Journal for healthcare quality : official publication of the National Association for Healthcare Quality
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This study highlighted the tensions that physicians face when communicating the death of a child to parents. Ten pediatric physicians participated in interviews in which they were asked to provide specific details about end-of-life discussions they have had with families in pediatric emergency rooms. From these findings, it is evident that physicians are required to balance multiple external and internal tensions embedded in these difficult conversations.
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This article provides tips to improve writing and to inspire readers to write for publication. Simple but powerful ways to improve writing include omitting needless words, using the active voice, and using first-person pronouns. ⋯ Pithy, witty quotes from well-known writers are included. This article should be helpful to experienced as well as novice writers.
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Ethical and regulatory guidelines recommend disclosure of medical errors to patients and families. Yet few studies examine how to effectively train healthcare professionals to deliver communications about adverse events to family members of affected pediatric patients. ⋯ Ratings of setting "realism" and simulation effectiveness were high (21 out of 25 composite score). Findings provide preliminary support for further research on simulation-based disclosure training for healthcare professionals.
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This article assesses the extent to which a team using quality improvement methods could improve the timeliness of the flow of admitted patients through the emergency department in one hospital. Using a structured approach, a multidisciplinary team redesigned the processes for admitting patients from the emergency department to the inpatient unit. Indicators of capacity limitations in the inpatient environment were also identified as triggers for a tiered institutional response to capacity constraints. ⋯ Significant reductions in the median minutes for a majority of the time intervals studied were achieved during the 6-month study period. The data from the study suggest that improvements in patient progression through an emergency department can be achieved with quality improvement methods. Success factors for this and other improvement strategies are discussed.
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Blue Cross and Blue Shield of Minnesota conducted a quality improvement project to quantify and improve the clinical and functional outcomes of low back pain and neck pain patients in a chiropractic network. Improved outcomes were encouraged through a financial incentive for implementation of standard clinical outcome measurement tools, quarterly feedback to individual practices, and a face-to-face meeting to share best practices. Although a large database on baseline neck pain and low back pain and functional disability was generated, and clinically and statistically significant improvements in outcomes were documented, progressive improvement in outcomes over the 4-year project period was not found.