International journal for quality in health care : journal of the International Society for Quality in Health Care
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Int J Qual Health Care · Aug 2014
Failure mode and effects analysis applied to the maintenance and repair of anesthetic equipment in an austere medical environment.
Medical technology designed for Western settings frequently does not function adequately or as intended when placed in an austere clinical environment because of issues such as the instability of the electrical grid, environmental conditions, access to replacement parts, level of provider training and general absence of biomedical engineering support. The purpose of this study was to demonstrate the feasibility of applying failure mode and effects analysis as part of an implementation strategy for medical devices in austere medical settings. ⋯ This study demonstrates the feasibility of using the failure mode and effects analysis approach to improve implementation of technology in austere medical environments.
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Int J Qual Health Care · Aug 2014
Randomized Controlled TrialFeasibility and evaluation of a pilot community health worker intervention to reduce hospital readmissions.
To pilot-test the feasibility and preliminary effect of a community health worker (CHW) intervention to reduce hospital readmissions. ⋯ Under performance-based payment systems, identifying cost-effective solutions for reducing hospital readmissions will be crucial to the economic survival of all hospitals, especially safety-net systems. This pilot study suggests that with appropriate supportive infrastructure, hospital-based CHWs may represent a feasible strategy for improving transitional care among vulnerable populations. An ongoing, randomized, controlled trial of a CHW intervention, developed according to the lessons of this pilot, will provide further insight into the utility of this approach to reducing readmissions.
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Int J Qual Health Care · Aug 2014
Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool.
To evaluate the impact of a new electronic handoff tool for emergency department to medicine ward patient transfers over a 1-year period. ⋯ The eSignout was perceived as more efficient and preferred over the mandatory verbal signout process. Rates of reported adverse events were similar before and after the intervention. Our experience suggests electronic platforms with optional verbal communication can be used to standardize and improve the perceived efficiency of patient handoffs.
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Int J Qual Health Care · Aug 2014
Patient safety in the operating theatre: how A3 thinking can help reduce door movement.
Research has often stressed the significance of reducing door movement during surgery for preventing surgical site infections. This study investigated the possible effect of a lean A3 intervention on the reduction of door movement during surgery in a university medical center in the Netherlands. ⋯ This paper shows the relevance of and the possibility for a reduction of door movement during surgery by lean management methods in general and an A3 intervention in particular. This intervention stimulated dialogue and encouraged knowledge-sharing and collaboration between specialized healthcare professionals and this resulted in a thorough root-cause analysis that provided synergy in the countermeasures-with, according to respondents, a sustainable result.
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Int J Qual Health Care · Aug 2014
The eCollaborative: using a quality improvement collaborative to implement the National eHealth Record System in Australian primary care practices.
The new national patient-controlled electronic health record is an important quality improvement, and there was a pressing need to pilot its use in Australian primary care practices. Implementation of electronic health records in other countries has met with mixed success. ⋯ The collaborative methodology was adapted for implementing innovation and proved useful for engaging with multiple small practices, facilitating low-risk testing of processes, sharing ideas among participants, development of clinical champions and development of resources to support wider use. Email discussion between participants and system designers facilitated improvements. Data quality was a key challenge for this innovation, and quality measures chosen require development. Patient participants were partners in improvement.