Journal for Healthcare Quality最新文献

Background: First case on time start is an increasingly important surgical operations metric. First case on time start delay is multifactorial, and institutional improvement requires an iterative, efficiency-centered approach.

Methods: An institution-specific Lean Six Sigma Approach was taken to identify causes for case start delay and modify processes to improve "ready for induction" (RFI) times. A perioperative checklist was developed to track active steps to on-time start. Emphasis was placed on a visual management board, daily perioperative huddles, shared responsibility across all stakeholder departments, and the sharing of granular surgeon data with department leadership.

Results: This study took place at a nonprofit multispecialty quaternary care academic medical center. From April 2024 to July 2025, RFI on-time improved from 52% to 77%. "In OR" time reduced by 6 minutes, RFI time by 7 minutes, and incision time by 7 minutes. After intervention, median skin incision time was 20 minutes earlier for comparable on-time starts, and these cases ended 47 minutes earlier. Delays were most often related to surgical team (19.6%).

Conclusions: This sustained quality improvement initiative demonstrated successful application of a perioperative checklist and focused behavior modification.

Background: Guidelines suggest that home blood pressure (BP) readings are more reliable than in-clinic measurements; however, quality metrics for patients with hypertension (HTN) primarily rely on in-clinic readings. To improve BP documentation and management, we implemented an advanced practice provider (APP)-managed remote patient monitoring (RPM) program.

Methods: The electronic health records (EHR) of internal medicine patients with HTN and uncontrolled BP (≥140/90 mm Hg, per our institution's quality metric) were reviewed for more recent controlled (<140/90 mm Hg) home readings. If found, these values were imported into the chart's patient-reported vitals section. If not, patients were offered RPM. Participants (n = 472) received a BP monitor that automatically transmitted home readings to the EHR and had APP-led follow-up to guide lifestyle and medication adjustments until target BP was achieved. Lower targets (<130/80 mm Hg) were pursued for higher risk patients.

Results: For 12 months, average systolic and diastolic BP of patients with initially uncontrolled HTN improved from 149.8 to 131.3 mm Hg and from 84.0 to 79.3 mm Hg, respectively (p < .001). The percentage of patients with HTN and last documented BP < 140/90 mm Hg increased 7.94% compared with 1.75% at a comparison clinic providing standard care (p = .022).

Conclusions: This APP-managed RPM program significantly improved BP outcomes and institutional quality metrics.

Background: There are no standardized methods to assess central lines that are present on admission (POA) for risk of central line-associated bloodstream infections (CLABSI). This pilot study validated a tool to identify patients at risk of CLABSI-POA.

Methods: A questionnaire to assess patients' risk of CLABSI-POA was developed based on four criteria. If any criteria were positive, two sets of blood cultures were obtained. From November 2023 to September 2025 (Phase 1), all patients admitted to general & colorectal surgery, liver & intestinal transplant, or hepatology with a central line POA were screened. Phase 2 of the pilot study began in June 2024, which included screening of patients admitted to the oncology units.

Resultsintotal,: 366 patients were screened for CLABSI POA, with 56% (n = 204) screening positive. Blood cultures were drawn for 97% (n = 198) of at-risk patients. In total, 15% (n = 30) of cultures were positive. After the pilot study, CLABSI counts across all nursing units in the pilot study decreased, and the time to CLABSI diagnosis shifted (median 6.5 days prepilot study vs. 15 days postpilot study) (p = .038) likely denoting true hospital-acquired CLABSIs, without a corresponding increase in resources for testing (p = .06).

Conclusions: Implementation of a screening questionnaire for patients with central line POA can lead to early identification of patients presenting with blood stream infections.

Background: U.S. hospitals generate ∼6 billion tons of medical waste annually. Disposal costs exceed $4 billion. High-temperature incineration, required for sharp wastes, is the most costly and carbon-intensive disposal. Inappropriate waste contributes significantly to health care's financial and environmental burdens.

Methods: This single-blinded cross-sectional study involved a one-time audit of 176 sharps containers from operating rooms, procedure rooms, and clinics across a Level 1 trauma center, conducted on a single day in 2023. Containers were photographed before disposal. Metadata, such as specialty and room type, were recorded separately. Independent reviewers who analyzed the images were masked to the containers' origins. The proportion of image area occupied by nonsharp items was calculated using ImageJ. Statistical comparisons were performed using independent-samples t-tests and ANOVAs.

Results: Overall, 24.74% of sharps container contents were inappropriate. Emergency services had the highest rate (40.22%), followed by surgical (22.37%) and medical services (9.79%) (p < .001). Specialties differed significantly (p < .001); orthopedics, otolaryngology, and plastic surgery had lower inappropriate disposal, while emergency medicine and general surgery had higher rates.

Conclusions: Our findings highlight an opportunity for targeted interventions to reduce medical waste misclassification. Standardized protocols and specialty-specific education may reduce costs and support environmental sustainability.

Background: The operating room (OR) is a dynamic environment requiring close communication between surgeons, anesthesiologists, and clinicians. First-case on-time starts (FCOTS) is a common metric of OR efficiency. OR delays are multifactorial and can increase hospital expenditures.

Purpose: We sought to determine whether implementing explicit deadlines, in conjunction with feedback to late individuals, would improve our institution's FCOTS.

Methods: After obtaining approval from quality board at our tertiary care, Level 1 trauma institution, a "pre versus post" quality improvement project implemented a multicomponent initiative with explicit deadlines for perioperative tasks, feedback to late surgeons, and OR tracking boards. We included American Society of Anesthesiologists (ASA) classification score ≤4 patients, undergoing elective or urgent surgery.

Results: A total of 14,609 patients were included (6,635 preimplementation and 7,974 postimplementation). Both groups were well balanced regarding most potential confounders, for example, age, sex, and ASA score. We observed a significant difference (p < .0001) in FCOTS between the preimplementation (39.0%) and postimplementation (74.0%) phases. Using a 5-minute grace period, the monthly average FCOTS percentage increased from 54.8% preimplementation to 83.2% postimplementation (p < .0001).

Conclusions: Implementation of a central OR tracking board, clinician feedback, and explicit 5:10:15:20-minute goals was associated with significant improvement of our hospital's FCOTS.

Background: Limited qualitative research has explored clinician behaviors that enhance communication with patients who have limited health literacy (HL). Teach-back is a patient-centered strategy used to confirm understanding and close HL gaps.

Purpose: This quality improvement initiative aimed to improve patient understanding of newly prescribed cardiac medications at discharge on a telemetry unit in a university-affiliated community hospital in New York. The goal was to increase the percentage of patients who understood the indication and side effects of their new medications to at least 85% by January 2024, using the Plan-Do-Study-Act framework.

Methods: Fifty eligible patients (mean age 71.7 years) admitted between November 2023 and January 2024 were considered. Inclusion criteria included a newly prescribed cardiac medication, intact cognition, English fluency, and discharge to home. Patients completed a baseline questionnaire assessing knowledge of medication purpose and side effects. Those with knowledge gaps received tailored education using plain language, followed by a teach-back session. Patients were asked to explain the medication's purpose and risks in their own words. Follow-up interviews 2-4 weeks postdischarge reassessed retention using the same framework.

Results: At baseline, 54% of patients understood the medication's purpose, and only 26% were aware of potential adverse effects. After the intervention, 92% accurately explained both indication and side effects, and 74% retained the information at follow-up. Standardized protocols and blinded follow-up interviews helped minimize selection and reporting bias.

Conclusions: The teach-back method significantly improved patient comprehension and short-term retention of discharge medication instructions. It is a feasible, low-cost strategy that can be effectively implemented in inpatient cardiology settings to address HL-related communication gaps and support safer transitions of care.

Background: Emergency department (ED) crowding is a crisis of an overstrained health care system that is associated with poor patient outcomes and dissatisfaction. We aimed to assess the effect of an interdisciplinary, provider-led triage team, "the Dugout," on ED length of stay (LOS), door-to-provider (DTP), and left without being seen (LWBS) rates.

Methods: We used a before-and-after design. The setting is an urban, teaching, adult and pediatric 63-bed emergency department with a total annual volume more than 90,000 and an admission rate of 35%. Data were collected on adult patients (18 years and older) who presented during a similar 6-month period before (October 2023-March 2024) and after (October 2024-March 2025) implementation of the Dugout.

Results: There were 34,106 and 31,704 adult encounters in the pre- and postimplementation periods, respectively. The Dugout was associated with a reduction in LWBS from 14.1% to 3.0% ( p < .001). DTP decreased from a median of 59 to 38 minutes ( p < .001). The median overall ED LOS decreased from 448 to 429 minutes ( p < .001), and the LOS for discharged patients decreased from 407 to 344 minutes ( p < .001).

Conclusions: The introduction of a dedicated, interdisciplinary team stationed in the triage area was associated with reduced LWBS, DTP, and ED LOS.

Introduction: Less than 1/5 th of eligible patients are prescribed statins for primary prevention in the United States.

Methods: We conducted a quality improvement program augmented by contextually responsive implementation strategies (IS), Plan-Do-Study-Act cycles, and Lean Six Sigma Principles to optimize statin therapy among 40-75-year-old patients without atherosclerotic cardiovascular diseases (ASCVD) in primary prevention in resident internal medicine clinic. We conducted needs assessment; identified process measures, barriers to statin optimization using discussions; and rank ordered these barriers. We mapped multiple IS to the barriers using discussions/consensus over 2 years. We retrofitted the IS to the Expert Recommendations for Implementing Change (ERIC) taxonomy to facilitate IS reporting.

Results: We noted significant improvement in process measures such as lipid panel orders (64.6% vs. 95.5%), its completion (78.6% vs. 95.3%), ASCVD risk score completion (3% vs. 91%), and statin therapy optimization (34.5% vs. 90%) over 2 years among eligible patients (baseline vs. final cohort, respectively; all p ≤ .001).

Conclusions: Using improvement and implementation science to identify needs assessment, process measures, and barriers in statin optimization and mapping IS to the barriers can help improve statin optimization in primary prevention. Our reporting of IS using the ERIC taxonomy should further help operationalize IS in other contexts.

Background: Surgical instrument inventory optimization leads to sizable cost savings through tray reduction. Yet, a commonly overlooked benefit is the increase in efficiency stemming from reduced task variety for health care workers resulting from this reduction in inventory variety. We hypothesized that reducing the variety of surgical instrument trays would lead to significant improvement in reprocessing time, labor cost savings, and staff satisfaction.

Methods: We conducted a 12-month observational study at an academic hospital's medical device reprocessing (MDR) department before and after inventory optimization. The evaluated outcome measures were MDR time saved, labor cost reduction, and worker satisfaction as measured by an anonymized survey.

Results: After standardization, the results revealed that the time savings of new MDR technicians (14 ± 6.2 minutes) were significantly higher than the time savings of experienced MDR technicians (4.6 ± 5.7 minutes) ( p < .001). The total reprocessing cost savings equal $2,575.96 Canadian Dollars (CAD) annually. We found a higher satisfaction with the standardized tray among MDR technicians, with eight of nine new MDR technicians (89%) significantly preferring it, and 12 of 19 (63%) experienced MDR technicians "somewhat" preferring the standardized tray.

Conclusion: Standardizing surgical trays enhances efficiency, reduces costs, and improves staff satisfaction, making it a valuable strategy in inventory management.

Introduction: Length of stay (LOS) is a critical metric for the efficient utilization of limited resources. A multidisciplinary task force in an academic hospital was created to optimize discharge planning with expanded resources to support a structured discharge process.

Methods: Between January and June 2023, multiple interventions were implemented in Hospital Medicine group. Inpatient LOS and other process, outcome, and balancing measures in the post-intervention period (July to December 2023) were compared to those in the pre-intervention period (July to December 2022). The patient demographics and clinical characteristics were adjusted for confounding factors.

Results: The mean inpatient LOS was 5.8 days post-intervention compared with 6.5 days in the pre-intervention cohort. After adjusting for potential confounding factors, we found a significant reduction in inpatient LOS by 0.56 days ( p = .019), while it did not affect all-cause readmissions or emergency department (ED) visits within 30 days after discharge.

Conclusions: Our multidisciplinary discharge bundle, appropriate case management support level and documentation enhancement seem to be a promising approach for coordinating discharge communication and subsequently reducing the LOS. Our plan is to scale this approach to other clinical areas, address identified care progression delays, and better manage the ED throughput to improve the care delivery system.