Journal for healthcare quality : official publication of the National Association for Healthcare Quality
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BlueCross BlueShield on the Rochester Area (BCBSRA) initiated a clinical quality improvement project that increased its diabetic retinopathy screening rate from 42.8% in 1995 to 58.1% in 1997. A multidisciplinary team examined the processes and discovered both member (patient) and provider (physician) barriers to annual screening. ⋯ Providers identified a role for BCBSRA to reinforce patient education on eye examinations and to assist with tracking of services. Involvement of these key stakeholders was critical to understanding and overcoming barriers.
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When our emergency department (ED) initiated a continuous quality improvement (CQI) program, we selected as a quality indicator the percentage of patients leaving without being seen (LWBS) by a physician. Because the primary reason for LWBS patients was determined to be dissatisfaction with waiting time, we devised four interventions in clinical operations to decrease delays in patient flow through the ED. Statistical process control (SPC) methodology was then used to assess the effect of these interventions. ⋯ Postintervention data, plotted using control statistics from the baseline period, demonstrated sustained special-cause variation, indicating a fundamental change in the overall system. A new control chart was then constructed using postintervention data. A significantly lowered mean percentage LWBS and a narrowed control limit range were observed, leading to the conclusion that the interventions improved the quality of care as measured by a reduction in percentage LWBS.
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The performance improvement department at The Queen's Medical Center (QMC) in Honolulu, has been monitoring the outcomes of cardiovascular interventional procedures and cardiothoracic surgical procedures. By using an institution-wide database as well as participating in national cardiac databases, a set of clinical indicators is tracked, and quarterly reports are provided to the cardiovascular medicine (CV) and thoracic and cardiovascular surgery (TCV) services. After reviewing the data, a combined CV/TCV/anesthesia morbidity and mortality committee meets monthly to further evaluate the data, review cases, and formulate action plans based upon the findings. Using these tools and methods, we have seen a marked improvement in clinical outcomes among cardiac patients.
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The surgical service at the Philadelphia Department of Veterans Affairs Medical Center has been making a continuous effort toward improving efficiency in the operating room. A multidisciplinary task force was created in May 1994 to look at delays in operating room start times for the first case of the day. ⋯ The team discovered that delays were related to system problems in the perioperative process and were not caused by any specific problem. Many of these problems proved correctable, as the statistical analysis shows, and the result was significant improvement in operating room efficiency.
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Assessing clinical performance is difficult. Members of the Nursing Service Clinical Practice Committee at the Carl T. ⋯ This article describes the committee's process of developing and implementing the program and includes a blueprint for competency assessment and selected performance measures for all nursing staff who provide patient care. The approach to competency assessment includes performance measures specific to patients' ages.