American journal of medical quality : the official journal of the American College of Medical Quality
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Glycemic control is an important quality indicator in the management of intensive care unit patients. Tight glycemic control and/or insulin infusion protocols may reduce complications and improve outcomes in certain intensive care unit patients. Unfortunately, a consistent method of describing glycemic control has not been used for this population. ⋯ The current glycemic control metrics such as mean, median, mean morning, hyperglycemic index, and time-weighted averages will be analyzed. The complexities associated with reporting glycemic control data for national quality performance will also be reviewed. The goal is to facilitate and propose the selection of a glycemic control metric for critically ill patients that can be universally applied in clinical trials and quality performance standards.
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Graduate medical education (GME) has traditionally focused on the diagnosis and management of disease with little attention devoted to patient safety and systems thinking. In this article, we describe the results of a needs assessment conducted to develop a patient safety curriculum for GME. ⋯ Objective structured clinical examinations and experiential learning (including simulation) were viewed as the most effective methods for teaching and assessing competence in patient safety. The results of this study provide a framework for the development of patient safety curricula in GME.
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End-of-life decision making, including consideration of advance directives and code status, is taking place more frequently in critical care units. There is a need to identify how nurses and physicians perceive end-of-life care so that nurse-physician understanding and communication can be improved. A total of 96 physicians and nurses completed a survey about their general beliefs and practices related to end-of-life care in the intensive care unit. ⋯ Physicians were more likely to discuss do-not-resuscitate (DNR) orders only when a prognosis was poor. Family dynamics and medical/legal concerns most often affect decisions to obtain/write a DNR order for a critically ill patient. Suggested approaches for improving physician and nurse collaboration about end-of-life decision making are discussed.
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This study describes a comparative analysis of replacing medical residents with physician assistants and hospitalists on patient outcomes in a community hospital. Prospective data during the physician assistants-hospitalists service for 2 years was compared with 2 years of retrospective data of the medical residents model. Outcome measures included mortality, adverse events, readmissions, and patient satisfaction. ⋯ Quality of care provided by the physician assistants-hospitalists model was equivalent. All-cause and case mix index- adjusted mortality was significantly lower during the physician assistants-hospitalists period. Although the application of these findings to other institutions requires further study, the authors found no intrinsic barriers that would impede implementation elsewhere.
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As organizations strive for ways to control health care spending, address the growing needs of an aging population, and respond satisfactorily to a more informed and demanding consumer base, the opportunities for innovation have increased exponentially. By means of this article, the authors describe the basic concepts of purposeful innovation, and compare and contrast it to quality improvement. The authors also provide an overview of the terminology and types of innovation, describe the innovation life cycle, and discuss diffusion and commercialization of innovations. This article provides a primer on innovation for quality improvement practitioners and physician leaders who play a key role in creating innovation and environments for innovations to flourish.