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Abdulelah M, Haider O, McAuliffe M, Al-Faris L, Paadam J, Medarametla V, Kleppel R, Joshi K. Do Decision Support Tools Decrease the Prevalence of Hospital-Acquired Venous Thromboembolisms When Compared to Clinical Judgement? A Single-Center Pre-Post Study. J Clin Med 2024; 13:3854. [PMID: 38999420 PMCID: PMC11242558 DOI: 10.3390/jcm13133854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/23/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Introduction: Hospital-acquired venous thromboembolisms (HA-VTEs) carry a significant health burden on patients and a financial burden on hospitals due to reimbursement penalties. VTE prophylaxis at our institute was performed through utilizing an order set based on healthcare professionals' perceived level of risk. However, the use of standardized risk assessment models is recommended by multiple professional societies. Furthermore, integrating decision support tools (DST) based on the standardized risk assessment models has been shown to increase the administration of appropriate deep vein thrombosis (DVT) prophylaxis. Nonetheless, such scoring systems are not inherently flawless and their integration into EMR as a mandatory step can come at the risk of healthcare professional fatigue and burnout. We conducted a study to evaluate the incidence of HA-VTE and length of stay pre- and post implementation of a DST. Methods: We conducted a retrospective, pre-post-implementation observational study at a tertiary medical center after implementing a mandatory DST. The DST used Padua scores for medical patients and Caprini scores for surgical patients. Patients were identified through ICD-10 codes and outcomes were collected from electronic charts. Healthcare professionals were surveyed through an anonymous survey and stored securely. Statistical analysis was conducted by using R (version 3.4.3). Results: A total of 343 patients developed HA-VTE during the study period. Of these, 170 patients developed HA-VTE in the 9 months following the implementation of the DST, while 173 patients were identified in the 9 months preceding the implementation. There was no statistically significant difference in mean HA-VTE/1000 discharge/month pre- and post implementation (4.4 (SD 1.6) compared to 4.6 (SD 1.2), confidence interval [CI] -1.6 to 1.2, p = 0.8). The DST was used in 73% of all HA-VTE cases over the first 6 months of implementation. The hospital length of stay (LOS) was 14.2 (SD 1.9) days prior to implementation and 14.1 (SD 1.6) days afterwards. No statistically significant change in readmission rates was noted (8.8% (SD 2.6) prior to implementation and 15.53% (SD 9.6) afterwards, CI -14.27 to 0.74, p = 0.07). Of the 56 healthcare professionals who answered the survey, 84% (n = 47) reported to be dissatisfied or extremely dissatisfied with the DST, while 91% (n = 51) reported that it slowed them down. Conclusions: There were no apparent changes in the prevalence of HA-VTE, length of stay, or readmission rates when VTE prophylaxis was mandated through DST compared to a prior model which used order sets based on perceived risk. Further studies are needed to further evaluate the current risk assessment models and improve healthcare professionals' satisfaction with DST.
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Affiliation(s)
- Mohammad Abdulelah
- Department of Internal Medicine, University of Massachusetts Chan Medical School—Baystate Regional Campus, Springfield, MA 01199, USA (R.K.)
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Ledbeter L. Self-efficacy in Quality Improvement Competency of Frontline Acute Care Registered Nurses. J Nurs Care Qual 2024; 39:168-174. [PMID: 37751558 DOI: 10.1097/ncq.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND Registered nurses (RNs) are attuned to health care quality and safety concerns but may lack competency in quality improvement (QI) to advance care quality. PURPOSE To describe frontline acute care RNs' self-efficacy in QI competencies, evaluate differences based on educational attainment, and evaluate relationships based on years of RN experience. METHODS The study used a descriptive, quantitative, correlational, comparative cross-sectional survey design to evaluate RNs' self-efficacy in QI competency using the 2021 American Association of Colleges of Nursing The Essentials : Core Competencies for Professional Nursing Education . RESULTS Frontline RNs' overall QI self-efficacy showed variability in knowledge, skills, and attitudes, with no relationship between self-efficacy and years of RN experience, nor difference based on educational attainment. CONCLUSIONS Insufficient self-efficacy signals the need for further QI focus in nursing education, nursing practice, and health care policy to harness RNs' ability to advance care outcomes.
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Affiliation(s)
- Lauri Ledbeter
- Author Affiliations: Providence Health & Services, Spokane, Washington
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Tai TWC, Mattie A, Miller SM, Yawson RM. An examination of Leapfrog safety measures and Magnet designation. J Healthc Risk Manag 2023; 42:21-29. [PMID: 36843561 DOI: 10.1002/jhrm.21533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/09/2023] [Indexed: 02/28/2023]
Abstract
Leapfrog Hospital Safety Grades and Magnet designation are two publicly available measures that serve as proxies for health care quality and safety. We examine whether hospitals with a better rating in one Leapfrog safety measure also have favorable ratings in other Leapfrog safety measures and whether Magnet-designated hospitals have better Leapfrog safety scores related to outcomes, processes, and structures than non-Magnet hospitals. Our study found that hospital-associated infections (HAIs) were not strongly correlated with one another, but Leapfrog safety process and structural measures were significantly and strongly correlated with one another, suggesting hospitals that invest in processes/structures to improve quality tend to do so across many dimensions. Also, Magnet-designated hospitals had higher Leapfrog grades for structural measures but not systematically better infection rates. Only one HAI (central line-associated bloodstream infections) had lower rates in Magnet hospitals than non-Magnet hospitals. These analyses suggest that improvements in process and structural measures do not necessarily translate into lower HAIs. Hospitals may need specific quality improvement strategies to target each HAI since HAIs are not strongly correlated with one another. Future research is needed to identify what process and structural measures can decrease HAIs and how this should be reflected in Magnet designation evaluation criteria.
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Affiliation(s)
| | - Angela Mattie
- School of Business & Medicine, Quinnipiac University, Hamden, Connecticut, USA
| | | | - Robert M Yawson
- School of Business, Quinnipiac University, Hamden, Connecticut, USA
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Boamah SA, Hamadi HY, Spaulding AC. Hospital-Acquired Conditions Reduction Program, Racial and Ethnic Diversity, and Magnet Designation in the United States. J Patient Saf 2022; 18:e1090-e1095. [PMID: 35532988 DOI: 10.1097/pts.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A key quality indicator in any health system is its ability to reduce morbidity and mortality. In recent years, healthcare organizations in the United States have been held to stricter measures of accountability to provide safe, quality care. This study aimed to explore the contextual factors driving racial disparities in hospital-acquired conditions incident rates among Medicare recipients in Magnet and non-Magnet hospitals. METHODS A cross-sectional observational study was performed using data from Hospital-Acquired Condition Reduction Program. Performance from 1823 hospitals were used to examine the association between Magnet recognition and community's racial and ethnic differences in hospital performance on the Hospital-Acquired Condition Reduction Program. The unit of analysis was the hospital level. A propensity score matching approach was used to take into account differences in baseline characteristics when comparing Magnet and non-Magnet hospitals. The outcome measures were risk-standardized hospital performance on the Hospital-Acquired Condition Reduction Program domains and overall performance. RESULTS Study findings show that Magnet hospitals had decreased methicillin-resistant Staphylococcus aureus (MRSA) rate (β = -0.22; 95% confidence interval, -0.36 to -0.08) compared with non-Magnet hospitals. No other statistical difference was identified. CONCLUSIONS Results from this study show community's racial and ethnic differences in hospital-acquired conditions occurrence differ between Magnet and non-Magnet hospitals for MRSA, indicating its association with nursing practice. However, because this improvement is limited to only MRSA, there are likely opportunities for Magnet hospitals to continue process improvements focused on additional Hospital-Acquired Condition Reduction Program measures.
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Affiliation(s)
- Sheila A Boamah
- From the School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Hanadi Y Hamadi
- Department of Health Administration, Brooks College of Health (Building 39), University of North Florida
| | - Aaron C Spaulding
- Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern, Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
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Rotteau L, Goldman J, Shojania KG, Vogus TJ, Christianson M, Baker GR, Rowland P, Coffey M. Striving for high reliability in healthcare: a qualitative study of the implementation of a hospital safety programme. BMJ Qual Saf 2022; 31:867-877. [PMID: 35649697 DOI: 10.1136/bmjqs-2021-013938] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Healthcare leaders look to high-reliability organisations (HROs) for strategies to improve safety, despite questions about how to translate these strategies into practice. Weick and Sutcliffe describe five principles exhibited by HROs. Interventions aiming to foster these principles are common in healthcare; however, there have been few examinations of the perceptions of those who have planned or experienced these efforts. OBJECTIVE This single-site qualitative study explores how healthcare professionals understand and enact the HRO principles in response to an HRO-inspired hospital-wide safety programme. METHODS We interviewed 71 participants representing hospital executives, programme leadership, and staff and physicians from three clinical services. We observed and collected data from unit and hospital-wide quality and safety meetings and activities. We used thematic analysis to code and analyse the data. RESULTS Participants reported enactment of the HRO principles 'preoccupation with failure', 'reluctance to simplify interpretations' and 'sensitivity to operations', and described the programme as adding legitimacy, training, and support. However, the programme was more often targeted at, and taken up by, nurses compared with other groups. Participants were less able to identify interventions that supported the HRO principles 'commitment to resilience' and 'deference to expertise' and reported limited examples of changes in practices related to these principles. Moreover, we identified inconsistent, and even conflicting, understanding of concepts related to the HRO principles, often related to social and professional norms and practices. Finally, an individualised rather than systemic approach hindered collective actions underlying high reliability. CONCLUSION Our findings demonstrate that the safety programme supported some HRO principles more than others, and was targeted at, and perceived differently across professional groups leading to inconsistent understanding and enactments of the principles across the organisation. Combining HRO-inspired interventions with more targeted attention to each of the HRO principles could produce greater, more consistent high-reliability practices.
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Affiliation(s)
- Leahora Rotteau
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Joanne Goldman
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
| | - Kaveh G Shojania
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Timothy J Vogus
- Owen Graduate School of Management, Vanderbilt University, Nashville, Tennessee, USA
| | - Marlys Christianson
- Rotman School of Management, University of Toronto, Toronto, Ontario, Canada
| | - G Ross Baker
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paula Rowland
- Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maitreya Coffey
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Children's Hospitals Solutions for Patient Safety, Cincinnati, Ohio, USA.,Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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