Journal for Healthcare Quality最新文献

Abstract: Since 2011, hospitals in the United States have used the Total Harm Rate as a metric to address and enhance patient safety by mitigating harmful events. However, upon evaluation, it was concluded that this tool had lost its validity and was not widely used as an effective measure to prevent harm to patients. There are no similar comparative data in the literature to which we can compare our results with others. The Quality Management Performance Improvement team began to develop a composite safety score that would be used to reflect the environment of patient safety and promote improvement opportunities.

Background: The accuracy of documentation of body weight and fluid balance in hospitalized patients is frequently questioned.

Methods: We conducted a survey to understand provider perceptions of the accuracy of intake, output, and weight charting in the electronic medical record. We sent a six-item questionnaire to nurses and physicians who provide inpatient service in a community-based teaching hospital of the Northeastern United States. We compared the response difference between nurses and physicians by Fisher exact test.

Results: One hundred eight nurses and 39 physicians participated in the survey. Both nurses and physicians responded that the accuracy of documentation is crucial. However, only 25.7% of participating physicians and 38.3% of participating nurses considered that documentation in the electronic medical record is reliable. Both physicians and nurses assumed that the nurses are too busy to collect and document the data, and the variability of non-patient weight and variations in body weight measurement under different conditions account for inaccuracies in the documented body weight.

Conclusions: Assessing the accuracy of documenting intake, output, and body weight in the electronic medical record is warranted. Providers believe that educating patients about fluid balance and volume assessment help to improve the accuracy in charting intake, output, and body weight in the electronic medical record.

Abstract: Functional neurological disorder (FND) sits at the intersection of neurology and psychology and has a variety of presentations, severity, and symptomatology. It affects a considerable number of pediatric patients and overwhelmingly influences healthcare spending. Diagnosis, treatment, and outcomes are varied, challenging, and lack standardization, often leading to frustration from patients, caregivers, and providers. Multidisciplinary care is essential though communication is often complex and disjunct. Using quality improvement tools and experiences from one institution, a team was established to ameliorate these concerns. A clinical care pathway was designed for the diagnosis and treatment of FND in the pediatric inpatient setting. This pathway was the result of the multidisciplinary team effort and an outcome, highlighting the need for early and intentional diagnosis with diagnosing provider specified, provider education and consistent language, patient and caregiver education, and clear and thorough discharge planning. Through the implementation of this pathway, it is anticipated that patient and provider satisfaction will improve as will the outcomes and care given to affected individuals. This work can be applied to the global treatment of FND and raise awareness to effectively managed care as well as the opportunity for clinicians to drive institutional change.

Purpose: Patient safety climate is an important factor in promoting patient safety for healthcare organizations. This study investigated the relationship between collaborative leadership and patient safety climate, the mediation effect of workplace social capital, or interprofessional collaboration practice.

Methods: A web-based cross-sectional questionnaire survey was administered between May 2021 and May 2022, to employees of three acute care hospitals in Japan. The relationship between variables was verified by structural equation modeling.

Results: A total of 1,276 staff members participated in the study. Collaborative leadership affected the workplace social capital (β = .734) and interprofessional collaboration (β = .561), which were positively associated with patient safety climate (β = .403 and .405, respectively), verifying the mediating relationship of workplace social capital and interprofessional collaboration between collaborative leadership and patient safety climate.

Conclusions: Collaborative leadership enhances the reciprocity and interprofessional practices of the healthcare team. The interaction among interprofessional team members fosters a patient safety climate. The results of this survey suggest that the development of collaborative leadership, which encourages interprofessional collaboration and fosters workplace social capital, is inherently crucial for cultivating a patient safety climate.

Introduction: Lung cancer ranks as the third most prevalent cancer in the United States. The use of low-dose computed tomography (LDCT) screening significantly reduces mortality from this disease. Unfortunately, Texas lags in completing lung cancer screening (LCS) for high-risk patients, ranking 48th among all states. It is crucial to implement quality improvement (QI) initiatives in Texas. In collaboration with the American Cancer Society, the primary care center (PCC) at our institution led a multidisciplinary QI project aimed at enhancing LCS through LDCT for eligible PCC patients.

Methods: The study included patients eligible for screening and who fall into the following categories: established patients with Medicaid, low-income or uninsured established patients, and established patients with either Medicare or commercial insurance. Enhancements to electronic medical records, education for clinical staff and patients, and a coordinated, multidisciplinary effort were implemented.

Results: The study revealed a substantial 40.2% improvement in LCS rates.

Conclusion: The US Preventive Services Task Force guidelines rely on an accurate history of patient's tobacco use to identify patients eligible for LCS. This QI project achieved success in improving the thoroughness of tobacco use history documentation and surpassed our target for increasing LCS by more than 10%.

Abstract: Many older adults prescribed opioid pain medications may be at increased risk of falls. As a quality improvement (QI) initiative, the University of Utah Sugar House clinic initiated a 9-month fall risk screening pilot for older adult patients on chronic opioids. This QI project sought to determine the feasibility of adding screening to a busy clinical practice, examine risk of falls in this patient cohort, and examine whether there were significant clinical and demographic differences between the patients who did or did not receive screening. We observed whether conventionally understood fall risk factors, including higher opioid doses, concurrent benzodiazepine prescription, and age, correlate with high fall risk. After the screening initiative, we determined that it was possible to significantly increase fall risk screening rates with prompts in Electronic Health Record (EHR). This cohort's fall risk screening increased from 18% to 33%. In the patients who were screened, 43% were found to be at high risk of falls. We did not see a correlation with high fall risk and patients taking higher doses of opioids or concurrent benzodiazepine prescriptions. These findings emphasize the need for consistent screening in primary care because review of the medication list alone is not a reliable predictor of fall risk.

Abstract: Loneliness and social isolation are serious problems that can impose negative consequences on individual well-being. Research suggests that loneliness can lead to an increased risk of depression, anxiety, and other health issues. Meritus Health, recognizing that loneliness is an issue within its community, has set a goal to comprehensively eradicate loneliness. As part of this effort, Meritus implemented the Care Caller program in November of 2021 through which a volunteer is paired up with a patient from our institution who has indicated that they are lonely. Each duo then finds a weekly cadence to share in 15- to 30-minute phone calls to facilitate meaningful social interaction. As of July 2023, the program has 500 participants enrolled with 47 volunteers and 2 full-time employees, and over 350 people are called weekly. In the last fiscal year, over 75,000 minutes have been spent on the phone between care callers and participants with promising results. Of the 172 participants who have been in the program for 4+ months, 166 have indicated that they felt less lonely, yielding a success rate of 97%. Meritus Health continues to further this program by increasing the number of care callers and utilization of Plan-Do-Study-Act rapid improvement.

Background: Hospital quality-assurance (QA) processes, including peer-review committees, seek to identify high-risk areas.

Purpose: To characterize emergency department (ED) cases sent for QA review.

Methods: A retrospective observational study was conducted of ED cases sent to a QA committee from November 2018 through July 2022 at three midwestern US hospitals. The QA records analyzed for these cases included the original incident report, case summary, and the committee determinations.

Results: One hundred and forty-seven cases were reviewed by the ED QA Committee. The most frequent referrals came from physicians. Common diagnostic categories included infectious (21%), cardiac (16%), gastrointestinal (11%), and neurologic (10%) concerns. Of the cases, 51% were considered nonpreventable, 33% were potentially preventable, and 9% were preventable. Inpatient boarding in the ED was explicitly implicated as a contributing factor in 6% of case reports.

Conclusions: Peer physician reporting represent the largest referral source sent for review with the most frequent diagnostic categories, including infectious, cardiac, gastrointestinal, and neurological conditions. Preventable concerns were rare.

Implications: This study provides a better understanding of the referral sources, diagnostic categories, and committee determinations in ED quality concerns. These results can target future investigations into case reporting and patient safety.

Objective: Gather insights into healthcare organization (HCO) preparedness for new 21st Century Cures Act information blocking disincentives and challenges in achieving greater accuracy /interoperability of patient identity/data.

Methods: Survey of 197 U.S. healthcare executives (54.7% response rate), included 46 health systems (23.4%), 141 hospitals (71.6%), and 10 payer organizations (5.1%), evaluated organizational gaps in patient identity data management/interoperability and preparation for information deblocking.

Results: Healthcare organizations are unprepared to meet information deblocking requirements and manage increased data influx/exchange. Although 61% have invested in meeting requirements, only 36% have capabilities in place. Majorities reported inability to comply with information blocking rules (59%), communicate electronic patient activity notifications to other organizations (56%), or share/receive patient-level information with patients and other HCOs (57%). Across 12 critical functionalities, 57% lacked key capabilities; 97% reported inadequate patient data/identity management/interoperability as data volume expands, adversely affecting care quality/safety and outcomes; and 57% envision patient data-matching errors precipitating a healthcare crisis in 5-10 years.

Conclusions: Many HCOs are unprepared to meet new Cures Act information blocking requirements and resultant increase of internal/external patient data volumes. Next generation master data management, enterprise master patient index, and referential matching technologies can improve HCO patient identity and data management, and information interoperability.

Objective: At our 710-bed academic medical center, nine (9) patients sustained injuries during nasogastric (NG) tube insertion attempts over a 16-month period (March 2021-July 2022). No injuries were reported during the comparable period before these events. This increase in reported events prompted an in-depth analysis to determine the root causes and implement a process improvement plan.

Methods: Root cause analysis (RCA) of these events failed to identify risk factors or actionable themes. The RCAs demonstrated wide variation in the number of insertion attempts and techniques.

Results: A standard process was created to provide team members with guidance for escalation when NG tube placement was difficult.

Conclusions: Although the complication rate for NG tube insertion was comparable with the criterion standard for large tertiary care institutions, we focused on minimizing risk and improving outcomes by creating a standard process for NG tube placement.