Best practices and benchmarking in healthcare : a practical journal for clinical and management application最新文献

Background: Early rehospitalization after coronary artery bypass grafting (CABG) is an expensive and frequently adverse outcome. Rehospitalization rates after various surgical procedures have been used as an indicator of quality of care. Determining the extent to which rehospitalization rates reflect patient case mix and severity of illness rather than quality of care requires detailed information regarding the patients, the care they received, and the reasons for their rehospitalization.

Methods: We conducted a nested case control study comparing 110 CABG patients who were rehospitalized within 30 days after discharge with 224 control patients. Control patients were randomly selected from patients undergoing CABG during the same time frame as the cases and were matched on age, gender, and priority of surgery. A detailed chart review provided information regarding treatment in the postsurgical period, in addition to the preoperative information collected on all CABG patients as part of an ongoing regional prospective study.

Results: The overall rehospitalization rate was 13.8%. The most common reasons for rehospitalization included: wound infection (19%), atrial fibrillation (13%), pleural effusion (11%), and thromboembolic event (10%). Preoperative severity of illness and comorbidity accounted for 24% of the total variance. After adjustment for these factors, discharge hematocrit less than 30% (OR = 2.01, p = 0.018) and several discharge medications including: antiarrhythmics (OR = 3.26, p = 0.047), diuretics (OR = 2.18, p = 0.055), beta blockers (OR = 0.44, p = 0.036), and long length of stay (more than 7 days; OR = 2.09, p = 0.029) were the most important predictors of rehospitalization risk.

Conclusions: Although the reasons for rehospitalization after CABG are heterogeneous and related to patient severity of illness as well as comorbid status, several of the most common are potentially preventable and related to quality of care. Rehospitalization was not related to early discharge.

Asking the patient is a critical step-but the format of a patient satisfaction survey has a significant impact on your perceptions. Design it carefully.

As the industry becomes more competitive, many hospitals and other healthcare companies are turning to benchmarking to help them make appropriate changes to their organizations. Benchmarking allows companies to identify "best practices" and make process comparisons with other organizations. The University of Cincinnati Hospital is one example of a hospital that has effectively used benchmarking for process improvement.

Liability exposures may occur from the development, implementation, or misuse of benchmarks. Identifying and rectifying risk-prone practices can have a salutary effect on limiting such liability exposures.

The role of clinical guidelines in malpractice litigation has been controversial. The primary purpose of guidelines as a quality improvement tool must be sustained, and applications of guidelines beyond this purpose must be done carefully, with full recognition of inherent limitations.

In recent years, there have been a proliferation of physician-hospital organizations (PHOs) in the medical community across the country. To date, many of them have been ineffective with unproven track records. This article will explore some of the benchmarks of successful PHOs.

Providers of subacute care are now faced with the reality of demonstrating their claims that they offer cost-effective programs. Developing internal standards or guidelines from an organizational and clinical perspective can help to assure and validate quality service delivery.

A practical application of a neurology case management healthcare delivery mode results in increased access to specialty providers, shorter follow-up periods, and improved continuity of medical care. The program described in the following sections was developed at a naval hospital for the ongoing evaluation of therapeutic schemes to optimize headache therapy and, 1 year after implementation, shows improvement in patient outcomes and resource use.

Background: Assuring that medication administration error (MAE) reports are reliable and valid is of great significance for the patient, the hospital, and the nurse. In most hospitals, MAE reporting relies on the nurse who discovers an error to initiate an error report, whether the error was committed by that nurse or someone else. Because of the potential for negative consequences, there may be significant disincentives for the nurse to report the error. This, the first of two articles, describes the results of a large-scale survey designed to assess nurses' perceptions of the reasons why MAE may not be reported. The companion article compares nurses' estimates of the extent to which MAEs are reported with the actual reported medication error rates.

Methods: Nurses in 24 acute-care hospitals were surveyed to determine perceptions of reasons why medication errors may not be reported.

Results: The factor analysis reveals four factors explaining why staff nurses may not report medication errors: fear, disagreement over whether an error occurred, administrative responses to medication errors, and effort required to report MAEs.

Conclusions: There are potential changes in both systems and management responses to MAEs that could improve current practice. These changes need to take into account the influences of organizational, professional, and work group culture.