Journal for healthcare quality : official publication of the National Association for Healthcare Quality
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Fecal occult blood testing (FOBT) is recommended by national guidelines for colorectal cancer (CRC) screening and has been shown to reduce both the incidence and mortality of CRC. FOBT screening is a complex process and little is known concerning the best methods for implementing FOBT screening in primary care clinics. The purpose of this study was to determine if direct gastroenterology (GI) service notification of all positive FOBT results in improved time for provider response and colonoscopy. ⋯ Data were collected prospectively following implementation of a direct referral strategy and compared with two retrospective time periods during which the ordering practitioners were responsible for follow-up of all positive FOBT. Implementation of immediate GI referral of positive tests eliminated improper and neglected follow-up, and resulted in shorter delays in provider response time and colonoscopy completion. Inappropriate use of FOBT was observed in 49% of patients, indicating that further interventions in primary care clinics to improve the quality of FOBT screening are necessary.
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Surgeons have been slow to incorporate industrial reliability techniques. Process control methods were applied to surgeon waiting time between cases, and to length of stay (LOS) after colon surgery. Waiting times between surgeries were evaluated by auditing the operating room records of a single hospital over a 1-month period. ⋯ These process issues are both expensive and adversely affect the quality of service offered by the institution. Process control mechanisms were suggested or implemented to improve these surgical processes. Industrial reliability and quality management tools can easily and effectively identify process control problems that occur on surgical services.
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Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of suboptimal discharge communication to PCPs. ⋯ Quality improvement strategies consisted of training and implementation of a new discharge process including: (1) enhanced PCP identification at discharge, (2) use of an electronic discharge order and instruction system, and (3) autofaxing discharge information to PCPs. The new discharge process's impact was evaluated on 2,530 hospitalist patient discharges over a 34-week period by measuring: (1) successful transfer of discharge information (proportion of discharge information sheets successfully faxed to PCPs), (2) timeliness (proportion of sheets faxed within 2 days of discharge), and (3) content (presence of key clinical elements in discharge sheets). Postintervention, success, and timeliness of discharge information transfer between pediatric hospitalists and PCPs significantly improved while content remained high.
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The treatment of ST-elevation myocardial infarction with primary percutaneous coronary intervention is a time-sensitive process, with outcomes correlated with the speed with which the healthcare team can make the diagnosis, start preliminary treatment, and successfully perform the intervention. This requires multidisciplinary teamwork involving Emergency Medical Services, Emergency Medicine and Nursing, the cardiac catheterization laboratory team, and interventional cardiology. The success of effectively delivering treatment is enhanced through focused analysis of key steps within the care process to identify systems problems and implement quality improvement initiatives. This article reviews the process whereby our institution achieved top decile performance in this multidisciplinary treatment.
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This article is the second in a two-part series focusing on catheter-associated urinary tract infections. Part I of the series focused on the most significant modifiable risk factor, avoiding use of urethral catheters. ⋯ A quality improvement case is provided to illustrate the strategies for limiting the duration of catheter use. Together, these two articles provide important information on the two most significant risk facts for eliminating the incidence of catheter-associated urinary tract infections.