Joint Commission journal on quality and patient safety / Joint Commission Resources
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Jt Comm J Qual Patient Saf · Oct 2011
"The MICU is full": one hospital's experience with an overflow triage policy.
Coronary care units (CCUs) are designed and staffed to care for patients with cardiovascular disease, while medical intensive care units (MICUs) are specially organized and staffed for the care of patients with noncardiovascular critical illness. Because the demand for MICU beds often exceeds their availability, patients in need of critical care often experience delays in admission and transfer to such specialized units, which may result in preventable harm. In response to this challenge, during times of MICU bed nonavailability Jacobi Medical Center (Bronx, New York) activates a policy whereby patients with noncardiovascular critical illness are admitted to a cardiology-staffed CCU for critical care to be delivered in a timely manner. A study was conducted to determine the impact of this novel overflow policy on patient outcomes and patient safety metrics. ⋯ A policy that directed critically ill patients to a CCU instead of an MICU during times of bed nonavailability appeared to be a safe practice. With careful planning, CCU bed resources might be an acceptable alternative for the delivery of critical care in an environment of constrained MICU bed access.
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Jt Comm J Qual Patient Saf · Oct 2011
Electronic prescribing within an electronic health record reduces ambulatory prescribing errors.
Health policy forces are promoting the adoption of interoperable electronic health records (EHRs) with electronic prescribing (e-prescribing). Despite the promise of EHRs with e-prescribing to improve medication safety in ambulatory care settings--where most prescribing occurs and where errors are common--few studies have demonstrated its effectiveness. A study was conducted to assess the effect of an e-prescribing system with clinical decision support, including checks for drug allergies and drug-drug interactions, that was integrated within an EHR on rates of ambulatory prescribing errors. ⋯ The preliminary findings from this small group of providers suggest that e-prescribing systems may decrease ambulatory prescribing errors, which are occurring at high rates among community-based providers.
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The Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey asks patients how frequently their physicians treated them with courtesy and respect, listened carefully, and explained things in a way they could understand. Such summary reports may obscure differences among the types of physicians involved. A study was conducted to examine the association between ratings for different physician types and the overall HCAHPS rating of physicians. ⋯ Physician communication scores may be most strongly influenced by patient experiences with hospitalists and specialists rather than with EM physicians. Several team communication and system issues represent opportunities for improving physician communication.
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Jt Comm J Qual Patient Saf · Oct 2011
Bridging the digital divide in health care: the role of health information technology in addressing racial and ethnic disparities.
Racial and ethnic disparities in health care have been consistently documented in the diagnosis, treatment, and outcomes of many common clinical conditions. There has been an acceleration of health information technology (HIT) implementation in the United States, with health care reform legislation including multiple provisions for collecting and using health information to improve and monitor quality and efficiency in health care. Despite an uneven and generally low level of implementation, research has demonstrated that HIT has the potential to improve quality of care and patient safety. If carefully designed and implemented, HIT also has the potential to eliminate disparities. ⋯ As investments are made in HIT, consideration must be given to the impact that these innovations have on the quality and cost of health care for all patients, including those who experience disparities.