American journal of medical quality : the official journal of the American College of Medical Quality
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The National Practitioner Data Bank (NPDB) began operation in September 1990 as a clearinghouse for adverse action, licensure, and malpractice information in an effort to protect consumers and promote quality in health care. This study analyzed 66,107 and 1291 records of payments made for 50,396 physicians and 1218 nurses, respectively, from 1994 through 1998, to describe characteristics, trends, and risk factors of malpractice payment for physicians and nurses. The median payments, more often settlements paid by insurance companies than judgments in courts of law, were higher for physicians than for nurses. ⋯ Although findings suggested that payment trends remained stable, there was great regional variation in the risk of malpractice payment for both physicians and nurses. The physician risk ranged from a low of 0.73% per physician per year in Alabama to a high of 3.7% in Wyoming, and the nurse risk ranged from a low of 0% per nurse per year in Vermont to a high of 0.075% in the District of Columbia. If the quality of health care provided by physicians and nurses does not vary geographically in the United States, then such a great discrepancy seems to challenge the notion that the risk of malpractice litigation consistently promotes the quality of health care.
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Hospitals use various methods to establish performance benchmarks. This may include cooperative data shared between organizations to allow broad, general comparisons. ⋯ The authors conclude that quality indicators are valuable when screening a hospital, just as we utilize screening tests to identify patients at potential risk. Neither should we apply broad quality indicators as standards of care without a full understanding of their strengths and weaknesses and the foundation on which they are built.
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The objective of this study was to assess the psychological impact of a 4-week emergency medicine (EM) rotation on residents undergoing their first EM experience. These findings were compared to the psychological impact the rotation had on residents with prior EM experience. Data were obtained from a post hoc analysis of a previous study. ⋯ Residents with prior EM experience (N = 53) displayed worsening in 9 of 13 scales (P = not significant) and no change in 1. Residents undergoing their first EM rotation showed a significant decrease in psychological distress over the 4-week period. Residents with prior EM experience did not show a similar change.
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Expansion of the preadmission process for same-day-admit (SDA) surgery patients through our Admissions Evaluation Center has provided an efficient and convenient means for complete patient evaluation up to 30 days in advance of surgery. Traditionally, collection of blood samples for the pretransfusion testing that is necessary to select compatible blood for transfusion occurs within 72 hours of admission, consistent with standards to ensure detection of red blood cell (RBC) alloantibodies formed as a result of recent transfusion or pregnancy. As a result, samples for many SDA patients were submitted Stat the morning of surgery, resulting in an unwieldy amount of testing and delay in blood availability. ⋯ To ensure safety, this change required documentation of patient transfusion and pregnancy history at 2 specific timepoints. Input from a multidisciplinary team was vital to assess the process of blood ordering and administration and to determine the best means to accomplish these steps. Implementation of the new process resulted in a decreased number of emergent requests for compatibility testing, decreased delays in blood delivery, and elimination of canceled surgery due to cases with unexpected RBC antibodies.
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Cost containment and quality of care represent the most important objectives of all health care professionals. Because of its progressive growth over the past decade, ambulatory surgery has become an area where these 2 issues need to be addressed. The goal of this paper is to discuss the economic and quality of care challenges faced by hospitals as they strive to become competitive in the 21st century. ⋯ The number of ambulatory surgery procedures performed each year will continue to increase, although perhaps not at the rate we experienced in the past. Procedures that once were performed in an inpatient setting can now be accomplished on an outpatient basis or even in the physician's office. We will continue to see this shift of volume as technologic advancements and anesthetic agents allow more complex procedures to be performed on an outpatient basis.