Joint Commission journal on quality and patient safety / Joint Commission Resources
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Jt Comm J Qual Patient Saf · Nov 2009
Redesigning intensive care unit flow using variability management to improve access and safety.
Poor flow of patients into and out of the ICU can result in gridlock and bottlenecks that disrupt care and have a detrimental effect on patient safety and satisfaction, hospital efficiency, staff stress and morale, and revenue. Beginning in 2006, Cincinnati Children's Hospital Medical Center implemented a series of interventions to "smooth" patient flow through the system. ⋯ A system for smoothing flow, based on an advanced predictive model for need, occupancy, and length of stay, coupled with an active daily strategy for demand/capacity matching of resources and needs, allowed much better early planning, predictions, and capacity management, thereby ensuring that all patients are in suitable ICU environments.
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Jt Comm J Qual Patient Saf · Oct 2009
Assessing processes of care to promote timely initiation of antibiotic therapy for emergency department patients hospitalized for pneumonia.
A mixed-methods quality improvement (QI) project for patients with pneumonia hospitalized from the emergency department (ED) was undertaken to (1) delineate the basic steps in the flow of patient care from presentation in the ED to time to first antibiotic dose (TFAD), (2) identify perceived barriers to and facilitators of reduced TFAD within these steps, (3) describe QI strategies to improve TFAD rates, and (4) identify perceived strategies for facilities to enhance performance. ⋯ TFAD relies on a series of complex, stepwise processes of care that involve numerous hospital departments and is often delayed by well-described barriers. Addressing these barriers, as well as involving facility leadership in setting institutional QI goals, could possibly improve performance on this pneumonia quality measure.
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Jt Comm J Qual Patient Saf · Oct 2009
Patient preferences for and satisfaction with methods of communicating test results in a primary care practice.
Appropriate and timely communication of test results is an important element of high-quality health care. Patients' preferences regarding and satisfaction with test result notification methods in a primary care practice were evaluated. ⋯ The results describe primary care patients preferences for communication from their providers. Disparities exist between current practice and patient preferences in this important care delivery process. A telephone call from a physician or nurse practitioner was used to deliver test results for fewer than half of the patients who preferred to receive their results by this method. Future work should explore reimbursement of patient-preferred options and assess ways to improve resource-conscious test result communication methods.
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Jt Comm J Qual Patient Saf · Aug 2009
Implementing standardized operating room briefings and debriefings at a large regional medical center.
Effective communication and teamwork are critical in many health care settings, particularly the operating room (OR). Several studies have implicated failures of communication and teamwork as the root cause in a high proportion of sentinel events in the OR. ⋯ Implementation of a standardized briefing and debriefing tool in a large regional medical center was a, practical and feasible strategy to improve perceptions of interdisciplinary communication and teamwork in the OR.
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Jt Comm J Qual Patient Saf · Aug 2009
What are the critical success factors for team training in health care?
Ineffective communication among medical teams is a leading cause of preventable patient harm throughout the health care system. A growing body of literature indicates that medical teamwork improves the quality, safety, and cost-effectiveness of health care delivery, and expectations for teamwork in health care have increased. Yet few health care professions' curricula include teamwork training, and few medical practices integrate teamwork principles. Because of this knowledge gap, growing numbers of health care systems are requiring staff to participate in formal teamwork training programs. Seven evidence-based, practical, systematic success factors for preparing, implementing, and sustaining a team training and performance improvement initiative were identified. Each success factor is accompanied by tips for deployment and a real-world example of application. ⋯ Although decades of research in other high-risk organizations have clearly demonstrated that properly designed team training programs can improve team performance, success is highly dependent on organizational factors such as leadership support, learning climate, and commitment to data-driven change. Before engaging in a teamwork training initiative, health care organizations should have a clear understanding of these factors and the strategies for their establishment.