Journal for healthcare quality : official publication of the National Association for Healthcare Quality
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Dr. David Nash, founder of the original Office of Health Policy in 1990 at Thomas Jefferson University and later the Founding Dean of the Jefferson School of Population Health, is known for his emphasis on measurement and variation in Medical Education. His knowledge and understanding of healthcare policy make this interview timely and relevant.
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Sepsis is recognized as an often-lethal disease. Recommended guidelines are complex and time sensitive. Response teams (RTs) have demonstrated success in implementation of quality initiatives. The purpose of this study was to evaluate variations in noncompliance with recommended sepsis guidelines overall and between a sepsis-focused RT and standard care. ⋯ Noncompliance is more complex than simple failure to initiate, especially in time-dependent therapies. The development and education of an RT demonstrates improvement in application of sepsis-focused therapies over standard care.
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This was an evaluation of the efforts of five hospitals that participated in a collaborative aimed at improving patient flow and reducing emergency department (ED) crowding. Interviews with hospital implementation team members were conducted at two separate times, and multivariate linear regression models and bivariate logistic models were constructed to assess changes in ED length of stay (LOS) and left without being seen (LWBS). ⋯ Those hospitals experienced modest improvements in patient flow: a hospital that implemented front-end improvements and devoted additional resources to fast track had a 51-min reduction in ED LOS, another that implemented only front-end improvements had a 9-min reduction in LOS, a third hospital that improved communication between the ED and inpatient units to facilitate admissions decreased LWBS from 0.6% to 0.4%, and a fourth hospital reduced LOS by 59 min for mid-acuity patients by establishing a new care process for them. Results suggest that relatively small changes may lead to improvements in measures of patient flow that are modest, at best.
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Pediatric patients with chronic disease are at risk for cardiopulmonary arrest (CPA). Outcomes of CPA are improved if prompt quality cardiopulmonary resuscitation (CPR) is performed. This study examined the efficacy of the CPR Anytime™ Kit as a standardized method of CPR discharge training to families of high-risk children. ⋯ A total of 82% of subjects reviewed the video at least once after discharge, and 79% of subjects shared the kit with at least two other family members or friends. A total of 72 of 74 nurses (97% ) surveyed were either "satisfied" or "very satisfied" with the program. Provision of the CPR Anytime Kit™ to families of high-risk pediatric patients prior to discharge leads to sustained levels of CPR knowledge and confidence.