stephen P. Schmaltz PhD, MPH, MS (is Senior Biostatistician, Department of Research, Division of Healthcare Quality Evaluation and Improvement, The Joint Commission.), Brian K. Ahmedani PhD, LMSW (is Director, Center for Health Policy and Health Services Research, and Director of Research, Behavioral Health Services, Henry Ford Health, Detroit.), Kimberly Roaten PhD, ABPP (is Professor, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas.), Edwin D. Boudreaux PhD (is Professor, Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School.), Gregory K. Brown PhD (is Associate Professor of Clinical Psychology in Psychiatry, Perelman School of Medicine, University of Pennyslvania. Please address correspondence to Salome Chitavi)","doi":"10.1016/j.jcjq.2024.02.007","DOIUrl":"10.1016/j.jcjq.2024.02.007","url":null,"abstract":"<div><h3>Background</h3><p>The Joint Commission's National Patient Safety Goal (NPSG) for suicide prevention (NPSG.15.01.01) requires that accredited hospitals maintain policies/procedures for follow-up care at discharge for patients identified as at risk for suicide. The proportion of hospitals meeting these requirements through use of recommended discharge practices is unknown.</p></div><div><h3>Methods</h3><p>This cross-sectional observational study explored the prevalence of suicide prevention activities among Joint Commission–accredited hospitals. A questionnaire was sent to 1,148 accredited hospitals. The authors calculated the percentage of hospitals reporting implementation of four recommended discharge practices for suicide prevention.</p></div><div><h3>Results</h3><p>Of 1,148 hospitals, 346 (30.1%) responded. The majority (<em>n</em> = 212 [61.3%]) of hospitals had implemented formal safety planning, but few of those (<em>n</em> = 41 [19.3%]) included all key components of safety planning. Approximately a third of hospitals provided a warm handoff to outpatient care (<em>n</em> = 128 [37.0%)] or made follow-up contact with patients (<em>n</em> = 105 [30.3%]), and approximately a quarter (<em>n</em> = 97 [28.0%]) developed a plan for lethal means safety. Very few (<em>n</em> = 14 [4.0%]) hospitals met full criteria for implementing recommended suicide prevention activities at time of discharge.</p></div><div><h3>Conclusion</h3><p>The study revealed a significant gap in implementation of recommended practices related to prevention of suicide postdischarge. Additional research is needed to identify factors contributing to this implementation gap.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 393-403"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024000679/pdfft?md5=e6b6403241b88154c3809606c04f8ba4&pid=1-s2.0-S1553725024000679-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140305668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.04.002
Sara E. Cosgrove MD, MS (is Professor of Medicine, Johns Hopkins University School of Medicine, and Director, Department of Antimicrobial Stewardship, The Johns Hopkins Hospital, Baltimore.), Roy Ahn ScM, ScD (is Vice President, Public Health, NORC at the University of Chicago.), Prashila Dullabh MD (is Vice President and Senior Fellow, Health Sciences, and Director, Health Implementation Science Center, NORC at the University of Chicago.), Janna Gordon PhD (is Research Scientist, Health Sciences, NORC at the University of Chicago.), Melissa A. Miller MD, MS (is Medical Officer, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland.), Pranita D. Tamma MD, MHS (is Associate Professor of Pediatrics, Johns Hopkins University School of Medicine. Please address correspondence to Pranita D. Tamma)
Background
The goal of antibiotic stewardship programs (ASPs) is to ensure that patients receive effective therapy while minimizing adverse events. To overcome barriers commonly faced in implementing successful ASPs, the Agency for Healthcare Research and Quality (AHRQ) established a multifaceted, nationwide Safety Program for Improving Antibiotic Use in 2018. This report summarizes the lessons learned from the implementation of this initiative based on structured interviews of personnel from participating sites.
Methods
At the completion of the one-year initiative, semistructured exit interviews were conducted with site leaders at 151 of the 402 hospitals that participated. These interviews consisted of open-ended questions about the perceived effectiveness of components of the Safety Program. Qualitative analyses incorporated both deductive coding themes (based on existing literature) and an iteratively developed inductive coding framework (based on salient themes that emerged from a subset of interviews).
Results
Several components of the Safety Program were identified as effective in expanding local stewardship activities, including techniques and strategies to implement sustainable ASPs, access to Implementation Advisors to keep sites engaged, provision of local benchmarked antibiotic use data to compare to similar hospitals, and Safety Program materials such as the antibiotic time-out tool to integrate stewardship techniques into daily work flows. The biggest challenges to greater effectiveness were suboptimal frontline staff engagement and difficulty changing antibiotic prescribing culture. Some approaches used to overcome these barriers (peer-to-peer communication and education through team huddles, identifying physician champions, informal rounds to enhance collegiality and buy-in, and engagement of hospital leadership) were identified.
Conclusion
Lessons learned from the Safety Program can be applied by other teams looking to promote an effective ASP at their hospital or system. The themes that emerged in this study likely also have relevance across a wide range of large-scale quality improvement initiatives.
{"title":"Lessons Learned from a National Hospital Antibiotic Stewardship Implementation Project","authors":"Sara E. Cosgrove MD, MS (is Professor of Medicine, Johns Hopkins University School of Medicine, and Director, Department of Antimicrobial Stewardship, The Johns Hopkins Hospital, Baltimore.), Roy Ahn ScM, ScD (is Vice President, Public Health, NORC at the University of Chicago.), Prashila Dullabh MD (is Vice President and Senior Fellow, Health Sciences, and Director, Health Implementation Science Center, NORC at the University of Chicago.), Janna Gordon PhD (is Research Scientist, Health Sciences, NORC at the University of Chicago.), Melissa A. Miller MD, MS (is Medical Officer, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland.), Pranita D. Tamma MD, MHS (is Associate Professor of Pediatrics, Johns Hopkins University School of Medicine. Please address correspondence to Pranita D. Tamma)","doi":"10.1016/j.jcjq.2024.04.002","DOIUrl":"10.1016/j.jcjq.2024.04.002","url":null,"abstract":"<div><h3>Background</h3><p>The goal of antibiotic stewardship programs (ASPs) is to ensure that patients receive effective therapy while minimizing adverse events. To overcome barriers commonly faced in implementing successful ASPs, the Agency for Healthcare Research and Quality (AHRQ) established a multifaceted, nationwide Safety Program for Improving Antibiotic Use in 2018. This report summarizes the lessons learned from the implementation of this initiative based on structured interviews of personnel from participating sites.</p></div><div><h3>Methods</h3><p>At the completion of the one-year initiative, semistructured exit interviews were conducted with site leaders at 151 of the 402 hospitals that participated. These interviews consisted of open-ended questions about the perceived effectiveness of components of the Safety Program. Qualitative analyses incorporated both deductive coding themes (based on existing literature) and an iteratively developed inductive coding framework (based on salient themes that emerged from a subset of interviews).</p></div><div><h3>Results</h3><p>Several components of the Safety Program were identified as effective in expanding local stewardship activities, including techniques and strategies to implement sustainable ASPs, access to Implementation Advisors to keep sites engaged, provision of local benchmarked antibiotic use data to compare to similar hospitals, and Safety Program materials such as the antibiotic time-out tool to integrate stewardship techniques into daily work flows. The biggest challenges to greater effectiveness were suboptimal frontline staff engagement and difficulty changing antibiotic prescribing culture. Some approaches used to overcome these barriers (peer-to-peer communication and education through team huddles, identifying physician champions, informal rounds to enhance collegiality and buy-in, and engagement of hospital leadership) were identified.</p></div><div><h3>Conclusion</h3><p>Lessons learned from the Safety Program can be applied by other teams looking to promote an effective ASP at their hospital or system. The themes that emerged in this study likely also have relevance across a wide range of large-scale quality improvement initiatives.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 435-441"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.03.006
Brenda Bursch PhD (is Professor, Department of Psychiatry and Biobehavioral Sciences, and Department of Pediatrics, David Geffen School of Medicine at UCLA.), Keren Ziv MD (is Clinical Professor, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA.), Shevaughn Marchese (is Faculty Development and Career Advancement Program Manager, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA.), Hilary Aralis PhD (is Professor, Department of Biostatistics, UCLA Fielding School of Public Health.), Teresa Bufford PhD (formerly Graduate Student Researcher and Biostatistician, Department of Biostatistics, UCLA Fielding School of Public Health, is Principal Statistician GSK, Wynnewood, Pennsylvania.), Patricia Lester MD (is Professor, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA. Please address correspondence to Brenda Bursch)
Background
Most anesthesia providers experience an adverse event during their training or career. Limited evidence suggests skilled peer support programs (SPSPs) reduce initial distress and support adaptive functioning and coping. This study evaluated second victim perceptions of a voluntary SPSP.
Methods
An SPSP was developed and implemented for all clinical and administrative personnel in the Department of Anesthesiology and Perioperative Medicine in three hospitals and six outpatient surgery centers in December 2017. The program incorporated the Scott Three-Tiered Interventional Model of Second Victim Support. Surveys were offered to clinicians in the department prior to implementation of the SPSP and again 18 months after implementation. Among the subset of respondents who experienced a serious adverse patient event, the authors used multiple logistic regression models that adjusted for role and number of night shifts per month to examine differences in perceived resource availability and post-event support received following implementation of the program.
Results
There were 94 surveys (83 complete; 11 partially complete) collected prior to implementation and 84 surveys (67 complete; 17 partially complete) collected after implementation. A total of 25 individuals took the survey at both pre and post (19 complete). After implementation, 62.5% of respondents indicated that institutional support had improved since the occurrence of their serious adverse patient event. Statistical models identified a significant improvement in the probability that a clinician agreed with the statement “I think that the organization learned from the event and took appropriate steps to reduce the chance of it happening again” at post vs. pre (adjusted odds ratio [aOR] 3.9, 95% confidence interval [CI] 1.01–15.1. A statistically significant increase from pre to post in the perceived availability of formal emotional support was identified (aOR 5.2, 95% CI 1.9–22.5).
Conclusion
Implementation of a skilled peer support program within a large department of anesthesiology can improve institutional-based emotional support.
{"title":"Department of Anesthesiology Skilled Peer Support Program Outcomes: Second Victim Perceptions","authors":"Brenda Bursch PhD (is Professor, Department of Psychiatry and Biobehavioral Sciences, and Department of Pediatrics, David Geffen School of Medicine at UCLA.), Keren Ziv MD (is Clinical Professor, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA.), Shevaughn Marchese (is Faculty Development and Career Advancement Program Manager, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA.), Hilary Aralis PhD (is Professor, Department of Biostatistics, UCLA Fielding School of Public Health.), Teresa Bufford PhD (formerly Graduate Student Researcher and Biostatistician, Department of Biostatistics, UCLA Fielding School of Public Health, is Principal Statistician GSK, Wynnewood, Pennsylvania.), Patricia Lester MD (is Professor, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA. Please address correspondence to Brenda Bursch)","doi":"10.1016/j.jcjq.2024.03.006","DOIUrl":"10.1016/j.jcjq.2024.03.006","url":null,"abstract":"<div><h3>Background</h3><p>Most anesthesia providers experience an adverse event during their training or career. Limited evidence suggests skilled peer support programs (SPSPs) reduce initial distress and support adaptive functioning and coping. This study evaluated second victim perceptions of a voluntary SPSP.</p></div><div><h3>Methods</h3><p>An SPSP was developed and implemented for all clinical and administrative personnel in the Department of Anesthesiology and Perioperative Medicine in three hospitals and six outpatient surgery centers in December 2017. The program incorporated the Scott Three-Tiered Interventional Model of Second Victim Support. Surveys were offered to clinicians in the department prior to implementation of the SPSP and again 18 months after implementation. Among the subset of respondents who experienced a serious adverse patient event, the authors used multiple logistic regression models that adjusted for role and number of night shifts per month to examine differences in perceived resource availability and post-event support received following implementation of the program.</p></div><div><h3>Results</h3><p>There were 94 surveys (83 complete; 11 partially complete) collected prior to implementation and 84 surveys (67 complete; 17 partially complete) collected after implementation. A total of 25 individuals took the survey at both pre and post (19 complete). After implementation, 62.5% of respondents indicated that institutional support had improved since the occurrence of their serious adverse patient event. Statistical models identified a significant improvement in the probability that a clinician agreed with the statement “I think that the organization learned from the event and took appropriate steps to reduce the chance of it happening again” at post vs. pre (adjusted odds ratio [aOR] 3.9, 95% confidence interval [CI] 1.01–15.1. A statistically significant increase from pre to post in the perceived availability of formal emotional support was identified (aOR 5.2, 95% CI 1.9–22.5).</p></div><div><h3>Conclusion</h3><p>Implementation of a skilled peer support program within a large department of anesthesiology can improve institutional-based emotional support.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 442-448"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024000746/pdfft?md5=c1cd74759868024f5c517009e4ebccbb&pid=1-s2.0-S1553725024000746-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140280918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.05.009
An interdisciplinary team developed, implemented, and evaluated a standardized structure and process for an electronic apparent cause analysis (eACA) tool that includes principles of high reliability, human factors engineering, and Just Culture. Steps include assembling a team, describing what happened, determining why the event happened, determining how defects might be fixed, and deciding which defects will be fixed. The eACA is an intuitive tool for identifying defects, apparent causes of those defects, and the strongest corrective actions. Moreover, the eACA facilitates system learning by aggregating apparent causes and corrective action trends to prioritize and implement system change(s).
{"title":"Developing, Implementing, Evaluating Electronic Apparent Cause Analysis Across a Health Care System","authors":"","doi":"10.1016/j.jcjq.2024.05.009","DOIUrl":"10.1016/j.jcjq.2024.05.009","url":null,"abstract":"<div><div><span>An interdisciplinary team developed, implemented, and evaluated a standardized structure and process for an electronic apparent cause analysis (eACA) tool that includes principles of high reliability, </span>human factors<span><span> engineering, and Just Culture. Steps include assembling a team, describing what happened, determining why the event happened, determining how defects might be fixed, and deciding which defects will be fixed. The eACA is an intuitive tool for identifying defects, apparent causes of those defects, and the strongest corrective actions. Moreover, the eACA facilitates </span>system learning by aggregating apparent causes and corrective action trends to prioritize and implement system change(s).</span></div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 10","pages":"Pages 724-736"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141274609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.01.001
Brittany N. Burton MD, MAS, MHS (is Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles (UCLA).), Janet O. Adeola MD (is Anesthesiologist, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School/Brigham & Women's Hospital, Boston.), Veena M. Do (is Medical Student, School of Medicine, University of California, San Diego.), Adam J. Milam MD, PhD (is Senior Associate Consultant and Associate Professor of Anesthesiology, Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix.), Maxime Cannesson MD, PhD (is Chair, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA.), Keith C. Norris MD, PhD (is Professor, Department of Medicine, David Geffen School of Medicine, UCLA.), Nicole E. Lopez MD (is Associate Professor, Division of Colorectal Surgery, Department of Surgery, University of California, San Diego.), Rodney A. Gabriel MD, MAS (is Associate Professor, Division of Regional Anesthesia, and Director, Division of Perioperative Informatics, University of California, San Diego. Please address correspondence to Brittany N. Burton)
Background
Health equity in pain management during the perioperative period continues to be a topic of interest. The authors evaluated the association of race and ethnicity with regional anesthesia in patients who underwent colorectal surgery and characterized trends in regional anesthesia.
Methods
Using the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2020, the research team identified patients who underwent open or laparoscopic colorectal surgery. Associations between race and ethnicity and use of regional anesthesia were estimated using logistic regression models.
Results
The final sample size was 292,797, of which 15.6% (n = 45,784) received regional anesthesia. The unadjusted rates of regional anesthesia for race and ethnicity were 15.7% white, 15.1% Black, 12.8% Asian, 29.6% American Indian or Alaska Native, 16.3% Native Hawaiian or Pacific Islander, and 12.4% Hispanic. Black (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.90–0.96, p < 0.001) and Asian (OR 0.76, 95% CI 0.71–0.80, p < 0.001) patients had lower odds of regional anesthesia compared to white patients. Hispanic patients had lower odds of regional anesthesia compared to non-Hispanic patients (OR 0.72, 95% CI 0.68–0.75, p < 0.001). There was a significant annual increase in regional anesthesia from 2015 to 2020 for all racial and ethnic cohorts (p < 0.05).
Conclusion
There was an annual increase in the use of regional anesthesia, yet Black and Asian patients (compared to whites) and Hispanics (compared to non-Hispanics) were less likely to receive regional anesthesia for colorectal surgery. These differences suggest that there are racial and ethnic differences in regional anesthesia use for colorectal surgery.
{"title":"Differences in the Receipt of Regional Anesthesia Based on Race and Ethnicity in Colorectal Surgery","authors":"Brittany N. Burton MD, MAS, MHS (is Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles (UCLA).), Janet O. Adeola MD (is Anesthesiologist, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School/Brigham & Women's Hospital, Boston.), Veena M. Do (is Medical Student, School of Medicine, University of California, San Diego.), Adam J. Milam MD, PhD (is Senior Associate Consultant and Associate Professor of Anesthesiology, Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix.), Maxime Cannesson MD, PhD (is Chair, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA.), Keith C. Norris MD, PhD (is Professor, Department of Medicine, David Geffen School of Medicine, UCLA.), Nicole E. Lopez MD (is Associate Professor, Division of Colorectal Surgery, Department of Surgery, University of California, San Diego.), Rodney A. Gabriel MD, MAS (is Associate Professor, Division of Regional Anesthesia, and Director, Division of Perioperative Informatics, University of California, San Diego. Please address correspondence to Brittany N. Burton)","doi":"10.1016/j.jcjq.2024.01.001","DOIUrl":"10.1016/j.jcjq.2024.01.001","url":null,"abstract":"<div><h3>Background</h3><p>Health equity in pain management during the perioperative period continues to be a topic of interest. The authors evaluated the association of race and ethnicity with regional anesthesia in patients who underwent colorectal surgery and characterized trends in regional anesthesia.</p></div><div><h3>Methods</h3><p>Using the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2020, the research team identified patients who underwent open or laparoscopic colorectal surgery. Associations between race and ethnicity and use of regional anesthesia were estimated using logistic regression models.</p></div><div><h3>Results</h3><p>The final sample size was 292,797, of which 15.6% (<em>n</em> = 45,784) received regional anesthesia. The unadjusted rates of regional anesthesia for race and ethnicity were 15.7% white, 15.1% Black, 12.8% Asian, 29.6% American Indian or Alaska Native, 16.3% Native Hawaiian or Pacific Islander, and 12.4% Hispanic. Black (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.90–0.96, <em>p</em> < 0.001) and Asian (OR 0.76, 95% CI 0.71–0.80, <em>p</em> < 0.001) patients had lower odds of regional anesthesia compared to white patients. Hispanic patients had lower odds of regional anesthesia compared to non-Hispanic patients (OR 0.72, 95% CI 0.68–0.75, <em>p</em> < 0.001). There was a significant annual increase in regional anesthesia from 2015 to 2020 for all racial and ethnic cohorts (<em>p</em> < 0.05).</p></div><div><h3>Conclusion</h3><p>There was an annual increase in the use of regional anesthesia, yet Black and Asian patients (compared to whites) and Hispanics (compared to non-Hispanics) were less likely to receive regional anesthesia for colorectal surgery. These differences suggest that there are racial and ethnic differences in regional anesthesia use for colorectal surgery.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 416-424"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139540189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.04.007
Celine Larkin PhD (is Assistant Professor, Department of Emergency Medicine and Center for Accelerating Practices to End Suicide (CAPES), UMass Chan Medical School, Worcester, Massachusetts. Please address correspondence to Celine Larkin)
{"title":"Implementation of Suicide Prevention Activities at Acute Care Discharge: Time for Change?","authors":"Celine Larkin PhD (is Assistant Professor, Department of Emergency Medicine and Center for Accelerating Practices to End Suicide (CAPES), UMass Chan Medical School, Worcester, Massachusetts. Please address correspondence to Celine Larkin)","doi":"10.1016/j.jcjq.2024.04.007","DOIUrl":"10.1016/j.jcjq.2024.04.007","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 391-392"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140788428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.03.007
Lisa Rotenstein MD, MBA, MSc (is Assistant Professor and Primary Care Physician, Division of General Internal Medicine and Division of Clinical Informatics, University of California at San Francisco.), Hanhan Wang MPS (is Biostatistician, WellMD Center, Stanford University School of Medicine.), Colin P. West MD, PhD (is Professor and Quantitative Health Sciences Researcher, Departments of Medicine and Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.), Liselotte N. Dyrbye MD (is Professor, Department of Medicine and Chief Well-Being Officer, University of Colorado School of Medicine.), Mickey Trockel MD (is Professor, Department of Psychiatry, Stanford University School of Medicine.), Christine Sinsky MD (is Vice President, Professional Satisfaction, American Medical Association, Chicago.), Tait Shanafelt MD (is Professor, Department of Medicine, Stanford University School of Medicine, and Chief Wellness Officer, Stanford Medicine. Please address correspondence to Lisa Rotenstein)
{"title":"Teamwork Climate, Safety Climate, and Physician Burnout: A National, Cross-Sectional Study","authors":"Lisa Rotenstein MD, MBA, MSc (is Assistant Professor and Primary Care Physician, Division of General Internal Medicine and Division of Clinical Informatics, University of California at San Francisco.), Hanhan Wang MPS (is Biostatistician, WellMD Center, Stanford University School of Medicine.), Colin P. West MD, PhD (is Professor and Quantitative Health Sciences Researcher, Departments of Medicine and Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.), Liselotte N. Dyrbye MD (is Professor, Department of Medicine and Chief Well-Being Officer, University of Colorado School of Medicine.), Mickey Trockel MD (is Professor, Department of Psychiatry, Stanford University School of Medicine.), Christine Sinsky MD (is Vice President, Professional Satisfaction, American Medical Association, Chicago.), Tait Shanafelt MD (is Professor, Department of Medicine, Stanford University School of Medicine, and Chief Wellness Officer, Stanford Medicine. Please address correspondence to Lisa Rotenstein)","doi":"10.1016/j.jcjq.2024.03.007","DOIUrl":"10.1016/j.jcjq.2024.03.007","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 458-462"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S155372502400076X/pdfft?md5=c3c52f641c9ff024820934eeb33be178&pid=1-s2.0-S155372502400076X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140276748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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