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"Quality improvement" driver

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https://www.readbyqxmd.com/read/29679047/a-quality-improvement-initiative-to-reduce-necrotizing-enterocolitis-across-hospital-systems
#1
Amy T Nathan, Laura Ward, Kurt Schibler, Laurel Moyer, Andrew South, Heather C Kaplan
OBJECTIVE: Necrotizing enterocolitis (NEC) is a devastating intestinal disease in premature infants. Local rates of NEC were unacceptably high. We hypothesized that utilizing quality improvement methodology to standardize care and apply evidence-based practices would reduce our rate of NEC. STUDY DESIGN: A multidisciplinary team used the model for improvement to prioritize interventions. Three neonatal intensive care units (NICUs) developed a standardized feeding protocol for very low birth weight (VLBW) infants, and employed strategies to increase the use of human milk, maximize intestinal perfusion, and promote a healthy microbiome...
April 20, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29643071/facilitating-the-timely-discharge-of-well-newborns-by-using-quality-improvement-methods
#2
Nicole T Rochester, Laurie P Banach, Wendy Hoffner, Deena Zeltser, Phyllis Lewis, Elizabeth Seelbach, Sandra Cuzzi
BACKGROUND AND OBJECTIVES: Discharges are a key driver of hospital throughput. Our pediatric hospitalist team sought to improve newborn nursery throughput by increasing the percentage of newborns on our service with a discharge order by 11 am. We hypothesized that implementing a discharge checklist would result in earlier discharge times for newborns who met discharge criteria. METHODS: We identified barriers to timely discharge through focus groups with key stakeholders, chart reviews, and brainstorming sessions...
April 11, 2018: Pediatrics
https://www.readbyqxmd.com/read/29601424/an-acuity-tool-for-heart-failure-case-management-quantifying-workload-service-utilization-and-disease-severity
#3
Matthew D Kilgore
PURPOSE: The cardiology service line director at a health maintenance organization (HMO) in Washington State required a valid, reliable, and practical means for measuring workloads and other productivity factors for six heart failure (HF) registered nurse case managers located across three geographical regions. The Kilgore Heart Failure Case Management (KHFCM) Acuity Tool was systematically designed, developed, and validated to measure workload as a dependent function of the number of heart failure case management (HFCM) services rendered and the duration of times spent on various care duties...
May 2018: Professional Case Management
https://www.readbyqxmd.com/read/29596822/impact-of-regional-collaboration-on-quality-improvement-and-associated-cost-savings-in-coronary-artery-bypass-grafting
#4
Jeffrey B Rich, Clifford E Fonner, Mohammed A Quader, Gorav Ailawadi, Alan M Speir
BACKGROUND: Prolonged ventilation and acute renal failure were identified as the biggest cost drivers following isolated CABG in a statewide database. Reducing these complications through regional collaboration should improve outcomes and lower healthcare costs. METHODS: 27,978 patients who underwent isolated CABG were divided into pre- and post-quality improvement initiative groups (early era, 2008-2011, n=15,176 and later era, 2012-2015, n=12,802). Focused learning sessions on prolonged ventilation (PV) and post-op renal failure (RF) were undertaken in the earlier era...
March 26, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29589983/a-quality-improvement-initiative-to-improve-feeding-and-growth-of-infants-with-cleft-lip-and-or-palate
#5
Adriane L Baylis, Gregory D Pearson, Courtney Hall, Lauren L Madhoun, Caitlin Cummings, Nancy Neal, Amanda Smith, Katherine Eastman, Christina Stocker, Richard E Kirschner
OBJECTIVE: The purpose of this quality improvement initiative was to improve feeding and growth outcomes in infants with cleft lip and/or palate (CL/P). DESIGN: Institute for Healthcare Improvement quality improvement model. SETTING: Large pediatric academic medical center in the Midwestern United States. PARTICIPANTS: One hundred forty-five infants with nonsyndromic CL/P ages 0 to 12 months. INTERVENTIONS: Key drivers included (1) caregiver education and resources, (2) care coordination and flow, and (3) provider education and training...
January 1, 2018: Cleft Palate-craniofacial Journal
https://www.readbyqxmd.com/read/29570048/key-drivers-of-patient-satisfaction-in-lumbar-spine-surgery
#6
Jay M Levin, Robert D Winkelman, Joseph E Tanenbaum, Edward C Benzel, Thomas E Mroz, Michael P Steinmetz
OBJECTIVE The Patient Experience of Care, composed of 9 dimensions derived from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, is being used by the Centers for Medicare & Medicaid Services to adjust hospital reimbursement. Currently, there are minimal data on how scores on the constituent HCAHPS items impact the global dimension of satisfaction, the Overall Hospital Rating (OHR). The purpose of this study was to determine the key drivers of overall patient satisfaction in the setting of inpatient lumbar spine surgery...
March 23, 2018: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/29559504/increasing-pcp-and-hospital-medicine-physician-verbal-communication-during-hospital-admissions
#7
Matthew W Zackoff, Camille Graham, Denise Warrick, Kathleen Pulda, Craig Gosdin, Blair Simpson, Jessica Marischen, Paul Bunch, Michael Vossmeyer, Grant M Mussman
OBJECTIVES: During hospital admission, communication between primary care physicians (PCPs) and hospital medicine (HM) physicians provides an opportunity for collaboration. Two-way communication facilitates collaboration by allowing the receiver to ask and respond to questions. At our institution, most HM-to-PCP communication occurred by telephone call after discharge. Our specific aim was to increase the percentage of patients for whom a telephone conversation occurred between HM and PCPs during hospital admission from 40% to >80%...
April 2018: Hospital Pediatrics
https://www.readbyqxmd.com/read/29504869/an-interdisciplinary-approach-to-improve-surgical-antimicrobial-prophylaxis
#8
Oisín Conaty, Leah Gaughan, Colum Downey, Noreen Carolan, Megan Joanne Brophy, Ruth Kavanagh, Deborah A A McNamara, Edmond Smyth, Karen Burns, Fidelma Fitzpatrick
Purpose The purpose of this paper is to improve surgical antimicrobial prophylaxis (SAP) prescribing in orthopaedic surgery using the model for improvement framework. Design/methodology/approach Orthopaedic patients receiving joint replacements, hip fracture repairs or open-reduction internal-fixation procedures were included. Antimicrobial(s); dose, time of administration and duration of SAP were evaluated for appropriateness based on the local SAP guidelines. After baseline data collection, a driver diagram was constructed with interventions devised for plan-do-study-act cycles...
March 12, 2018: International Journal of Health Care Quality Assurance
https://www.readbyqxmd.com/read/29453272/building-the-child-safety-collaborative-innovation-and-improvement-network-how-does-it-work-and-what-is-it-achieving
#9
Jennifer B Leonardo, Rebecca S Spicer, Maria Katradis, Jennifer Allison, Rebekah Thomas
OBJECTIVE: This study investigated whether the Child Safety Collaborative Innovation and Improvement Network (CS CoIIN) framework could be applied in the field of injury and violence prevention to reduce fatalities, hospitalizations and emergency department visits among 0-19 year olds. SAMPLE: Twenty-one states/jurisdictions were accepted into cohort 1 of the CS CoIIN, and 14 were engaged from March 2016 through April 2017. A quality improvement framework was used to test, implement and spread evidence-based change ideas (strategies and programs) in child passenger safety, falls prevention, interpersonal violence prevention, suicide and self-harm prevention and teen driver safety...
February 16, 2018: Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention
https://www.readbyqxmd.com/read/29329301/estimated-mortality-on-hiv-treatment-among-active-patients-and-patients-lost-to-follow-up-in-4-provinces-of-zambia-findings-from-a-multistage-sampling-based-survey
#10
Charles B Holmes, Izukanji Sikazwe, Kombatende Sikombe, Ingrid Eshun-Wilson, Nancy Czaicki, Laura K Beres, Njekwa Mukamba, Sandra Simbeza, Carolyn Bolton Moore, Cardinal Hantuba, Peter Mwaba, Caroline Phiri, Nancy Padian, David V Glidden, Elvin Geng
BACKGROUND: Survival represents the single most important indicator of successful HIV treatment. Routine monitoring fails to capture most deaths. As a result, both regional assessments of the impact of HIV services and identification of hotspots for improvement efforts are limited. We sought to assess true mortality on treatment, characterize the extent under-reporting of mortality in routine health information systems in Zambia, and identify drivers of mortality across sites and over time using a multistage, regionally representative sampling approach...
January 2018: PLoS Medicine
https://www.readbyqxmd.com/read/29251701/lower-emergency-general-surgery-egs-mortality-among-hospitals-with-higher-quality-trauma-care
#11
John W Scott, Thomas C Tsai, Pooja U Neiman, Gregory J Jurkovich, Garth H Utter, Adil H Haider, Ali Salim, Joaquim M Havens
BACKGROUND: Patients undergoing emergency general surgery (EGS) procedures are up to eight times more likely to die than patients undergoing the same procedures electively. This excess mortality is often attributed to nonmodifiable patient factors including comorbidities and physiologic derangements at presentation, leaving few targets for quality improvement. Although the hospital-level traits that contribute to EGS outcomes are not well understood, we hypothesized that facilities with lower trauma mortality would have lower EGS mortality...
March 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29192315/clinical-factors-associated-with-reoperation-and-prolonged-length-of-stay-in-free-tissue-transfer-to-oncologic-head-and-neck-defects
#12
William W Thomas, Jason Brant, Jinbo Chen, Orly Coblens, John P Fischer, Jason G Newman, Ara A Chalian, Rabie M Shanti, Steven B Cannady
Importance: Prolonged hospitalization and reoperation after free tissue transfer may be associated with certain clinical factors. Objective: To determine patient and surgical factors associated with length of stay (LOS) and reoperation following surgical procedures for malignant neoplasm of the head and neck involving microvascular free tissue transfer reconstruction. Design, Setting, and Participants: This was a retrospective review of American College of Surgeons National Surgical Quality Improvement Program data from 2012 to 2014 using International Classification of Diseases, Ninth Revision (ICD-9), codes for malignant neoplasms of the head and neck...
November 30, 2017: JAMA Facial Plastic Surgery
https://www.readbyqxmd.com/read/29162345/postacute-care-after-pediatric-hospitalizations-for-a-primary-mental-health-condition
#13
James C Gay, Bonnie T Zima, Tumaini R Coker, Stephanie K Doupnik, Matthew Hall, Jonathan Rodean, Margaret O'Neill, Rustin Morse, Kris P Rehm, Jay G Berry, Naomi S Bardach
OBJECTIVES: To determine the proportion of US children hospitalized for a primary mental health condition who are discharged to postacute care (PAC); whether PAC discharge is associated with demographic, clinical, and hospital characteristics; and whether PAC use varies by state. STUDY DESIGN: Retrospective cohort study of a nationally representative sample of US acute care hospitalizations for children ages 2-20 years with a primary mental health diagnosis, using the 2009 and 2012 Kids' Inpatient Databases...
November 18, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29144047/evaluation-of-patient-satisfaction-in-pediatric-dermatology
#14
Sarah Ahmed, Jonathan Miller, James F Burrows, Ben Khallouq Bertha, Paul Rosen
BACKGROUND/OBJECTIVES: There remains a lack of investigation into which factors patients and families value the most in their experience at pediatric dermatology clinics. Most of the current literature on quality improvement in dermatology does not encompass the pediatric population. To determine the drivers that are most predictive of a positive patient experience, we observed the indirect relationship between several factors of the patient experience and their role in patient satisfaction...
November 2017: Pediatric Dermatology
https://www.readbyqxmd.com/read/29093967/a-multisite-study-of-performance-drivers-among-institutional-review-boards
#15
Michael Caligiuri, Karen Allen, Nate Buscher, Lisa Denney, Cynthia Gates, Kip Kantelo, Anthony Magit, Rachael Sak, Gary S Firestein, John Fontanesi
Introduction: The time required to obtain Institutional Review Board (IRB) approval is a frequent subject of efforts to reduce unnecessary delays in initiating clinical trials. This study was conducted by and for IRB directors to better understand factors affecting approval times as a first step in developing a quality improvement framework. Methods: 807 IRB-approved clinical trials from 5 University of California campuses were analyzed to identify operational and clinical trial characteristics influencing IRB approval times...
June 2017: Journal of Clinical and Translational Science
https://www.readbyqxmd.com/read/29045256/a-quality-improvement-initiative-to-increase-scoring-consistency-and-accuracy-of-the-finnegan-tool-challenges-in-obtaining-reliable-assessments-of-drug-withdrawal-in-neonatal-abstinence-syndrome
#16
Wendy Timpson, Cheryl Killoran, Louise Maranda, Alan Picarillo, Elisabeth Bloch-Salisbury
BACKGROUND: Current practice for diagnosing neonatal abstinence syndrome and guiding pharmacological management of neonatal drug withdrawal is dependent on nursing assessments and repeated evaluation of clinical signs. PURPOSE: This single-center quality improvement initiative was designed to improve accuracy and consistency of Finnegan scores among neonatal nurses. METHODS: One-hundred seventy neonatal nurses participated in a single-session withdrawal-assessment program that incorporated education, scoring guidelines, and a restructured Finnegan scale...
February 2018: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/29043947/outpatient-continuing-care-after-residential-substance-use-disorder-treatment-in-the-us-veterans-health-administration-facilitators-and-challenges
#17
Anna D Rubinsky, Laura S Ellerbe, Shalini Gupta, Tyler E Phelps, Thomas Bowe, Jennifer L Burden, Alex H S Harris
BACKGROUND: In the U.S. Veterans Health Administration (VHA), residential treatment programs are an important part of the continuum of care for patients with substance use disorders (SUDs). Outpatient continuing care after residential treatment helps maintain early recovery and treatment gains. Knowing more about the drivers of variation in continuing care practices and performance across residential programs might inform quality improvement efforts. METHODS: Metrics of continuing care were operationalized and calculated for each of VHA's 63 SUD Residential Rehabilitation Treatment Programs (SUD RRTPs) and 34 Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs) with a SUD track in fiscal year 2012...
October 18, 2017: Substance Abuse
https://www.readbyqxmd.com/read/28974584/regular-and-frequent-feedback-of-specific-clinical-criteria-delivers-a-sustained-improvement-in-the-management-of-diabetic-ketoacidosis
#18
Punith Kempegowda, Ben Coombs, Peter Nightingale, Joht Singh Chandan, Jaffar Al-Sheikhli, Bhavana Shyamanur, Kasun Theivendran, Anitha Vijayan Melapatte, Umesh Salanke, Mohammed Akber, Sandip Ghosh, Parth Narendran
Efficient management of diabetic ketoacidosis (DKA) improves outcomes and reduces length of stay. While clinical audit improves the management of DKA, significant and sustained improvement is often difficult to achieve. We aimed to improve the management of DKA in our trust through the implementation of quality improvement methodology. Five specific targets (primary drivers: fluid prescription, fixed rate intravenous insulin infusion, glucose measurement, ketone measurement and specialist referral) were selected following a baseline audit...
October 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28967954/deviation-management-key-management-subsystem-driver-of-knowledge-based-continuous-improvement-in-the-henry-ford-production-system
#19
Richard J Zarbo, Jacqueline R Copeland, Ruan C Varney
Objectives: To develop a business subsystem fulfilling International Organization for Standardization 15189 nonconformance management regulatory standard, facilitating employee engagement in problem identification and resolution to effect quality improvement and risk mitigation. Methods: From 2012 to 2016, the integrated laboratories of the Henry Ford Health System used a quality technical team to develop and improve a management subsystem designed to identify, track, trend, and summarize nonconformances based on frequency, risk, and root cause for elimination at the level of the work...
October 1, 2017: American Journal of Clinical Pathology
https://www.readbyqxmd.com/read/28912950/quality-improvement-regarding-handoff
#20
Scott Studeny, Lauren Burley, Kelsey Cowen, Melanie Akers, Kelly O'Neill, Susan L Flesher
BACKGROUND AND OBJECTIVES: Previous studies have emphasized the importance of effectual communication during patient handoffs. The objectives of this study were to (1) implement a resident-driven quality improvement project to improve handoffs by including key elements that are necessary for a safe and effective handoff. We chose to use the IPASS (illness severity, patient summary, action items, situation awareness and contingency planning, synthesis by receiver) mnemonic as our standardized handoff model; (2) Consider balancing measures in an effort to be aware of any negative effects of our interventions on resident satisfaction with the system...
2017: SAGE Open Medicine
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