Health and Medical Administration Commons^™

Quality Improvement In Healthcare: A Practical Guide For Providers (Part 3), Jeremy Ellis

Transformative Medicine (T-Med)

No abstract provided.

Results Of A Needs Assessment: Use Of Sexual Orientation And Gender Identity Data In Health Systems In Maine, Lucy Soule, Melissa Fairfield, Sivana Barron, Natalie Kuhn, Brandy Brown

Journal of Maine Medical Center

Introduction: Lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) patients experience significantly more health care disparities than non-LGBTQ+ patients. Although sexual orientation and gender identity data (SOGI) would help quantify and track these known disparities, there are no standardized methods for routinely and consistently including SOGI into health care management in Maine. Our needs assessment (1) evaluates the comfort of health care professionals (HCPs) in collecting SOGI and incorporating it into the medical record and (2) identifies barriers to SOGI collection.

Methods: An interprofessional team conducted a survey of Maine HCPs who identified as working directly with patients or patient …

Evaluation Of A Community Based Teaching Hospital’S Geriatric Emergency Medicine Initiative, Josette Hartnett, Isabel Muronzi-Belfon, Suzanne J. Rose

Journal of Geriatric Emergency Medicine

INTRODUCTION: To accommodate the complex healthcare needs of the rising geriatric population, Stamford Hospital’s (SH) emergency department (ED) began a Geriatric Emergency Medicine Initiative (GEMI) in 2018 to improve our ED environment, practices, and focused assessments for our community-dwelling older adults.

METHODS: This retrospective program evaluation describes SH’s novel ED processes for at-risk older adults and compares GEMI and non-GEMI assessed patient outcomes using aggregate frequencies on throughput metrics such as length of stay (LOS), 72 hour and 30-day re-admission rates, and other outcomes of interest. Chi-square tests and group t-tests were used for all analyses with a p-value of …

Enhancing The Rates Of Advance Directive Documentation To Improve The Quality Of Patient Care, Sydney Sheppard, Katie Salyers, Carolyn Curtis, Adam Franks Franks, Courtney Wellman

Marshall Journal of Medicine

Introduction

Advance Directives (AD) allow patients to maintain autonomy during incapacitation. Patients and their caregivers benefit from these documents in times of crisis. Overcoming barriers to AD completion and documentation can improve patient care quality.

Methods

A retrospective chart review was performed initially, after consolidation of the electronic health record (EHR) and after alteration of the EHR, to evaluate the availability of a patient’s medical power of attorney (MPOA), living will (LW), and code status.

Results

Baseline documentation of MPOA (7.33%), LW (6.00%), and code status (5.33%) within the outpatient EHR was low. After 2 cycles, this improved to 13.10%, …

Quality Improvement In Healthcare: A Practical Guide For Providers, Jeremy Ellis

Transformative Medicine (T-Med)

No abstract provided.

Measuring Blood Pressure In Primary Care For Accurate Diagnosis And Decision Making: Implementing Evidence-Based Protocols Across A Health System, Gertrude W. Manchester, Deirdre C. Donahue, Catarina I. Kiefe, Lori Pelletier, Marie A. Sosa, Sheri A. Keitz

The Lahey Journal

Abstract

Background: Evidence-based blood pressure (BP) measurement is required for optimal clinical decision-making while improper measurement risks daily diagnostic and therapeutic errors.

Objective: To implement and sustain an evidence-based BP measurement protocol without extra resources and disseminate the protocol across a primary care network.

Design, Setting, and Participants: A Plan-Do-Study-Act (PDSA) framework for quality improvement was used to design a standardized BP measurement protocol including a 5-minute rest period only for patients with persistently elevated blood pressure. The protocol was developed using Goldratt’s Theory of Constraints and Layers of Resistance to ensure multidisciplinary buy-in and was implemented in 3 groups …

Retrospective Evaluation Of The Covid-19 Contact Tracing Program At The Maine Center For Disease Control And Prevention, Elisabeth Brewington Mha, Mph, Ben K. Greenfield Phd, Jessica Purser Phd

Journal of Maine Medical Center

Introduction: Despite the widespread use of contact tracing efforts throughout the COVID-19 pandemic, there are limited findings available about best practices and recommendations. The Maine Center for Disease Control and Prevention contracted staff to conduct COVID-19 contact tracing from August 2020 through February 2022. A retrospective evaluation of this program was conducted to share lessons learned with public health and health care leaders for future use.

Methods: Contracted contact tracing staff participated in facilitated discussions structured by the Strengths, Weaknesses, Opportunities, and Threats analysis framework. Three sessions were recorded and transcribed, and qualitative analysis through thematic review and evaluation coding …

Video Documentation As A Measure Of Written Documentation Accuracy In Emergency Medical Service Field Intubations, Christopher S. Keller, Christopher Dilger, Shih-Chin Chou, Rasheed Lawal, Shane Jenks

HCA Healthcare Journal of Medicine

Introduction

Quality improvement (QI) is a major focus of all departments and fields of health care, including emergency medical services. The chaotic and rapidly evolving atmosphere in which paramedics must practice can lead to inconsistency between what is documented and the actual events. This leads to difficulty when trying to evaluate the practitioners and when implementing a QI program. In this study, we evaluated the prevalence of discrepancy between the video and written record for Rapid Sequence Intubation (RSI) performed in the field as a demonstration of the utility of video documentation in QI.

Methods

We used a systematic retrospective …

Nurse-Initiated Treatment Reduces Costs For Acute Asthma In A Pediatric Emergency Department, Michael D. Johnson Md, Ms, Minkyoung Yoo Phd, Richard E. Nelson Phd, Amanda K. Nielson Md, Lauren Allen Mas, Nanette Dudley Md, Brandon Andersen Rrt, Amanda Orme Dnp, Cpnp-Ac, Cameron Mcfarland Np-C, Michael Mundorff Mba, Mhsa

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Standardized emergency department (ED) pathways can improve care delivery to children with acute asthma, though their impact on hospitalization and costs is unclear. An Acute Asthma Care Pathway (AACP) that facilitates nurse initiation of treatment was implemented at a tertiary care pediatric ED using standard quality improvement methodology. The impact of implementation was assessed using process control methodology and multivariable time series analyses between pre- and post-implementation periods. Provision of a steroid within 30 minutes and 60 minutes of arrival increased by 21 and 22 percentage points respectively, IV magnesium sulfate administration increased by 30 percentage points, the proportion hospitalized …

Outcomes Of Asthma Quality Improvement In Pediatric Patients, Kathryn M. Murray Md, Faap

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction. The Utah Pediatric Partnership to Improve Healthcare Quality (UPIQ) and Utah Department of Health (UDOH) Asthma Program Learning Collaborative is a quality improvement initiative designed to standardize asthma care in pediatric patients and improve the overall assessment and patient education process for both healthcare providers and patients. The aim of the Asthma QI Project was to improve the diagnosis and management of asthma for patients in the state of Utah by implementing a standardized approach to the identification and treatment of patients with asthma.

Methods. Patients scheduled to see a healthcare provider at our pediatric clinic were screened for …

Improving The Accuracy Of Interactive Voice Response (Ivr) Technology For Pediatric Experience Scores, Elizabeth Spaargaren Ms, Mph, Cpxp, Abigail Kozak Mba, Cpxp, Cara Herbener Cpxp, Barbara Lawlor Burke Ma, Cpxp

Patient Experience Journal

The increased use of interactive voice response (IVR) in assessing patient and family experience should be paired with evidence-based practices on how to obtain the most accurate information via this survey mode. We added a brief clarification sentence of the survey scale at the start of the IVR call to improve our experience data both qualitatively and quantitatively. Our setting was an urban pediatric hospital. We gathered lived experiences from our patients, families, and providers to understand and design a change to the IVR survey mode that would reduce survey inaccuracies. Outcome measures were assessed by baseline measurement and post-intervention …

Asking The Question ‘What Matters To You?’ In A London Intensive Care Unit, Harriet Pittaway, Laura White, Karen Turner, Angelique Mcgillivary

Journal of Patient-Centered Research and Reviews

Purpose: At the heart of the paradigm shift in approach to patient care from paternalism toward shared decision-making lies the international “What Matters To You?” (WMTY) movement. However, WMTY principles are not frequently applied to the critical care setting. The aim of this quality improvement project work was to design and integrate a tool for all patients admitted to the intensive care unit (ICU) that helped answer WMTY.

Methods: Using Plan-Do-Study-Act (PDSA) methodology across 8 cycles, a multidisciplinary team designed and integrated a bedside poster into the ICU. Quantitative and qualitative data were collected via a bedside audit process on …

Care Alert Program In Chronic Recurrent Ed Utilizing Patients, Kaitlyn Phelps, Jonathan Bryan, Jonathan Leggett, Erica Gibbons, Brian Griggs

HCA Healthcare Journal of Medicine

The Care Alert program is designed to help navigate encounters with patient populations that are high utilizers of emergency department (ED) resources. These populations often have chronic medical conditions, have a poor understanding of their conditions, are unfamiliar with the EDs’ role in the management of these conditions, and commonly lack outpatient resources. The Care Alert program intends to address the needs of this challenging patient population by designing individualized care plans that are approved through a multidisciplinary committee. Data from this study showed a 37% decrease in ED visits and a 47% decrease in hospitalizations during the initial 8 …

When Healthcare Leadership And Philanthropy Lead To An Improved Patient Experience: The Paul Lepsoe Music Initiative, Sara Olivier Rn Bscn Mn, Corianne Bell Ba Mus, Cheryl Jones Registered Psychotherapist, Mta, Phd, Jerry M. Maniate Md, M.Ed, Frcpc, Facp

Patient Experience Journal

Through an unprecedented collaboration between an academic acute tertiary care hospital (The Ottawa Hospital (TOH) and a community-based professional orchestra (Ottawa Symphony Orchestra (OSO), the Paul Lepsoe Music Initiative represented an innovative partnership focused on improving patient care via (a) the integration of live music in waiting areas of the hospital’s Cancer Center and (b) the creation of individualized music therapy interventions on the inpatient Palliative Care Unit. Patient, family, and volunteer/staff feedback further refined the intervention throughout the duration of the Initiative; a qualitative process that provided insight into the overall patient experience and opportunities for patients and families …

The Use Of Patient Experience Data For Quality Improvement In Hospitals: A Scoping Review, Lauren Cadel, Michelle Marcinow, Harprit Singh, Kerry Kuluski

Patient Experience Journal

In this paper we identified what was reported in the literature on qualitative and quantitative approaches used to capture and improve patient experiences in a hospital setting. For inclusion, articles were required to describe an embedded strategy for capturing patient experiences that was used to inform quality improvement in a hospital setting. Articles also had to be published in English between January 2004 and December 2020. Six databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Health and Psychosocial Instruments and Cochrane Library) and grey literature (relevant hospital and government websites) were searched. All articles were screened by two reviewers and any disagreements were …

Patient Reported Experience In A Radiation Oncology Department, Demetra Yannitsos, Petra Grendarova, Abdulla Al-Rashdan, Linda Watson, Wendy Smith, Fiona Lochray, Jackson Wu, Lisa Barbera

Patient Experience Journal

Understanding patient experience is essential to providing high quality, person-centered care. A real-time baseline cross-sectional study was completed to identify gaps in patient experience that can be targeted for quality improvement (QI). This study is part of PROSE (Person-centered Radiation Oncology Service Enhancement), a QI initiative developed to improve patient experience at a tertiary cancer centre Radiation Oncology (RO) Department. Data was collected using the Your Voice Matters (YVM) questionnaire. The YVM captures information on the patient’s last visit, and questions are organized based on dimensions of person-centered care. Recruitment occurred between May and August 2019 in the radiation department. …

Implementation Of A Drive-Through Covid-19 Mass Vaccination Site: Experiences From Louvax–Broadbent In Louisville, Kentucky, Ruth Carrico, Sarah Beth Hartlage, Valenchia Brown Msn, Aprn, Fnp-C, Sarah M. Bishop, Luanne Didelot, William Hayden, Beverly Williams Coleman, Sarah Tan, Delanor Manson, Kellie Kane, Dawn Balcom, Paul Kern

The University of Louisville Journal of Respiratory Infections

Background: Response to the COVID-19 pandemic has required innovative approaches to vaccination, including methods to rapidly and safely immunize communities. A major challenge to such a response involved access to untapped healthcare worker resources. The Louisville, Kentucky, response involved the use of a large volunteer workforce to supplement local public health employees in planning and implementing a large-scale drive-through vaccination event. The objective of this manuscript was to outline processes involved in training a mass immunization workforce and implementating a large-scale COVID-19 community vaccination.

Approach: Competency-based and standardized training was provided for every volunteer before working their shift. Volunteers worked …

Improving Cancer Screening Rates In Primary Care Via Practice Facilitation And Academic Detailing: A Multi-Pbrn Quality Improvement Project, Christopher P. Morley, Laura A. Schad, Laurene M. Tumiel-Berhalter, Laura A. Brady, Alexandrea Bentham, Karen Vitale, Amanda Norton, Gary Noronha, Carlos Swanger

Journal of Patient-Centered Research and Reviews

Purpose: In the United States, cancer screening rates are often below national targets. This project implemented practice facilitation and academic detailing aimed at increasing breast, cervical, and colorectal cancer screening rates in safety-net primary care practices.

Methods: Three practice-based research networks across western and central New York State partnered to provide quality improvement strategies on breast, cervical, and colorectal cancer screening. Pre/postintervention screening rates for all participating practices were collected annually, as were means across all practices over 7 years. Simple ordinary least squares linear regression was used to calculate the trend for each cancer type and test for statistical …

Increasing Breast, Cervical, And Colorectal Cancer Screenings: A Qualitative Assessment Of Barriers And Promoters In Safety-Net Practices, Laura A. Brady, Laurene M. Tumiel-Berhalter, Laura A. Schad, Alexandrea Bentham, Karen Vitale, Amanda Norton, Gary Noronha, Carlos Swanger, Christopher P. Morley

Journal of Patient-Centered Research and Reviews

Purpose: Breast, cervical, and colorectal cancer screening rates are suboptimal in underserved populations. A 7-year quality improvement (QI) project implemented academic detailing and practice facilitation in safety-net primary care practices to increase cancer screening rates. This manuscript assesses barriers and promoters.

Methods: Primary care practices providing care to underserved patients were recruited in New York cities Buffalo, Rochester, and Syracuse. Enrollment totaled 31 practices, with 12 practices participating throughout. Annually, each practice received 6 months of practice facilitation support for development and implementation of evidence-based interventions to increase screening rates for the three cancer types. At the end of each …

Improvement Cycles In Medical Education: From Quality Improvement To Patient Care And Clinical Research, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Building Patient Participation In Quality Of Care Through The Healthcare Stories Project: A Demonstration Program In New York State Hiv Clinics, Abigail Baim-Lance, Freda Coren, Margaret Brown, Hazel Lever, Daniel Tietz, Bruce Agins

Patient Experience Journal

There is growing recognition that patients should play a central role in defining, assessing, and improving the quality of healthcare, thereby enhancing patient experiences. Healthcare organizations struggle to meet these goals, which require becoming more patient-centered and patient-involved. The Healthcare Stories Project (HCSP), a demonstration program of the NYS Department of Health AIDS Institute, aimed to address this. HCSP comprises three, stepwise activities to: 1) Capture how patients define and experience ‘quality of care’ in the clinic; 2) Engage patients and providers as equal partners in understanding and improving the quality of care; and through partnerships, 3) Support the building …

Effect Of An Electronic Order Set On Newborn Hepatitis B Immunization Rates, Daniel Pedersen, Angelina Rodriguez, Olu Oyesanmi, Heather Schramm, Michael King

HCA Healthcare Journal of Medicine

Objective

Hepatitis B is an infectious deoxyribonucleic acid virus which can cause significant morbidity and mortality. There is no current definitive treatment, however in the United States immunization is widely available. A paper published by the Advisory Committee on Immunization Practices/Centers for Disease Control (ACIP/CDC) in 2018 made updated recommendations regarding vaccination practices in the United States. The most notable change made was that all healthy newborns weighing ≥2000 g with a negative hepatitis B-status mother should receive hepatitis B immunization within 24 hours of birth. This quality improvement project studied the effect of the electronic medical record newborn admission …

Patient Experience Rounds (Per): Real-Time Feedback To Improve The Patient Experience And Quality Of Care, Amber Moore, Caroline Moore, Lydia Bunker, Barbara Sarnoff

Patient Experience Journal

While patient feedback is critical to improving the patient experience and clinical care, we are currently limited in our ability to collect feedback in real-time from hospitalized patients. This paper describes our experience and outcomes implementing Patient Experience Rounds (PER). Our model uses trained former patients or family members as volunteers to collect feedback in real-time. Through this feedback, we were able to identify areas for improvement, make adjustments in the moment, and provide targeted feedback to providers. A total of 321 patient encounters were recorded by eight PER advisors. Nursing staff received the highest percentage of positive comments. 49% …

Enhancing Patient Involvement In Quality Improvement: How Complaint Managers See Their Roles And Limitations, Nathalie Clavel, Marie-Pascale Pomey

Patient Experience Journal

Patient involvement is a priority for healthcare organizations seeking to improve the quality of care and services. The contribution that complaint handling can make towards quality improvement has remained underexplored, while healthcare organizations are implementing strategies to effectively involve patients in quality improvement. We conducted a qualitative study to understand how complaint managers see their roles and limitations in enhancing patient involvement in quality improvement. A convenience sample of eleven complaint managers was selected from nine Canadian healthcare organizations with various annual volumes of complaints and situated in different settings (urban, rural, and semi-urban). The data were analyzed using a …

Exploring Peer Mentoring In Pediatric Transition: Perspectives Of Different Stakeholders About Accompanying Patients In Gastroenterology, Guillaume Dumais-Lévesque, Marie-Pascale Pomey

Patient Experience Journal

The literature identifies several issues in the pediatric transition, such as the lack of coordination between pediatric and adult settings and young patients who are not exercising independence in the self-management of their disease. The objective of this study is to explore the potential for a pediatric transition program in gastroenterology, introducing an accompanying patient program to support the transition. A qualitative case study was conducted, including semi-structured focus groups and individual interviews with each group involved in the pediatric transition between two centres in Quebec. A thematic analysis of the collected data was performed using QDA Miner v5.1. In …

Teleboard: The Move To A Virtual Family Advisory Board, Sheryl Chadwick, Deejo Miller, Kathryn Taff, Amanda Montalbano

Patient Experience Journal

Restrictions on in-person meetings were going to hamper the ability for the well-established Family Advisory Board (FAB) for our pediatric hospital to continue meeting unless a virtual meeting platform was introduced. The FAB was moved to a virtual platform for the April and May 2020 meetings. Attendance rates from family members and staff were measured and compared to the previous 14 in-person meetings. Contributions during the virtual meetings from each attendee type were recorded to analyze engagement during virtual meetings. There was no statistical difference in average attendance for virtual compared to in-person meetings, 75% versus 64.3% for family members …

Evaluation Of An Advanced Quality Improvement Program, Arjun M. Dangre Bds Mph, Angelo P. Giardino Md, Phd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Texas Children’s Hospital implemented the Advanced Quality Improvement and Patient Safety Program (AQI) in 2009, designed to train clinicians and staff to develop leaders in quality improvement to improve patient care, lower costs, change culture, and lead improvement initiatives at the organization. Evaluations of the AQI programs measured the program’s effectiveness in achieving its goals and objectives. This paper describes the Texas Children’s Hospital’s Advanced Quality Improvement and Patient Safety program (AQI,) the program’s evaluation processes, and show the results of the evaluation of the AQI programs using evaluation surveys completed by QI participants over the span of 13 successful …

“Anyone Can Co-Design?”: A Case Study Synthesis Of Six Experience-Based Co-Design (Ebcd) Projects For Healthcare Systems Improvement In New South Wales, Australia, Tara L. Dimopoulos-Bick, Claire O'Connor, Jane Montgomery, Tracey Szanto, Marion Fisher, Violeta Sutherland, Helen Baines, Phillip Orcher, John Stubbs, Lynne Maher, Raj Verma, Victoria J. Palmer

Patient Experience Journal

Experience-based co-design (EBCD) is a quality improvement approach that is being used internationally to bring service users and health professionals together to improve healthcare experiences, systems and processes. Early evaluations and case studies of EBCD have shown promise in terms of improvements to experience and organisational processes, however challenges remain in participation around shared power and decision making, mobilisation for implementation, sustainment of improvements and measurement of outcomes. The objective of this case study was to explore the emergent issues in EBCD participation and implementation in six quality improvement projects conducted in mental health, rehabilitation, blood and bone marrow transplant, …

Use Of Best Practice Alerts To Improve Adherence To Evidence-Based Screening In Pediatric Diabetes Care, Daniel Desalvo, Sara K. Bartz, Blair Mockler, Rona Y. Sonabend

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background: Youth with type 1 diabetes (T1D) are at increased risk for comorbid autoimmune conditions and long-term complications. To help with early identification of these complications, the American Diabetes Association (ADA) has published evidence-based screening guidelines. The aim of our quality improvement intervention was to improve and sustain adherence to the ADA recommended screening guidelines to >90% for youth with T1D in the Texas Children’s Hospital (TCH) Diabetes Center by utilizing best practice alerts (BPA) within the electronic medical record (EMR).

Methods: In accordance with the ADA Standards of Care screening guidelines for youth with T1D, we analyzed the database …

Peripheral Intravenous Infiltrates: Engaging Staff To Increase Reporting, Emily Weber, Kimberly Castrillon, Joyce Ramsey-Coleman

Journal of Nursing & Interprofessional Leadership in Quality & Safety

A large free standing children’s academic hospital aimed to improve patient safety and outcomes by decreasing the overall severity of peripheral intravenous infiltration and extravasations (PIVIEs). A care bundle was developed by creating a PIVIE measurement tool within the electronic medical record (EMR) and integrating the tool into standardized daily practice for nurses. The care bundle included creating a team of clinical leaders consisting of empowered bedside nurses acting as mobilized resources embedded into each unit. The initiative resulted in a large scale increase in reported PIVIEs system-wide within 1 month of education dissemination to bedside RN staff. The QI …