Journal for Healthcare Quality最新文献

Background: Patient satisfaction is a key indicator of health care quality, yet the impact of primary diseases on outpatient satisfaction remains underexplored. This study examined whether the primary disease independently influences patient satisfaction.

Methods: We retrospectively analyzed 8,259 outpatient experience records from clinics (n = 6,347), hospitals (n = 1,374), and tertiary hospitals (n = 538) using data from the 2023 Medical Service Experience Survey in Korea. The primary diseases for outpatient visit were categorized into 50 specific conditions grouped under 9 disease categories. Multivariate analyses were conducted, adjusting for demographic and health care-related factors.

Results: The primary disease was identified as an independent factor affecting satisfaction. Patients with cancer, particularly those with thyroid and breast cancer, reported the highest satisfaction, whereas patients with depression or bipolar disorder had the lowest. In addition, different diseases independently influenced satisfaction to varying degrees. Factors such as medical provider's manner (especially nurses) and facility convenience were also significantly associated with satisfaction.

Conclusions: Although the precise mechanisms remain unclear, the primary disease should be considered an important determinant of patient satisfaction. Future research should take into account the impact of specific diseases on patient satisfaction when designing studies or interpreting results.

Introduction: Hurricane Helene's disruption of Baxter's North Carolina manufacturing facility in September 2024 created significant supply disruptions and an urgent need to reduce intravenous fluid (IVF) usage across our 12 acute care hospital health system.

Methods: Our approach combined an integrated informatics and operational response that included real-time electronic health record monitoring, clinical decision support tools, and hospital-level operational interventions.

Results: We achieved and sustained a peak 44% reduction in IVF usage while maintaining quality metrics.

Conclusions: Analysis of 68,430 patient encounters demonstrated no significant changes in acute kidney injury or mortality rate, although demonstrating a reduction in length of stay. This study describes the rationale and impact of our approach and provides a framework for healthcare systems facing similar supply chain disruptions.

Background: Discharge to home is an increasingly used hospital metric unlikely to be met by all patients after hip fracture surgery. There has never been a study using a badge buddy system in patients with hip fracture to improve rates of discharge to home.

Methods: This was a retrospective review of patients who underwent hip fracture surgery between October 2022 and September 2024. The badge buddy was a tag placed on the ID badges of the hip fracture care team, containing information regarding fracture type and talking points for staff members. Primary outcome variables included discharge disposition and readmissions.

Results: A total of 172 patients were included in the control group and 163 patients in the badge buddy group. Discharge to home improved by 14.4% after project implementation (33.1% vs. 47.5%; p = .0038) without any differences in total readmissions (24 control vs. 22 badge buddy).

Conclusion: Use of the badge buddy is associated with an improved rate of discharge home in patients admitted to an orthopedic service without any difference in absolute number of readmissions after badge buddy initiation. The badge buddy system is a useful adjunct to create cohesive messaging across hospital staff to improve home discharge rates in our patients with hip fracture.

Introduction: Patient-centered care is paramount for optimal outcomes. To address this, at Meritus Health, we asked a simple, yet profound question: "What matters most to you? (WMM)" This question, integrated into the patients' electronic health records (EHRs), facilitates meaningful conversations and helps tailor care to align with patient goals. This initiative, grounded in the principles of Age-Friendly Healthcare from the John A. Hartford Foundation, underscores the power of information by enabling clinicians to gain a comprehensive understanding of their patients. Our implementation required significant teamwork and provider engagement. Over 3 years, we have recorded more than 65,000 responses, creating a strategic priority for the health system to personalize care, guide clinical decision making, and drive continuous improvement. This strategic priority is health system wide. Patient-facing units and departments all across the health system track and report monthly metrics on the number of WMM responses captured. In addition, many departments across the system lead quality-improvement projects to improve and refine the process of asking this question.

Methods: We assessed the patient responses to the WMM question to identify the frequency of common answers and also sought to review the implementation of the question process for learning.

Results: In our analysis of more than 65,000 patient responses, we categorized the answers into the top distinct groups with the top five categories identified being family and relationships (noted 38% of the time), well-being (22%), health concerns (15%), lifestyle (6%), and religion and faith (3%).

Conclusions: Asking and knowing WMM to patients offers more than just insight; it builds a meaningful conversation and relationship between the provider and patient in knowing the whole person. The top responses from patients are intuitively not surprising. The key to our questioning of the patients and the integration in the EHR are not the responses themselves, but the process of asking, knowing, and acting on WMM to patients. Ultimately, asking WMM can be a powerful tool in advancing patient-centric care and building population health.

Abstract: Unplanned return emergency department (ED) visits (RV) and return ED visits leading to admission (RVA) are common. A comprehensive assessment of prognostic factors associated with RVs and RVAs is required to guide further inquiry into how they might be mitigated. We conducted a prognostic indicator systematic review of factors associated with an emergency department (ED) return visit (RV) and RV with admission (RVA) within 30 days of the index ED visit using PRIMSA guidelines (PROSPERO #CRD42023483802). After searching Medline, EMBASE, CINAHL, and Cochrane Library, two investigators independently screened titles/abstracts, extracted data, and assessed risks of bias using the QUIPS template. In total, six studies were included. Most studies were hampered by risks of bias from study participation and study attrition. We found wide variation in the inclusion or exclusion of patient phenotypes associated with frequent ED utilization in the denominator of patients at risk for RV and RVA. Ultimately, heterogeneity and risk of bias precluded meta-analyses. We tabulated ranges of odds ratios for multiple subject-level, ED-level, and hospital-level prognostic factors. Male patient sex, Medicaid or Medicare insurance, and lower acuity emergency severity index scores were most consistently associated with higher risks of RV and RVA within 30 days.

Background: Miscommunication is the leading cause of hospital medical error, most occurring during patient care handoffs. Even with successful implementation of a standardized handoff methodology, our hospital experienced continued handoff problems in the perioperative space. No studies have yet examined barriers to effective perioperative handoff communication.

Purpose: This study aims to identify and understand the barriers to effective perioperative handoffs that persist despite quality improvement efforts to improve handoff communication.

Methods: We initiated a qualitative study using thematic analysis of semistructured face-to-face interviews with nurses and physicians from perioperative units. Interviews were coded into themes and then categories.

Results: The barriers were categorized into administration, communication, and personnel. Administration involves knowledge and interpretation of administrative processes. Communication refers to forms and components of handoff communication and the environment where handoffs occur. Personnel refers to individual roles and responsibilities, and also as a quantitative resource. Specific quality improvement initiatives were proposed based on our study results.

Conclusions: Our findings suggest that successful handoff communication between perioperative areas requires identification of critical administrative, communication, and personnel barriers.

Implications: Hospitals can conduct similar interview-based studies to discover barriers to effective handoffs, and implement policies and procedures to improve safety in the perioperative space.

Introduction: Laboratory test utilization initiatives are well-studied in academic centers but less so in rural and community hospitals. We applied the EPIDEM model ( e xploration, p romotion, i mplementation, d ocumentation, e valuation, m odification) across a nine-hospital, predominantly rural health system to reduce unnecessary daily laboratory tests.

Methods: At the medical center, we began engaging key partners in October 2020 through targeted in-person meetings. Electronic health record (EHR) interventions (removing daily ×3 ordering, Choosing Wisely reminders, interval-based ordering restrictions) started system-wide in April 2021. Regional hospitals received EHR interventions and educational materials only.

Results: After clinical leadership approval in December 2020, our initiative's popularity accelerated, as groups requested inclusion. Across the health system, there was a 6%-20% reduction in tests per inpatient day. At the medical center, ordering decreased in December 2020 and dropped further with each EHR intervention. Unlike the sustained improvement observed at the medical center, ordering initially increased in the regional hospitals, decreased with each EHR intervention, but ultimately returned near baseline levels.

Conclusions: Social and behavioral strategies are essential for sustaining daily laboratory test reduction efforts. Lasting cultural change may require local champions at each hospital. The EPIDEM model prioritizes relational and contextual factors, enabling quality improvement even in resource-limited settings.

Introduction: Early identification and management of sepsis improves patient outcomes, yet hospitals struggle to consistently screen patients on arrival and during hospitalization. The Centers for Disease Control published Hospital Sepsis Program Core Elements to guide hospital sepsis management and outcomes improvement efforts and will measure the sepsis core elements with the National Healthcare Safety Network Annual Hospital Survey.

Methods: To further sepsis care management, our community-owned, nonprofit hospital implemented an emergency department quality improvement project, introducing rule-based artificial intelligence (AI) for sepsis identification with a workflow. Objectives were to measure rule-based AI sensitivity, sepsis management compliance, length of stay (LOS), and mortality rate.

Results: A total of 895 cases were included in the final dataset, 370 preimplementation and 525 postimplementation. Postimplementation rule-based AI alerts identified 93.9% (493 of 525) cases for sepsis management interventions. After rule and workflow implementation, combined 3-hour compliance for antibiotic given, blood culture drawn, and lactate measured was 89.5%. Average LOS decreased by 2.3 days ( p < .001), and mortality per 100 cases decreased by 22.3% ( p = .0998).

Conclusions: Implementing rule-based AI software to identify severe sepsis in conjunction with a sepsis workflow decreased LOS for patients diagnosed with either severe sepsis or septic shock.

Abstract: Although pneumococcal vaccination decreases the rate of pneumonia-associated hospitalization and mortality, rates of pneumococcal vaccination among adults aged 65 years and older remained relatively unchanged during the period of 2019-2022. To improve the rate of pneumococcal vaccine coverage among patients aged 65 years and older in our academic internal medicine clinic, we conducted a quality improvement project centered on previsit planning as the intervention. Previsit planning was implemented in a phased approach, divided into three intervention periods, each involving an increasing number of medical teams. The previsit planning intervention was performed by medical assistants who reviewed vaccination status of patients scheduled for the following day and pended vaccination orders when indicated. When compared with baseline vaccination rates, rates increased in each of the three interventions (7.5%-33.3% [ p < .05], 8.9%-39.6% [ p < .05], 27.8%-38.9% [ p < .05], respectively). Previsit planning can improve pneumococcal vaccination uptake in the ambulatory setting by distributing responsibilities for addressing care gaps across multiple team members, with potential benefits also including reduced provider burnout, improved clinic flow, and improvement of team members' preparation for patient visits.

Abstract: Effective management of patient care delivery within the Veterans Affairs (VA) and Department of Defense (DOD) healthcare systems requires innovative strategies to implement clinical practice guidelines (CPGs). The authors explore the expansion of these strategies by leveraging the Strategic Analytics for Improvement and Learning data, the Electronic Quality Measures dashboard, and Patient Aligned Care Teams across the Veterans Health Administration enterprise. A multidisciplinary, national, virtual Community of Practice (CoP) using subject matter expert presentations that utilize the VA/DOD CPGs and strategic methods for implementation to enhance patient outcomes was developed and implemented. This work aims to detail the development and implementation of a virtual CoP that integrates multidisciplinary expertise and data analytics to enhance CPG adoption and implementation. The implications of CPG CoP discussed reflect the ongoing success and growth of the program's CPG CoP.