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Transforming Hospital Quality Improvement Through Harnessing the Power of Artificial Intelligence. 通过利用人工智能的力量改进医院质量。
Pub Date : 2024-08-01 DOI: 10.36401/JQSH-24-4
Hana J Abukhadijah, Abdulqadir J Nashwan

This policy analysis focuses on harnessing the power of artificial intelligence (AI) in hospital quality improvement to transform quality and patient safety. It examines the application of AI at the two following fundamental levels: (1) diagnostic and treatment and (2) clinical operations. AI applications in diagnostics directly impact patient care and safety. At the same time, AI indirectly influences patient safety at the clinical operations level by streamlining (1) operational efficiency, (2) risk assessment, (3) predictive analytics, (4) quality indicators reporting, and (5) staff training and education. The challenges and future perspectives of AI application in healthcare, encompassing technological, ethical, and other considerations, are also critically analyzed.

本政策分析侧重于在医院质量改进中利用人工智能(AI)的力量来改变质量和患者安全。它研究了人工智能在以下两个基本层面的应用:(1) 诊断和治疗;(2) 临床操作。人工智能在诊断方面的应用直接影响到患者护理和安全。同时,人工智能通过简化(1)操作效率、(2)风险评估、(3)预测分析、(4)质量指标报告以及(5)员工培训和教育,间接影响临床操作层面的患者安全。此外,还对人工智能在医疗保健领域应用的挑战和未来前景进行了批判性分析,包括技术、伦理和其他方面的考虑。
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引用次数: 0
Exploration of Mental Health and Well-Being of Healthcare Professionals During the COVID-19 Pandemic. 探讨 COVID-19 大流行期间医疗保健专业人员的心理健康和幸福感。
Pub Date : 2024-08-01 DOI: 10.36401/JQSH-23-47
Taurzhan K Aldabergenova, Anthony Abiodun Eniola, Bibi-Aisha Sh Orynbayeva, Feruza S Sarsenbayeva, Nurzhamal S Askarova, Sidikat Shitu

Introduction: In response to curbing the spread of SARS-CoV-2, healthcare professionals (HCPs) encounter a multitude of mental stresses. The primary intent was to explore the mental health and well-being experienced by HCPs in Ekiti State, Nigeria, amid the COVID-19 pandemic.

Methods: Data were analyzed using inductive qualitative methodology. The study was undertaken among HCPs in two teaching hospitals in Ekiti State during the SARS-CoV-2 outbreak. Convenience sampling techniques were employed to select participants for this study. A comprehensive interview ranging from 30 to 50 minutes per participant was administered to a sample of 14 HCPs (doctors and nurses) representing various departments within the hospital. The interviews were conducted between March 2020 and May 2020. COVID-19 stressful situations, the physiological consequences of stress, personality, disposition, stress management techniques, and coping mechanisms were evaluated.

Results: The study outcomes indicate that a significant proportion of HCPs currently face mental well-being. The primary sources of stress identified in this study included heavy workloads and pressure from social media platforms and government agencies. The outbreak crisis significantly influenced on their lives and work, with the fear of catching diseases and their anxiety about spreading infections to their loved ones.

Conclusions: HCPs require a secure working environment during the current circumstances, along with an enhanced support system to alleviate stressors. This study contributes to a significant proportion of HCPs currently facing stress.

简介在遏制 SARS-CoV-2 传播的过程中,医疗保健专业人员(HCPs)遇到了许多精神压力。研究的主要目的是探讨尼日利亚埃基蒂州的医护人员在 COVID-19 大流行期间所经历的心理健康和幸福感:采用归纳定性方法分析数据。研究对象是 SARS-CoV-2 爆发期间埃基蒂州两家教学医院的高级专业人员。本研究采用了便利抽样技术来选择参与者。对代表医院各部门的 14 名高级专业人员(医生和护士)进行了每人 30 至 50 分钟的综合访谈。访谈在 2020 年 3 月至 2020 年 5 月期间进行。对 COVID-19 压力情境、压力的生理后果、人格、性格、压力管理技巧和应对机制进行了评估:研究结果表明,目前有相当一部分住院医师面临精神压力。本研究确定的主要压力来源包括繁重的工作量以及来自社交媒体平台和政府机构的压力。疫情危机对他们的生活和工作产生了重大影响,他们害怕感染疾病,担心传染给亲人:结论:在当前情况下,卫生保健人员需要一个安全的工作环境,以及一个强化的支持系统来缓解压力。这项研究为目前面临压力的很大一部分高级保健人员提供了帮助。
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引用次数: 0
Transforming Hospital Housekeeping: The Kayakalp Journey 改造医院内务:Kayakalp 之旅
Pub Date : 2024-07-22 DOI: 10.36401/jqsh-23-54
J. Pillai, Biswajeevan Sahoo, M. C. Sahoo, B. Behera, R. Baby, Mariamma V. George, Jyotirmayee Rath, Chandramani Sahoo, Ashoka Mohapatra, Gaurav Chhabra, B. Behera, Arvind Kumar Singh, B. Patro, Ashok Kumar Jena
The Kayakalp guidelines for public healthcare facilities under the Swachh Bharat Abhiyan (Clean India Mission) focus on improving sanitation, cleanliness, and infection control at public hospitals in India. This study was conducted in a 960-bed tertiary-level teaching hospital in eastern India. Housekeeping has been a challenge in public institutions, with factors like overcrowding and resource constraints. Tobacco and betel nut chewing, spitting, poor sanitation practices, and open urination are major challenges in ensuring sanitation at the hospital. The research objective was to study the implementation of the Kayakalp guidelines for quality improvement in housekeeping services at the institution. A pre- and post-interventional study was conducted using the Plan-Do-Check-Act (PDCA) quality tool. Plan phases included the gap assessment using the Kayakalp checklist with numerical scoring. Necessary interventions were done under three headings: structure, processes, and outcomes in the “Do” phase. The “Check” phase included monitoring of the activities followed by the “Act” phase, which included a review of the action plan. External experts nominated by the government conducted the final assessments and recommended it as one of the cleanest hospitals. A 360-degree improvement was observed in hospital services, with assessment score improvement from 73.68% to 95.0%. The institution received the first prize in 2020 and 2021 and runners-up Kayakalp National Award under category “B” (Institute of National Importance) Hospitals in 2019. The implementation of Kayakalp guidelines of the Government of India proved to be efficient in the improvement of housekeeping and infection control practices in the institution.
根据 "清洁印度计划"(Swachh Bharat Abhiyan)制定的公共医疗机构 Kayakalp 指导方针侧重于改善印度公立医院的卫生、清洁和感染控制。本研究在印度东部一家拥有 960 张床位的三级教学医院进行。由于过度拥挤和资源限制等因素,内务管理一直是公立医院面临的挑战。咀嚼烟草和槟榔、随地吐痰、不良卫生习惯和随地大小便是确保医院卫生的主要挑战。这项研究的目的是研究 Kayakalp 准则的实施情况,以提高医院内务管理服务的质量。 使用计划-执行-检查-行动(PDCA)质量工具开展了一项前后干预研究。计划阶段包括使用 Kayakalp 检查表进行差距评估和数字评分。在 "做 "的阶段,按照结构、过程和结果三个标题进行必要的干预。检查 "阶段包括监测各项活动,随后是 "行动 "阶段,包括审查行动计划。由政府提名的外部专家进行了最终评估,并推荐该医院为最清洁的医院之一。 医院服务得到了 360 度的改善,评估得分从 73.68%提高到 95.0%。该机构于 2020 年和 2021 年获得一等奖,并于 2019 年获得 "B "类(国家重要机构)医院 Kayakalp 国家奖亚军。 事实证明,印度政府 Kayakalp 准则的实施有效改善了该机构的内务管理和感染控制做法。
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引用次数: 0
Reply to Blom: Drugs Do Not Work in Patients Who Cannot Tolerate Them 回复布洛姆:药物对不能耐受药物的患者不起作用
Pub Date : 2024-07-10 DOI: 10.36401/jqsh-24-x1
Laila Carolina Abu Esba, Hani Alharbi
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引用次数: 0
Patient-Centered Healthcare: From Patient Experience to Human Experience 以患者为中心的医疗保健:从患者体验到人类体验
Pub Date : 2024-07-10 DOI: 10.36401/jqsh-24-x2
Muhammad Hasan Abid, Augustine Kumah, Ahmed Newera, Passant Hafez
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引用次数: 0
Using the Failure Mode and Effect Analysis Tool to Improve the Automatic Stop Order Process 使用故障模式和影响分析工具改进自动停止命令流程
Pub Date : 2024-07-10 DOI: 10.36401/jqsh-24-9
Ghada Hussain Al Mardawi, R. Rajendram, Arwa Balharith, Abdulaziz Alomaim
Automatic stop orders (ASOs) in computerized prescription order entry (CPOE) systems predefine the length of treatment. This can improve resource use for select therapies (e.g., empirical antibiotics). However, root cause analysis of dose omission errors identified inappropriate ASO-directed termination of medications without prescriber notification. This quality improvement initiative aimed to identify potential failures of the medication ASO processes to develop a new workflow and anticipate issues that may arise after implementation. A failure mode and effect analysis (FMEA) was conducted following Institute of Healthcare Improvement guidance. A multidisciplinary ASO-FMEA team reviewed the existing workflow. Failure modes, risk priority numbers (RPNs), and interventions were identified and assessed. The RPNs calculated for the proposed new workflow (assuming all recommendations were implemented) were compared with those of the existing workflow. Eight failure modes, 17 effects, and 31 causes were identified in the five workflow steps (mean RPN 365.4; median 280). Specific, measurable, achievable, realistic, and time-bound interventions were proposed. Assuming successful implementation of all recommendations, the RPNs of the proposed workflow (mean 117.6; median 112) were significantly lower (p < 0.05). When modifying existing CPOE systems, FMEA may identify possible failures that can be addressed before the implementation of a new process. This may prevent errors, improving medication safety. Regardless, continuous audit and monitoring are required to ensure the effectiveness of implemented changes.
计算机化处方单输入(CPOE)系统中的自动停止处方单(ASO)可预先确定治疗时间。这可以提高特定疗法(如经验性抗生素)的资源利用率。然而,对剂量遗漏错误的根本原因分析发现,在未通知处方医生的情况下,存在不适当的 ASO 定向终止用药的情况。这项质量改进措施旨在找出用药 ASO 流程的潜在故障,以制定新的工作流程,并预测实施后可能出现的问题。 根据美国医疗保健改进研究所的指导,进行了故障模式和影响分析(FMEA)。一个多学科的 ASO-FMEA 小组审查了现有的工作流程。确定并评估了故障模式、风险优先级(RPN)和干预措施。将为建议的新工作流程(假设所有建议都已实施)计算出的 RPN 与现有工作流程的 RPN 进行了比较。 在五个工作流程步骤中确定了 8 种故障模式、17 种影响和 31 种原因(平均 RPN 为 365.4;中位数为 280)。提出了具体的、可衡量的、可实现的、现实的和有时限的干预措施。假定成功实施所有建议,建议工作流程的 RPN(平均值 117.6;中位数 112)将显著降低(p < 0.05)。 在修改现有 CPOE 系统时,FMEA 可以发现可能存在的故障,从而在实施新流程之前解决这些故障。这可以防止错误发生,提高用药安全。无论如何,都需要进行持续的审核和监控,以确保所实施更改的有效性。
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引用次数: 0
Letter in Response to “Lomitapide: A Medication Use Evaluation and a Formulary Perspective” by Esba and Alharbi 回应 Esba 和 Alharbi 所著《洛米他匹:Esba 和 Alharbi 撰写的 "洛米他匹:用药评估和处方集视角 "的回复
Pub Date : 2024-07-10 DOI: 10.36401/jqsh-24-17
Dirk J. Blom
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引用次数: 0
Practical Application for the Theory of Profound Knowledge in a Quality Improvement Project 深奥知识理论在质量改进项目中的实际应用
Pub Date : 2024-05-06 DOI: 10.36401/jqsh-23-45
Hakem Alomani, F. A. Mostafa, Basim Felemban, Hani Redwan, Khaled Masaud, Khadijah Alshanqiti, Claudine Neff, Matea Vidovic
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引用次数: 0
Evaluation of a Risk Screening Checklist for Venous Thromboembolism Prophylaxis in a Women and Newborn Hospital 评估一家妇女和新生儿医院的静脉血栓栓塞预防风险筛查清单
Pub Date : 2024-05-03 DOI: 10.36401/jqsh-23-51
Rebecca Lewis, Deborah Gordon, Julie Lam, S. Teoh, T. Lebedevs
The venous thromboembolism (VTE) risk screening forms were developed to allow for recording identified risk factors for VTE including thrombophilia, history of VTE, postpartum hemorrhage, and cesarean delivery, and documentation of specific actions taken to mitigate these risks and reduce complications due to VTE. Compliance with hospital guidelines in assessing VTE risk and appropriate prescribing of thromboprophylaxis was evaluated prior to the introduction of VTE risk screening forms (March 2022). Efficacy of the new VTE risk screening forms was also assessed (April 2023). Patient discharge summaries and patient medical records including medication charts were used to review the documentation of VTE risk assessments and details of thromboprophylaxis prescribing. Of 74 postnatal patients, 37.8% had VTE risk assessment documented prior to the introduction of VTE risk screening forms. Of 37 patients identified to be at moderate to high risk of VTE requiring pharmacological prophylaxis, 70.3% (n = 26) were appropriately prescribed pharmacological prophylaxis. After the risk screening forms were introduced, a total of 67 antenatal, postnatal, and gynecologic patients were studied. Of these, 32.8% (n = 22) of patients had all required fields completed appropriately. When using the forms, 26.9% (n = 7) of postnatal and 88% (n = 22) of gynecological patients were rated as medium or high risk, and all received medical review within 24 hours. Pharmacological prophylaxis was indicated in 88% (n = 22) of gynecological, 43.8% (n = 7) of antenatal, and 38.5% (n = 10) of postnatal patients, and all were appropriately prescribed. The guideline review and introduction of VTE risk screening forms was valuable to provide guidance in the risk assessment for VTE and to identify patients requiring prophylaxis.
开发静脉血栓栓塞症(VTE)风险筛查表的目的是记录已确定的 VTE 风险因素,包括血栓性疾病、VTE 病史、产后出血和剖宫产,并记录为降低这些风险和减少 VTE 并发症而采取的具体措施。 在引入 VTE 风险筛查表(2022 年 3 月)之前,对医院在评估 VTE 风险和适当开具血栓预防处方方面的指南合规性进行了评估。同时还评估了新的 VTE 风险筛查表的有效性(2023 年 4 月)。使用患者出院摘要和患者病历(包括用药记录)来审查 VTE 风险评估文件和血栓预防处方的详细信息。 在 74 名产后患者中,37.8% 的患者在引入 VTE 风险筛查表之前进行了 VTE 风险评估。在 37 名被确定为需要药物预防的中度至高度 VTE 风险的患者中,70.3%(n = 26)的患者得到了适当的药物预防处方。引入风险筛查表后,共对 67 名产前、产后和妇科患者进行了研究。其中,32.8%(22 人)的患者正确填写了所有必填项。在使用表格时,26.9%(n = 7)的产后患者和 88%(n = 22)的妇科患者被评为中度或高度风险,并且所有患者都在 24 小时内接受了医疗审查。88%(n = 22)的妇科患者、43.8%(n = 7)的产前患者和 38.5%(n = 10)的产后患者需要药物预防,并且所有患者都得到了适当的处方。 指南审查和引入 VTE 风险筛查表对于指导 VTE 风险评估和识别需要预防的患者很有价值。
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引用次数: 0
Adherence to Infection Prevention Practice Standard Protocol and Associated Factors Among Healthcare Workers. 医护人员对《预防感染操作标准协议》的遵守情况及相关因素。
Pub Date : 2024-05-02 eCollection Date: 2024-05-01 DOI: 10.36401/JQSH-23-14
Getachew Ossabo Babore, Yaregal Eyesu, Daniel Mengistu, Sisay Foga, Asnakech Zekiwos Heliso, Taye Mezgebu Ashine

Introduction: Healthcare-associated infection affects more than 100 million patients annually. Healthcare workers' poor adherence to standard infection prevention and control procedures can result in many negative consequences, ranging from disability to death.

Methods: A facility-based, cross-sectional study was conducted in June 2021 among 379 healthcare workers selected using a stratified random sampling technique. All types of healthcare providers except pharmacy professionals were included in the study. Standardization and validation of the study tool were performed ahead of data collection. Multivariable regression was used to assess the variables associated with adherence.

Results: The study found that 60.2% of healthcare workers (95% CI, 55.1-65.2) had good adherence to infection prevention practices, and 68.7% and good knowledge of infection prevention practices. Training on infection prevention methods (adjusted odds ratio [AOR] = 1.68; 95% CI, 1.04-2.72), availability of water supply at hand washing station (AOR = 2.90; 95% CI, 1.62-5.31), and attitude toward infection prevention (AOR = 2.64; 95% CI, 1.65-4.24) were identified as predictors of adherence to infection prevention and control procedures.

Conclusion: More than half of the participants had good adherence to infection prevention guideline practices. In-service infection prevention training, a consistent water supply at the hand washing station, and a positive attitude of participants were associated with good adherence to infection prevention practices.

导言:每年有 1 亿多病人受到医疗相关感染的影响。医护人员不严格遵守标准的感染预防和控制程序会导致许多负面后果,从残疾到死亡不等:2021 年 6 月,我们采用分层随机抽样技术,对 379 名医护人员进行了一项基于医疗机构的横断面研究。除药学专业人员外,所有类型的医护人员均被纳入研究范围。在收集数据之前,对研究工具进行了标准化和验证。研究采用多变量回归法评估与依从性相关的变量:研究发现,60.2% 的医护人员(95% CI,55.1-65.2)对感染预防措施有良好的依从性,68.7% 的医护人员对感染预防措施有良好的了解。感染预防方法培训(调整赔率[AOR] = 1.68;95% CI,1.04-2.72)、洗手台供水(AOR = 2.90;95% CI,1.62-5.31)和对感染预防的态度(AOR = 2.64;95% CI,1.65-4.24)被认为是感染预防和控制程序依从性的预测因素:结论:一半以上的参与者都能很好地遵守感染预防指南的做法。在职感染预防培训、洗手站的持续供水以及参与者的积极态度都与良好遵守感染预防措施有关。
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引用次数: 0
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Global journal on quality and safety in healthcare
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