American journal of medical quality : the official journal of the American College of Medical Quality
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Comparative Study
Apples and oranges: comparison of ACS-NSQIP observed outcomes with premier's quality manager-predicted outcomes.
The National Surgical Quality Improvement Program (NSQIP) is used by the American College of Surgeons to measure and report surgical quality and outcomes. Premier's Quality Manager (QM) generates expected outcomes from patient charts. The authors compared observed NSQIP morbidity and mortality outcomes with those predicted by QM. ⋯ NSQIP identified 478 postoperative occurrences, whereas QM predicted 714 patients with at least 1 complication; 223 of these were subclassified as patients with at least 1 morbid complication (C statistic, 0.83). QM did not perform as well in predicting the observed NSQIP morbidities. Surgical leaders and hospital administrators must critically evaluate products before adopting programs designed to improve patient outcomes or making decisions regarding physician practice.
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There are differences between nurse and physician perceptions of teamwork. The purpose of this study was to determine whether these differences would be reduced with medical team training (MTT). The Safety Attitudes Questionnaire was administered to nurses and physicians working in the operating rooms of 101 consecutive hospitals before and at the completion of an MTT program. ⋯ Physicians demonstrated improvement on all 6 teamwork climate items. Nurses demonstrated improvement in perceptions on all teamwork climate items except "Nurse input is well received." Physicians still had a more favorable perception than nurses on all 6 teamwork climate items at follow-up. Despite an improvement in perceptions by physicians and nurses, baseline nurse-physician differences persisted at completion of the Veterans Health Administration MTT Program.
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Hospitals have experienced increasing requirements for public reporting of various infection rates using clinical and administrative data. Until recently, such reports have not included analysis of "present on admission" (POA), an indicator designed to assess whether such infections are hospital acquired. ⋯ The authors found that 70% of hospitalizations of patients with S-S, 86% of patients with MRSA, and 67% of patients with CDI had these conditions coded POA. The authors recommend that public reporting of hospital infection rates include POA status and that all health care organizations and providers should work more closely together to identify early and prevent such serious infections.