Joint Commission journal on quality and patient safety / Joint Commission Resources
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Jt Comm J Qual Patient Saf · Jul 2009
Multicenter Study Clinical TrialImproving patient satisfaction with pain management using Six Sigma tools.
Patient satisfaction as a direct and public measure of quality of care is changing the way hospitals address quality improvement. The feasibility of using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) methodology to improve patient satisfaction as it relates to pain management was evaluated. ⋯ The Six Sigma DMAIC methodology can be used successfully to improve patient satisfaction. The project led to measurable improvements in patient satisfaction with pain management, which have endured past the duration of the Six Sigma project. The Control phase of DMAIC allows the improvements to be incorporated into daily operations.
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Jt Comm J Qual Patient Saf · Jul 2009
Clinical validation of the AHRQ postoperative venous thromboembolism patient safety indicator.
The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) screen for potentially preventable complications in hospitalized patients using hospital administrative data. The PSI for postoperative venous thromboembolism (VTE) relies on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for deep vein thrombosis (DVT) or pulmonary embolism (PE) in secondary diagnoses fields. In a clinical validation study of the PSI for postoperative VTE, natural language processing (NLP), supplemented by pharmacy and billing data, was used to identify VTE events missed by medical records coders. ⋯ The VTE PSI performed well as a screening tool but generated a significant number of false-positive cases, a problem that could be substantially reduced with improved coding methods.
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Jt Comm J Qual Patient Saf · Jun 2009
Multicenter StudyParent-driven technology for decision support in pediatric emergency care.
A quasi-experimental intervention study composed of control and intervention periods was conducted to determine if a parent-driven health information technology influenced completeness of documentation and adherence to evidence-based emergency care for children. ⋯ Parent-driven health information technology intended to translate parents' knowledge into clinical practice and to support evidence-based care suggested a trend toward modest impact on pain management but did not demonstrate broad effects across diseases or care processes. The emergence and proliferation of personally controlled health records (PCHRs) presents opportunities for patients and parents to control their medical profiles. Although ParentLink is not a comprehensive PCHR, it represents a step in incorporating parent-derived information into medical decision making.
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Jt Comm J Qual Patient Saf · Jun 2009
Multicenter StudySustaining and spreading reduced door-to-balloon times for ST-segment elevation myocardial infarction patients.
Prompt primary percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) significantly reduces mortality and morbidity. In 2004 the American College of Cardiology (ACC) and American Heart Association (AHA) set a goal to reduce door-to-balloon (D2B) time to < 90 minutes in 75% of STEMI cases. IMPLEMENTING THE STEMI INITIATIVE: In 2004, the STEMI/D2B leadership team broke down D2B time into four segments: door to data, data to diagnosis, diagnosis to decision, and decision to device. Each segment was examined for inefficiencies, duplication, and nonstandardization. In 2005, after the internal D2B processes and results showed improvement, the STEMI/D2B leadership team extended the project to prehospital emergency medical services. In 2006, UMass Memorial began to roll out a regional system for STEMI care to the 12 community hospitals in its service area without on-site PCI capabilities. ⋯ The D2B time process is being applied to other clinical venues; a vascular surgery project is underway to reduce "door-to-incision time" for patients with ruptured abdominal aortic aneurysms.
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Jt Comm J Qual Patient Saf · Apr 2009
A comprehensive hand hygiene approach to reducing MRSA health care-associated infections.
Methicillin-resistant Staphylococcus aureus (MRSA) infections are the most common health care-associated infections (HAI) in the acute care setting. The major mode of transmission from patient to patient is through bedside care providers via contaminated hands. After individual projects within Novant Health proved to be ineffective, with any gains in hand hygiene compliance being short-lived, a program was implemented to address unsatisfactory hand hygiene compliance rates. Published studies have associated improvements in hand hygiene compliance with decreases in HAIs. ⋯ Understanding hand hygiene compliance is a simple matter of observing caregiver behavior during each hand hygiene opportunity and recording the actions taken. The improvements in hand hygiene compliance translated into a real decrease in the number of hospital-acquired MRSA infections.