Pub Date : 2024-03-19DOI: 10.1016/j.jcjq.2024.03.011
David W. Baker MD, MPH, FACP (is Editor-in-Chief, Joint Commission Journal on Quality and Patient Safety, Oakbrook Terrace, Illinois. Please address correspondence to David W. Baker)
{"title":"Handoffs and Care Transitions: Interviews with Chris Landrigan and Theresa Murray","authors":"David W. Baker MD, MPH, FACP (is Editor-in-Chief, Joint Commission Journal on Quality and Patient Safety, Oakbrook Terrace, Illinois. Please address correspondence to David W. Baker)","doi":"10.1016/j.jcjq.2024.03.011","DOIUrl":"10.1016/j.jcjq.2024.03.011","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273710","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 : 2024-03-13DOI: 10.1016/j.jcjq.2024.03.008
Robert Metter MD (is Assistant Professor, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora.), Amanda Johnson MD (is Assistant Professor, Division of Hospital Medicine, University of Colorado School of Medicine.), Marisha Burden MD, MBA (is Division Head of Hospital Medicine, University of Colorado School of Medicine. Please address correspondence to Marisha Burden)
{"title":"Optimizing Hospitalist Co-Management for Improved Patient, Workforce, and Organizational Outcomes","authors":"Robert Metter MD (is Assistant Professor, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora.), Amanda Johnson MD (is Assistant Professor, Division of Hospital Medicine, University of Colorado School of Medicine.), Marisha Burden MD, MBA (is Division Head of Hospital Medicine, University of Colorado School of Medicine. Please address correspondence to Marisha Burden)","doi":"10.1016/j.jcjq.2024.03.008","DOIUrl":"10.1016/j.jcjq.2024.03.008","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278439","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 : 2024-03-07DOI: 10.1016/j.jcjq.2024.03.002
Background
The emotional impact of medical errors on patients may be long-lasting. Factors associated with prolonged emotional impacts are poorly understood.
Methods
The authors conducted a subanalysis of a 2017 survey (response rate 36.8% [2,536/6,891]) of US adults to assess emotional impact of medical error. Patients reporting a medical error were included if the error occurred ≥ 1 year prior. Duration of emotional impact was categorized into no/short-term impact (impact lasting < 1 month), prolonged impact (> 1 month), and especially prolonged impact (> 1 year). Based on their reported experience with communication about the error, patients’ experience was categorized as consistent with national disclosure guidelines, contrary to guidelines, mixed, or neither. Multinomial regression was used to examine associations between patient factors, event characteristics, and organizational communication with prolonged emotional impact (> 1 month, > 1 year).
Results
Of all survey respondents, 17.8% (451/2,536) reported an error occurring ≥ 1 year prior. Of these, 51.2% (231/451) reported prolonged/especially prolonged emotional impact (30.8% prolonged, 20.4% especially prolonged). Factors associated with prolonged emotional impact included female gender (adjusted odds ratio 2.1 [95% confidence interval 1.5–2.9]); low socioeconomic status (SES; 1.7 [1.1–2.7]); physical impact (7.3 [4.3–12.3]); no organizational disclosure and no patient/family error reporting (1.5 [1.03–2.3]); communication contrary to guidelines (4.0 [2.1–7.5]); and mixed communication (2.2 [1.3–3.7]). The same factors were significantly associated with especially prolonged emotional impact (female, 1.7 [1.2–2.5]; low SES, 2.2 [1.3–3.6]; physical impact, 6.8 [3.8–12.5]; no disclosure/reporting, 1.9 [1.2–3.2]; communication contrary to guidelines, 4.6 [2.2–9.4]; mixed communication, 2.1 [1.1–3.9]).
Conclusion
Prolonged emotional impact affected more than half of Americans self-reporting a medical error. Organizational failure to communicate according to disclosure guidelines after patient-perceived errors may exacerbate harm, particularly for patients at risk of health care disparities.
{"title":"Associations Between Organizational Communication and Patients’ Experience of Prolonged Emotional Impact Following Medical Errors","authors":"","doi":"10.1016/j.jcjq.2024.03.002","DOIUrl":"10.1016/j.jcjq.2024.03.002","url":null,"abstract":"<div><h3>Background</h3><p>The emotional impact of medical errors on patients may be long-lasting. Factors associated with prolonged emotional impacts are poorly understood.</p></div><div><h3>Methods</h3><p>The authors conducted a subanalysis of a 2017 survey (response rate 36.8% [2,536/6,891]) of US adults to assess emotional impact of medical error. Patients reporting a medical error were included if the error occurred ≥ 1 year prior. Duration of emotional impact was categorized into no/short-term impact (impact lasting < 1 month), prolonged impact (> 1 month), and especially prolonged impact (> 1 year). Based on their reported experience with communication about the error, patients’ experience was categorized as consistent with national disclosure guidelines, contrary to guidelines, mixed, or neither. Multinomial regression was used to examine associations between patient factors, event characteristics, and organizational communication with prolonged emotional impact (> 1 month, > 1 year).</p></div><div><h3>Results</h3><p>Of all survey respondents, 17.8% (451/2,536) reported an error occurring ≥ 1 year prior. Of these, 51.2% (231/451) reported prolonged/especially prolonged emotional impact (30.8% prolonged, 20.4% especially prolonged). Factors associated with prolonged emotional impact included female gender (adjusted odds ratio 2.1 [95% confidence interval 1.5–2.9]); low socioeconomic status (SES; 1.7 [1.1–2.7]); physical impact (7.3 [4.3–12.3]); no organizational disclosure and no patient/family error reporting (1.5 [1.03–2.3]); communication contrary to guidelines (4.0 [2.1–7.5]); and mixed communication (2.2 [1.3–3.7]). The same factors were significantly associated with especially prolonged emotional impact (female, 1.7 [1.2–2.5]; low SES, 2.2 [1.3–3.6]; physical impact, 6.8 [3.8–12.5]; no disclosure/reporting, 1.9 [1.2–3.2]; communication contrary to guidelines, 4.6 [2.2–9.4]; mixed communication, 2.1 [1.1–3.9]).</p></div><div><h3>Conclusion</h3><p>Prolonged emotional impact affected more than half of Americans self-reporting a medical error. Organizational failure<span> to communicate according to disclosure guidelines after patient-perceived errors may exacerbate harm, particularly for patients at risk of health care disparities.</span></p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273920","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 : 2024-03-02DOI: 10.1016/j.jcjq.2024.03.001
Rafael Vazquez MD (is Director of Anesthesia for Interventional Radiology, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, and Assistant Professor, Department of Anaesthesia, Harvard Medical School, Boston.), Alexander F. Arriaga MD, MPH, ScD (is Associate Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School.), Marc Philip T. Pimentel MD, MPH (is Medical Director of Quality, Brigham and Women's Hospital, Department of Quality and Safety, and Associate Clinical Director for Quality, Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School. Please address correspondence to Marc Philip T. Pimentel)
{"title":"Taming the Wild West of Procedural Safety: Assessing Interprofessional Teams in Non-Operating Room Anesthesia","authors":"Rafael Vazquez MD (is Director of Anesthesia for Interventional Radiology, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, and Assistant Professor, Department of Anaesthesia, Harvard Medical School, Boston.), Alexander F. Arriaga MD, MPH, ScD (is Associate Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School.), Marc Philip T. Pimentel MD, MPH (is Medical Director of Quality, Brigham and Women's Hospital, Department of Quality and Safety, and Associate Clinical Director for Quality, Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School. Please address correspondence to Marc Philip T. Pimentel)","doi":"10.1016/j.jcjq.2024.03.001","DOIUrl":"10.1016/j.jcjq.2024.03.001","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140083373","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 : 2024-02-07DOI: 10.1016/j.jcjq.2024.02.002
David W. Baker MD, MPH, FACP (is Editor-in-Chief, Joint Commission Journal on Quality and Patient Safety, Oakbrook Terrace, Illinois. Please address correspondence to David W. Baker)
{"title":"Advancing Antibiotic Stewardship: Interviews with Dr. Arjun Srinivasan and Dr. Payal Patel","authors":"David W. Baker MD, MPH, FACP (is Editor-in-Chief, Joint Commission Journal on Quality and Patient Safety, Oakbrook Terrace, Illinois. Please address correspondence to David W. Baker)","doi":"10.1016/j.jcjq.2024.02.002","DOIUrl":"10.1016/j.jcjq.2024.02.002","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139830702","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 : 2024-02-07DOI: 10.1016/j.jcjq.2024.02.001
James Shaw PT, PhD (is Canada Research Chair in Responsible Health Innovation (Tier 2) and Assistant Professor, Department of Physical Therapy, University of Toronto.), Payal Agarwal MSc, MD (is Integrated Chief Information and Innovation Officer, Grand River and St. Mary's General Hospitals, and Innovation Fellow, Women's College Hospital.), Onil Bhattacharyya MD, PhD (is Frigon-Blau Chair in Family Medicine Research at Women's College Hospital, and Associate Professor, Department of Family and Community Medicine, University of Toronto. Please address correspondence to James Shaw)
{"title":"Implementing Multiple Digital Technologies in Health Care: Seeing the Unintended Consequences for Patient Safety","authors":"James Shaw PT, PhD (is Canada Research Chair in Responsible Health Innovation (Tier 2) and Assistant Professor, Department of Physical Therapy, University of Toronto.), Payal Agarwal MSc, MD (is Integrated Chief Information and Innovation Officer, Grand River and St. Mary's General Hospitals, and Innovation Fellow, Women's College Hospital.), Onil Bhattacharyya MD, PhD (is Frigon-Blau Chair in Family Medicine Research at Women's College Hospital, and Associate Professor, Department of Family and Community Medicine, University of Toronto. Please address correspondence to James Shaw)","doi":"10.1016/j.jcjq.2024.02.001","DOIUrl":"10.1016/j.jcjq.2024.02.001","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139874980","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 : 2024-01-30DOI: 10.1016/j.jcjq.2024.01.013
Milisa Manojlovich PhD, RN, FAAN (is Professor, Department of Systems, Populations and Leadership, University of Michigan School of Nursing.), Amanda P. Bettencourt PhD, APRN, CCRN-K, ACCNS-P (is Assistant Professor, Department of Family and Community Health, University of Pennsylvania School of Nursing.), Courtney W. Mangus MD (is Clinical Assistant Professor, Department of Emergency Medicine, University of Michigan.), Sarah J. Parker MPH (is Research Area Specialist, Department of Emergency Medicine, University of Michigan.), Sarah E. Skurla MPH (is Project Manager, Center for Clinical Management Research, US Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan.), Heather M. Walters MS (is Senior Research Project Manager, VA Ann Arbor Healthcare System.), Prashant Mahajan MD, MPH, MBA (is Professor, Department of Emergency Medicine, University of Michigan. Please address correspondence to. Milisa Manojlovich)
Background
Emergency departments (EDs) are susceptible to diagnostic error. Suboptimal communication between the patient and the interdisciplinary care team increases risk to diagnostic safety. The role of communication remains underrepresented in existing diagnostic decision-making conceptual models.
Methods
The authors used eDelphi methodology, whereby data are collected electronically, to achieve consensus among an expert panel of 18 clinicians, patients, family members, and other participants on a refined ED–based diagnostic decision-making framework that integrates several potential opportunities for communication to enhance diagnostic quality. This study examined the entire diagnostic process in the ED, from prehospital to discharge or transfer to inpatient care, and identified where communication breakdowns could occur. After four iterative rounds of the eDelphi process, including a final validation round by all participants, the project's a priori consensus threshold of 80% agreement was reached.
Results
The authors developed a final framework that positions communication more prominently in the diagnostic process in the ED and enhances the original National Academies of Sciences, Engineering, and Medicine (NASEM) and ED–adapted NASEM frameworks. Specific points in the ED journey were identified where more attention to communication might be helpful. Two specific types of communication—information exchange and shared understanding—were identified as high priority for optimal outcomes. Ideas for communication-focused interventions to prevent diagnostic error in the ED fell into three categories: patient-facing, clinician-facing, and system-facing interventions.
Conclusion
This project's refinement of the NASEM framework adapted to the ED can be used to develop communications-focused interventions to reduce diagnostic error in this highly complex and error-prone setting.
{"title":"Refining a Framework to Enhance Communication in the Emergency Department During the Diagnostic Process: An eDelphi Approach","authors":"Milisa Manojlovich PhD, RN, FAAN (is Professor, Department of Systems, Populations and Leadership, University of Michigan School of Nursing.), Amanda P. Bettencourt PhD, APRN, CCRN-K, ACCNS-P (is Assistant Professor, Department of Family and Community Health, University of Pennsylvania School of Nursing.), Courtney W. Mangus MD (is Clinical Assistant Professor, Department of Emergency Medicine, University of Michigan.), Sarah J. Parker MPH (is Research Area Specialist, Department of Emergency Medicine, University of Michigan.), Sarah E. Skurla MPH (is Project Manager, Center for Clinical Management Research, US Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan.), Heather M. Walters MS (is Senior Research Project Manager, VA Ann Arbor Healthcare System.), Prashant Mahajan MD, MPH, MBA (is Professor, Department of Emergency Medicine, University of Michigan. Please address correspondence to. Milisa Manojlovich)","doi":"10.1016/j.jcjq.2024.01.013","DOIUrl":"10.1016/j.jcjq.2024.01.013","url":null,"abstract":"<div><h3>Background</h3><p>Emergency departments (EDs) are susceptible to diagnostic error. Suboptimal communication between the patient and the interdisciplinary care team increases risk to diagnostic safety. The role of communication remains underrepresented in existing diagnostic decision-making conceptual models.</p></div><div><h3>Methods</h3><p>The authors used eDelphi methodology, whereby data are collected electronically, to achieve consensus among an expert panel of 18 clinicians, patients, family members, and other participants on a refined ED–based diagnostic decision-making framework that integrates several potential opportunities for communication to enhance diagnostic quality. This study examined the entire diagnostic process in the ED, from prehospital to discharge or transfer to inpatient care, and identified where communication breakdowns could occur. After four iterative rounds of the eDelphi process, including a final validation round by all participants, the project's a priori consensus threshold of 80% agreement was reached.</p></div><div><h3>Results</h3><p>The authors developed a final framework that positions communication more prominently in the diagnostic process in the ED and enhances the original National Academies of Sciences, Engineering, and Medicine (NASEM) and ED–adapted NASEM frameworks. Specific points in the ED journey were identified where more attention to communication might be helpful. Two specific types of communication—information exchange and shared understanding—were identified as high priority for optimal outcomes. Ideas for communication-focused interventions to prevent diagnostic error in the ED fell into three categories: patient-facing, clinician-facing, and system-facing interventions.</p></div><div><h3>Conclusion</h3><p>This project's refinement of the NASEM framework adapted to the ED can be used to develop communications-focused interventions to reduce diagnostic error in this highly complex and error-prone setting.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139996308","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 : 2024-01-26DOI: 10.1016/j.jcjq.2024.01.009
Sydney Hyder MD, MS (is Pulmonary Disease and Critical Care Medicine Attending, Division of Pulmonary, Critical Care and Sleep Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago.), Ryan Tang MD (is Internal Medicine Resident, Northwestern University Feinberg School of Medicine.), Reiping Huang PhD, MS (is Health Services Research and Adjunct Assistant Professor, Department of Surgery, Northwestern University Feinberg School of Medicine.), Amy Ludwig MD (is Clinical Fellow, Pulmonary Disease and Critical Care Medicine, Northwestern University Feinberg School of Medicine.), Kelli Scott PhD (is Assistant Professor of Medical Social Sciences, Center for Dissemination & Implementation Science, Northwestern University Feinberg School of Medicine.), Nandita Nadig MD, MS (is Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine. Please address correspondence to Sydney Hyder)
Background
ICU transfers from a regional to a tertiary-level hospital are initiated typically for a higher level of care. Extended transfer wait times can negatively affect survival, length of stay (LOS), and cost.
Methods
In this prospective single-center study, the subjects were adult ICU patients admitted to regional hospitals between January and October 2022, for whom a request was made to transfer to a tertiary-level medical ICU. The authors developed and implemented an interdisciplinary transfer huddle intervention (THI) with the goal of reducing wait times by providing a consistent channel of communication between key stakeholders. The primary outcome was the number of hours elapsed between transfer request and the time of transfer to the tertiary hospital. Secondary outcomes included in-hospital mortality, discharge to home, ICU LOS, and hospital LOS. Data were abstracted from electronic health records and periods before (January to June 2022) and after (June to October 2022) the intervention were compared. Data were analyzed using logistic regression or negative binomial regression, adjusting for patient demographic and clinical characteristics. ICU fellows also completed a daily survey about barriers they perceived to the THI application.
Results
During the study period, 76 patients were transferred. The THI was completed 75.0% of the time. There were no statistically significant differences in the primary and secondary outcomes before and after the intervention. The top perceived barriers to transfer were lack of physical beds (50.0%) and staffing limitations (37.5%).
Conclusion
The authors successfully developed and implemented a transfer huddle to ensure consistent interdisciplinary communication for patients being transferred between ICUs and identified barriers to such transfer. However, transfer times and patient outcomes were not significantly different after the change. Future studies should consider staffing challenges, hospital capacity, and the role of dedicated transfer teams in in decreasing inter-ICU transfer wait times.
{"title":"Implementation of an Interdisciplinary Transfer Huddle Intervention for Prolonged Wait Times During Inter-ICU Transfer","authors":"Sydney Hyder MD, MS (is Pulmonary Disease and Critical Care Medicine Attending, Division of Pulmonary, Critical Care and Sleep Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago.), Ryan Tang MD (is Internal Medicine Resident, Northwestern University Feinberg School of Medicine.), Reiping Huang PhD, MS (is Health Services Research and Adjunct Assistant Professor, Department of Surgery, Northwestern University Feinberg School of Medicine.), Amy Ludwig MD (is Clinical Fellow, Pulmonary Disease and Critical Care Medicine, Northwestern University Feinberg School of Medicine.), Kelli Scott PhD (is Assistant Professor of Medical Social Sciences, Center for Dissemination & Implementation Science, Northwestern University Feinberg School of Medicine.), Nandita Nadig MD, MS (is Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine. Please address correspondence to Sydney Hyder)","doi":"10.1016/j.jcjq.2024.01.009","DOIUrl":"10.1016/j.jcjq.2024.01.009","url":null,"abstract":"<div><h3>Background</h3><p>ICU transfers from a regional to a tertiary-level hospital are initiated typically for a higher level of care. Extended transfer wait times can negatively affect survival, length of stay (LOS), and cost.</p></div><div><h3>Methods</h3><p>In this prospective single-center study, the subjects were adult ICU patients admitted to regional hospitals between January and October 2022, for whom a request was made to transfer to a tertiary-level medical ICU. The authors developed and implemented an interdisciplinary transfer huddle intervention (THI) with the goal of reducing wait times by providing a consistent channel of communication between key stakeholders. The primary outcome was the number of hours elapsed between transfer request and the time of transfer to the tertiary hospital. Secondary outcomes included in-hospital mortality, discharge to home, ICU LOS, and hospital LOS. Data were abstracted from electronic health records and periods before (January to June 2022) and after (June to October 2022) the intervention were compared. Data were analyzed using logistic regression or negative binomial regression, adjusting for patient demographic and clinical characteristics. ICU fellows also completed a daily survey about barriers they perceived to the THI application.</p></div><div><h3>Results</h3><p>During the study period, 76 patients were transferred. The THI was completed 75.0% of the time. There were no statistically significant differences in the primary and secondary outcomes before and after the intervention. The top perceived barriers to transfer were lack of physical beds (50.0%) and staffing limitations (37.5%).</p></div><div><h3>Conclusion</h3><p>The authors successfully developed and implemented a transfer huddle to ensure consistent interdisciplinary communication for patients being transferred between ICUs and identified barriers to such transfer. However, transfer times and patient outcomes were not significantly different after the change. Future studies should consider staffing challenges, hospital capacity, and the role of dedicated transfer teams in in decreasing inter-ICU transfer wait times.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139639291","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 : 2024-01-24DOI: 10.1016/j.jcjq.2024.01.010
Nehal R. Parikh DO (is Fellow Physician, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Leticia S. Francisco (is Pre-Med Student, College of Liberal Arts and Sciences, University of Iowa.), Shilpa C. Balikai DO (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Mitchell A. Luangrath MD (is Clinical Assistant Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Heather R. Elmore DNP, ARNP (is Pediatric Nurse Practitioner, Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa.), Jennifer Erdahl MSN, RN, CCRN-K (is Nurse Manager, Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital.), Aditya Badheka MBBS, MS (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Madhuradhar Chegondi MBBS, MD (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Christopher P. Landrigan MD, MPH (is Chief, Division of General Pediatrics, Boston Children's Hospital, and Director, Sleep and Patient Safety Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital / Harvard Medical School, Boston.), Priyadarshini Pennathur PhD (is Associate Professor, Department of Industrial, Manufacturing, and Systems Engineering, University of Texas at El Paso.), Heather Schacht Reisinger PhD (is Associate Professor, Department of Internal Medicine, Carver College of Medicine, University of Iowa, and Core Investigator, Institute for Clinical and Translational Science, University of Iowa.), Christina L. Cifra MD, MS (is Assistant Professor, Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital / Harvard Medical School and Adjunct Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa. Please address correspondence to Christina L. Cifra)
Background
Miscommunication during interfacility handoffs to a higher level of care can harm critically ill children. Adapting evidence-based handoff interventions to interfacility referral communication may prevent adverse events. The objective of this project was to develop and evaluate a standard electronic referral template (I-PASS-to-PICU) to improve communication for interfacility pediatric ICU (PICU) transfers.
Methods
I-PASS-to-PICU was iteratively developed in a single PICU. A core PICU stakeholder group collaboratively designed an electronic health record (EHR)–supported clinical note template by adapting elements from I-PASS, an evidence-based handoff program, to support information exchange between referring clinicians and receiving PICU physicians. I-PASS-to-PICU is a receiver-driven tool used by PICU physicians to guide verbal communication and electronic documentation during PICU transfer calls. The template underwent three cycles of iterative evaluation and redesign informed by individual and group interviews of multidisciplinary PICU staff, usability testing using simulated and actual referral calls, and debriefing with PICU physicians.
Results
Individual and group interviews with 21 PICU staff members revealed that relevant, accurate, and concise information was needed for adequate admission preparedness. Time constraints and secondhand information transmission were identified as barriers. Usability testing with six receiving PICU physicians using simulated and actual calls revealed good usability on the validated System Usability Scale (SUS), with a mean score of 77.5 (standard deviation 10.9). Fellows indicated that most fields were relevant and that the template was feasible to use.
Conclusion
I-PASS-to-PICU was technically feasible, usable, and relevant. The authors plan to further evaluate its effectiveness in improving information exchange during real-time PICU practice.
{"title":"Development and Evaluation of I-PASS-to-PICU: A Standard Electronic Template to Improve Referral Communication for Interfacility Transfers to the Pediatric ICU","authors":"Nehal R. Parikh DO (is Fellow Physician, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Leticia S. Francisco (is Pre-Med Student, College of Liberal Arts and Sciences, University of Iowa.), Shilpa C. Balikai DO (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Mitchell A. Luangrath MD (is Clinical Assistant Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Heather R. Elmore DNP, ARNP (is Pediatric Nurse Practitioner, Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa.), Jennifer Erdahl MSN, RN, CCRN-K (is Nurse Manager, Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital.), Aditya Badheka MBBS, MS (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Madhuradhar Chegondi MBBS, MD (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Christopher P. Landrigan MD, MPH (is Chief, Division of General Pediatrics, Boston Children's Hospital, and Director, Sleep and Patient Safety Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital / Harvard Medical School, Boston.), Priyadarshini Pennathur PhD (is Associate Professor, Department of Industrial, Manufacturing, and Systems Engineering, University of Texas at El Paso.), Heather Schacht Reisinger PhD (is Associate Professor, Department of Internal Medicine, Carver College of Medicine, University of Iowa, and Core Investigator, Institute for Clinical and Translational Science, University of Iowa.), Christina L. Cifra MD, MS (is Assistant Professor, Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital / Harvard Medical School and Adjunct Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa. Please address correspondence to Christina L. Cifra)","doi":"10.1016/j.jcjq.2024.01.010","DOIUrl":"10.1016/j.jcjq.2024.01.010","url":null,"abstract":"<div><h3>Background</h3><p>Miscommunication during interfacility handoffs to a higher level of care can harm critically ill children. Adapting evidence-based handoff interventions to interfacility referral communication may prevent adverse events. The objective of this project was to develop and evaluate a standard electronic referral template (I-PASS-to-PICU) to improve communication for interfacility pediatric ICU (PICU) transfers.</p></div><div><h3>Methods</h3><p>I-PASS-to-PICU was iteratively developed in a single PICU. A core PICU stakeholder group collaboratively designed an electronic health record (EHR)–supported clinical note template by adapting elements from I-PASS, an evidence-based handoff program, to support information exchange between referring clinicians and receiving PICU physicians. I-PASS-to-PICU is a receiver-driven tool used by PICU physicians to guide verbal communication and electronic documentation during PICU transfer calls. The template underwent three cycles of iterative evaluation and redesign informed by individual and group interviews of multidisciplinary PICU staff, usability testing using simulated and actual referral calls, and debriefing with PICU physicians.</p></div><div><h3>Results</h3><p>Individual and group interviews with 21 PICU staff members revealed that relevant, accurate, and concise information was needed for adequate admission preparedness. Time constraints and secondhand information transmission were identified as barriers. Usability testing with six receiving PICU physicians using simulated and actual calls revealed good usability on the validated System Usability Scale (SUS), with a mean score of 77.5 (standard deviation 10.9). Fellows indicated that most fields were relevant and that the template was feasible to use.</p></div><div><h3>Conclusion</h3><p>I-PASS-to-PICU was technically feasible, usable, and relevant. The authors plan to further evaluate its effectiveness in improving information exchange during real-time PICU practice.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631913","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 : 2024-01-19DOI: 10.1016/j.jcjq.2024.01.008
Kristina DeVore MSN, RN (is Nurse Navigator, Department of Nursing–Continuum of Care Management, University of Iowa Health Care.), Katherine Schneider MSN, RN (is Clinical Coordinator, Department of Emergency Medicine, Carver College of Medicine, University of Iowa.), Elyse Laures PhD, RN (is Nurse Scientist, Department of Nursing–Nursing Research and Evidence-Based Practice, University of Iowa Health Care.), Alison Harmon MSN, RN (is Director of Emergency Medical Transport Services, Department of Nursing, University of Iowa Health Care.), Paul Van Heukelom MD (is Associate Clinical Professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa. Please address correspondence to Katherine Schneider)
Background
Outpatient providers refer to emergency departments (EDs) due to findings requiring assessment beyond existing capabilities. However, poor communication surrounding these transitions may hinder safety and timeliness of emergency care. Receiver-driven handoff (RDH) is a process that helps ensure that all pertinent information is shared. This quality improvement project aimed to (1) improve knowledge of RDH, (2) increase satisfaction and perceptions surrounding RDH, (3) modify behaviors in relation to RDH, and (4) decrease referred patients leaving without being seen (LWBS).
Methods
The Iowa Model and Implementation Framework guided this evidence-based quality improvement project. A multidisciplinary team developed and implemented a standardized RDH process consisting of screening to determine whether a patient was referred to the ED, review of electronic health record (EHR), and use of EHR documentation. Process measures were collected via questionnaire pre- and postimplementation and were analyzed quantitatively. Outcome measures were trended by a statistical process control p-chart, which was developed to demonstrate changes in the percentage of patients who were referred to the ED from the outpatient setting and LWBS.
Results
The average response for the question “How satisfied are you with the handoff of patient information from referring clinic providers to the ED?” increased from 1.51 preintervention to 2.04 postintervention (p = 0.005). Respondents rated the information received during handoff higher postintervention (2.12 vs. 2.52, p = 0.04). Compliance with screening for referral to the ED was 84.0%. The proportion of patients LWBS after referral decreased by 6.2 percentage points (p < 0.001).
Conclusion
Using RDH in conjunction with a standardized triage screening may improve quality of information shared during this vulnerable transition and may assist in reduction of referred patients LWBS. The RDH process should be adapted into everyday workflow to ensure sustainability and effectiveness.
{"title":"Improving Outcomes in Patients Sent to the Emergency Department from Outpatient Providers: A Receiver-Driven Handoff Process Improvement","authors":"Kristina DeVore MSN, RN (is Nurse Navigator, Department of Nursing–Continuum of Care Management, University of Iowa Health Care.), Katherine Schneider MSN, RN (is Clinical Coordinator, Department of Emergency Medicine, Carver College of Medicine, University of Iowa.), Elyse Laures PhD, RN (is Nurse Scientist, Department of Nursing–Nursing Research and Evidence-Based Practice, University of Iowa Health Care.), Alison Harmon MSN, RN (is Director of Emergency Medical Transport Services, Department of Nursing, University of Iowa Health Care.), Paul Van Heukelom MD (is Associate Clinical Professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa. Please address correspondence to Katherine Schneider)","doi":"10.1016/j.jcjq.2024.01.008","DOIUrl":"10.1016/j.jcjq.2024.01.008","url":null,"abstract":"<div><h3>Background</h3><p>Outpatient providers refer to emergency departments (EDs) due to findings requiring assessment beyond existing capabilities. However, poor communication surrounding these transitions may hinder safety and timeliness of emergency care. Receiver-driven handoff (RDH) is a process that helps ensure that all pertinent information is shared. This quality improvement project aimed to (1) improve knowledge of RDH, (2) increase satisfaction and perceptions surrounding RDH, (3) modify behaviors in relation to RDH, and (4) decrease referred patients leaving without being seen (LWBS).</p></div><div><h3>Methods</h3><p>The Iowa Model and Implementation Framework guided this evidence-based quality improvement project. A multidisciplinary team developed and implemented a standardized RDH process consisting of screening to determine whether a patient was referred to the ED, review of electronic health record (EHR), and use of EHR documentation. Process measures were collected via questionnaire pre- and postimplementation and were analyzed quantitatively. Outcome measures were trended by a statistical process control p-chart, which was developed to demonstrate changes in the percentage of patients who were referred to the ED from the outpatient setting and LWBS.</p></div><div><h3>Results</h3><p>The average response for the question “How satisfied are you with the handoff of patient information from referring clinic providers to the ED?” increased from 1.51 preintervention to 2.04 postintervention (<em>p</em> = 0.005). Respondents rated the information received during handoff higher postintervention (2.12 vs. 2.52, <em>p</em> = 0.04). Compliance with screening for referral to the ED was 84.0%. The proportion of patients LWBS after referral decreased by 6.2 percentage points (<em>p</em> < 0.001).</p></div><div><h3>Conclusion</h3><p>Using RDH in conjunction with a standardized triage screening may improve quality of information shared during this vulnerable transition and may assist in reduction of referred patients LWBS. The RDH process should be adapted into everyday workflow to ensure sustainability and effectiveness.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139636529","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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