International journal for quality in health care : journal of the International Society for Quality in Health Care
-
Int J Qual Health Care · Apr 2004
Nationwide continuous quality improvement using clinical indicators: the Danish National Indicator Project.
In most countries there is no mandatory national system to track the quality of care delivered to the citizens. This paper describes an example of a national indicator project that aims at documenting and improving the quality of care nationwide. ⋯ The surveillance of health care quality is greatly aided by the use of relevant quantitative indicators. This paper describes how it is possible to organize nationwide monitoring using clinical indicators.
-
Int J Qual Health Care · Apr 2004
Comparative StudyThe characteristics of very short stay ICU admissions and implications for optimizing ICU resource utilization: the Saudi experience.
Patients with very short stays (<24 hours) in intensive care units (ICUs) constitute a distinct group with a high turnover rate and a unique patient mix. Our aim was to study their characteristics with the aim of developing strategic approaches for better and more appropriate utilization of ICU resources. ⋯ Our study has provided crucial input for the study of strategic change towards more optimal utilization of scarce ICU resources. Implementing protocols to target ICU care to patients most likely to benefit, making DNR decisions early in the hospital stay, and operating an Intermediate Care Unit have been proposed as strategic approaches.
-
Efforts to improve pain assessment and treatment in critically ill patients are poorly studied and represent an opportunity to improve quality of care. We sought to improve pain assessment and treatment in patients in a surgical intensive care unit at an academic medical center. ⋯ Our interventions were associated with significant improvements in pain assessment and treatment without an increase in adverse events related to pain therapy. Our interventions were relatively simple and may be implemented broadly. Our interventions provide insights into the application of complexity theory in improvement efforts.
-
Int J Qual Health Care · Feb 2004
Rating the strength of scientific evidence: relevance for quality improvement programs.
To summarize an extensive review of systems for grading the quality of research articles and rating the strength of bodies of evidence, and to highlight for health professionals and decision-makers concerned with quality measurement and improvement the available "best practices" tools by which these steps can be accomplished. ⋯ Formally grading study quality and rating overall strength of evidence, using sound instruments and procedures, can produce reasonable levels of confidence about the science base for parts of quality improvement programs. With such information, health care professionals and administrators concerned with quality improvement can understand better the level of science (versus only clinical consensus or opinion) that supports practice guidelines, review criteria, and assessments that feed into quality assurance and improvement programs. New systems are appearing and research is needed to confirm the conceptual and practical underpinnings of these grading and rating systems, but the need for those developing systematic reviews, practice guidelines, and quality or audit criteria to understand and undertake these steps is becoming increasingly clear.
-
Int J Qual Health Care · Dec 2003
Improving patient safety across a large integrated health care delivery system.
Patient safety is moving up the list of priorities for hospitals and health care delivery systems, but improving safety across a large organization is challenging. We sought to create a common patient safety strategy for the Partners HealthCare system, a large, integrated, non-profit health care delivery system in the United States. ⋯ This loosely integrated delivery system represents a daunting landscape for the development and institution of patient safety concepts. Many projects aimed at different components of patient safety must occur at the same time for significant change, yet culture and care-related beliefs vary substantially within the system, and measurement is especially challenging. Moreover, with many potential interventions, and limited resources, prioritization and selection is difficult. Nonetheless, consensus about some issues has been reached, in particular because of a well delineated patient safety structure. We believe the net result will be substantial improvement in patient safety.