Journal for healthcare quality : official publication of the National Association for Healthcare Quality
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In response to concerns regarding delays in transferring critically ill patients to intensive care units (ICU), a quality improvement project, using the Six Sigma process, was undertaken to correct issues leading to transfer delay. ⋯ The Six Sigma approach is a problem-solving methodology that resulted in almost a 60% reduction in patient transfer time from a general medical floor to a critical care area. The Six Sigma process is a feasible method for implementing healthcare related quality of care projects, especially those that are complex.
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Even though rapid response teams (RRTs) have been widely adopted, reports about their efficacy in reducing mortality have been conflicting, both in terms of outcomes, and standardization of measures. Our data demonstrate that it is possible to detect significant changes within the patient population while overall mortality rates appear not to change. ⋯ With less severe patients able to remain on the medical wards, 12.5% of ICU beds were able to be utilized by more severe patients, and the Hospital-Standardized Mortality Ratio decreased 31.2%. The All Patient Refined Diagnostic-Related Groups (APR DRGs) risk of mortality (ROM) was used to stratify and group patients by severity, and revealed reductions in mortality among specific risk groups as well as shifts in the proportion of patient risk groups within the ICU population which were not readily apparent.
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Analyze the effectiveness of mandated point-of-care (POC) blood glucose (BG) meter quality control (QC) testing. All POC BG QC tests were analyzed to evaluate operator and strip/meter error rates and institutional cost. POC BG QC test failure (17/103,580 over 24 months) was low and no meters failed subsequent linearity testing. ⋯ POC BG meter failure within current guidelines is rare and does not justify the cost of daily QC testing. Frequent QC testing can identify operators needing retraining in POC testing. Strip/meter QC errors are common, are not prevented by current QC testing standards, and may contribute to clinical errors.
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Study on defensive medicine practices among obstetricians and gynecologists who provide breast care.
The purpose of this study was to assess malpractice concerns, career satisfaction, defensive medicine, experience with liability lawsuits, and changes in breast care practices among obstetricians and gynecologists (ob-gyns) who provide breast care. Four hundred ACOG Fellows were randomly selected and invited to participate, 247 (62%) responded. A majority of responders had increased the number of referrals for the diagnosis of breast abnormalities (58.9%) and treatment of breast disease (53.6%) due to fears and concerns regarding malpractice. ⋯ In a regression analysis, having been sued was a significant predictor of practicing defensive medicine more often. Physicians from states with malpractice crisis reported practicing defensive medicine more frequently and more lawsuits than physicians from stable states. Malpractice fears and defensive medicine continue to affect the practices of ob-gyns, most specifically, as this study shows, ob-gyns who provide breast care.
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We audited the seven surgical departments of a university hospital before and after implementation of a program aiming to improve practices in postoperative pain management (POPM). Audits were conducted 2 years apart. During each evaluation, 10 medical charts from each surgical department (i.e., 70 charts) were analyzed for 9 quality criteria (five concerning anesthetist practices and four nursing practices). ⋯ Moreover, overall scores for seven of the nine evaluated criteria improved, significantly for three criteria. Anesthetists significantly increased their overall score from 2.5 ± 0.8 to 3.7 ± 0.6 out of 5 points (p=.018), while surgical nurses' overall score did not change significantly from 2.3 ± 0.7 to 2.9 ± 0.7 out of 4 points (p=.128). In conclusion, using a standardized and validated instrument to evaluate POPM practices enables the identification of surgical departments requiring practice improvement and those quality criteria requiring reinforcement.