Clinical performance and quality health care
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Clin Perform Qual Health Care · Apr 1999
The psychological and physiological effects of an intensive-care unit environment on healthy individuals.
The ideal inpatient environment would be one in which patient stress and anxiety are alleviated, but current inpatient hospital settings often do not seem to take this fact into consideration. To date, the effects of the actual hospital environment itself on patients is poorly understood. The purpose of the present study was to investigate the types of psychological and physiological changes that people undergo in response to being placed in an inpatient setting. ⋯ The findings of increased feelings of depression attributable solely to being in an ICU setting are inconsistent with the type of environment generally considered necessary to alleviate patient anxiety and tension in a critical-care-ward environment. The negative perception of this environment strongly suggests room for improvement. Efforts in this regard should focus on improving the five senses, particularly sight, sound, and taste within the ICU.
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Clin Perform Qual Health Care · Jan 1999
Red blood cell transfusions for elective hip and knee arthroplasty: opportunity to improve quality of care and documentation.
To assess current practice for red blood cell transfusion relative to the American College of Physicians guideline for red blood cell transfusion; to determine comparative rates and relative appropriateness of autologous versus allogeneic blood use; and, to assess cost implications of current transfusion practices. ⋯ These findings demonstrate that current medical records lack the documentation necessary to evaluate transfusion practice for the majority of Medicare beneficiaries undergoing elective hip and knee arthroplasty. The direct costs of preoperative and postoperative blood transfusion for these two procedures could be reduced by nearly 40% through adherence to the American College of Physicians guideline. The majority of this cost saving would be realized through reduction in unnecessary collection and use of autologous blood.
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Clin Perform Qual Health Care · Jan 1999
Counterpoint: public disclosure of process and outcome measures.
Bad data is a toxic substance. In the release of process and outcome measures in the field of health care, numerous examples exist of published bad data. ⋯ Such procedures include appropriate definitions of the process or outcome to be measured and careful description of the population being observed, risk adjusted for severity of illness. When this is done, the data can be published with some confidence that it will have value.
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Clin Perform Qual Health Care · Oct 1998
Utilizing national nosocomial infection surveillance system data to improve urinary tract infection rates in three intensive-care units.
To reduce catheter-related urinary tract infection rates in three intensive-care units to at or below the National Nosocomial Infection Surveillance System pooled mean for similar units. ⋯ A multidisciplinary approach assisted in reducing catheter-associated urinary tract infections in three intensive-care units, although not to the extent desired. The teams are investigating preconnected and antimicrobial-coated catheters further.
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Clin Perform Qual Health Care · Oct 1998
Preventable trauma deaths: evaluation by peer review and a guide for quality improvement. Emergency Medical Study Group for Quality.
The trauma-injury severity-score (TRISS) methodology was developed in the United States to calculate the probability of survival for trauma patients presenting for emergency care. ⋯ TRISS can be used as a screening tool to identify potentially preventable trauma deaths. Peer review is appropriate to confirm preventability and to identify potential medical errors.