Journal for healthcare quality : official publication of the National Association for Healthcare Quality
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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.
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Dr. Verna Gibbs describes the "NoThing Left Behind" Program designed to eliminate retained devices from surgical procedures. She explains the genesis of the program along with adjuncts to counting including computer-assisted sponge count, radiofrequency detection system, radiofrequency identification system, and the Sponge ACCOUNTing system. She provides comments on the use of these adjuncts with responses on their effectiveness on improving safety.
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It is often difficult to maintain quality improvement change. Many behavioral strategies have been used to improve uptake of new practices and knowledge. One effective way of changing medication prescribing is audit and feedback with specific educational feedback. ⋯ There was continued improvement in performance, assessed by increases in the percentage of patients with measured pain and sedation scores and in those with documented pain management plans at discharge, compared with earlier APOP project audits. Using this example of the APOP toolkit and "snapshot" audits, we have now demonstrated that hospitals nationwide are able to undertake quality improvement activities voluntarily to maintain optimal performance. Encouragement, guidance, and availability of ready-made tools developed by a national team facilitate opportunities for ongoing quality improvements.
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Interventions such as mandatory "time-outs" have contributed to intraoperative safety but improvements are still necessary. We present data provided by 3 professions always present in the intraoperative setting that suggest next steps in the quest for improvements. We describe the differences and similarities in operating room (OR) nurses', anesthesia providers', and surgeons' beliefs about team function, case difficulty, nonroutine event (NRE), and error causation using a qualitative design at 3 Veterans' Administration hospitals. ⋯ There may be "cascade" and "perfect storm conditions" before and during operative procedures that increase the likelihood of NREs. Confirmation of these phenomena could improve prediction and prevention of NREs. Exploration of differences in team definition and team performance ratings by provider type may also identify avenues for improvement.