Pub Date : 2024-01-18DOI: 10.1016/j.jcjq.2024.01.006
Donna Ron MD (is Clinical Research Fellow, Department of Community and Family Medicine, and Department of Anesthesiology and Perioperative Medicine, Dartmouth Health and Geisel School of Medicine at Dartmouth.), Christine M. Gunn PhD (is Assistant Professor, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.), Jeana E. Havidich MD, MS (is Pediatric Anesthesiologist and Associate Professor, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth.), Madison M. Ballacchino (is Medical Student, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo.), Timothy E. Burdick MD, MBA, MSc (is Associate Professor, Department of Community and Family Medicine, Dartmouth Health and Geisel School of Medicine at Dartmouth, and Associate Professor, Dartmouth Institute for Health Policy and Clinical Practice.), Stacie G. Deiner MD, MS (is Anesthesiologist and Professor, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth. Please address correspondence to Donna Ron)
Background
Suboptimal communication between clinicians remains a frequent driver of preventable adverse health care–related events, increased costs, and patient and physician dissatisfaction.
Methods
Cross-sectional surveys on preoperative interspecialty communication, tailored by stakeholder type, were administered to (1) primary care providers in northern New England, (2) anesthesia providers working in the perioperative clinic of a tertiary rural academic medical center, (3) surgeons from the same center, and (4) older surgical patients who underwent preoperative assessment at the same center.
Results
In total, 107/249 (43.0%) providers and 103/265 (39.9%) patients completed the survey. Preoperative communication was perceived as logistically challenging (59.8%), particularly across health systems. More than 77% of anesthesia and surgery providers indicated that they communicate frequently or sometimes, but 92.5% of primary care providers indicated that they rarely or never communicate with anesthesia providers. Some of the most common reasons for preoperative communication were discussion of complex patients, perioperative medication management, and optimization of comorbidities. Although 96.1% of older surgical patients reported that preoperative communication between providers is important, only 40.4% felt that their providers communicate very or extremely well. Many patients emphasized the importance of preoperative communication between providers to ensure transfer of critical clinical information.
Conclusion
Surgeons and anesthesiologists infrequently communicate with primary care providers in one rural tertiary center, in contrast to patient expectations and values. These study results will help identify priorities and potentially resolvable barriers to bridging the gap between the inpatient perioperative and outpatient primary care teams. Future studies should focus on strategies to improve communication between hospital and community providers to prevent complications and readmission.
{"title":"Preoperative Communication Between Anesthesia, Surgery, and Primary Care Providers for Older Surgical Patients","authors":"Donna Ron MD (is Clinical Research Fellow, Department of Community and Family Medicine, and Department of Anesthesiology and Perioperative Medicine, Dartmouth Health and Geisel School of Medicine at Dartmouth.), Christine M. Gunn PhD (is Assistant Professor, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.), Jeana E. Havidich MD, MS (is Pediatric Anesthesiologist and Associate Professor, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth.), Madison M. Ballacchino (is Medical Student, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo.), Timothy E. Burdick MD, MBA, MSc (is Associate Professor, Department of Community and Family Medicine, Dartmouth Health and Geisel School of Medicine at Dartmouth, and Associate Professor, Dartmouth Institute for Health Policy and Clinical Practice.), Stacie G. Deiner MD, MS (is Anesthesiologist and Professor, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth. Please address correspondence to Donna Ron)","doi":"10.1016/j.jcjq.2024.01.006","DOIUrl":"10.1016/j.jcjq.2024.01.006","url":null,"abstract":"<div><h3>Background</h3><p>Suboptimal communication between clinicians remains a frequent driver of preventable adverse health care–related events, increased costs, and patient and physician dissatisfaction.</p></div><div><h3>Methods</h3><p>Cross-sectional surveys on preoperative interspecialty communication, tailored by stakeholder type, were administered to (1) primary care providers in northern New England, (2) anesthesia providers working in the perioperative clinic of a tertiary rural academic medical center, (3) surgeons from the same center, and (4) older surgical patients who underwent preoperative assessment at the same center.</p></div><div><h3>Results</h3><p>In total, 107/249 (43.0%) providers and 103/265 (39.9%) patients completed the survey. Preoperative communication was perceived as logistically challenging (59.8%), particularly across health systems. More than 77% of anesthesia and surgery providers indicated that they communicate frequently or sometimes, but 92.5% of primary care providers indicated that they rarely or never communicate with anesthesia providers. Some of the most common reasons for preoperative communication were discussion of complex patients, perioperative medication management, and optimization of comorbidities. Although 96.1% of older surgical patients reported that preoperative communication between providers is important, only 40.4% felt that their providers communicate very or extremely well. Many patients emphasized the importance of preoperative communication between providers to ensure transfer of critical clinical information.</p></div><div><h3>Conclusion</h3><p>Surgeons and anesthesiologists infrequently communicate with primary care providers in one rural tertiary center, in contrast to patient expectations and values. These study results will help identify priorities and potentially resolvable barriers to bridging the gap between the inpatient perioperative and outpatient primary care teams. Future studies should focus on strategies to improve communication between hospital and community providers to prevent complications and readmission.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139633114","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 : 2024-01-18DOI: 10.1016/j.jcjq.2024.01.007
Hedwig Schroeck MD (is Associate Professor of Anesthesiology, Geisel School of Medicine at Dartmouth College, and Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.), Michaela A. Whitty MPH (is Manager of Perioperative Inventory and Logistics, Dartmouth Health, Lebanon, New Hampshire.), Bridget Hatton MPH (formerly with the Dartmouth Institute of Health Policy, Hanover, New Hampshire, is DrPH Student, Johns Hopkins Bloomberg School of Public Health, Baltimore.), Pablo Martinez-Camblor PhD (is Assistant Professor of Anesthesiology, and Biomedical Data Science, Geisel School of Medicine at Dartmouth College.), Louise Wen MD (is Clinical Assistant Professor, Geisel School of Medicine at Dartmouth College, and Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center.), Andreas H. Taenzer MD (is Professor of Anesthesiology, and Pediatrics, Geisel School of Medicine at Dartmouth College. Please address correspondence to Hedwig Schroeck)
Background
An increasing number of procedures are performed in non-operating room anesthesia (NORA) settings, including magnetic resonance imaging (MRI) suites. Patient care in NORA is accomplished by interprofessional ad hoc teams (anesthesia clinicians, imaging technologists, and others), who do not regularly work together otherwise. The authors aimed to explore team relations and role perceptions during crisis situations in MRI settings among such ad hoc teams.
Methods
This mixed methods study used a convergent parallel design: The Relational Coordination Index (RCI) and a survey about role perceptions were administered to anesthesia and non-anesthesia personnel working in MRI settings, and semistructured interviews were conducted among a purposive sample. After descriptive statistics and thematic analysis, the authors integrated quantitative and qualitative findings to identify and describe overlapping and mismatched perceptions between the two groups.
Results
A total of 67 surveys (response rate 74.4%) and 17 interviews were analyzed. RCI ratings revealed moderate relational coordination between the anesthesia and non-anesthesia groups. Anesthesia and non-anesthesia respondents agreed that the anesthesia clinician assumes leadership during crisis management while non-anesthesia personnel assist. There were nuanced differences in expectations about the role of non-anesthesia personnel in calling for help, understanding specific equipment needs, and performing patient care actions. Many anesthesia clinicians felt unsure about crisis-relevant skills of their non-anesthesia colleagues. MRI technologists emphasized attention to magnetic safety as integral to their role, which was infrequently mentioned by anesthesia personnel.
Conclusion
Nuanced mismatches in role expectations within the interprofessional care team exist, which may hinder effective crisis management in MRI settings.
{"title":"Team Relations and Role Perceptions During Anesthesia Crisis Management in Magnetic-Resonance Imaging Settings: A Mixed Methods Exploration","authors":"Hedwig Schroeck MD (is Associate Professor of Anesthesiology, Geisel School of Medicine at Dartmouth College, and Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.), Michaela A. Whitty MPH (is Manager of Perioperative Inventory and Logistics, Dartmouth Health, Lebanon, New Hampshire.), Bridget Hatton MPH (formerly with the Dartmouth Institute of Health Policy, Hanover, New Hampshire, is DrPH Student, Johns Hopkins Bloomberg School of Public Health, Baltimore.), Pablo Martinez-Camblor PhD (is Assistant Professor of Anesthesiology, and Biomedical Data Science, Geisel School of Medicine at Dartmouth College.), Louise Wen MD (is Clinical Assistant Professor, Geisel School of Medicine at Dartmouth College, and Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center.), Andreas H. Taenzer MD (is Professor of Anesthesiology, and Pediatrics, Geisel School of Medicine at Dartmouth College. Please address correspondence to Hedwig Schroeck)","doi":"10.1016/j.jcjq.2024.01.007","DOIUrl":"10.1016/j.jcjq.2024.01.007","url":null,"abstract":"<div><h3>Background</h3><p>An increasing number of procedures are performed in non-operating room anesthesia (NORA) settings, including magnetic resonance imaging (MRI) suites. Patient care in NORA is accomplished by interprofessional ad hoc teams (anesthesia clinicians, imaging technologists, and others), who do not regularly work together otherwise. The authors aimed to explore team relations and role perceptions during crisis situations in MRI settings among such ad hoc teams.</p></div><div><h3>Methods</h3><p>This mixed methods study used a convergent parallel design: The Relational Coordination Index (RCI) and a survey about role perceptions were administered to anesthesia and non-anesthesia personnel working in MRI settings, and semistructured interviews were conducted among a purposive sample. After descriptive statistics and thematic analysis, the authors integrated quantitative and qualitative findings to identify and describe overlapping and mismatched perceptions between the two groups.</p></div><div><h3>Results</h3><p>A total of 67 surveys (response rate 74.4%) and 17 interviews were analyzed. RCI ratings revealed moderate relational coordination between the anesthesia and non-anesthesia groups. Anesthesia and non-anesthesia respondents agreed that the anesthesia clinician assumes leadership during crisis management while non-anesthesia personnel assist. There were nuanced differences in expectations about the role of non-anesthesia personnel in calling for help, understanding specific equipment needs, and performing patient care actions. Many anesthesia clinicians felt unsure about crisis-relevant skills of their non-anesthesia colleagues. MRI technologists emphasized attention to magnetic safety as integral to their role, which was infrequently mentioned by anesthesia personnel.</p></div><div><h3>Conclusion</h3><p>Nuanced mismatches in role expectations within the interprofessional care team exist, which may hinder effective crisis management in MRI settings.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139633688","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 : 2024-01-13DOI: 10.1016/j.jcjq.2024.01.004
David W. Baker MD, MPH, FACP (is Editor-in-Chief, The Joint Commission Journal on Quality and Patient Safety. Please address correspondence to David W. Baker)
{"title":"The Joint Commission Journal on Quality and Patient Safety 50th Anniversary Article Collections","authors":"David W. Baker MD, MPH, FACP (is Editor-in-Chief, The Joint Commission Journal on Quality and Patient Safety. Please address correspondence to David W. Baker)","doi":"10.1016/j.jcjq.2024.01.004","DOIUrl":"10.1016/j.jcjq.2024.01.004","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024000084/pdfft?md5=67eee484c0019b42d20605899a7f5178&pid=1-s2.0-S1553725024000084-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139512435","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 : 2024-01-12DOI: 10.1016/j.jcjq.2024.01.005
James P. Phillips MD, FACEP (is Associate Professor, Emergency Medicine, and Section Chief and Fellowship Director, Disaster and Operational Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, and Chair, Disaster Medicine Section, American College of Emergency Physicians, Irving, Texas. Please address correspondence to James P. Phillips)
{"title":"Measuring Healthcare Workplace Violence in Real Time","authors":"James P. Phillips MD, FACEP (is Associate Professor, Emergency Medicine, and Section Chief and Fellowship Director, Disaster and Operational Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, and Chair, Disaster Medicine Section, American College of Emergency Physicians, Irving, Texas. Please address correspondence to James P. Phillips)","doi":"10.1016/j.jcjq.2024.01.005","DOIUrl":"10.1016/j.jcjq.2024.01.005","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024000096/pdfft?md5=e664823c812117376738ec2da8cf94bd&pid=1-s2.0-S1553725024000096-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139512432","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 : 2024-01-09DOI: 10.1016/j.jcjq.2024.01.003
Álvaro Marchán-López MD (Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid.), Jaime Lora-Tamayo MD, PhD (Department of Internal Medicine, Hospital Universitario 12 de Octubre.), Cristina de la Calle MD, PhD (Department of Internal Medicine, Hospital Universitario 12 de Octubre.), Luis Jiménez Roldán MD, PhD (Department of Neurosurgery, Hospital Universitario 12 de Octubre.), Luis Miguel Moreno Gómez MD, PhD (Department of Neurosurgery, Hospital Universitario 12 de Octubre.), Ignacio Sáez de la Fuente MD, PhD (Department of Critical Care Medicine, Hospital Universitario 12 de Octubre.), Mario Chico Fernández MD, PhD (Department of Critical Care Medicine, Hospital Universitario 12 de Octubre.), Alfonso Lagares MD, PhD (Department of Neurosurgery, Hospital Universitario 12 de Octubre, and School of Medicine, Complutense University, Madrid.), Carlos Lumbreras MD, PhD (Department of Internal Medicine, Hospital Universitario 12 de Octubre, and School of Medicine, Complutense University.), Ana García Reyne MD, PhD (Department of Internal Medicine, Hospital Universitario 12 de Octubre. Please address correspondence to Álvaro Marchán-López)
Background
The impact of co-management on clinical outcomes in neurosurgical patients is uncertain. This study aims to describe the implementation of a hospitalist co-management program in a neurosurgery department and its impact on the incidence of complications, mortality, and length of stay.
Methods
The authors used a quasi-experimental study design that compared a historical control period (July–December 2017) to a prospective intervention arm. During the intervention period, patients admitted to a neurosurgery inpatient unit who were older than 65 years, suffered certain conditions, or were admitted from ICUs were included in the co-management program. Two hospitalists joined the surgical staff and intervened in the diagnostic and therapeutical plan of patients, participating in clinical decisions and coordinating patient navigation with neurosurgeons. The incidence of moderate or severe complications measured by the Accordion Severity Grading System, in-hospital mortality, and length of stay of the two cohorts were compared. Multivariate regression was used to adjust for confounders, and the average treatment effect was estimated using inverse probability of treatment weighting.
Results
The adjusted incidence of moderate or severe complications was lower among co-managed patients (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.39–0.91). Mortality was unchanged (OR 0.83, 95% CI 0.15–4.17). Length of stay was lower in co-managed patients, with a 1.3-day reduction observed after inverse probability of treatment weighting analysis.
Conclusion
Hospitalist co-management was associated with a reduced incidence of complications and length of stay in neurosurgical patients, but there was no difference in in-hospital mortality.
{"title":"Impact of a Hospitalist Co-Management Program on Medical Complications and Length of Stay in Neurosurgical Patients","authors":"Álvaro Marchán-López MD (Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid.), Jaime Lora-Tamayo MD, PhD (Department of Internal Medicine, Hospital Universitario 12 de Octubre.), Cristina de la Calle MD, PhD (Department of Internal Medicine, Hospital Universitario 12 de Octubre.), Luis Jiménez Roldán MD, PhD (Department of Neurosurgery, Hospital Universitario 12 de Octubre.), Luis Miguel Moreno Gómez MD, PhD (Department of Neurosurgery, Hospital Universitario 12 de Octubre.), Ignacio Sáez de la Fuente MD, PhD (Department of Critical Care Medicine, Hospital Universitario 12 de Octubre.), Mario Chico Fernández MD, PhD (Department of Critical Care Medicine, Hospital Universitario 12 de Octubre.), Alfonso Lagares MD, PhD (Department of Neurosurgery, Hospital Universitario 12 de Octubre, and School of Medicine, Complutense University, Madrid.), Carlos Lumbreras MD, PhD (Department of Internal Medicine, Hospital Universitario 12 de Octubre, and School of Medicine, Complutense University.), Ana García Reyne MD, PhD (Department of Internal Medicine, Hospital Universitario 12 de Octubre. Please address correspondence to Álvaro Marchán-López)","doi":"10.1016/j.jcjq.2024.01.003","DOIUrl":"10.1016/j.jcjq.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><p>The impact of co-management on clinical outcomes in neurosurgical patients<span> is uncertain. This study aims to describe the implementation of a hospitalist co-management program in a neurosurgery department and its impact on the incidence of complications, mortality, and length of stay.</span></p></div><div><h3>Methods</h3><p>The authors used a quasi-experimental study design that compared a historical control period (July–December 2017) to a prospective intervention arm. During the intervention period, patients admitted to a neurosurgery inpatient unit who were older than 65 years, suffered certain conditions, or were admitted from ICUs<span><span> were included in the co-management program. Two hospitalists joined the surgical staff and intervened in the </span>diagnostic<span><span> and therapeutical plan of patients, participating in clinical decisions and coordinating patient navigation with neurosurgeons. The incidence of moderate or severe complications measured by the Accordion Severity Grading System, in-hospital mortality, and length of stay of the two cohorts were compared. Multivariate regression was used to adjust for confounders, and the average </span>treatment effect was estimated using inverse probability of treatment weighting.</span></span></p></div><div><h3>Results</h3><p>The adjusted incidence of moderate or severe complications was lower among co-managed patients (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.39–0.91). Mortality was unchanged (OR 0.83, 95% CI 0.15–4.17). Length of stay was lower in co-managed patients, with a 1.3-day reduction observed after inverse probability of treatment weighting analysis.</p></div><div><h3>Conclusion</h3><p>Hospitalist co-management was associated with a reduced incidence of complications and length of stay in neurosurgical patients, but there was no difference in in-hospital mortality.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139457188","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 : 2024-01-07DOI: 10.1016/j.jcjq.2024.01.002
Lindy King PhD (is Academic Status and Web Supervisor, College of Nursing and Health Sciences, Flinders University Adelaide, South Australia, Australia.), Stanislav Minyaev BN (Hons) (is Associate Lecturer, College of Nursing and Health Sciences, Flinders University.), Hugh Grantham MBBS (is Adjunct Professor, Flinders Medical Centre/ School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.), Robyn A. Clark PhD (is Professor and Senior Clinician, College of Nursing and Health Sciences, Caring Futures Institute, Flinders University. Please address correspondence to Lindy King)
Background
Early detection of deterioration of hospitalized patients with timely intervention improves outcomes in the hospital. Patients, family members, and visitors (consumers) at the patient's bedside who are familiar with the patient's condition may play a critical role in detecting early patient deterioration. The authors sought to understand clinicians’ views on consumer reporting of patient deterioration through an established hospital consumer-initiated escalation-of-care system.
Methods
A convenience sample of new graduate-level to senior-level nurses and physicians from two hospitals in South Australia was administered a paper survey containing six open-ended questions. Data were analyzed with a matrix-style framework and six steps of thematic analysis.
Results
A total of 244 clinicians—198 nurses and 46 physicians—provided their views on the consumer-initiated escalation-of-care system. Six major themes and subthemes emerged from the responses indicating that (1) clinicians were supportive of consumer reporting and felt that consumers were ideally positioned to recognize deterioration early and raise concerns about it; (2) management support was required for consumer escalation processes to be effective; (3) clinicians’ workload could possibly increase or decrease from consumer escalation; (4) education of consumers and staff on escalation protocol is a requirement for success; (5) there is need to build consumer confidence to speak up; and (6) there is a need to address barriers to consumer escalation.
Conclusion
Clinicians were supportive of consumers acting as first reporters of patient deterioration. Use of interactive, encouraging communication skills with consumers was recognized as critical. Annual updating of clinicians on consumer reporting of deterioration was also recommended.
{"title":"Opinions of Nurses and Physicians on a Patient, Family, and Visitor Activated Rapid Response System in Use Across Two Hospital Settings","authors":"Lindy King PhD (is Academic Status and Web Supervisor, College of Nursing and Health Sciences, Flinders University Adelaide, South Australia, Australia.), Stanislav Minyaev BN (Hons) (is Associate Lecturer, College of Nursing and Health Sciences, Flinders University.), Hugh Grantham MBBS (is Adjunct Professor, Flinders Medical Centre/ School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.), Robyn A. Clark PhD (is Professor and Senior Clinician, College of Nursing and Health Sciences, Caring Futures Institute, Flinders University. Please address correspondence to Lindy King)","doi":"10.1016/j.jcjq.2024.01.002","DOIUrl":"10.1016/j.jcjq.2024.01.002","url":null,"abstract":"<div><h3>Background</h3><p>Early detection of deterioration of hospitalized patients with timely intervention improves outcomes in the hospital. Patients, family members, and visitors (consumers) at the patient's bedside who are familiar with the patient's condition may play a critical role in detecting early patient deterioration. The authors sought to understand clinicians’ views on consumer reporting of patient deterioration through an established hospital consumer-initiated escalation-of-care system.</p></div><div><h3>Methods</h3><p>A convenience sample of new graduate-level to senior-level nurses and physicians from two hospitals in South Australia was administered a paper survey containing six open-ended questions. Data were analyzed with a matrix-style framework and six steps of thematic analysis.</p></div><div><h3>Results</h3><p>A total of 244 clinicians—198 nurses and 46 physicians—provided their views on the consumer-initiated escalation-of-care system. Six major themes and subthemes emerged from the responses indicating that (1) clinicians were supportive of consumer reporting and felt that consumers were ideally positioned to recognize deterioration early and raise concerns about it; (2) management support was required for consumer escalation processes to be effective; (3) clinicians’ workload could possibly increase or decrease from consumer escalation; (4) education of consumers and staff on escalation protocol is a requirement for success; (5) there is need to build consumer confidence to speak up; and (6) there is a need to address barriers to consumer escalation.</p></div><div><h3>Conclusion</h3><p>Clinicians were supportive of consumers acting as first reporters of patient deterioration. Use of interactive, encouraging communication skills with consumers was recognized as critical. Annual updating of clinicians on consumer reporting of deterioration was also recommended.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725024000059/pdfft?md5=ffa6b3bf299f86080cedfcd4957d8742&pid=1-s2.0-S1553725024000059-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139458216","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 : 2024-01-01DOI: 10.1016/j.jcjq.2023.08.007
Lizzeth N. Alarcon MD (Formerly Assistant Professor, Department of Family Medicine, Boston University School of Medicine/Boston Medical Center, is Assistant Professor, Department of Medical Education, Herbert Wertheim College of Medicine, Florida International University.), Alana M. Ewen MPH (Formerly Graduate Medical Education Data Analyst and Project Management Specialist, Office of Graduate Medical Education, Boston Medical Center, is Pre-Doctoral Fellow, Curtis Center for Health Equity Research and Training, University of Michigan, PhD student, University of Maryland School of Public Health.), Elida Acuña-Martinez MS (Formerly Director of Interpreter Services, Boston Medical Center, is Senior Director of Interpreter Services and Office of the Patient Advocate, East Boston Neighborhood Health Center.), Christine C. Cheston MD (is Assistant Professor, Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine/Boston Medical Center.)
{"title":"Improving Communication with Patients with Limited English Proficiency: Non-English Language Proficiency Assessment for Clinicians","authors":"Lizzeth N. Alarcon MD (Formerly Assistant Professor, Department of Family Medicine, Boston University School of Medicine/Boston Medical Center, is Assistant Professor, Department of Medical Education, Herbert Wertheim College of Medicine, Florida International University.), Alana M. Ewen MPH (Formerly Graduate Medical Education Data Analyst and Project Management Specialist, Office of Graduate Medical Education, Boston Medical Center, is Pre-Doctoral Fellow, Curtis Center for Health Equity Research and Training, University of Michigan, PhD student, University of Maryland School of Public Health.), Elida Acuña-Martinez MS (Formerly Director of Interpreter Services, Boston Medical Center, is Senior Director of Interpreter Services and Office of the Patient Advocate, East Boston Neighborhood Health Center.), Christine C. Cheston MD (is Assistant Professor, Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine/Boston Medical Center.)","doi":"10.1016/j.jcjq.2023.08.007","DOIUrl":"10.1016/j.jcjq.2023.08.007","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725023002040/pdfft?md5=01e66bff1c1486fffc526fd2e70777c6&pid=1-s2.0-S1553725023002040-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41114961","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 : 2024-01-01DOI: 10.1016/j.jcjq.2023.10.002
Justin M. List MD, MAR, MSc, FACP (Director, Health Care Outcomes, Office of Health Equity, US Department of Veterans Affairs (VA), Washington, DC.) , Lauren E. Russell MPH, MPP (is Health System Specialist and ACORN Co-Lead, Office of Health Equity, US Department of Veterans Affairs.) , Leslie R.M. Hausmann PhD (is Associate Director, VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, and Associate Professor of Medicine and Clinical Translational Science, University of Pittsburgh School of Medicine.), Kristine Groves RN, BSN, MBA-HCM, CPHQ (is Executive Director, Office of Quality Management, US Department of Veterans Affairs.), Benjamin Kligler MD, MPH (is Executive Director, Office of Patient Centered Care and Cultural Transformation, US Department of Veterans Affairs, and Professor, Department of Family and Community Medicine, Icahn School of Medicine at Mount Sinai, New York.), Jennifer Koget MS, LCSW, BCD (is National Director of Social Work, Fisher House and Family Hospitality and Intimate Partner Violence Assistance Programs, Care Management and Social Work Services, US Department of Veterans Affairs.), Ernest Moy MD, MPH (is Executive Director, Office of Health Equity, US Department of Veterans Affairs.), Carolyn Clancy MD, MACP (is Assistant Under Secretary for Health for Discovery, Education and Affiliate Networks, US Department of Veterans Affairs. Please address correspondence to Justin M. List)
Background
The Joint Commission recently named reduction of health care disparities and improvement of health care equity as quality and safety priorities (Leadership [LD] Standard LD.04.03.08 and National Patient Safety Goal [NPSG] Standard NPSG.16.01.01). As the largest integrated health system, the Veterans Health Administration (VHA) sought to leverage these new accreditation standards to further integrate and expand existing tools and initiatives to reduce health care disparities and address health-related social needs (HRSNs).
Initiatives and Tools
A combination of existing data tools (for example, Primary Care Equity Dashboard), resource tools (for example, Assessing Circumstances and Offering Resources for Needs tool), and a care delivery approach (for example, Whole Health) are discussed as quality improvement opportunities to further integrate and expand how VHA addresses health care disparities and HRSNs. The authors detail the development timeline, building, limitations, and future plans for these tools and initiatives.
Coordination of Initiatives
Responding to new health care equity Joint Commission standards led to new implementation strategies and deeper partnerships across VHA that facilitated expanded dissemination, technical assistance activities, and additional resources for VHA facilities to meet new standards and improve health care equity for veterans. Health care systems may learn from VHA's experiences, which include building actionable data platforms, employing user-centered design for initiative development and iteration, designing wide-reaching dissemination strategies for tools, and recognizing the importance of providing technical assistance for stakeholders.
Future Directions
VHA continues to expand implementation of a diverse set of tools and resources to reduce health care disparities and identify and address unmet individual veteran HRSNs more widely and effectively.
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Pub Date : 2024-01-01DOI: 10.1016/j.jcjq.2023.10.018
David W. Baker MD, MPH, FACP (is Executive Vice President for Healthcare Quality Evaluation, The Joint Commission, Oakbrook Terrace, Illinois, and Editor-in-Chief, The Joint Commission Journal on Quality and Patient Safety. Please address correspondence to David W. Baker)
{"title":"Achieving Health Care Equity Requires a Systems Approach","authors":"David W. Baker MD, MPH, FACP (is Executive Vice President for Healthcare Quality Evaluation, The Joint Commission, Oakbrook Terrace, Illinois, and Editor-in-Chief, The Joint Commission Journal on Quality and Patient Safety. Please address correspondence to David W. Baker)","doi":"10.1016/j.jcjq.2023.10.018","DOIUrl":"10.1016/j.jcjq.2023.10.018","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725023002696/pdfft?md5=4f3f8ac6046afdfe283bbfe1c6cbee8e&pid=1-s2.0-S1553725023002696-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135410519","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 : 2024-01-01DOI: 10.1016/j.jcjq.2023.10.006
Megan A. Morris PhD, MPH, CCC-SLP (is Associate Professor, General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.), Cristina Sarmiento MD (is Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus.), Kori Eberle (is Research Assistant, and Program Director, Disability Equity Collaborative, Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus. Please address correspondence to Megan Morris)
Background
This qualitative study aimed to understand how early adopting health care organizations (HCOs) implement the documentation of patients’ disability status and accommodation needs in the electronic health record (EHR).
Methods
The authors conducted qualitative interviews with HCOs that had active or past initiatives to implement systematic collection of disability status in the EHR. The interviews elicited participants’ current experiences, desired features of a standard EHR build, and challenges and successes. A team-based analysis approach was used to review and summarize quotations to identify themes and categorize text that exemplified identified themes.
Results
Themes identified from the interviews included “why” organizations collected disability status; of “what” their EHR build consisted, including who collected, how often data were collected, and what data were collected; and “how” organizations were implementing systematic collection. The main purpose for collection of disability status and accommodation needs was to prepare for patients with disabilities. Due to this priority, participants believed collection should (1) occur prior to patients’ clinical encounters, (2) be conducted regularly, (3) use standardized language, and (4) be available in a highly visible location in the EHR. Leadership support to integrate collection into existing workflows was essential for success.
Conclusion
Patients with disabilities experience significant disparities in the receipt of equitable health care services. To provide equitable care, HCOs need to systematically collect disability status and accommodation needs in the EHR to ensure that they are prepared to provide equitable care to all patients with disabilities.
{"title":"Documentation of Disability Status and Accommodation Needs in the Electronic Health Record: A Qualitative Study of Health Care Organizations’ Current Practices","authors":"Megan A. Morris PhD, MPH, CCC-SLP (is Associate Professor, General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.), Cristina Sarmiento MD (is Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus.), Kori Eberle (is Research Assistant, and Program Director, Disability Equity Collaborative, Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus. Please address correspondence to Megan Morris)","doi":"10.1016/j.jcjq.2023.10.006","DOIUrl":"10.1016/j.jcjq.2023.10.006","url":null,"abstract":"<div><h3>Background</h3><p>This qualitative study aimed to understand how early adopting health care organizations (HCOs) implement the documentation of patients’ disability status and accommodation needs in the electronic health record (EHR).</p></div><div><h3>Methods</h3><p>The authors conducted qualitative interviews with HCOs that had active or past initiatives to implement systematic collection of disability status in the EHR. The interviews elicited participants’ current experiences, desired features of a standard EHR build, and challenges and successes. A team-based analysis approach was used to review and summarize quotations to identify themes and categorize text that exemplified identified themes.</p></div><div><h3>Results</h3><p>Themes identified from the interviews included “why” organizations collected disability status; of “what” their EHR build consisted, including who collected, how often data were collected, and what data were collected; and “how” organizations were implementing systematic collection. The main purpose for collection of disability status and accommodation needs was to prepare for patients with disabilities. Due to this priority, participants believed collection should (1) occur prior to patients’ clinical encounters, (2) be conducted regularly, (3) use standardized language, and (4) be available in a highly visible location in the EHR. Leadership support to integrate collection into existing workflows was essential for success.</p></div><div><h3>Conclusion</h3><p>Patients with disabilities experience significant disparities in the receipt of equitable health care services. To provide equitable care, HCOs need to systematically collect disability status and accommodation needs in the EHR to ensure that they are prepared to provide equitable care to all patients with disabilities.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1553725023002507/pdfft?md5=8c9a45b203afd06971282ad7bfa94c2f&pid=1-s2.0-S1553725023002507-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136009245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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