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

Continual evaluation of institutional policies and systems can lead to better customer service and organizational success through TQM.

Managed care is, in reality, managed payment delivered through exclusive price-competitive contracts that require healthcare providers to reorganize to participate as equals in the division of premium dollars.

Purpose: A multidisciplinary project was undertaken at The New York Hospital-Cornell Medical Center to develop critical pathways for open-heart surgery to help reduce cost, shorten hospital length of stay (LOS), and streamline patient care.

Methods: A critical pathway for elective coronary artery bypass grafting instituted on March 1, 1995, was developed through a cooperative effort involving surgeons, anesthesiologists, nurses, social workers, physical therapists, nutritionists, and patient case managers. Prospective data collected on consecutive patients forming a critical pathway group (n = 114) over a 6-month period were compared with retrospective data on consecutive patients forming a cohort group (n = 382) who underwent elective coronary artery bypass grafting in 1994.

Results: The critical pathway group of patients experienced a significantly shorter total hospital LOS (7.7 +/- 2.3 days vs 11.1 +/- 6 days, p < 0.0001) and shorter intensive care unit LOS (1.5 +/- 0.9 days vs 2.0 +/- 2.8 days, p < 0.0001). Direct costs were computed by use of hospital charges multiplied by the Medicare cost-to-charge ratio. Mean hospital direct cost (ancillary resources) was $1181 lower in the critical pathway group when compared with the control group (p < 0.0001). The postoperative mortality and readmission rates were similar for the two groups of patients.

Conclusions: The ongoing analysis of cost, LOSs, and outcomes has made possible a process of continuous quality improvement on the cardiothoracic service in which further areas for improvement are identified and studied. The use of a critical pathway for elective coronary artery bypass grafting at our institution significantly reduced hospital LOS and direct costs while maintaining the overall quality of patient care.

Physicians need to be involved in organizational decision making, and institutional goals are achieved through the integration of operational quality committees.

Background: The authors served as external consultants to an academic health science center in the eastern United States to identify current and future space needs in response to reported deficiencies, especially in the medical school. This work established a framework to identify, prioritize, and plan future facility and space improvement projects.

Methods: The authors used several methods to quantify and profile current space needs and future space requirements, including data and plan reviews, surveys and questionnaires, and on-site facility tours and inspections. Most important, the consultants brought their collective experience as well as their proprietary planning database and guidelines to formulate findings and develop practical recommendations.

Results: The engagement substantiated faculty's concerns and perceptions that additional space was necessary for many existing programs, especially the medical school. However, specific space needs, by department or program, frequently differed from faculty's perceived needs as well as those of the university administration.

Conclusions: Several important conclusions dealt with the client's need to develop and formalize the space planning and management process. Appropriate guidelines for space planning purposes for this academic health science center also were identified as were the "next steps" to build on this successful study.

Healthcare organizations can avoid many commonly encountered obstacles to benchmarking. Avoiding them requires attention to organization, content area and methodologic factors.