Journal for healthcare quality : official publication of the National Association for Healthcare Quality
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The nation's emergency rooms are overflowing with patients who endure increasingly long waits to be examined and treated. When our large metropolitan adult acute care hospital adopted LEAN as its standard operating procedure, we began to examine our processes from the customers' perspective and identified a significant opportunity to reduce the emergency department length of stay. Using LEAN tools we designed and implemented a Rapid Assessment and Disposition process to decrease the amount of time patients waited in the emergency department, reduce diversion time, and reduce the number of patients who left without being seen. We have succeeded in reducing the average length of stay for all emergency department patients by 45 minutes, diversion by 55%, and patients who left without being seen by 28%.
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Karen Davis is president of The Commonwealth Fund, a national philanthropy engaged in independent research on health and social policy issues. Dr. Davis is a nationally recognized economist, with a distinguished career in public policy and research. ⋯ She was elected to the Institute of Medicine (IOM) in 1975; has served two terms on the IOM governing Council (1986-90 and 1997-2000); was a member of the IOM Committee on Redesigning Health Insurance Benefits, Payment and Performance Improvement Programs; and was awarded the Adam Yarmolinsky medal in 2007 for her contributions to the mission of the Institute of Medicine. She is a past president of the Academy Health (formerly AHSRHP) and an Academy Health distinguished fellow, a member of the Kaiser Commission on Medicaid and the Uninsured, and a former member of the Agency for Healthcare Quality and Research National Advisory Committee. She also serves on the Panel of Health Advisors for the Congressional Budget Office.
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The University Medical Center at Princeton has been a leading teaching hospital for more than 30 years. Established in 1919, University Medical Center at Princeton is committed to redefining care by continually enhancing the quality of the care provided and improving the health of the communities served. University Medical Center at Princeton, in collaboration with the Hill-Rom Clinical Excellence Team, designed, implemented, and monitored a new fall prevention program.
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Patients in the intensive care unit (ICU) are usually very sick and have complicated, multisystem dysfunctions and often life-threatening medical conditions. Their management requires skilled, comprehensive, and organized medical care. ⋯ The daily goals checklist presented here is a quality tool that incorporates several evidence-based quality parameters, and it is easy to use and cost-effective. Its implementation is likely to greatly improve the quality of care and reduce complications in ICUs.
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The need for measures of the quality of healthcare provided to children and adolescents is well documented. However, children have been underrepresented in national healthcare quality measurement and reporting efforts. The Pediatric Data Quality Systems (Pedi-QS) Collaborative is addressing this gap. ⋯ The framework and measure set development process are described. Lessons learned from applying the process are summarized, and future directions are suggested. Voluntary collaborative efforts are vital for advancing children's measures, and national support and funding are also needed.