The Joint Commission journal on quality improvement
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The patient safety program in the Department of Veterans Affairs (VA) began in 1998, when the National Center for Patient Safety (NCPS) was established to lead the effort on a day-to-day basis. NCPS provides the structure, training, and tools, and VA facilities provide front-line expertise, feedback about the process, and root cause analysis (RCA) of adverse events and close calls. ⋯ NCPS monitors the quality and completeness of RCAs through the immediate review and feedback process. Still to be investigated is the effectiveness of RCA actions addressing the hypothesized root causes and contributing factors of the close calls and adverse events.
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Jt Comm J Qual Improv · Sep 2002
A rapid interview protocol supporting patient-centered quality improvement: hearing the parent's voice in a pediatric cancer unit.
The Institute of Medicine's 2001 report on quality delimits six dimensions of optimal care: safety, effectiveness, efficiency, timeliness, patient centeredness, and equity. In fall 2001 parents of pediatric cancer patients were interviewed to determine how well they thought these dimensions were addressed with respect to medication administration. Immediate goals were to identify system weaknesses and devise strategies to prevent future errors. A higher-order goal was to develop and demonstrate a model protocol for rapid-cycle interview assessments. ⋯ With good supervision and limited focused training, inexperienced staff can successfully administer semistructured qualitative interviews and help analyze findings for rapid cycle improvement purposes. The protocol can be adapted for use in organizations interested in rapid qualitative assessments of patient and parent preferences.
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Jt Comm J Qual Improv · Aug 2002
Randomized Controlled Trial Clinical TrialA randomized trial of three diabetes registry implementation strategies in a community internal medicine practice.
Disease registries are powerful tools with the potential to transform the way chronic diseases are managed. To date, however, little work has been done to determine how to optimize the implementation of a chronic disease registry in practice. ⋯ Disease registries can be used to improve outcomes in the management of diabetes and other chronic diseases. Better outcomes were seen in patients who received letters based on registry-generated data. This strategy should be included as part of a comprehensive chronic disease management plan. Further refinements in the use of registries should result in further incremental improvement.
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Jt Comm J Qual Improv · Aug 2002
Expanding a performance improvement initiative in critical care from hospital to system.
Concern about the expense and effects of intensive care prompted the development and implementation of a hospital-based performance improvement initiative in critical care at North Shore University Hospital, Manhasset, New York, a 730-bed acute care teaching hospital. THE HOSPITAL-BASED PERFORMANCE IMPROVEMENT INITIATIVE IN CRITICAL CARE: The initiative was intended to use a uniform set of measurements and guidelines to improve patient care and resource utilization in the intensive care units (ICUs), to establish and implement best practices (regarding admission and discharge criteria, nursing competency, unplanned extubations, and end-of-life care), and to improve performance in the other hospitals in the North Shore-Long Island Jewish Health System. In the medical ICU, the percentage of low-risk (low-acuity) patients was reduced from 42% to 22%. ICU length of stay was reduced from 4.6 days to 4.1 days. ⋯ Changing the critical care delivered on multiple units at multiple hospitals required sensitivity to existing organizational cultures and leadership styles. Merging organizational cultures is most successful when senior leadership set clear expectations that support the need for change. The process of collecting, trending, and communicating quality data has been instrumental in improving care practices and fostering a culture of safety throughout the health care system.
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Jt Comm J Qual Improv · Jul 2002
Reducing sharps injuries among health care workers: a sharps container quality improvement project.
Many needlestick injuries at Vanderbilt University Medical Center were found to be related to the method of disposal in sharps containers. The "straight-drop" system allowed staff to stuff more needles into a full box, resulting in needlestick injuries. This was also a common problem elsewhere, as reflected in the literature. ANALYZING THE PROBLEM: A multidisciplinary committee reviewed other sharps containers, piloted one, found problems, and then piloted and selected another. Implementation was complex and difficult, but focus was kept on the goal of decreased needlestick injuries. Staff identified other problems, which were taken to the manufacturer of the sharps container selected and resulted in product design changes. ⋯ This experience is an example of real-life implementation--and the problems institutions may have to overcome before success can be realized.