American journal of medical quality : the official journal of the American College of Medical Quality
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Hospice organizations are adopting quality measurement and quality improvement (QI) practices to comply with the Medicare Conditions of Participation effective January 31, 2009. However, little is known about organizational best practices or specific needs during implementation. ⋯ Though challenging, participants provided recommendations that they believed would facilitate QI in hospice. Categorizing barriers and facilitators as within or outside an organization's control may help organizations assess their capabilities and locate resources to address areas for improvement.
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Door-to-physician time in the emergency department (ED) correlates with patient satisfaction and clinical quality and outcomes. Delays in seeing a provider result in a 3% nationwide rate of patients leaving without being seen (LWBS) after presenting for ED care. Two community hospitals had door-to-physician times of 51 and 47 minutes. ⋯ The change occurred in less than a month and was sustained for 6 months after the study. In addition, the LWBS rates at each facility fell by one third. Basic process improvement strategies borrowed from service industries were used in 2 EDs to improve the door-to-physician process.