Pub Date : 2024-08-01DOI: 10.1016/j.jcjq.2024.04.009
Background
INFORM (Improving Nursing Home Care through Feedback on Performance Data) was a research intervention that equipped nursing home managers with skills to conduct local improvement projects and supported them in improving performance through modifiable elements in their units. Prior reports have found positive and sustained outcomes from INFORM intervention. In this article, the authors report findings from a formative service evaluation of INFORM as modified for implementation in real-world settings.
Methods
INFORM was transformed for real-world implementation with an initial cohort of 26 nursing homes in British Columbia, Canada (INFORM BC). Three stakeholder groups were involved: nursing home teams, an academic team that modified INFORM for implementation, and a BC team that implemented INFORM and coached participating nursing home teams in applying it locally. Service evaluation was conducted drawing on participants from all three stakeholder groups, using convenience sampling, with numbers varying by data source. Using a mixed methods design, outcome data included qualitative and quantitative assessment of surveys, discussions, observations, and a review of documents and resources.
Results
The majority of nursing home teams reported positive outcomes relative to the usefulness and relevance of the initiative for local needs despite a number of operational challenges during implementation. A key factor in their success was combining targeted external support with the opportunity to set goals and measure success locally. Challenges included a lack of time at the nursing home level, COVID-19–related disruptions, and issues with role clarity and alignment of expectations among the academic and BC teams.
Conclusion
INFORM BC advanced the processes of change planning and transferable learning among nursing home managers and their local teams. Success was facilitated externally but defined and achieved locally. Future iterations should probe outcome sustainability and how nursing home teams adapt the INFORM approach in practice.
{"title":"Evaluating Real-World Implementation of INFORM (Improving Nursing Home Care through Feedback on Performance Data): An Improvement Initiative in Canadian Nursing Homes","authors":"","doi":"10.1016/j.jcjq.2024.04.009","DOIUrl":"10.1016/j.jcjq.2024.04.009","url":null,"abstract":"<div><h3>Background</h3><p>INFORM (Improving Nursing Home Care through Feedback on Performance Data) was a research intervention that equipped nursing home managers with skills to conduct local improvement projects and supported them in improving performance through modifiable elements in their units. Prior reports have found positive and sustained outcomes from INFORM intervention. In this article, the authors report findings from a formative service evaluation of INFORM as modified for implementation in real-world settings.</p></div><div><h3>Methods</h3><p>INFORM was transformed for real-world implementation with an initial cohort of 26 nursing homes in British Columbia, Canada (INFORM BC). Three stakeholder groups were involved: nursing home teams, an academic team that modified INFORM for implementation, and a BC team that implemented INFORM and coached participating nursing home teams in applying it locally. Service evaluation was conducted drawing on participants from all three stakeholder groups, using convenience sampling, with numbers varying by data source. Using a mixed methods design, outcome data included qualitative and quantitative assessment of surveys, discussions, observations, and a review of documents and resources.</p></div><div><h3>Results</h3><p>The majority of nursing home teams reported positive outcomes relative to the usefulness and relevance of the initiative for local needs despite a number of operational challenges during implementation. A key factor in their success was combining targeted external support with the opportunity to set goals and measure success locally. Challenges included a lack of time at the nursing home level, COVID-19–related disruptions, and issues with role clarity and alignment of expectations among the academic and BC teams.</p></div><div><h3>Conclusion</h3><p>INFORM BC advanced the processes of change planning and transferable learning among nursing home managers and their local teams. Success was facilitated externally but defined and achieved locally. Future iterations should probe outcome sustainability and how nursing home teams adapt the INFORM approach in practice.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 8","pages":"Pages 579-590"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024001223/pdfft?md5=57536e6e6dec894838eb39457f26e932&pid=1-s2.0-S1553725024001223-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283710","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 : 2024-08-01DOI: 10.1016/j.jcjq.2024.03.009
Objective
This study was conducted to determine if there were racial/ethnic disparities in pain assessment and management from labor throughout the postpartum period.
Methods
This was a retrospective cohort study of all births from January 2019 to December 2021 in a single urban, quaternary care hospital, excluding patients with hysterectomy, ICU stay, transfusion of more than 3 units of packed red blood cells, general anesthesia, or evidence of a substance abuse disorder. We characterized and compared patterns of antepartum and postpartum pain assessments, epidural use, pain scores, and postpartum pain management by racial/ethnic group with bivariable analyses. Multivariable regression was performed to test for an association between race/ethnicity and amount of opioid pain medication in milligram equivalent units, stratified by delivery mode.
Results
There were 18,085 births between 2019 and 2021 with available race/ethnicity data. Of these, 58.3% were white, 15.0% were Hispanic, 11.9% were Asian, 7.4% were Black, and the remaining 7.4% were classified as Other/Declined. There were no significant differences by race/ethnicity in the number of antepartum or postpartum pain assessments or the proportion of patients who received epidural analgesia. Black and Hispanic patients reported the highest maximum postpartum pain scores after vaginal and cesarean birth compared to white and Asian patients. However, Black and Hispanic patients received lower daily doses of opioid medications than white patients, regardless of delivery mode. After adjusting for patient factors and non-opioid medication dosages, all other racial/ethnic groups received less opioid medication than white patients.
Conclusion
Inequities were found in postpartum pain treatment, including among patients reporting the highest pain levels.
{"title":"Racial/Ethnic Disparities in Peripartum Pain Assessment and Management","authors":"","doi":"10.1016/j.jcjq.2024.03.009","DOIUrl":"10.1016/j.jcjq.2024.03.009","url":null,"abstract":"<div><h3>Objective</h3><p>This study was conducted to determine if there were racial/ethnic disparities in pain assessment and management from labor throughout the postpartum period.</p></div><div><h3>Methods</h3><p>This was a retrospective cohort study of all births from January 2019 to December 2021 in a single urban, quaternary care hospital, excluding patients with hysterectomy, ICU stay, transfusion of more than 3 units of packed red blood cells, general anesthesia, or evidence of a substance abuse disorder. We characterized and compared patterns of antepartum and postpartum pain assessments, epidural use, pain scores, and postpartum pain management by racial/ethnic group with bivariable analyses. Multivariable regression was performed to test for an association between race/ethnicity and amount of opioid pain medication in milligram equivalent units, stratified by delivery mode.</p></div><div><h3>Results</h3><p>There were 18,085 births between 2019 and 2021 with available race/ethnicity data. Of these, 58.3% were white, 15.0% were Hispanic, 11.9% were Asian, 7.4% were Black, and the remaining 7.4% were classified as Other/Declined. There were no significant differences by race/ethnicity in the number of antepartum or postpartum pain assessments or the proportion of patients who received epidural analgesia. Black and Hispanic patients reported the highest maximum postpartum pain scores after vaginal and cesarean birth compared to white and Asian patients. However, Black and Hispanic patients received lower daily doses of opioid medications than white patients, regardless of delivery mode. After adjusting for patient factors and non-opioid medication dosages, all other racial/ethnic groups received less opioid medication than white patients.</p></div><div><h3>Conclusion</h3><p>Inequities were found in postpartum pain treatment, including among patients reporting the highest pain levels.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 8","pages":"Pages 552-559"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.jcjq.2024.04.003
Background
Quality improvement (QI) programs require significant financial investment. The authors evaluated the cost-effectiveness of a physician-led, performance-incentivized, QI intervention that increased appropriate peripherally inserted central catheter (PICC) use.
Methods
The authors used an economic evaluation from a health care sector perspective. Implementation costs included incentive payments to hospitals and costs for data abstractors and the coordinating center. Effectiveness was calculated from propensity score-matched observations across two time periods for complications (venous thromboembolism [VTE], central line–associated bloodstream infection [CLABSI], and catheter occlusion): preintervention period (January 2015 through December 2016) and intervention period (January 2017 through December 2021). Cost-effectiveness was presented as the cost-offset per averted complication, reflecting the health care costs avoided due to having lower complication rates.
Results
Across 35 hospitals, this study sampled 17,418 PICCs placed preintervention and 26,004 placed during the intervention period. PICC complications decreased significantly following the intervention. CLABSIs decreased from 2.1% to 1.5%, VTEs from 3.2% to 2.3%, and catheter occlusions from 10.8% to 7.0% (all p < 0.01). Estimated number of complications prevented included 871 CLABSIs, 2,535 VTEs, and 8,743 catheter occlusions. Project implementation costs were $31.8 million, and the cost-offset related to avoided complications was $64.4 million. Each participating hospital averaged $932,073 in cost-offset over seven years, and the average cost-offset per complication averted was $2,614 (95% CI [confidence interval] $2,314–$3,003).
Conclusion
A large-scale, multihospital QI initiative to improve appropriate PICC use yielded substantial return on investment from cost-offset of prevented complications.
{"title":"Improving Appropriate Use of Peripherally Inserted Central Catheters Through a Statewide Collaborative Hospital Initiative: A Cost-Effectiveness Analysis","authors":"","doi":"10.1016/j.jcjq.2024.04.003","DOIUrl":"10.1016/j.jcjq.2024.04.003","url":null,"abstract":"<div><h3>Background</h3><p>Quality improvement (QI) programs require significant financial investment. The authors evaluated the cost-effectiveness of a physician-led, performance-incentivized, QI intervention that increased appropriate peripherally inserted central catheter (PICC) use.</p></div><div><h3>Methods</h3><p>The authors used an economic evaluation from a health care sector perspective. Implementation costs included incentive payments to hospitals and costs for data abstractors and the coordinating center. Effectiveness was calculated from propensity score-matched observations across two time periods for complications (venous thromboembolism [VTE], central line–associated bloodstream infection [CLABSI], and catheter occlusion): preintervention period (January 2015 through December 2016) and intervention period (January 2017 through December 2021). Cost-effectiveness was presented as the cost-offset per averted complication, reflecting the health care costs avoided due to having lower complication rates.</p></div><div><h3>Results</h3><p>Across 35 hospitals, this study sampled 17,418 PICCs placed preintervention and 26,004 placed during the intervention period. PICC complications decreased significantly following the intervention. CLABSIs decreased from 2.1% to 1.5%, VTEs from 3.2% to 2.3%, and catheter occlusions from 10.8% to 7.0% (all <em>p</em> < 0.01). Estimated number of complications prevented included 871 CLABSIs, 2,535 VTEs, and 8,743 catheter occlusions. Project implementation costs were $31.8 million, and the cost-offset related to avoided complications was $64.4 million. Each participating hospital averaged $932,073 in cost-offset over seven years, and the average cost-offset per complication averted was $2,614 (95% CI [confidence interval] $2,314–$3,003).</p></div><div><h3>Conclusion</h3><p>A large-scale, multihospital QI initiative to improve appropriate PICC use yielded substantial return on investment from cost-offset of prevented complications.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 8","pages":"Pages 591-600"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140796408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.jcjq.2024.05.010
{"title":"An Interview with Eduardo Salas, PhD","authors":"","doi":"10.1016/j.jcjq.2024.05.010","DOIUrl":"10.1016/j.jcjq.2024.05.010","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 8","pages":"Pages 549-551"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419221","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 : 2024-07-31DOI: 10.1016/j.jcjq.2024.07.009
Peter Alarcon Manchego MD (is Director for Pediatric Value, Office of Quality and Safety, NYC Health + Hospitals, New York, and Pediatrician, Kings County Hospital, Brooklyn, New York.), Mona Krouss MD (formerly Assistant Vice President of Value and Patient Safety, NYC Health + Hospitals, is Chief of Hospital Medicine and Director of Inpatient Quality, James J. Peters VA [US Department of Veterans Affairs] Medical Center, Bronx, New York, and Associate Clinical Professor, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York.), Daniel Alaiev (formerly Director of Outcomes and Biostatistics, NYC Health + Hospitals, is Medical Student, Perelman School of Medicine, University of Pennsylvania.), Joseph Talledo MS (is Data Analyst, Office of Quality and Safety, NYC Health + Hospitals.), Surafel Tsega MD (is Hospitalist, NYC Health + Hospitals/King's County, and Assistant Clinical Professor, Department of Medicine, Icahn School of Medicine at Mount Sinai.), Komal Chandra PhD (is Director of Operations for Patient Safety and High Value Care, NYC Health + Hospitals.), Milana Zaurova M (is Director of Quality, Equity, and Palliative Care, Office of Quality and Safety, NYC Health + Hospitals, and Assistant Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai.), Dawi Shin (is Medical Student, Icahn School of Medicine at Mount Sinai.), Victor Cohen PharmD (is Assistant Vice President, Pharmacy Services, NYC Health + Hospitals.), Hyung J Cho MD (is Internist. and Vice President of Quality, Department of Quality and Safety, Brigham and Women's Hospital, Boston. Please address correspondence to Peter Alacon Manchego)
Background
Inpatient serum phosphate replacement is common, but there is great variability in replacement practice, which leads to overuse. Electronic health record (EHR) interventions with clinical decision support (CDS) can be effective tools to guide clinicians toward best clinical practices. The authors’ objective was to use CDS tools to reduce overuse of hypophosphatemia corrections at a large safety-net health care system.
Methods
The first intervention involved enhancing an existing order set for phosphate repletion by incorporating CDS to guide appropriate repletion orders based on deficit severity and simplifying ordering. The second intervention was a Best Practice Advisory (BPA) that triggered when an intravenous (IV) phosphate repletion was ordered for a patient with mild to moderate phosphate deficiency without an existing nil per os (NPO) order. The primary outcome measure was the number of patients with mild and moderate hypophosphatemia receiving IV replacement without NPO orders per 1,000 patient-days.
Results
Across all hospitals, rate of IV replacement in patients with mild to moderate hypophosphatemia (1.0 to 1.9 mg/dL) without NPO orders decreased from 7.22 to 3.40 per 1,000 patient-days (53.0% reduction, p < 0.001), while the oral replacements in this population increased from 6.39 to 8.87 (38.8% increase, p < 0.001). For patients with phosphate levels ≥ 2.0, IV replacements decreased from 10.66 to 5.36 (49.8% reduction, p < 0.001), and oral replacements from decreased 19.78 to 16.69 (15.6% reduction, p < 0.01).
Conclusion
This intervention successfully reduced inpatient IV phosphate replacements by 53.0% in patients with mild to moderate hypophosphatemia using a two-pronged EHR intervention across a large safety-net setting.
{"title":"Using a Built-in Clinical Decision Support to Improve Phosphate Repletion Practice: A Quasi-Experimental Study","authors":"Peter Alarcon Manchego MD (is Director for Pediatric Value, Office of Quality and Safety, NYC Health + Hospitals, New York, and Pediatrician, Kings County Hospital, Brooklyn, New York.), Mona Krouss MD (formerly Assistant Vice President of Value and Patient Safety, NYC Health + Hospitals, is Chief of Hospital Medicine and Director of Inpatient Quality, James J. Peters VA [US Department of Veterans Affairs] Medical Center, Bronx, New York, and Associate Clinical Professor, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York.), Daniel Alaiev (formerly Director of Outcomes and Biostatistics, NYC Health + Hospitals, is Medical Student, Perelman School of Medicine, University of Pennsylvania.), Joseph Talledo MS (is Data Analyst, Office of Quality and Safety, NYC Health + Hospitals.), Surafel Tsega MD (is Hospitalist, NYC Health + Hospitals/King's County, and Assistant Clinical Professor, Department of Medicine, Icahn School of Medicine at Mount Sinai.), Komal Chandra PhD (is Director of Operations for Patient Safety and High Value Care, NYC Health + Hospitals.), Milana Zaurova M (is Director of Quality, Equity, and Palliative Care, Office of Quality and Safety, NYC Health + Hospitals, and Assistant Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai.), Dawi Shin (is Medical Student, Icahn School of Medicine at Mount Sinai.), Victor Cohen PharmD (is Assistant Vice President, Pharmacy Services, NYC Health + Hospitals.), Hyung J Cho MD (is Internist. and Vice President of Quality, Department of Quality and Safety, Brigham and Women's Hospital, Boston. Please address correspondence to Peter Alacon Manchego)","doi":"10.1016/j.jcjq.2024.07.009","DOIUrl":"10.1016/j.jcjq.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Inpatient serum phosphate replacement is common, but there is great variability in replacement practice, which leads to overuse. Electronic health record (EHR) interventions with clinical decision support (CDS) can be effective tools to guide clinicians toward best clinical practices. The authors’ objective was to use CDS tools to reduce overuse of hypophosphatemia corrections at a large safety-net health care system.</div></div><div><h3>Methods</h3><div>The first intervention involved enhancing an existing order set for phosphate repletion by incorporating CDS to guide appropriate repletion orders based on deficit severity and simplifying ordering. The second intervention was a Best Practice Advisory (BPA) that triggered when an intravenous (IV) phosphate repletion was ordered for a patient with mild to moderate phosphate deficiency without an existing nil per os (NPO) order. The primary outcome measure was the number of patients with mild and moderate hypophosphatemia receiving IV replacement without NPO orders per 1,000 patient-days.</div></div><div><h3>Results</h3><div>Across all hospitals, rate of IV replacement in patients with mild to moderate hypophosphatemia (1.0 to 1.9 mg/dL) without NPO orders decreased from 7.22 to 3.40 per 1,000 patient-days (53.0% reduction, <em>p</em> < 0.001), while the oral replacements in this population increased from 6.39 to 8.87 (38.8% increase, <em>p</em> < 0.001). For patients with phosphate levels ≥ 2.0, IV replacements decreased from 10.66 to 5.36 (49.8% reduction, <em>p</em> < 0.001), and oral replacements from decreased 19.78 to 16.69 (15.6% reduction, <em>p</em> < 0.01).</div></div><div><h3>Conclusion</h3><div>This intervention successfully reduced inpatient IV phosphate replacements by 53.0% in patients with mild to moderate hypophosphatemia using a two-pronged EHR intervention across a large safety-net setting.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 11","pages":"Pages 801-808"},"PeriodicalIF":2.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287756","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 : 2024-07-26DOI: 10.1016/j.jcjq.2024.07.004
Farrukh N. Jafri MD, MS-HPEd, FACEP (is Medical Director, WPH Cares, White Plains Hospital, White Plains, New York, and Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York.), Kenay Johnson MA, CPHQ (is Senior Manager, Network Performance Group, Montefiore Medical Center, Bronx, New York.), Michelle Elsener MBA, BSN, RN-BC, CPHQ (is Clinical Quality Nurse, White Plains Hospital.), Michael Latchmansingh RN, JD, MBA (is Senior Director, Department of Innovation, White Plains Hospital.), Jonathan Sege MS (is Senior Director, Data Management and Analytics, White Plains Hospital.), Melanie Plotke PharmD (formerly Clinical Data Pharmacist, Cureatr, New York, is Manager, Science and Clinical Practice Guidelines, American Academy of Dermatology, Chicago.), Tina Jing MD (is Resident, Department of Anesthesiology, NewYork Presbyterian /Columbia University.), Adeel Arif (is Research Associate, White Plains Hospital, and Applied Analytics Master's Student, Columbia University.), Fran Ganz-Lord MD, FACP (is Senior Director, Network Performance Group, Montefiore Medical Center, and Associate Professor of Medicine, Division of Internal Medicine, Albert Einstein College of Medicine. Please address correspondence to Farrukh N Jafri)
Background
Congestive heart failure (HF) is a leading cause of hospitalization and readmission, leading to increased health care utilization and cost. This is complicated by high incidence, prevalence, and hospitalization rates among racial and ethnic minorities, with a widening in the mortality disparity gap. Remote patient monitoring (RPM) has the potential to proactively engage patients after discharge to optimize medication management and intervene to avoid rehospitalization. However, it also may widen the equity gap due to technological barriers and bias.
Methods
A prospective, observational quality improvement (QI) initiative leveraging an amended tool from the Institute for Healthcare Improvement Model for Improvement was incorporated with an equity lens and five Plan-Do-Study-Act (PDSA) cycles at a single site. The intervention used an HF bundle that included RPM, clinical telepharmacy, remote therapeutic monitoring, and community paramedicine.
Results
Between May 2022 and March 2023, five PDSA cycles were run involving 90 enrolled patients. In total, 38 (42.2%) patients received the complete HF bundle, 42 (46.7%) a partial bundle, and 10 (11.1%) only RPM. The patients with the complete bundle had a readmission rate of 2.6% compared to 14.3% in the partial bundle and 20.0% in RPM alone. The biggest impact of this program was the incorporation of community paramedicine. The program also noted an improvement in equitable enrollment after adjusting mid-program by avoiding cellular phone–enabled devices and transitioning to a hub-based model.
Conclusion
This single-site QI–based initiative implemented an HF–based RPM program that leveraged clinical telepharmacy and community paramedicine. This program identified a disparity of care gap regarding the equitable distribution of services and made mid-study adjustments to improve the disparity gap. The program found that use of the HF bundle resulted in a decreased hospital readmission rate.
{"title":"A Quality Improvement-based Approach to Implementing a Remote Monitoring–Based Bundle in Transitional Care Patients for Heart Failure","authors":"Farrukh N. Jafri MD, MS-HPEd, FACEP (is Medical Director, WPH Cares, White Plains Hospital, White Plains, New York, and Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York.), Kenay Johnson MA, CPHQ (is Senior Manager, Network Performance Group, Montefiore Medical Center, Bronx, New York.), Michelle Elsener MBA, BSN, RN-BC, CPHQ (is Clinical Quality Nurse, White Plains Hospital.), Michael Latchmansingh RN, JD, MBA (is Senior Director, Department of Innovation, White Plains Hospital.), Jonathan Sege MS (is Senior Director, Data Management and Analytics, White Plains Hospital.), Melanie Plotke PharmD (formerly Clinical Data Pharmacist, Cureatr, New York, is Manager, Science and Clinical Practice Guidelines, American Academy of Dermatology, Chicago.), Tina Jing MD (is Resident, Department of Anesthesiology, NewYork Presbyterian /Columbia University.), Adeel Arif (is Research Associate, White Plains Hospital, and Applied Analytics Master's Student, Columbia University.), Fran Ganz-Lord MD, FACP (is Senior Director, Network Performance Group, Montefiore Medical Center, and Associate Professor of Medicine, Division of Internal Medicine, Albert Einstein College of Medicine. Please address correspondence to Farrukh N Jafri)","doi":"10.1016/j.jcjq.2024.07.004","DOIUrl":"10.1016/j.jcjq.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Congestive heart failure (HF) is a leading cause of hospitalization and readmission, leading to increased health care utilization and cost. This is complicated by high incidence, prevalence, and hospitalization rates among racial and ethnic minorities, with a widening in the mortality disparity gap. Remote patient monitoring (RPM) has the potential to proactively engage patients after discharge to optimize medication management and intervene to avoid rehospitalization. However, it also may widen the equity gap due to technological barriers and bias.</div></div><div><h3>Methods</h3><div>A prospective, observational quality improvement (QI) initiative leveraging an amended tool from the Institute for Healthcare Improvement Model for Improvement was incorporated with an equity lens and five Plan-Do-Study-Act (PDSA) cycles at a single site. The intervention used an HF bundle that included RPM, clinical telepharmacy, remote therapeutic monitoring, and community paramedicine.</div></div><div><h3>Results</h3><div>Between May 2022 and March 2023, five PDSA cycles were run involving 90 enrolled patients. In total, 38 (42.2%) patients received the complete HF bundle, 42 (46.7%) a partial bundle, and 10 (11.1%) only RPM. The patients with the complete bundle had a readmission rate of 2.6% compared to 14.3% in the partial bundle and 20.0% in RPM alone. The biggest impact of this program was the incorporation of community paramedicine. The program also noted an improvement in equitable enrollment after adjusting mid-program by avoiding cellular phone–enabled devices and transitioning to a hub-based model.</div></div><div><h3>Conclusion</h3><div>This single-site QI–based initiative implemented an HF–based RPM program that leveraged clinical telepharmacy and community paramedicine. This program identified a disparity of care gap regarding the equitable distribution of services and made mid-study adjustments to improve the disparity gap. The program found that use of the HF bundle resulted in a decreased hospital readmission rate.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 11","pages":"Pages 775-783"},"PeriodicalIF":2.3,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848511","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 : 2024-07-26DOI: 10.1016/j.jcjq.2024.07.007
Mark Ettenberger PhD, MA, MT (is Coordinator, Music Therapy Service, Department of Social Management, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia, and Director, SONO – Centro de Musicoterapia, Bogotá, Colombia.), Andrés Salgado MMT, MT (is Clinical Musical Therapist, Department of Social Management, University Hospital Fundación Santa Fe de Bogotá, and Clinical Musical Therapist, SONO – Centro de Musicoterapia.), Rafael Maya MNMT, NMT, MT (is Clinical Musical Therapist, Department of Social Management, University Hospital Fundación Santa Fe de Bogotá, and Clinical Musical Therapist, SONO – Centro de Musicoterapia.), Adriana Merchán-Restrepo MSc (is Coordinator, Epidemiological Surveillance, University Hospital Fundación Santa Fe de Bogotá.), Pedro Barrera-López MD (is Pediatric Intensivist and Consultant Epidemiologist, Office of Clinical Studies and Epidemiology, University Hospital Fundación Santa Fe de Bogotá. Please address correspondence to Mark Ettenberger)
Background
Health care–associated infections (HAIs) can affect patient safety and recovery. Musical instruments used by music therapy services may carry pathogens, particularly in ICUs. The aim of this study was to determine the efficacy of the cleaning and disinfection protocol by the music therapy service of the University Hospital Fundación Santa Fe de Bogotá.
Methods
This prospective cohort study included all ICU music therapy patients from July to August 2023. Adenosine triphosphate (ATP) bioluminescence tests and microbiological cultures were taken before and after cleaning the musical instruments for nine patients in the adult and pediatric ICUs. ATPs were taken before starting music therapy, after finishing music therapy, and after cleaning the instruments. Cultures were taken if an ATP test was above the established cutoff of ≤ 200 relative light units (RLUs). If no ATP value was above the cutoff, cultures were taken randomly.
Results
A total of 63 ATPs and 10 random microbiological cultures were taken. After applying the cleaning and disinfection protocol, all ATP values were ≤ 200 RLUs. Of the 10 microbiological cultures, 1 screened positive for Streptococcus sp., yeast, and Micrococcus. One hundred ICU music therapy patients were followed up, and positive associations with HAIs were found for age (p = 0.01), type of unit (p = 0.001), tracheostomy (p < 0.001), arterial line (p = 0.005), hemodialysis catheter (p = 0.05), bladder catheter (p = 0.02), number of invasive devices (p = 0.02), duration use of invasive devices (p = 0.01), and days of hospitalization (p = 0.01). Number of music therapy sessions/patient was not associated with HAIs (p = 0.86).
Conclusion
The results indicate that the current cleaning and disinfection protocol can be considered safe and effective. To the authors’ knowledge, this is one of the first studies investigating biosafety of musical instruments in a hospital-based music therapy service. Patient safety is of the utmost importance in hospital settings, and awareness about proper cleaning of their work tools among music therapists is paramount.
{"title":"Efficacy and Impact of a Cleaning and Disinfection Protocol for Musical Instruments Used in Music Therapy Services in ICUs: A Prospective Cohort Study","authors":"Mark Ettenberger PhD, MA, MT (is Coordinator, Music Therapy Service, Department of Social Management, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia, and Director, SONO – Centro de Musicoterapia, Bogotá, Colombia.), Andrés Salgado MMT, MT (is Clinical Musical Therapist, Department of Social Management, University Hospital Fundación Santa Fe de Bogotá, and Clinical Musical Therapist, SONO – Centro de Musicoterapia.), Rafael Maya MNMT, NMT, MT (is Clinical Musical Therapist, Department of Social Management, University Hospital Fundación Santa Fe de Bogotá, and Clinical Musical Therapist, SONO – Centro de Musicoterapia.), Adriana Merchán-Restrepo MSc (is Coordinator, Epidemiological Surveillance, University Hospital Fundación Santa Fe de Bogotá.), Pedro Barrera-López MD (is Pediatric Intensivist and Consultant Epidemiologist, Office of Clinical Studies and Epidemiology, University Hospital Fundación Santa Fe de Bogotá. Please address correspondence to Mark Ettenberger)","doi":"10.1016/j.jcjq.2024.07.007","DOIUrl":"10.1016/j.jcjq.2024.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Health care–associated infections (HAIs) can affect patient safety and recovery. Musical instruments used by music therapy services may carry pathogens, particularly in ICUs. The aim of this study was to determine the efficacy of the cleaning and disinfection protocol by the music therapy service of the University Hospital Fundación Santa Fe de Bogotá.</div></div><div><h3>Methods</h3><div>This prospective cohort study included all ICU music therapy patients from July to August 2023. Adenosine triphosphate (ATP) bioluminescence tests and microbiological cultures were taken before and after cleaning the musical instruments for nine patients in the adult and pediatric ICUs. ATPs were taken before starting music therapy, after finishing music therapy, and after cleaning the instruments. Cultures were taken if an ATP test was above the established cutoff of ≤ 200 relative light units (RLUs). If no ATP value was above the cutoff, cultures were taken randomly.</div></div><div><h3>Results</h3><div>A total of 63 ATPs and 10 random microbiological cultures were taken. After applying the cleaning and disinfection protocol, all ATP values were ≤ 200 RLUs. Of the 10 microbiological cultures, 1 screened positive for <em>Streptococcus</em> sp., yeast, and <em>Micrococcus.</em> One hundred ICU music therapy patients were followed up, and positive associations with HAIs were found for age (<em>p</em> = 0.01), type of unit (<em>p</em> = 0.001), tracheostomy (<em>p</em> < 0.001), arterial line (<em>p</em> = 0.005), hemodialysis catheter (<em>p</em> = 0.05), bladder catheter (<em>p</em> = 0.02), number of invasive devices (<em>p</em> = 0.02), duration use of invasive devices (<em>p</em> = 0.01), and days of hospitalization (<em>p</em> = 0.01). Number of music therapy sessions/patient was not associated with HAIs (<em>p</em> = 0.86).</div></div><div><h3>Conclusion</h3><div>The results indicate that the current cleaning and disinfection protocol can be considered safe and effective. To the authors’ knowledge, this is one of the first studies investigating biosafety of musical instruments in a hospital-based music therapy service. Patient safety is of the utmost importance in hospital settings, and awareness about proper cleaning of their work tools among music therapists is paramount.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 11","pages":"Pages 755-763"},"PeriodicalIF":2.3,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843557","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 : 2024-07-23DOI: 10.1016/j.jcjq.2024.07.005
Kandice Bledsaw PhD, RN (is Director, Quality Outcomes and Analytics, Texas Children's Hospital, Houston.), Zachary D. Prudowsky MD, FAAP (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine, Houston.), Mark C. Zobeck MD, MPH (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Jenell Robins BSDH, RDH (is Oral Health Educator/Registered Dental Hygienist, Texas Children's Hospital.), Sharon Staton MS-SSEM, BSN, RN (is Clinical Specialist, Texas Children's Hospital.), Janet DeJean MSN, RN (is Clinical Specialist, Texas Children's Hospital.), Esther Yang DDS (is Chief of Service, Department of Dentistry, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Claudia X. Harriehausen DDS, MSD (is Pediatric Dentist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Judith R. Campbell MD (is Attending Physician, Texas Children's Hospital, and Professor, Department of Pediatrics, Baylor College of Medicine.), Andrea L. Davis MPH, CIC (is Infection Control Preventionist, Texas Children's Hospital.), Anil George MD (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), David Steffin MD (is Associate Chief, Cell Therapy and Bone Marrow Transplant Program, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Gabriella Llaurador MD (is Pediatric Stem Cell and Transplant Therapy Physician, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Alexandra M. Stevens MD, PhD (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine. Please address correspondence to Zachary Prudowsky)
Background
Mucosal barrier injury central line–associated bloodstream infections (MBI-CLABSIs) remain a challenge among the pediatric cancer population. These infections commonly occur by oral or gastrointestinal (GI) bacteria translocating through impaired gut or oral mucosa. Although strategies to prevent gut MBI-CLABSIs are well characterized, oral pathogen prevention strategies are lacking.
Methods
The authors’ oncodental collaboration quality improvement project, which included two Plan-Do-Study-Act (PDSA) cycles, aimed to improve MBI-CLABSI rates and oral care adherence on a pediatric hematopoietic stem cell transplant (HSCT) unit. PDSA cycle 1 integrated dental residents into existing rounds every third week to screen for dental, gum, and mucosal disease and provide targeted education to patients and families. PDSA cycle 2 implemented a novel oral health educator (OHE) role in which a trained dental hygienist rounded four days per week. Monthly MBI-CLABSI rates and oral care adherence were followed from December 2020 to May 2021 (baseline), June 2021 to March 2022 (PDSA cycle 1), and April 2022 to December 2022 (PDSA cycle 2). Qualitative surveys captured patient and family perception, and a cost savings analysis was completed.
Results
A 58.8% reduction in MBI-CLABSI rate (events per 1,000 central venous line days) was detected (baseline: 5.1; PDSA cycle 2: 2.1), oral care adherence improved 41.7% (baseline: 60.9%; PDSA cycle 2: 86.3%), 100% of patients found it beneficial to receive oral care demonstrations, and an annual cost savings of $541,000 was estimated.
Conclusion
Direct patient outcomes have measurably improved. This project suggests the implementation of an OHE in pediatric HSCT inpatient units may be valuable to patients and families and may be a cost-effective way to reduce MBI-CLABSIs resulting from oral pathogens.
{"title":"Implementing an Oral Health Educator Contributes to Reduced MBI-CLABSI Rates for Pediatric Hematopoietic Stem Cell Transplant Patients","authors":"Kandice Bledsaw PhD, RN (is Director, Quality Outcomes and Analytics, Texas Children's Hospital, Houston.), Zachary D. Prudowsky MD, FAAP (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine, Houston.), Mark C. Zobeck MD, MPH (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Jenell Robins BSDH, RDH (is Oral Health Educator/Registered Dental Hygienist, Texas Children's Hospital.), Sharon Staton MS-SSEM, BSN, RN (is Clinical Specialist, Texas Children's Hospital.), Janet DeJean MSN, RN (is Clinical Specialist, Texas Children's Hospital.), Esther Yang DDS (is Chief of Service, Department of Dentistry, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Claudia X. Harriehausen DDS, MSD (is Pediatric Dentist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Judith R. Campbell MD (is Attending Physician, Texas Children's Hospital, and Professor, Department of Pediatrics, Baylor College of Medicine.), Andrea L. Davis MPH, CIC (is Infection Control Preventionist, Texas Children's Hospital.), Anil George MD (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), David Steffin MD (is Associate Chief, Cell Therapy and Bone Marrow Transplant Program, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Gabriella Llaurador MD (is Pediatric Stem Cell and Transplant Therapy Physician, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Alexandra M. Stevens MD, PhD (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine. Please address correspondence to Zachary Prudowsky)","doi":"10.1016/j.jcjq.2024.07.005","DOIUrl":"10.1016/j.jcjq.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Mucosal barrier injury central line–associated bloodstream infections (MBI-CLABSIs) remain a challenge among the pediatric cancer population. These infections commonly occur by oral or gastrointestinal (GI) bacteria translocating through impaired gut or oral mucosa. Although strategies to prevent gut MBI-CLABSIs are well characterized, oral pathogen prevention strategies are lacking.</div></div><div><h3>Methods</h3><div>The authors’ oncodental collaboration quality improvement project, which included two Plan-Do-Study-Act (PDSA) cycles, aimed to improve MBI-CLABSI rates and oral care adherence on a pediatric hematopoietic stem cell transplant (HSCT) unit. PDSA cycle 1 integrated dental residents into existing rounds every third week to screen for dental, gum, and mucosal disease and provide targeted education to patients and families. PDSA cycle 2 implemented a novel oral health educator (OHE) role in which a trained dental hygienist rounded four days per week. Monthly MBI-CLABSI rates and oral care adherence were followed from December 2020 to May 2021 (baseline), June 2021 to March 2022 (PDSA cycle 1), and April 2022 to December 2022 (PDSA cycle 2). Qualitative surveys captured patient and family perception, and a cost savings analysis was completed.</div></div><div><h3>Results</h3><div>A 58.8% reduction in MBI-CLABSI rate (events per 1,000 central venous line days) was detected (baseline: 5.1; PDSA cycle 2: 2.1), oral care adherence improved 41.7% (baseline: 60.9%; PDSA cycle 2: 86.3%), 100% of patients found it beneficial to receive oral care demonstrations, and an annual cost savings of $541,000 was estimated.</div></div><div><h3>Conclusion</h3><div>Direct patient outcomes have measurably improved. This project suggests the implementation of an OHE in pediatric HSCT inpatient units may be valuable to patients and families and may be a cost-effective way to reduce MBI-CLABSIs resulting from oral pathogens.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 11","pages":"Pages 784-790"},"PeriodicalIF":2.3,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843644","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 : 2024-07-23DOI: 10.1016/j.jcjq.2024.07.008
Jennifer L. Sullivan PhD (is Associate Director, Center of Innovation in Long Term Services and Supports (LTSS COIN), VA [US Department of Veterans Affairs] Providence Healthcare System, Providence, Rhode Island, and Associate Professor, Department of Health Services, Policy and Practice, School of Public Health, Brown University.), Marlena H. Shin JD, MPH (is Research Health Scientist. Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System.), Allison Ranusch MA (is Research Health Scientist, Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor Michigan.), David C. Mohr PhD (is Investigator, Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, and Adjunct Research Assistant Professor, Department of Health Policy and Management, Boston University School of Public Health.), Charity Chen MS (is Data Analyst/Statistician, Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System.), Laura J. Damschroder (is Research Scientist, VA Center for Clinical Management Research (CCMR) VA Ann Arbor Healthcare System. Please address correspondence to Jennifer L. Sullivan)
Background
Patient safety culture (PSC) fosters an environment of trust where people are encouraged to share information to promote psychological safety. To measure PSC, the Veteran's Health Administration (VHA) developed a PSC survey consisting of 20 items administered to all VHA employees. The survey comprises four scales: (1) risk identification and Just Culture, (2) error transparency and mitigation, (3) supervisor communication and trust, and (4) team cohesion and engagement. Our objective was to compare the PSC survey data to qualitative data regarding high reliability organization (HRO) implementation from four purposively selected VHA hospitals to assess how it manifests and converges.
Methods
Qualitative data focused on understanding HRO implementation efforts were collected from key informants between 2019 and 2020 at 4 of the 18 VHA HRO implementation hospitals. To explore the extent and manifestation of each of the PSC scales among the 4 sites, we combined the qualitative data with the PSC survey data from each hospital using a joint display.
Results
Survey responses were significantly different between the 4 hospitals for all 4 PSC scales. Of the 20 PSC survey items, 12 (60.0%) significantly differed across the 4 hospitals. For example, we saw cross-hospital differences in the following survey items: “We are given feedback about changes put into place based on event reports” and “We take the time to identify and assess risks to patient safety.” Qualitative data supported manifestations for 80.0% (16/20) of PSC individual survey items among hospitals.
Conclusion
The authors found that the qualitative data manifestations were well aligned with the VHA PSC scales, but relationships were not always consistent between data sources. Further research is necessary to elucidate these relationships.
{"title":"A Mixed Methods Study Exploring Patient Safety Culture at Four VHA Hospitals","authors":"Jennifer L. Sullivan PhD (is Associate Director, Center of Innovation in Long Term Services and Supports (LTSS COIN), VA [US Department of Veterans Affairs] Providence Healthcare System, Providence, Rhode Island, and Associate Professor, Department of Health Services, Policy and Practice, School of Public Health, Brown University.), Marlena H. Shin JD, MPH (is Research Health Scientist. Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System.), Allison Ranusch MA (is Research Health Scientist, Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor Michigan.), David C. Mohr PhD (is Investigator, Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, and Adjunct Research Assistant Professor, Department of Health Policy and Management, Boston University School of Public Health.), Charity Chen MS (is Data Analyst/Statistician, Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System.), Laura J. Damschroder (is Research Scientist, VA Center for Clinical Management Research (CCMR) VA Ann Arbor Healthcare System. Please address correspondence to Jennifer L. Sullivan)","doi":"10.1016/j.jcjq.2024.07.008","DOIUrl":"10.1016/j.jcjq.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Patient safety culture (PSC) fosters an environment of trust where people are encouraged to share information to promote psychological safety. To measure PSC, the Veteran's Health Administration (VHA) developed a PSC survey consisting of 20 items administered to all VHA employees. The survey comprises four scales: (1) risk identification and Just Culture, (2) error transparency and mitigation, (3) supervisor communication and trust, and (4) team cohesion and engagement. Our objective was to compare the PSC survey data to qualitative data regarding high reliability organization (HRO) implementation from four purposively selected VHA hospitals to assess how it manifests and converges.</div></div><div><h3>Methods</h3><div>Qualitative data focused on understanding HRO implementation efforts were collected from key informants between 2019 and 2020 at 4 of the 18 VHA HRO implementation hospitals. To explore the extent and manifestation of each of the PSC scales among the 4 sites, we combined the qualitative data with the PSC survey data from each hospital using a joint display.</div></div><div><h3>Results</h3><div>Survey responses were significantly different between the 4 hospitals for all 4 PSC scales. Of the 20 PSC survey items, 12 (60.0%) significantly differed across the 4 hospitals. For example, we saw cross-hospital differences in the following survey items: “We are given feedback about changes put into place based on event reports” and “We take the time to identify and assess risks to patient safety.” Qualitative data supported manifestations for 80.0% (16/20) of PSC individual survey items among hospitals.</div></div><div><h3>Conclusion</h3><div>The authors found that the qualitative data manifestations were well aligned with the VHA PSC scales, but relationships were not always consistent between data sources. Further research is necessary to elucidate these relationships.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 11","pages":"Pages 791-800"},"PeriodicalIF":2.3,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845224","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 : 2024-07-18DOI: 10.1016/j.jcjq.2024.07.002
Ian R. Slade MD (is Associate Professor, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine.), Aspen D. Avery MPH (is Research Coordinator, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington.), Carmen Gonzalez PhD, MA (is Associate Professor, Department of Communication, University of Washington.), Christine Chung MD (is Assistant Professor Division of Cardiology, Department of Medicine, University of Washington School of Medicine.), Qian Qiu MBA (is Research Consultant, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine.), Yvonne M. Simpson MA (is Senior Director, Language Access and Cultural Advocacy, Department of Interpreter Services, Harborview Medical Center, University of Washington.), Christine Ector MPH (is Continuing Education Coordinator, Northwest Center for Public Health Practice, University of Washington.), Monica S. Vavilala MD (is Professor, Department of Anesthesiology and Pain Medicine, Professor, Pediatrics, and Adjunct Professor, Health Systems and Population Health, University of Washington School of Medicine. Please send correspondence to Ian R. Slade)
Introduction
Culturally and linguistically diverse (CALD) patients should but do not routinely receive professional interpretation. The authors examined provider perceptions of barriers and solutions to interpreter services (IS) in a safety-net hospital to inform quality improvement (QI).
Methods
A 13-item survey was distributed to 750 clinicians representing 10 services across professional roles, including social workers. Closed- and open-ended questions addressed accessing IS, IS value, and care for CALD patients. Respondents ranked eight barriers to routine IS use and provided ideas for improvement. Descriptive statistics characterized survey results in aggregate and by professional role and care team. Quantitative and qualitative results were triangulated for agreement between survey domains and coded free-text response themes.
Results
A total of 221 responses were analyzed (29.5% response rate). Cost was the lowest-ranked barrier across roles. Leading barriers were efficiency pressures and cumbersome access. Free-text responses agreed with these findings. CALD patients were perceived to have higher complication risk by 87.5% of social workers but by 56.8% of other roles. Recommendations to increase IS varied by team: streamlined access process (46.2% emergency, 37.8% inpatient respondents), expanded in-person interpretation (55.6% inpatient, 45.8% perioperative respondents), and better equipment (44.4% outpatient, 35.9% emergency, 25.0% perioperative respondents).
Conclusion
Provider experiences vary by care team and interpretation modality. Interpretation services are cumbersome to access and compete with efficiency pressures, leading to shortcuts that fail to provide adequate language access. Three initial QI efforts resulted: increased video interpretation equipment, a new language access committee, and a new language access leadership role.
{"title":"Effective Use of Interpreter Services for Diverse Patients in a Safety-Net Hospital: Provider Perceptions of Barriers and Solutions","authors":"Ian R. Slade MD (is Associate Professor, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine.), Aspen D. Avery MPH (is Research Coordinator, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington.), Carmen Gonzalez PhD, MA (is Associate Professor, Department of Communication, University of Washington.), Christine Chung MD (is Assistant Professor Division of Cardiology, Department of Medicine, University of Washington School of Medicine.), Qian Qiu MBA (is Research Consultant, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine.), Yvonne M. Simpson MA (is Senior Director, Language Access and Cultural Advocacy, Department of Interpreter Services, Harborview Medical Center, University of Washington.), Christine Ector MPH (is Continuing Education Coordinator, Northwest Center for Public Health Practice, University of Washington.), Monica S. Vavilala MD (is Professor, Department of Anesthesiology and Pain Medicine, Professor, Pediatrics, and Adjunct Professor, Health Systems and Population Health, University of Washington School of Medicine. Please send correspondence to Ian R. Slade)","doi":"10.1016/j.jcjq.2024.07.002","DOIUrl":"10.1016/j.jcjq.2024.07.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Culturally and linguistically diverse (CALD) patients should but do not routinely receive professional interpretation. The authors examined provider perceptions of barriers and solutions to interpreter services (IS) in a safety-net hospital to inform quality improvement (QI).</div></div><div><h3>Methods</h3><div>A 13-item survey was distributed to 750 clinicians representing 10 services across professional roles, including social workers. Closed- and open-ended questions addressed accessing IS, IS value, and care for CALD patients. Respondents ranked eight barriers to routine IS use and provided ideas for improvement. Descriptive statistics characterized survey results in aggregate and by professional role and care team. Quantitative and qualitative results were triangulated for agreement between survey domains and coded free-text response themes.</div></div><div><h3>Results</h3><div>A total of 221 responses were analyzed (29.5% response rate). Cost was the lowest-ranked barrier across roles. Leading barriers were efficiency pressures and cumbersome access. Free-text responses agreed with these findings. CALD patients were perceived to have higher complication risk by 87.5% of social workers but by 56.8% of other roles. Recommendations to increase IS varied by team: streamlined access process (46.2% emergency, 37.8% inpatient respondents), expanded in-person interpretation (55.6% inpatient, 45.8% perioperative respondents), and better equipment (44.4% outpatient, 35.9% emergency, 25.0% perioperative respondents).</div></div><div><h3>Conclusion</h3><div>Provider experiences vary by care team and interpretation modality. Interpretation services are cumbersome to access and compete with efficiency pressures, leading to shortcuts that fail to provide adequate language access. Three initial QI efforts resulted: increased video interpretation equipment, a new language access committee, and a new language access leadership role.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 10","pages":"Pages 700-710"},"PeriodicalIF":2.3,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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