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Hu R, Chen Y, Hu J, Yi L. Establishing Nursing-Sensitive Quality Indicators for the Central Sterile Supply Department: A Modified Delphi Study. Qual Manag Health Care 2024:00019514-990000000-00069. [PMID: 38427344 DOI: 10.1097/qmh.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Previous studies have shown that improving quality management in the central sterile supply department (CSSD) is an effective measure to control and decrease hospital-acquired infections. This study aimed to establish nursing-sensitive quality indicators for CSSD nursing in China. METHODS We drafted nursing-sensitive quality indicators on the basis of the Structure-Process-Outcome model, and then conducted 2 rounds of consultation with experts using a modified Delphi method to determine the indicators and scientific methods of measurement. RESULTS We identified five CSSD nursing-sensitive quality indicators. Recovery rates of the 2 rounds of valid questionnaires were 100%. Expert authority coefficients were 0.810 and 0.902, respectively. Kendall's coefficients of concordance were 0.168 and 0.210, respectively ( P < .05). CONCLUSION Evidence-based nursing-sensitive quality indicators for the CSSD were established.
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Affiliation(s)
- Ruixue Hu
- Author Affiliations: Department of Sterile processing Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China; and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Bilò MB, Corsi A, Pravettoni V, Bignardi D, Bonadonna P, Quercia O, Mauro M, Novembre E, Micheletti R, Papa R. Development of a model care pathway for the management of Hymenoptera venom allergy: evidence-based key interventions and indicators. Clin Transl Allergy 2020; 10:8. [PMID: 32158533 PMCID: PMC7055031 DOI: 10.1186/s13601-020-00312-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/24/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Hymenoptera venom allergy (HVA) is an underestimated condition representing an important cause of morbidity and mortality worldwide. Preventing future allergic reactions in patients who have already developed a systemic reaction is based on the correct management of the acute phase of the reaction followed by a correct diagnosis and, where indicated, prescription of adrenaline autoinjectors and VIT. A possible strategy to optimize care processes and to improve outcomes is the implementation of a Diagnostic and Therapeutic Care Pathways, also known as Integrated Care Pathways or Clinical Pathways (CPWs). The aim of the care pathway is to enhance the quality of care by improving risk-adjusted patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. To our knowledge, currently in Italy as well as in Europe, there is no CPWs codified for the management of HVA patients. This paper describes the development of the clinical content of a care pathway for the management of HVA. METHODS The methodology applied is based on the eight step method to build the clinical content of an evidence-based care pathway suggested by Lodewijckx et al. RESULTS Three hundred and seventeen different clinical activities were extracted from the selected literature. The expert panel was involved in their evaluation, expressing a judgment of relevance through the Delphi study. As a result, 126 clinical activities were appraised to be valid and feasible. The final recommendations (126) were translated into 123 key interventions. Six indicators were produced by the clinical activities. CONCLUSION A set of 123 key interventions and of six process indicators were found to be appropriate for the development and standardization of the clinical content of the Hymenoptera venom allergy care pathway.
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Affiliation(s)
- Maria Beatrice Bilò
- Allergy Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
- Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
| | - Alice Corsi
- Postgraduate School of Allergy and Clinical Immunology, Università Politecnica delle Marche, Ancona, Italy
| | - Valerio Pravettoni
- U.O.C. General Medicine-Immunology and Allergology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Patrizia Bonadonna
- U.S.D. Allergology Integrated University-Hospital of Verona, Verona, Italy
| | - Oliviero Quercia
- High Specialization Unit of Allergology, Hospital of Faenza, AUSL (Local Health Unit) of Romagna, Romagna, Italy
| | | | - Elio Novembre
- Complex Organizational Unit of Allergology, University-Hospital A. Meyer, Florence, Italy
| | - Rebecca Micheletti
- Postgraduate School of Hygiene and Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Roberto Papa
- S.O. Hospital Medical Management, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
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Seys D, Bruyneel L, Sermeus W, Lodewijckx C, Decramer M, Deneckere S, Panella M, Vanhaecht K. Teamwork and Adherence to Recommendations Explain the Effect of a Care Pathway on Reduced 30-day Readmission for Patients with a COPD Exacerbation. COPD 2018; 15:157-164. [PMID: 29461135 DOI: 10.1080/15412555.2018.1434137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to increase our understanding of processes that underlie the effect of care pathway implementation on reduced 30-day readmission rate. Adherence to evidence-based recommendations, teamwork and burnout have previously been identified as potential mechanisms in this association. We conducted a secondary data analysis of 257 patients admitted with chronic obstructive pulmonary disease exacerbation and 284 team members caring for these patients in 19 Belgian, Italian and Portuguese hospitals. Clinical measures included 30-day readmission and adherence to a specific set of five care activities. Teamwork measures included team climate for innovation, level of organized care and burnout (emotional exhaustion, level of competence and mental detachment). Care pathway implementation was significantly associated with better adherence and reduced 30-day readmission. Better adherence and higher level of competence were also related to reduced 30-day readmission. Only better adherence fully mediated the association between care pathway implementation and reduced 30-day readmission. Better team climate for innovation and level of organized care, although both improved after care pathway implementation, did not show any explanatory mechanisms in the association between care pathway implementation and reduced 30-day readmission. Implementation of a care pathway had an impact on clinical and team indicators. To reduce 30-day readmission rates, in the development and implementation of a care pathway, hospitals should measure adherence to evidence-based recommendations during the whole process, as this can give information regarding the success of implementation.
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Affiliation(s)
- Deborah Seys
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium
| | - Luk Bruyneel
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
| | - Walter Sermeus
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium
| | - Cathy Lodewijckx
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,c AZ Sint Maarten , Mechelen , Belgium
| | - Marc Decramer
- d Department of Clinical and Experimental Medicine , KU Leuven - University of Leuven , Leuven , Belgium.,e Chief Executive Officer , University Hospitals Leuven , Leuven , Belgium
| | - Svin Deneckere
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,f Delta hospitals Roeselare , Roeselare , Belgium
| | - Massimiliano Panella
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,g Department of Translational Medicine , University of Eastern Piedmont , Piedmont , Italy
| | - Kris Vanhaecht
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
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Aeyels D, Sinnaeve PR, Claeys MJ, Gevaert S, Schoors D, Sermeus W, Panella M, Coeckelberghs E, Bruyneel L, Vanhaecht K. Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey. Acta Cardiol 2017; 73:1-10. [PMID: 29237337 DOI: 10.1080/00015385.2017.1411664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. METHODS AND RESULTS A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI. CONCLUSIONS A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.
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Affiliation(s)
- Daan Aeyels
- a Leuven Institute for Healthcare Policy , Katholieke Universiteit Leuven , Leuven , Belgium
| | - Peter R Sinnaeve
- b Department of Cardiology , University Hospitals Leuven , Leuven , Belgium
| | - Marc J Claeys
- c Department of Cardiology , Antwerp University Hospital , Edegem , Belgium
| | - Sofie Gevaert
- d Department of Cardiology , Ghent University Hospital , Ghent , Belgium
| | - Danny Schoors
- e Department of Cardiology , University Hospitals Brussels , Brussels , Belgium
| | - Walter Sermeus
- f Institute for Healthcare Policy , University of Leuven , Leuven , Belgium
| | - Massimiliano Panella
- g Department of Clinical and Experimental Medicine , Amedeo Avogadro University of Eastern Piedmont , Vercelli , Italy
| | | | - Luk Bruyneel
- f Institute for Healthcare Policy , University of Leuven , Leuven , Belgium
| | - Kris Vanhaecht
- h Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
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Seys D, Bruyneel L, Decramer M, Lodewijckx C, Panella M, Sermeus W, Boto P, Vanhaecht K. An International Study of Adherence to Guidelines for Patients Hospitalised with a COPD Exacerbation. COPD 2016; 14:156-163. [PMID: 27997254 DOI: 10.1080/15412555.2016.1257599] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Guideline adherence rates for the treatment of chronic obstructive pulmonary disease (COPD) exacerbation are low. The aim of this study is to perform an importance-performance analysis as an approach for prioritisation of interventions by linking guidelines adherence rates to expert consensus rates for the in-hospital management of COPD exacerbation. We illustrate the relevance of such approach by describing variation in guideline adherence across indicators and hospitals. A secondary data analysis of patients with an acute COPD exacerbation admitted to Belgian, Italian and Portuguese hospitals was performed. Twenty-one process indicators were used to describe adherence to guidelines from patient record reviews. Expert consensus on the importance for follow-up of these 21 indicators was derived from a previous Delphi study. Three of the twenty-one indicators had high level of expert consensus and a high level of adherence. Eleven of the twenty-one indicators had high level of expert consensus but a low level of adherence. For none of the 378 patients included in this study were all process indicators adhered to, patients received 41.0% of the recommended care on average, and only 34.1% of the patients received 50% or more of the care they should receive. There was also a large variation within and between hospitals regarding the care received. This study confirms the findings of previous studies, indicating that COPD exacerbations are largely undertreated. Importance-performance analysis provides a decision-making tool for prioritising indicators. All hospitals in this study would benefit from having in place a quality framework for systematic follow-up of these indicators.
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Affiliation(s)
- Deborah Seys
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium
| | - Luk Bruyneel
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.,b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
| | - Marc Decramer
- c Department of Clinical and Experimental Medicine , KU Leuven-University of Leuven , Leuven , Belgium.,d Chief Executive Officer, University Hospitals Leuven , Leuven , Belgium
| | - Cathy Lodewijckx
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium
| | - Massimiliano Panella
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.,e Department of Translational Medicine , University of Eastern Piedmont , Vercelli , Italy
| | - Walter Sermeus
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium
| | - Paulo Boto
- f Department of Health Services Policy and Management Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP), Universidade Nova de Lisboa (UNL) , Lisbon , Portugal
| | - Kris Vanhaecht
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.,b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
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Aeyels D, Van Vugt S, Sinnaeve PR, Panella M, Van Zelm R, Sermeus W, Vanhaecht K. Lack of evidence and standardization in care pathway documents for patients with ST-elevated myocardial infarction. Eur J Cardiovasc Nurs 2015; 15:e45-51. [DOI: 10.1177/1474515115580237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/12/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Daan Aeyels
- Department of Public Health and Primary Care, University of Leuven, Belgium
- European Pathway Association, Belgium
| | - Stijn Van Vugt
- Department of Public Health and Primary Care, University of Leuven, Belgium
| | - Peter R Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium
| | - Massimiliano Panella
- Department of Clinical and Experimental Medicine, Amedeo Avogadro University of Eastern Piedmont, Italy
| | - Ruben Van Zelm
- European Pathway Association, Belgium
- QConsult, The Netherlands
| | - Walter Sermeus
- Department of Public Health and Primary Care, University of Leuven, Belgium
- European Pathway Association, Belgium
| | - Kris Vanhaecht
- Department of Public Health and Primary Care, University of Leuven, Belgium
- European Pathway Association, Belgium
- Department of Quality Management, University Hospitals Leuven, Belgium
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Ore T, Ireland P. Chronic obstructive pulmonary disease hospitalisations and mortality in Victoria: analysis of variations by socioeconomic status. Aust N Z J Public Health 2015; 39:243-9. [PMID: 25559228 DOI: 10.1111/1753-6405.12305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 08/01/2014] [Accepted: 08/01/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This paper analysed chronic obstructive pulmonary disease (COPD) hospitalisations, unplanned readmissions and deaths in Victoria to identify associations with socioeconomic status (SES). METHODS The data was taken from the Victorian Admitted Episodes Dataset, the Victorian Health Information Surveillance System, the Victorian Burden of Disease Study and the Australian Bureau of Statistics' Index of Relative Socioeconomic Disadvantage. RESULTS COPD separations have a greater variation by SES than all separations. The average age-standardised separation rate (10.43) for the top percentile Local Government Areas (LGA) was 5.8 times that of the bottom percentile LGAs (1.80). The top percentile group was the lowest SES group (effect size = 0.93). There were significant negative correlations between the age-standardised COPD separation rates and SES across LGAs (r = -0.60) and Regions (r = -0.89). Analysis of readmissions (r = -0.49), mortality data (r = -0.51) and the burden of disease data (r = -0.39) also showed significant inverse associations between COPD and SES. CONCLUSIONS AND IMPLICATIONS Victorians living in the most disadvantaged areas have a greater burden from COPD, highlighting a need to prioritise public health services interventions to improve outcomes.
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Affiliation(s)
- Timothy Ore
- Department of Health, Commission for Hospital Improvement, Victoria
| | - Paul Ireland
- Department of Health, Commission for Hospital Improvement, Victoria
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Lodewijckx C, Decramer M, Sermeus W, Panella M, Deneckere S, Vanhaecht K. Eight-step method to build the clinical content of an evidence-based care pathway: the case for COPD exacerbation. Trials 2012; 13:229. [PMID: 23190552 PMCID: PMC3543249 DOI: 10.1186/1745-6215-13-229] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 10/23/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Optimization of the clinical care process by integration of evidence-based knowledge is one of the active components in care pathways. When studying the impact of a care pathway by using a cluster-randomized design, standardization of the care pathway intervention is crucial. This methodology paper describes the development of the clinical content of an evidence-based care pathway for in-hospital management of chronic obstructive pulmonary disease (COPD) exacerbation in the context of a cluster-randomized controlled trial (cRCT) on care pathway effectiveness. METHODS The clinical content of a care pathway for COPD exacerbation was developed based on recognized process design and guideline development methods. Subsequently, based on the COPD case study, a generalized eight-step method was designed to support the development of the clinical content of an evidence-based care pathway. RESULTS A set of 38 evidence-based key interventions and a set of 24 process and 15 outcome indicators were developed in eight different steps. Nine Belgian multidisciplinary teams piloted both the set of key interventions and indicators. The key intervention set was judged by the teams as being valid and clinically applicable. In addition, the pilot study showed that the indicators were feasible for the involved clinicians and patients. CONCLUSIONS The set of 38 key interventions and the set of process and outcome indicators were found to be appropriate for the development and standardization of the clinical content of the COPD care pathway in the context of a cRCT on pathway effectiveness. The developed eight-step method may facilitate multidisciplinary teams caring for other patient populations in designing the clinical content of their future care pathways.
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Affiliation(s)
- Cathy Lodewijckx
- Respiratory Department, University Hospitals Leuven, Leuven, Belgium
- Department of Public Health, KU Leuven University of Leuven, Leuven, Belgium
- European Pathway Association, Kapucijnenvoer, Leuven, Belgium
| | - Marc Decramer
- Respiratory Department, University Hospitals Leuven, Leuven, Belgium
- Faculty of Medicine, KU Leuven University of Leuven, Leuven, Belgium
| | - Walter Sermeus
- Department of Public Health, KU Leuven University of Leuven, Leuven, Belgium
- European Pathway Association, Kapucijnenvoer, Leuven, Belgium
| | - Massimiliano Panella
- European Pathway Association, Kapucijnenvoer, Leuven, Belgium
- Department of Public Health, Department of Clinical and Experimental Medicine, Faculty of Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Svin Deneckere
- Department of Public Health, KU Leuven University of Leuven, Leuven, Belgium
- European Pathway Association, Kapucijnenvoer, Leuven, Belgium
| | - Kris Vanhaecht
- Department of Public Health, KU Leuven University of Leuven, Leuven, Belgium
- European Pathway Association, Kapucijnenvoer, Leuven, Belgium
- Western Norway Research Network on Integrated Care, Helse Fonna, Haugesund, Norway
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