Healthcare quarterly (Toronto, Ont.)
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In order to understand how to effectively approach end-of-life disputes, this study surveyed physicians' attitudes towards one process for resolving end-of-life disputes, namely, the Consent and Capacity Board of Ontario. In this case, the process involved examining interpretation of best interests between substitute decision-makers and medical teams. Physicians who made "Form G" applications to the Consent and Capacity Board of Ontario that resulted in a decision posted on the open-access database, Canadian Legal Information Institute (CanLii), were identified and surveyed. ⋯ Physicians reported this particular approach, namely the Consent and Capacity Board has a mechanism that is worthwhile, patient centred, process oriented, orderly and efficient for resolving end-of-life disputes and, in particular, determining best interests. However, unless the appeal process can be adjusted to respond to the ICU context there is a risk of not serving the best interest of patients. Physicians would recommend framing end-of-life treatment plans in the positive instead of negative, for example, propose palliative care and no escalation of treatment as opposed to withdrawal.
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This article discusses the background and process for developing a multi-year corporate quality plan. The Ottawa Hospital's goal is to be a top 10% performer in quality and patient safety in North America. In order to create long-term measurable and sustainable changes in the quality of patient care, The Ottawa Hospital embarked on the development of a three-year strategic corporate quality plan. ⋯ The three-year quality plan was approved by senior management and the board in April 2009. This process has supported The Ottawa Hospital's journey of excellence through the creation of a quality plan that will enable long-term measurable and sustainable changes in the quality of patient care. It also engaged healthcare providers who aim to achieve more measured quality patient care, engaged practitioners through collaboration resulting in both alignment of goals and outcomes and allowed for greater commitment by those responsible for achieving quality goals.
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The Canadian Neonatal Network conducted a trial of Evidence-Based Practice for Improving Quality (EPIQ) between 2002 and 2005. Improved neonatal intensive care unit (NICU) outcomes established credibility for quality improvement. We surveyed team members and physician leaders to examine critical success factors and barriers to improvement during EPIQ. ⋯ The collaborative nature of the project was key to success. Respondents identified the need for additional training and resources in quality improvement. Better communication between clinicians and senior leaders is required to support quality improvement in NICUs.
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Neonatal intensive care units (NICUs) and intensive care units (ICUs) provide care for newborns in need of specialized medical attention. Across Canada, rates of NICU/ICU admission vary. Due to the high cost of monitoring and interventions these admissions cost more than general newborn stays - whether the newborn is in a specialized NICU or in an ICU in those facilities without specialized units for newborns. ⋯ We focus further on the association between NICU/ICU admission and Caesarean section (C-section). After excluding multiple births, preterm births, small for gestational age births and those delivered by women with select complications, we find an increased risk for NICU/ICU admission for babies born by C-section as their only indication. NICU/ICU admission following C-section alone may not represent the most desirable pathway of care for these newborns.