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https://www.readbyqxmd.com/read/27933147/large-scale-implementation-of-a-medicines-reconciliation-care-bundle-in-nhs-ggc-gp-practices
#1
Rachel Bruce
Medicines reconciliation (MR) is an essential process for patient safety, promoting safer use of medicines with effective communication at the interface, particularly when patients are admitted and discharged from hospital. Much of the work on MR has been focussed in secondary care, however, the principles are equally important in primary care. The aim of the work was to test the Scottish Patient Safety in Primary Care (SPSP-PC) MR care bundle and consider scale up and spread across all NHS Greater Glasgow and Clyde (NHS GGC) GP practices...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27928414/leber-hereditary-optic-neuropathy-with-interval-of-visual-loss-greater-than-12-months
#2
Renata Cristina Ferreira Prado, Frederico Castelo Moura
A 28-year-old man presented with severe left visual loss and normal right visual acuity. The left fundus examination showed temporal pallor and complete absence of the nerve fibre layer (NFL) of papillomacular bundle. Right fundus examination showed focal loss of inferotemporal NFL. Magnetic resonance and serum aquaporin-4 antibody were negative. After 14 months of the initial visual involvement, the patient suffered subacute visual loss in contralateral eye. Genetic study revealed the 11778 point mitochondrial DNA (mtDNA) mutation associated with Leber hereditary optic neuropathy (LHON)...
October 2016: Neuro-ophthalmology
https://www.readbyqxmd.com/read/27926675/improvement-in-total-joint-replacement-quality-metrics-year-one-versus-year-three-of-the-bundled-payments-for-care-improvement-initiative
#3
John M Dundon, Joseph Bosco, James Slover, Stephen Yu, Yousuf Sayeed, Richard Iorio
BACKGROUND: In January 2013, a large, tertiary, urban academic medical center began participation in the Bundled Payments for Care Improvement (BPCI) initiative for total joint arthroplasty, a program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011. Medicare Severity-Diagnosis Related Groups (MS-DRGs) 469 and 470 were included. We participated in BPCI Model 2, by which an episode of care includes the inpatient and all post-acute care costs through 90 days following discharge...
December 7, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27926634/consensus-bundle-on-prevention-of-surgical-site-infections-after-major-gynecologic-surgery
#4
Joseph E Pellegrini, Paloma Toledo, David E Soper, William C Bradford, Deborah A Cruz, Barbara S Levy, Lauren A Lemieux
Surgical site infections are the most common complication of surgery in the United States. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effort to reduce the incidence of surgical site infection...
December 2, 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27924201/central-line-associated-bloodstream-infections-in-the-intensive-care-unit-importance-of-the-care-bundle
#5
Aynur Atilla, Zahide Doğanay, Hale Kefeli Çelik, Leman Tomak, Özgür Günal, S Sırrı Kılıç
BACKGROUND: The importance and efficacy of a care bundle for preventing central line-associated bloodstream infections (CLABSIs) and infectious complications related to placing a central venous catheter (CVC) in patients in the intensive care unit (ICU). METHODS: A care bundle was implemented from July 2013 to June 2014 in a medical ICU and surgical ICU. Data were divided into three periods: the prior period (July 2012-June 2013), the intervention period (July 2013-June 2014; first and second periods), and the post-intervention period (July 2014-December 2014; third period)...
December 2016: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/27923418/outbreak-of-klebsiella-pneumoniae-carbapenemase-producing-citrobacter-freundii-at-a-tertiary-acute-care-facility-in-miami-florida
#6
Adriana Jiménez, José G Castro, L Silvia Munoz-Price, Dennise de Pascale, Luis Shimose, Mustapha M Mustapha, Caressa N Spychala, Roberta T Mettus, Vaughn S Cooper, Yohei Doi
OBJECTIVE To describe the investigation and control of a rare cluster of Klebsiella pneumoniae carbapenemase-producing Citrobacter freundii in a hospital in southern Florida. METHODS An epidemiologic investigation, review of infection prevention procedures, and molecular studies including whole genome sequencing were conducted. RESULTS An outbreak of K. pneumoniae carbapenemase-3-producing C. freundii was identified at a tertiary hospital in Florida in 2014. Of the 6 cases identified, 3 occurred in the same intensive care unit and were caused by the same clone...
December 7, 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27922870/quality-and-safety-in-health-care-part-xx-goal-directed-fluid-therapy-and-the-universal-protocol
#7
Jay A Harolds
There have been numerous initiatives to improve quality and safety in surgery. Goal-directed fluid therapy and a quality bundle for emergency laparotomy surgery are two of them. The establishment of a Universal Protocol to prevent the wrong procedure, the wrong patient having a procedure, or the wrong site for a procedure is an important safeguard for patients.
December 3, 2016: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/27922866/quality-and-safety-in-health-care-part-xix-variants-of-the-eras-program
#8
Jay A Harolds
The integrated recovery pathway is a variant of the enhanced recovery pathway after surgery program, which saw a further decrease in complications and mean length of stay after a change in culture was instituted with more accountability of the staff to following the pathway. This was accomplished using a team-based comprehensive unit-based safety program. It has also been found that another variant of the enhanced recovery pathway after surgery program had a further improvement of patient outcomes after instituting a "preventive surgical site infection bundle...
December 3, 2016: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/27919450/development-and-validation-of-a-prediction-model-for-patients-discharged-to-post-acute-care-after-colorectal-cancer-surgery
#9
Elizabeth A Bailey, Rebecca L Hoffman, Christopher Wirtalla, Giorgos Karakousis, Rachel R Kelz
BACKGROUND: As payment shifts toward bundled reimbursement, decreasing unnecessary inpatient care may provide cost savings. This study examines the association between discharge status, hospital duration of stay, and cost for colorectal operation patients without complications and uses risk factors to predict the need for post-acute care. METHODS: We used the New York Statewide Planning and Research Cooperative System and the California Healthcare Cost and Utilization Project State Inpatient Databases to identify all patients who underwent operative resection for colorectal cancer in 2009-2010 and were discharged to home or post-acute care...
December 2, 2016: Surgery
https://www.readbyqxmd.com/read/27918335/consensus-bundle-on-prevention-of-surgical-site-infections-after-major-gynecologic-surgery
#10
Joseph E Pellegrini, Paloma Toledo, David E Soper, William C Bradford, Deborah A Cruz, Barbara S Levy, Lauren A Lemieux
Surgical site infections are the most common complication of surgery in the United States. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effort to reduce the incidence of surgical site infection...
December 1, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27917479/hospital-postacute-care-referral-networks-is-referral-concentration-associated-with-medicare-style-bundled-payments
#11
Ramandeep Kaur, Jennifer N Perloff, Christopher Tompkins, Christine E Bishop
OBJECTIVE: To evaluate whether Medicare-style bundled payments are lower or higher for beneficiaries discharged from hospitals with postacute care (PAC) referrals concentrated among fewer PAC providers. DATA SOURCE: Medicare Part A and Part B claim (2008-2012) for all beneficiaries residing in any of 17 market areas: the Provider of Service file, the Healthcare Cost Report Information System, and the Dartmouth Atlas. STUDY DESIGN: An observational study in which hospitals were distinguished according to PAC referral concentration, which is the tendency to utilize fewer rather than more PAC providers...
December 5, 2016: Health Services Research
https://www.readbyqxmd.com/read/27911972/integrating-behavioral-health-into-pediatric-primary-care-implications-for-provider-time-and-cost
#12
Natasha Gouge, Jodi Polaha, Rachel Rogers, Amy Harden
OBJECTIVES: Integrating a behavioral health consultant (BHC) into primary care is associated with improved patient outcomes, fewer medical visits, and increased provider satisfaction; however, few studies have evaluated the feasibility of this model from an operations perspective. Specifically, time and cost have been identified as barriers to implementation. Our study aimed to examine time spent, patient volume, and revenue generated during days when the on-site BHC was available compared with days when the consultant was not...
December 2016: Southern Medical Journal
https://www.readbyqxmd.com/read/27908954/chlorhexidine-impregnated-dressings-and-prevention-of-catheter-associated-bloodstream-infections-in-a-pediatric-intensive-care-unit
#13
Duygu Sönmez Düzkaya, Nejla Canbulat Sahiner, Gülzade Uysal, Tülay Yakut, Agop Çitak
BACKGROUND: Bloodstream infections related to use of catheters are associated with increased morbidity and mortality rates, prolonged hospital lengths of stay, and increased medical costs. OBJECTIVES: To compare the effectiveness of chlorhexidine-impregnated dressings with that of standard dressings in preventing catheter-related bloodstream infections. METHODS: A total of 100 children were randomly divided into 2 groups of 50 each: a chlorhexidine group and a standard group...
December 2016: Critical Care Nurse
https://www.readbyqxmd.com/read/27908335/the-past-present-and-future-of-the-centers-for-medicare-and-medicaid-services-quality-measure-sep-1-the-early-management-bundle-for-severe-sepsis-septic-shock
#14
REVIEW
Jeremy S Faust, Scott D Weingart
SEP-1, the new national quality measure on sepsis, resulted from an undertaking to standardize care for severe sepsis and septic shock regardless of the size of the emergency department where the patient is being treated. SEP-1 does not necessarily follow the best current evidence available. Nevertheless, a thorough understanding of SEP-1 is crucial because all hospitals and emergency providers will be accountable for meeting the requirements of this measure. SEP-1 is the first national quality measure on early management of sepsis care...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27907964/critical-care-neurology-perspective-on-delirium
#15
Matthew B Maas, Andrew M Naidech
The evidence linking delirium to poor outcomes after critical illness is compelling, including higher mortality, prolonged mechanical ventilation, longer length of intensive care unit stay, and long-term cognitive impairments. The attitude toward delirium in the neurologic community is shifting away from viewing it as an unmodifiable, inevitable consequence of severe illness to treating it is as a neurologic emergency, akin to seizures or encephalitis. Delirium, like other manifestations of critical illness encephalopathy, is an organ dysfunction syndrome...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907062/sepsis-prevalence-and-outcome-on-the-general-wards-and-emergency-departments-in-wales-results-of-a-multi-centre-observational-point-prevalence-study
#16
Tamas Szakmany, Robert M Lundin, Ben Sharif, Gemma Ellis, Paul Morgan, Maja Kopczynska, Amrit Dhadda, Charlotte Mann, Danielle Donoghue, Sarah Rollason, Emma Brownlow, Francesca Hill, Grace Carr, Hannah Turley, James Hassall, James Lloyd, Llywela Davies, Michael Atkinson, Molly Jones, Nerys Jones, Rhodri Martin, Yousef Ibrahim, Judith E Hall
Data on sepsis prevalence on the general wards is lacking on the UK and in the developed world. We conducted a multicentre, prospective, observational study of the prevalence of patients with sepsis or severe sepsis on the general wards and Emergency Departments (ED) in Wales. During the 24-hour study period all patients with NEWS≥3 were screened for presence of 2 or more SIRS criteria. To be eligible for inclusion, patients had to have a high clinical suspicion of an infection, together with a systemic inflammatory response (sepsis) and evidence of acute organ dysfunction and/or shock (severe sepsis)...
2016: PloS One
https://www.readbyqxmd.com/read/27906760/improving-the-quality-of-ward-based-surgical-care-with-a-human-factors-intervention-bundle
#17
Maximilian J Johnston, Sonal Arora, Dominic King, Ara Darzi
OBJECTIVE: This study aimed to explore the impact of a human factors intervention bundle on the quality of ward-based surgical care in a UK hospital. SUMMARY OF BACKGROUND DATA: Improving the culture of a surgical team is a difficult task. Engagement with stakeholders before intervention is key. Studies have shown that appropriate supervision can enhance surgical ward safety. METHODS: A pre-post intervention study was conducted. The intervention bundle consisted of twice-daily attending ward rounds, a "chief resident of the week" available at all times on the ward, an escalation of care protocol and team contact cards...
November 30, 2016: Annals of Surgery
https://www.readbyqxmd.com/read/27895528/nurses-perceptions-of-a-pressure-ulcer-prevention-care-bundle-a-qualitative-descriptive-study
#18
Shelley Roberts, Elizabeth McInnes, Marianne Wallis, Tracey Bucknall, Merrilyn Banks, Wendy Chaboyer
BACKGROUND: Pressure ulcer prevention is a critical patient safety indicator for acute care hospitals. An innovative pressure ulcer prevention care bundle targeting patient participation in their care was recently tested in a cluster randomised trial in eight Australian hospitals. Understanding nurses' perspectives of such an intervention is imperative when interpreting results and translating evidence into practice. As part of a process evaluation for the main trial, this study assessed nurses' perceptions of the usefulness and impact of a pressure ulcer prevention care bundle intervention on clinical practice...
2016: BMC Nursing
https://www.readbyqxmd.com/read/27893504/accurate-identification-of-infection-source-in-burn-trauma-patients-with-central-line-infection-to-determine-appropriate-treatment-option-as-well-as-proper-public-reporting
#19
Holly M Hampe, Lisa Graper, Kathy Hayes-Leight, Deborah Olszewski, Matthew Moffa, Derek N Bremmer
With the advent of the Patient Safety Movement in the late 1990s and the CMS (Centers for Medicare & Medicaid Services) nonreimbursement program for never events, there has been much focus on the prevention and accurate identification of health care-associated infections such as central line-associated bloodstream infections (CLABSIs). There has certainly been a national effort to decrease the occurrence of these infections. With the implementation of patient safety initiatives such as the central line prevention bundle, there has been a considerable reduction in the number of CLABSIs except for patients with burn trauma...
January 2017: Critical Care Nursing Quarterly
https://www.readbyqxmd.com/read/27890309/patterns-of-ninety-day-readmissions-following-total-joint-replacement-in-a-bundled-payment-initiative
#20
Omar A Behery, Benjamin S Kester, Jarrett Williams, Joseph A Bosco, James D Slover, Richard Iorio, Ran Schwarzkopf
BACKGROUND: Alternative payment models aim to improve quality and decrease costs associated with total joint replacement. Postoperative readmissions within 90 days are of interest to clinicians and administrators as there is no additional reimbursement beyond the episode bundled payment target price. The aim of this study is to improve the understanding of the patterns of readmission which would better guide perioperative patient management affecting readmissions. We hypothesize that readmissions have different timing, location, and patient health profile patterns based on whether the readmission is related to a medical or surgical diagnosis...
November 1, 2016: Journal of Arthroplasty
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