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李 正. [Significance and application of quality improvement in clinical medicine]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:219-223. [PMID: 38557371 PMCID: PMC10986376 DOI: 10.7499/j.issn.1008-8830.2309009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/08/2024] [Indexed: 04/04/2024]
Abstract
Quality improvement is a methodology which was initially developed and employed in the field of industrial manufacturing. This approach involves implementing a series of interventions aimed at elevating the existing quality standards to a higher level. In daily medical work, there are often spontaneous quality improvements. Medical quality improvements supported by scientific methodology can evaluate medical quality more scientifically and provide objective feedback on the quality of medical work for healthcare professionals. This article provides a concise introduction to quality improvement and shows its application and significance in the field of clinical medicine through examples.
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Daniel Pereira D, Market MR, Bell SA, Malic CC. Assessing the quality of reporting on quality improvement initiatives in plastic surgery: A systematic review. J Plast Reconstr Aesthet Surg 2023; 79:101-110. [PMID: 36907019 DOI: 10.1016/j.bjps.2023.01.036] [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: 09/24/2022] [Revised: 01/07/2023] [Accepted: 01/29/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND There has been a recent increase in the number and complexity of quality improvement studies in plastic surgery. To assist with the development of thorough quality improvement reporting practices, with the goal of improving the transferability of these initiatives, we conducted a systematic review of studies describing the implementation of quality improvement initiatives in plastic surgery. We used the SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guideline to appraise the quality of reporting of these initiatives. METHODS English-language articles published in Embase, MEDLINE, CINAHL, and the Cochrane databases were searched. Quantitative studies evaluating the implementation of quality improvement initiatives in plastic surgery were included. The primary endpoint of interest in this review was the distribution of studies per SQUIRE 2.0 criteria scores in proportions. Abstract screening, full-text screening, and data extraction were completed independently and in duplicate by the review team. RESULTS We screened 7046 studies, of which 103 full texts were assessed, and 50 met inclusion criteria. In our assessment, only 7 studies (14%) met all 18 SQUIRE 2.0 criteria. SQUIRE 2.0 criteria that were met most frequently were abstract, problem description, rationale, and specific aims. The lowest SQUIRE 2.0 scores appeared in funding, conclusion, and interpretation criteria. CONCLUSIONS Improvements in QI reporting in plastic surgery, especially in the realm of funding, costs, strategic trade-offs, project sustainability, and potential for spread to other contexts, will further advance the transferability of QI initiatives, which could lead to significant strides in improving patient care.
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Affiliation(s)
- D Daniel Pereira
- Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada.
| | - Marisa R Market
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephanie A Bell
- Department of Plastic Surgery, Children's Hospital of Eastern Ontario, Canada
| | - Claudia C Malic
- Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada; Department of Plastic Surgery, Children's Hospital of Eastern Ontario, Canada
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Carroll AR, Smith CM, Frazier SB, Weiner JG, Johnson DP. Designing and Conducting Scholarly Quality Improvement: A Practical Guide for Improvers Everywhere. Hosp Pediatr 2022; 12:e359-e363. [PMID: 36172802 PMCID: PMC9645019 DOI: 10.1542/hpeds.2022-006717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Successful publication of quality improvement (QI) work is predicated on the use of established QI frameworks and rigorous analytical methods that allow teams to understand the impact of interventions over time. This article is meant to help QI teams disseminate their work more broadly through publication by providing tangible methods that many journals desire in QI articles with specific examples of published works referenced throughout the article. We introduce improvement frameworks that teams should identify early and use as a foundation throughout their projects. We review vital aspects of QI projects, such as team formation, creation of a succinct and clear aim statement, defining primary, process, and balancing measures, as well as QI tools like key driver diagrams, Ishikawa (fishbone) diagrams, and Pareto charts. Finally, we highlight the importance of analyzing data over time to understand the impacts of plan-do-study-act cycles on data. Annotated run charts or, more preferably, annotated statistical process control (or Shewhart) charts are both statistically sound methods to identify significant changes over time. Deliberate planning and execution of QI projects using these concepts will lead to improved chances of QI teams finding success in their project and eventual article acceptance.
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Affiliation(s)
- Alison R. Carroll
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Christine M. Smith
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - S. Barron Frazier
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jeffrey G. Weiner
- Department of Pediatrics, Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville Tennessee
| | - David P. Johnson
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
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Wagstaff D, Warnakulasuriya S, Singleton G, Moonesinghe SR, Fulop N, Vindrola-Padros C. A scoping review of local quality improvement using data from UK perioperative National Clinical Audits. Perioper Med (Lond) 2022; 11:43. [PMID: 36031654 PMCID: PMC9422140 DOI: 10.1186/s13741-022-00273-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 06/22/2022] [Indexed: 11/28/2022] Open
Abstract
Background Significant resources are invested in the UK to collect data for National Clinical Audits (NCAs), but it is unclear whether and how they facilitate local quality improvement (QI). The perioperative setting is a unique context for QI due to its multidisciplinary nature and history of measurement. It is unclear which NCAs evaluate perioperative care, to what extent their data have been used for QI, and which factors influence this usage. Methods NCAs were identified from the directories held by Healthcare Quality Improvement Partnership (HQIP), Scottish Healthcare Audits and the Welsh National Clinical Audit and Outcome Review Advisory Committee. QI reports were identified by the following: systematically searching MEDLINE, CINAHL Plus, Web of Science, Embase, Google Scholar and HMIC up to December 2019, hand-searching grey literature and consulting relevant stakeholders. We charted features describing both the NCAs and the QI reports and summarised quantitative data using descriptive statistics and qualitative themes using framework analysis. Results We identified 36 perioperative NCAs in the UK and 209 reports of local QI which used data from 19 (73%) of these NCAs. Six (17%) NCAs contributed 185 (89%) of these reports. Only one NCA had a registry of local QI projects. The QI reports were mostly brief, unstructured, often published by NCAs themselves and likely subject to significant reporting bias. Factors reported to influence local QI included the following: perceived data validity, measurement of clinical processes as well as outcomes, timely feedback, financial incentives, sharing of best practice, local improvement capabilities and time constraints of clinicians. Conclusions There is limited public reporting of UK perioperative NCA data for local QI, despite evidence of improvement of most NCA metrics at the national level. It is therefore unclear how these improvements are being made, and it is likely that opportunities are being missed to share learning between local sites. We make recommendations for how NCAs could better support the conduct, evaluation and reporting of local QI and suggest topics which future research should investigate. Trial registration The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42018092993). Supplementary Information The online version contains supplementary material available at 10.1186/s13741-022-00273-0.
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Linam WM, Trivedi KK, Schaffzin JK. Don't just do it-Conducting and publishing improvement science in infection prevention and antibiotic stewardship. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e33. [PMID: 36310783 PMCID: PMC9614962 DOI: 10.1017/ash.2021.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 06/16/2023]
Affiliation(s)
- W. Matthew Linam
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Kavita K. Trivedi
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California
| | - Joshua K. Schaffzin
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Levy AE, Whittington MD, Anstett TJ, Simon ST, Wentworth A, Carter JE, Ho PM. A Systems-Based Morbidity and Mortality Conference Was Associated With a Transient Reduction in ECG Completion Times. Qual Manag Health Care 2022; 31:28-33. [PMID: 34724456 PMCID: PMC9050961 DOI: 10.1097/qmh.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES During its monthly morbidity and mortality conference (MMC), the University of Colorado Division of Cardiology reviewed a "near-miss" patient safety event involving the delayed completion of a Stat-priority (ie, statim, meaning high priority) electrocardiogram (ECG). Because critical and interprofessional stakeholders participated in the conference, we hypothesized that the MMC would be associated with reduced ECG completion times. METHODS Data were collected for in-hospital ECGs performed at the University of Colorado Hospital between January 1, 2017, and June 30, 2018. An interrupted time series analysis was used to estimate the immediate and ongoing impact of the MMC (held on February 28, 2018) on ECG completion times, stratified by order priority (Stat, Now, or Routine). The percentage of delayed Stat-priority ECGs was analyzed as a secondary outcome. RESULTS Before the MMC, ECG completion times were stable for all order priorities ( P > .2), but the proportion of delayed Stat-priority ECGs increased from 5% in January 2017 to 20% in February 2018 ( P < .01). The MMC was associated with an immediate reduction in average daily ECG completion times for Routine (-18.4 minutes, P = .03) and Now (-8 minutes, P = .024) priority ECGs. No reduction was seen for Stat ECGs ( P = .97), though the percentage of delayed Stat ECGs stopped increasing ( P = .63). In the post-MMC period, completion times for Routine-priority ECGs increased and approached pre-MMC levels. CONCLUSIONS The MMC was associated with an immediate, but temporary, improvement in ECG completion times. Although the observed clinical benefit of the MMC is novel, these data support the need for more durable reforms to sustain initial improvements.
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Affiliation(s)
- Andrew E. Levy
- University of Colorado School of Medicine, Aurora, CO, USA
- Denver Health and Hospital Authority, Denver, CO, USA
| | | | | | | | | | | | - P. Michael Ho
- University of Colorado School of Medicine, Aurora, CO, USA
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Birgisdóttir D, Duarte A, Dahlman A, Sallerfors B, Rasmussen BH, Fürst CJ. A novel care guide for personalised palliative care - a national initiative for improved quality of care. BMC Palliat Care 2021; 20:176. [PMID: 34763677 PMCID: PMC8582140 DOI: 10.1186/s12904-021-00874-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Even when palliative care is an integrated part of the healthcare system, the quality is still substandard for many patients and often initiated too late. There is a lack of structured guidelines for identifying and caring for patients; in particular for those with early palliative care needs. A care guide can act as a compass for best practice and support the care of patients throughout their palliative trajectory. Such a guide should both meet the needs of health care professionals and patients and families, facilitating discussion around end-of-life decision-making and enabling them to plan for the remaining time in life. The aim of this article is to describe the development and pilot testing of a novel Swedish palliative care guide. Methods The Swedish Palliative Care Guide (S-PCG) was developed according to the Medical Research Council framework and based on national and international guidelines for good palliative care. An interdisciplinary national advisory committee of over 90 health care professionals together with patient, family and public representatives were engaged in the process. The feasibility was tested in three pilot studies in different care settings. Results After extensive multi-unit and interprofessional testing and evaluation, the S-PCG contains three parts that can be used independently to identify, assess, address, follow up, and document the individual symptoms and care-needs throughout the whole palliative care trajectory. The S-PCG can provide a comprehensive overview and shared understanding of the patients’ needs and possibilities for ensuring optimal quality of life, the family included. Conclusions Based on broad professional cooperation, patients and family participation and clinical testing, the S-PCG provides unique interprofessional guidance for assessment and holistic care of patients with palliative care needs, promotes support to the family, and when properly used supports high-quality personalised palliative care throughout the palliative trajectory. Future steps for the S-PCG, entails scientific evaluation of the clinical impact and effect of S-PCG in different care settings – including implementation, patient and family outcomes, and experiences of patient, family and personnel. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00874-4.
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Affiliation(s)
- Dröfn Birgisdóttir
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University, Scheeletorget 1, Hus 404B, 223 81, Lund, Sweden. .,The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.
| | - Anette Duarte
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - Anna Dahlman
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University, Scheeletorget 1, Hus 404B, 223 81, Lund, Sweden
| | - Bengt Sallerfors
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University, Scheeletorget 1, Hus 404B, 223 81, Lund, Sweden
| | - Birgit H Rasmussen
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Faculty of Medicine, Department for Healthcare Sciences, Institute for Palliative Care, Lund University, Lund, Sweden
| | - Carl Johan Fürst
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University, Scheeletorget 1, Hus 404B, 223 81, Lund, Sweden.,The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
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Sarkies MN, Moullin J, Ludwick T, Robinson S. Guest editorial. J Health Organ Manag 2021. [DOI: 10.1108/jhom-10-2021-513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Urwitz V, Vuylsteke B, Apers H, Hales D, Wentzlaff-Eggebert M, Nöstlinger C. A multicountry European study on Succeed: a general quality improvement tool in HIV prevention. Health Promot Int 2021; 35:935-946. [PMID: 33099280 DOI: 10.1093/heapro/daz081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The context-sensitive nature of the European HIV epidemic (e.g. differences in key populations, prevention settings, resource commitments) makes it challenging to monitor and evaluate HIV prevention and sexual health promotion programs. Systematic quality improvement (QI) tools and quality indicators adapted to HIV prevention are not widely known or implemented. The European 'Quality Action' introduced five such tools in 26 countries involving 45 nongovernmental and governmental organizations during 2014-2016. Approximately, half of the organizations used the tool 'Succeed'. This study aims to describe challenges and supportive factors in its use, and answers the research question if Succeed can be applied as a general QI tool despite the high contextuality of the European HIV prevention field. Mixed method research was conducted: data from quantitative pre- and post-training and implementation surveys were triangulated with qualitative data from multiple data sources analysed inductively. In a second analytical step, Chaudoir's evidence-based framework on implementation of innovations (2013) guided the data analysis on five levels: policy, organization, functionality of the tool, results and perceived innovations. Succeed contributed to goal and result orientation, facilitated stakeholders' participation and contributed to organizational development. Succeed was used in similar ways and with similar results across different policy contexts, types of organizations, target groups and interventions. Contributing factors for sustainable implementation were supporting environments, sufficient resources and a strategy for training tool users. Findings strongly support the use of Succeed as a general QI tool to monitor, document, adapt and improve HIV prevention and sexual health promotion work across Europe.
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Affiliation(s)
- Viveca Urwitz
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Hanne Apers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Rosenstein MG, Chang SC, Sakowski C, Markow C, Teleki S, Lang L, Logan J, Cape V, Main EK. Hospital Quality Improvement Interventions, Statewide Policy Initiatives, and Rates of Cesarean Delivery for Nulliparous, Term, Singleton, Vertex Births in California. JAMA 2021; 325:1631-1639. [PMID: 33904868 PMCID: PMC8080226 DOI: 10.1001/jama.2021.3816] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Safe reduction of the cesarean delivery rate is a national priority. OBJECTIVE To evaluate the rates of cesarean delivery for nulliparous, term, singleton, vertex (NTSV) births in California in the context of a statewide multifaceted intervention designed to reduce the rates of cesarean delivery. DESIGN, SETTING, AND PARTICIPANTS Observational study of cesarean delivery rates from 2014 to 2019 among 7 574 889 NTSV births in the US and at 238 nonmilitary hospitals providing maternity services in California. From 2016 to 2019, California Maternal Quality Care Collaborative partnered with Smart Care California to implement multiple approaches to decrease the rates of cesarean delivery. Hospitals with rates of cesarean delivery greater than 23.9% for NTSV births were invited to join 1 of 3 cohorts for an 18-month quality improvement collaborative between July 2016 and June 2019. EXPOSURES Within the collaborative, multidisciplinary teams implemented multiple strategies supported by mentorship, shared learning, and rapid-cycle data feedback. Partnerships among nonprofit organizations, state governmental agencies, purchasers, and health plans addressed the external environment through transparency, award programs, and incentives. MAIN OUTCOMES AND MEASURES The primary outcome was the change in cesarean delivery rates for NTSV births in California and a difference-in-differences analysis was performed to compare cesarean delivery rates for NTSV births in California vs the rates in the rest of the US. A mixed multivariable logistic regression model that adjusted for patient-level and hospital-level confounders also was used to assess the collaborative and the external statewide actions. The cesarean delivery rates for NTSV births at hospitals participating in the collaborative were compared with the rates from the nonparticipating hospitals and the rates in the participating hospitals prior to participation in the collaborative. RESULTS A total of 7 574 889 NTSV births occurred in the US from 2014 to 2019, of which 914 283 were at 238 hospitals in California. All California hospitals were exposed to the statewide actions to reduce the rates of cesarean delivery, including the 149 hospitals that had baseline rates of cesarean delivery greater than 23.9% for NTSV births, of which 91 (61%) participated in the quality improvement collaborative. The rate of cesarean delivery for NTSV births in California decreased from 26.0% (95% CI, 25.8%-26.2%) in 2014 to 22.8% (95% CI, 22.6%-23.1%) in 2019 (relative risk, 0.88; 95% CI, 0.87-0.89). The rate of cesarean delivery for NTSV births in the US (excluding California births) was 26.0% in both 2014 and 2019 (relative risk, 1.00; 95% CI, 0.996-1.005). The difference-in-differences analysis revealed that the reduction in the rate of cesarean delivery for NTSV births in California was 3.2% (95% CI, 1.7%-3.5%) higher than in the US (excluding California). Compared with the hospitals and the periods not exposed to the collaborative activities, and after adjusting for patient characteristics and time using a modified stepped-wedge analysis, exposure to collaborative activities was associated with a lower odds of cesarean delivery for NTSV births (24.4% vs 24.6%; adjusted odds ratio, 0.87 [95% CI, 0.85-0.89]). CONCLUSIONS AND RELEVANCE In this observational study of NTSV births in California from 2014 to 2019, the rates of cesarean delivery decreased over time in the setting of the implementation of a coordinated hospital-level collaborative and statewide initiatives designed to support vaginal birth.
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Affiliation(s)
- Melissa G. Rosenstein
- California Maternal Quality Care Collaborative, Stanford University, Stanford
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Shen-Chih Chang
- California Maternal Quality Care Collaborative, Stanford University, Stanford
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Christa Sakowski
- California Maternal Quality Care Collaborative, Stanford University, Stanford
| | - Cathie Markow
- California Maternal Quality Care Collaborative, Stanford University, Stanford
| | | | | | - Julia Logan
- California Department of Health Care Services, Sacramento
- California Public Employees’ Retirement System, Sacramento
| | - Valerie Cape
- California Maternal Quality Care Collaborative, Stanford University, Stanford
| | - Elliott K. Main
- California Maternal Quality Care Collaborative, Stanford University, Stanford
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
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Myall M, May C, Richardson A, Bogle S, Campling N, Dace S, Lund S. Creating pre-conditions for change in clinical practice: the influence of interactions between multiple contexts and human agency. J Health Organ Manag 2020; ahead-of-print. [PMID: 33103399 PMCID: PMC9251639 DOI: 10.1108/jhom-06-2020-0240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the implementation of Treatment Escalation Plans to explore the dynamics shaping the translational journey of a complex intervention from research into the everyday context of real-world healthcare settings.Design/methodology/approachA qualitative instrumental collective case study design was used. Data were gathered using qualitative interviews (n = 36) and observations (n = 46) in three English acute hospital trusts. Normalisation process theory provided the theoretical lens and informed data collection and analysis.FindingsWhile each organisation faced the same translational problem, there was variation between settings regarding adoption and implementation. Successful change was dependent on participants' ability to manage and shape contexts and the work this involved was reliant on individual capacity to create a new, receptive context for change. Managing contexts to facilitate the move from research into clinical practice was a complex interactive and iterative process.Practical implicationsThe paper advocates a move away from contextual factors influencing change and adoption, to contextual patterns and processes that accommodate different elements of whole systems and the work required to manage and shape them.Originality/valueThe paper addresses important and timely issues of change in healthcare, particularly for new regulatory and service-oriented processes and practices. Insights and explanations of variations in implementation are revealed which could contribute to conceptual generalisation of context and implementation.
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Affiliation(s)
- Michelle Myall
- School of Health Sciences,
University of Southampton
, Southampton,
UK
| | - Carl May
- Faculty of Public Health and Policy,
London School of Hygiene and Tropical Medicine
, London,
UK
| | - Alison Richardson
- School of Health Sciences,
University of Southampton
, Southampton,
UK
- Clinical Academic Facility, Southampton General Hospital,
University Hospital Southampton NHS Foundation Trust
, Southampton,
UK
| | - Sarah Bogle
- School of Health Sciences,
University of Southampton
, Southampton,
UK
| | - Natasha Campling
- School of Health Sciences,
University of Southampton
, Southampton,
UK
| | - Sally Dace
- School of Health Sciences,
University of Southampton
, Southampton,
UK
| | - Susi Lund
- School of Health Sciences,
University of Southampton
, Southampton,
UK
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12
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Brand J, Hardy R, Monroe E. Research Pearls: Checklists and Flowcharts to Improve Research Quality. Arthroscopy 2020; 36:2030-2038. [PMID: 32169662 DOI: 10.1016/j.arthro.2020.02.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/22/2020] [Accepted: 02/28/2020] [Indexed: 02/02/2023]
Abstract
To instill quality in published clinical research, reporting guidelines, consisting of checklists and flowcharts, were developed to protect against reporting poorly designed research, and researchers should be aware of the available instruments and their appropriate use. With the popularity of synthetic reviews, meta-analyses, and systematic reviews, there is a greater need to assess risk of bias and study quality. This review highlights the most frequently used guidelines and checklists, risk-of-bias scales, and quality rating scales that can assist researchers with improving their research and its eventual publication.
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Affiliation(s)
- Jefferson Brand
- Department of Sports Medicine, Heartland Orthopedic Specialists, Alexandria, Minnesota, U.S.A
| | - Richard Hardy
- Department of Sports Medicine, Heartland Orthopedic Specialists, Alexandria, Minnesota, U.S.A.
| | - Emily Monroe
- Department of Sports Medicine, Heartland Orthopedic Specialists, Alexandria, Minnesota, U.S.A
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Singh H, Sittig DF. A Sociotechnical Framework for Safety-Related Electronic Health Record Research Reporting: The SAFER Reporting Framework. Ann Intern Med 2020; 172:S92-S100. [PMID: 32479184 DOI: 10.7326/m19-0879] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Electronic health record (EHR)-based interventions to improve patient safety are complex and sensitive to who, what, where, why, when, and how they are delivered. Success or failure depends not only on the characteristics and behaviors of individuals who are targeted by an intervention, but also on the technical characteristics of the intervention and the culture and environment of the health system that implements it. Current reporting guidelines do not capture the complexity of sociotechnical factors (technical and nontechnical factors, such as workflow and organizational issues) that confound or influence these interventions. This article proposes a methodological reporting framework for EHR interventions targeting patient safety and builds on an 8-dimension sociotechnical model previously developed by the authors for design, development, implementation, use, and evaluation of health information technology. The Safety-related EHR Research (SAFER) Reporting Framework enables reporting of patient safety-focused EHR-based interventions while accounting for the multifaceted, dynamic sociotechnical context affecting intervention implementation, effectiveness, and generalizability. As an example, an EHR-based intervention to improve communication and timely follow-up of subcritical abnormal test results to operationalize the framework is presented. For each dimension, reporting should include what sociotechnical changes were made to implement an EHR-related intervention to improve patient safety, why the intervention did or did not lead to safety improvements, and how this intervention can be applied or exported to other health care organizations. A foundational list of research and reporting recommendations to address implementation, effectiveness, and generalizability of EHR-based interventions needed to effectively reduce preventable patient harm is provided. The SAFER Reporting Framework is not meant to replace previous research reporting guidelines, but rather provides a sociotechnical adjunct that complements their use.
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Affiliation(s)
- Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas (H.S.)
| | - Dean F Sittig
- University of Texas Memorial Hermann Center for Healthcare Quality & Safety, School of Biomedical Informatics, University of Texas Health Science Center at Houston, Texas (D.F.S.)
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Price C, Kudchadkar SR, Basyal PS, Nelliot A, Smith M, Friedman M, Needham DM. Librarian integration into health care conferences: a case report. J Med Libr Assoc 2020; 108:278-285. [PMID: 32256239 PMCID: PMC7069835 DOI: 10.5195/jmla.2020.803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/01/2019] [Indexed: 11/20/2022] Open
Abstract
Background Health care continuing education conferences are important educational events that present opportunities for structured learning, interactive sharing, and professional networking. Conference presenters frequently cite published literature, such as clinical trials, to supply an evidence-based foundation, with presenters’ slides often shared with conference attendees. By using social media, these conferences can have greater impact, assist in supporting evidence-based clinical practice, and increase stakeholder engagement. Case Presentation The authors present a case of embedding a health sciences librarian into the Annual Johns Hopkins Critical Care Rehabilitation Conference. The librarian served multiple roles, including social media ambassador, conference exhibitor, and presenter. We explore how these roles contributed to the field of early rehabilitation research through information dissemination and education. We also address best practices for librarian support of the conference, with a discussion of tools, platforms, and work flows that were beneficial. Conclusions Librarian integration facilitated education about bibliographic literature database content, database searching, critical appraisal, and reporting of search methodology. Additionally, the librarian contributed to real-time distribution of scholarly literature through proficiency with web platforms, citation management programs, and social media. Librarians’ expertise in information organization and dissemination, as well as various technology platforms, make them a valuable addition to health care conferences.
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Affiliation(s)
- Carrie Price
- Librarian, Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, , https://orcid.org/0000-0003-4345-3547
| | - Sapna R Kudchadkar
- Physician, Department of Anesthesiology and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD,
| | - Pragyashree Sharma Basyal
- Staff, Division of Pulmonary and Critical Care Medicine, and Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, , http://orcid.org/0000-0002-7180-6955
| | - Archana Nelliot
- Resident, Department of Pediatrics, Penn State Hershey Medical Center, Hershey, PA,
| | - Madison Smith
- Staff, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD,
| | - Michael Friedman
- Physical Therapist, Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD,
| | - Dale M Needham
- Professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD; and School of Nursing, Johns Hopkins University, Baltimore, MD,
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Improving Geriatric Care Processes on Two Medical-Surgical Acute Care Units: A Pilot Study. J Healthc Qual 2020; 41:23-31. [PMID: 29794813 DOI: 10.1097/jhq.0000000000000140] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Acute Care for Elders (ACE) Unit model improves cognitive and functional outcomes for hospitalized elders but reaches a small proportion of patients. To disseminate ACE Unit principles, we piloted the "Virtual ACE Intervention" that standardizes care processes for cognition and function without daily geriatrician oversight on two non-ACE units. The Virtual ACE Intervention includes staff training on geriatric assessments for cognition and function and on nurse-driven care algorithms. Completion of the geriatric assessments by nursing staff in patients aged 65 years and older and measures of patient mobility and prevalence of an abnormal delirium screening score were compared preintervention and postintervention. Postintervention, the completion of the assessments for current functional status and delirium improved (62.5% vs. 88.5%, p < .001) and (4.2% vs. 96.5%, p < .001). In a subsample analysis, in the postintervention period, more patients were up to the chair in the past day (36.4% vs. 63.5%, p = .04) and the prevalence of an abnormal delirium screening score was lower (13.6% vs. 4.8%, p = .16). The Virtual ACE Intervention is a feasible model for disseminating ACE Unit principles to non-ACE Units and may lead to increased adherence to care processes and improved clinical outcomes.
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Balch Samora J, Spencer SP, Valleru J, Bartman T, Brilli RJ, Davis M, Davis JT, McClead R, Crandall W. Writing Group Increases Quality Improvement Writing Competency. Am J Med Qual 2019; 35:349-354. [DOI: 10.1177/1062860619886910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Quality improvement (QI) is critically important in current medical practice. Although many QI courses teach improvement science and methods, formal education in writing QI manuscripts for academic journal publication is lacking. The authors developed a QI Writing program, consisting of educational sessions with both coach and peer mentors, to improve comfort and productivity in preparing QI manuscripts for publication. Program participants conducted pre- and post-course QI writing skills self-evaluations in 4 competency domains: SQUIRE guidelines, writing for peer-reviewed journals, QI publication submission steps, and critically examining QI results. Course success was measured by the number of manuscripts submitted for publication. QI writing competencies doubled in 3 of 4 domains and increased 70% in the fourth. Fifteen of 17 (88%) course participants submitted manuscripts to a peer-reviewed journal, and 12 have been accepted to date. A formal writing group with didactic content and committed mentors increases QI writing competencies and manuscript submissions to peer-reviewed journals.
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Affiliation(s)
- Julie Balch Samora
- The Ohio State University, Columbus, OH
- Nationwide Children’s Hospital, Columbus, OH
| | - Sandra P. Spencer
- The Ohio State University, Columbus, OH
- Nationwide Children’s Hospital, Columbus, OH
| | | | - Thomas Bartman
- The Ohio State University, Columbus, OH
- Nationwide Children’s Hospital, Columbus, OH
| | - Richard J. Brilli
- The Ohio State University, Columbus, OH
- Nationwide Children’s Hospital, Columbus, OH
| | | | | | | | - Wallace Crandall
- The Ohio State University, Columbus, OH
- Nationwide Children’s Hospital, Columbus, OH
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Abstract
A systematic review of published English-language articles on handoffs is conducted (1987 to June 4, 2008). Forty-six articles describing 24 handoff mnemonics are identified by trained reviewers. The majority (82.6%) have been published in the last 3 years (2006-2008), and SBAR (Situation, Background, Assessment, Recommendation) is the most frequently cited mnemonic (69.6%). Of 7 handoff research articles, only 4 study mnemonics. All 4 of these studies have relatively small sample sizes (10-100) and lack validated instruments. Only 1 study has obtained IRB approval. Scientifically rigorous research studies are needed to assess the effectiveness of handoff mnemonics. These should be published in the peer-reviewed literature using the Standards for QUality Improvement Reporting Excellence (SQUIRE) guidelines.
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Affiliation(s)
- Lee Ann Riesenberg
- 1 Dr Riesenberg is with Academic Affairs, Christiana Care Health System, Newark, Delaware, and the Jefferson School of Population Health, Philadelphia, Pennsylvania
| | - Jessica Leitzsch
- 2 Ms Leitzsch is with Academic Affairs, Christiana Care Health System, Newark, Delaware
| | - Brian W Little
- 3 Dr Little is with Academic Affairs, Christiana Care Health System, Newark, Delaware, and Jefferson Medical College, Philadelphia, Pennsylvania
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Bergerum C, Thor J, Josefsson K, Wolmesjö M. How might patient involvement in healthcare quality improvement efforts work-A realist literature review. Health Expect 2019; 22:952-964. [PMID: 31044517 PMCID: PMC6803394 DOI: 10.1111/hex.12900] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 03/07/2019] [Accepted: 04/06/2019] [Indexed: 01/12/2023] Open
Abstract
Introduction This realist literature review, regarding active patient involvement in healthcare quality improvement (QI), seeks to identify possible mechanisms that contribute to success or failure. Furthermore, the paper outlines key considerations for organizing and supporting patient involvement in healthcare QI efforts. Methods Two literature searches were performed. Altogether, 1204 articles from a healthcare context were screened, focusing on improvement efforts that involve patients, healthcare professionals and/or managers and leaders. Among these, 107 articles fulfilled the chosen study selection criteria and were further analysed. Eighteen articles underwent a full realist review. In the realist synthesis, context‐mechanism‐outcome configurations were articulated as middle‐range theories and organized thematically to generate a program theory on how active patient involvement in QI efforts might work. Results The articles exhibited a diversity of patient involvement approaches at different levels of healthcare organizations. To be successful, organizations’ support of QI efforts that actively involved patients tailored the QI efforts to their context to achieve the desired outcomes, and involved the relevant microsystem members. Furthermore, it promoted interaction and partnership within the microsystem, and supported the behavioural change that follows. Conclusion This realist synthesis generates a program theory for active patient involvement in QI efforts; active patient involvement can be a tool (resource), if tailored for interaction and partnership (reasoning), that leads to behaviour change (outcome) within healthcare QI efforts. The theory explains essential resource and reasoning mechanisms, and outcomes that together form guidance for healthcare organizations when managing active patient involvement in QI efforts.
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Affiliation(s)
- Carolina Bergerum
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Johan Thor
- School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Karin Josefsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Maria Wolmesjö
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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19
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de Oliveira KF, Pires PDS, De-Mattia AL, Barichello E, Galvão CM, de Araújo CA, Barbosa MH. Influence of support surfaces on the distribution of body interface pressure in surgical positioning. Rev Lat Am Enfermagem 2018; 26:e3083. [PMID: 30517574 PMCID: PMC6280176 DOI: 10.1590/1518-8345.2692.3083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/11/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE to evaluate the interface pressure (IP) of support surfaces (SSs) on bony prominences. METHOD a quasi-experimental study with repeated measures on each SS. Twenty healthy adult volunteers participated in the study. The participants were placed in the supine position on a standard operating table for evaluation of IP on the bony prominences of the occipital, subscapular, sacral, and calcaneal regions using sensors. Seven evaluations were performed for each bony prominence: one on a standard operating table, and the others on tables containing SSs made of viscoelastic polymer, soft foam, or sealed foam. Descriptive statistics and analysis of variance were used to analyze the data. RESULTS the mean IP was higher on the viscoelastic polymer-based SS compared to the other SSs (p<0.001). The mean IP was relatively lower on the density-33 sealed foam and density-18 soft foam. In addition, this variable was comparatively higher in the sacral region (42.90 mmHg) and the calcaneal region (15.35 mmHg). CONCLUSION IP was relatively lower on foam-based SSs, especially on density-18 soft foam and density-33 sealed foam. Nonetheless, IP was not reduced on the viscoelastic polymer SS compared to the control SS.
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Affiliation(s)
- Karoline Faria de Oliveira
- Universidade Federal do Triângulo Mineiro, Departamento de
Enfermagem na Assistência Hospitalar, Uberaba, Minas Gerais, Brazil
| | | | - Ana Lúcia De-Mattia
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo
Horizonte, Minas Gerais, Brazil
| | - Elizabeth Barichello
- Universidade Federal do Triângulo Mineiro, Departamento de
Enfermagem na Assistência Hospitalar, Uberaba, Minas Gerais, Brazil
| | - Cristina Maria Galvão
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
| | - Cleudmar Amaral de Araújo
- Universidade Federal de Uberlândia, Faculdade de Engenharia
Mecânica, Uberlândia, Minas Gerais, Brazil
| | - Maria Helena Barbosa
- Universidade Federal do Triângulo Mineiro, Departamento de
Enfermagem na Assistência Hospitalar, Uberaba, Minas Gerais, Brazil
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20
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Stonko DP, O Neill DC, Dennis BM, Smith M, Gray J, Guillamondegui OD. Trauma Quality Improvement: Reducing Triage Errors by Automating the Level Assignment Process. JOURNAL OF SURGICAL EDUCATION 2018; 75:1551-1557. [PMID: 29656835 DOI: 10.1016/j.jsurg.2018.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/31/2018] [Accepted: 03/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Trauma patients are triaged by the severity of their injury or need for intervention while en route to the trauma center according to trauma activation protocols that are institution specific. Significant research has been aimed at improving these protocols in order to optimize patient outcomes while striving for efficiency in care. However, it is known that patients are often undertriaged or overtriaged because protocol adherence remains imperfect. The goal of this quality improvement (QI) project was to improve this adherence, and thereby reduce the triage error. It was conducted as part of the formal undergraduate medical education curriculum at this institution. STUDY DESIGN A QI team was assembled and baseline data were collected, then 2 Plan-Do-Study-Act (PDSA) cycles were implemented sequentially. During the first cycle, a novel web tool was developed and implemented in order to automate the level assignment process (it takes EMS-provided data and automatically determines the level); the tool was based on the existing trauma activation protocol. The second PDSA cycle focused on improving triage accuracy in isolated, less than 10% total body surface area burns, which we identified to be a point of common error. Traumas were reviewed and tabulated at the end of each PDSA cycle, and triage accuracy was followed with a run chart. SETTING This study was performed at Vanderbilt University Medical Center and Medical School, which has a large level 1 trauma center covering over 75,000 square miles, and which sees urban, suburban, and rural trauma. PARTICIPANTS The baseline assessment period and each PDSA cycle lasted 2 weeks. During this time, all activated, adult, direct traumas were reviewed. There were 180 patients during the baseline period, 189 after the first test of change, and 150 after the second test of change. All were included in analysis. RESULTS Of 180 patients, 30 were inappropriately triaged during baseline analysis (3 undertriaged and 27 overtriaged) versus 16 of 189 (3 undertriaged and 13 overtriaged) following implementation of the web tool (p = 0.017 for combined errors). Overtriage dropped further from baseline to 10/150 after the second test of change (p = 0.005). The total number of triaged patients dropped from 92.3/week to 75.5/week after the second test of change. There was no statistically significant change in the undertriage rate. CONCLUSION The combination of web tool implementation and protocol refinement decreased the combined triage error rate by over 50% (from 16.7%-7.9%). We developed and tested a web tool that improved triage accuracy, and provided a sustainable method to enact future quality improvement. This web tool and QI framework would be easily expandable to other hospitals.
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Affiliation(s)
- David P Stonko
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Bradley M Dennis
- Vanderbilt Division of Trauma and Surgical Critical Care, Nashville, Tennessee
| | - Melissa Smith
- Vanderbilt Division of Trauma and Surgical Critical Care, Nashville, Tennessee
| | - Jeffrey Gray
- Vanderbilt LifeFlight, Vanderbilt University Medical Center, Nashville, Tennessee
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21
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Schondelmeyer AC, Brower LH, Statile AM, White CM, Brady PW. Quality Improvement Feature Series Article 3: Writing and Reviewing Quality Improvement Manuscripts. J Pediatric Infect Dis Soc 2018; 7:188-190. [PMID: 29040710 DOI: 10.1093/jpids/pix078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/23/2017] [Indexed: 11/12/2022]
Abstract
Achieving rapid and meaningful improvement in healthcare requires the dissemination of quality improvement project results via publication. Doing this well requires detailed descriptions of the complex interventions and of the context in which the improvement took place. This report builds on the first 2 articles in the series to cover important considerations in writing quality improvement manuscripts with a focus on how it differs from writing traditional clinical research reports. The recommendations we outline here also apply to reviewing quality improvement manuscripts.
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Affiliation(s)
- Amanda C Schondelmeyer
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio.,James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio
| | - Laura H Brower
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio
| | - Angela M Statile
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio
| | - Christine M White
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio.,James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio
| | - Patrick W Brady
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio.,James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio
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22
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Koyle MA, Koyle LCC, Baker GR. Quality improvement and patient safety: Reality and responsibility from Codman to today. J Pediatr Urol 2018; 14:16-19. [PMID: 28988674 DOI: 10.1016/j.jpurol.2017.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/12/2017] [Indexed: 01/17/2023]
Abstract
Quality improvement and patient safety (QIPS) has become increasingly important in the practice of medicine, particularly since the Institute of Medicine's report, "To Err is Human." Despite surgery having been initially at the forefront in instituting QIPS, there has been a lag in promoting its importance until recently. A short history of QIPS is presented along with an introduction to the SQUIRE guidelines used for standardizing QIPS publications. As surgeons we are becoming even more accountable in promoting value in health care. As such, knowledge of QIPS will become an increasingly important component of our future practices and publications.
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Affiliation(s)
- Martin A Koyle
- Section of Pediatric Urology, The Hospital for Sick Children, Toronto, Ontario, Canada; The Institute of Health Policy, Management, and Evaluation (IHPME), The University of Toronto, Toronto, Ontario, Canada.
| | | | - G Ross Baker
- The Institute of Health Policy, Management, and Evaluation (IHPME), The University of Toronto, Toronto, Ontario, Canada
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23
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Itri JN, Bakow E, Probyn L, Kadom N, Duong PAT, Gettle LM, Mendiratta-Lala M, Scali EP, Winokur RS, Zygmont ME, Kung JW, Rosenkrantz AB. The Science of Quality Improvement. Acad Radiol 2017; 24:253-262. [PMID: 28193375 DOI: 10.1016/j.acra.2016.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 02/04/2023]
Abstract
Scientific rigor should be consistently applied to quality improvement (QI) research to ensure that healthcare interventions improve quality and patient safety before widespread implementation. This article provides an overview of the various study designs that can be used for QI research depending on the stage of investigation, scope of the QI intervention, constraints on the researchers and intervention being studied, and evidence needed to support widespread implementation. The most commonly used designs in QI studies are quasi-experimental designs. Randomized controlled trials and cluster randomized trials are typically reserved for large-scale research projects evaluating the effectiveness of QI interventions that may be implemented broadly, have more than a minimal impact on patients, or are costly. Systematic reviews of QI studies will play an important role in providing overviews of evidence supporting particular QI interventions or methods of achieving change. We also review the general requirements for developing quality measures for reimbursement, public reporting, and pay-for-performance initiatives. A critical part of the testing process for quality measures includes assessment of feasibility, reliability, validity, and unintended consequences. Finally, publication and critical appraisal of QI work is discussed as an essential component to generating evidence supporting QI initiatives in radiology.
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Affiliation(s)
- Jason N Itri
- Department of Radiology, University of Virginia, 1215 Lee Street, Box 800170, Charlottesville, CA 22908.
| | - Eric Bakow
- UPMC Health Plan, Pittsburgh, Pennsylvania
| | - Linda Probyn
- Sunnybrook Health Sciences Centre, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | | | - Lori Mankowski Gettle
- Division of Abdominal Imaging and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mishal Mendiratta-Lala
- Abdominal and Cross-sectional Interventional Radiology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Elena P Scali
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ronald S Winokur
- Department of Radiology, Division of Interventional Radiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Matthew E Zygmont
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Justin W Kung
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised Publication Guidelines From a Detailed Consensus Process. J Contin Educ Nurs 2017; 46:501-7. [PMID: 26509402 DOI: 10.3928/00220124-20151020-02] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/17/2015] [Indexed: 11/20/2022]
Abstract
Since the publication of Standards for QUality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semi-structured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts, and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of three key components of systematic efforts to improve the quality, value, and safety of healthcare: the use of formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve healthcare, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (http://www.squire-statement.org).
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Davis J, Roach C, Elliott C, Mardis M, Justice EM, Riesenberg LA. Feedback and Assessment Tools for Handoffs: A Systematic Review. J Grad Med Educ 2017; 9:18-32. [PMID: 28261391 PMCID: PMC5319625 DOI: 10.4300/jgme-d-16-00168.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resident handoff communication skills are essential components of medical education training. There are no previous systematic reviews of feedback and evaluation tools for physician handoffs. OBJECTIVE We performed a systematic review of articles focused on inpatient handoff feedback or assessment tools. METHODS The authors conducted a systematic review of English-language literature published from January 1, 2008, to May 13, 2015 on handoff feedback or assessment tools used in undergraduate or graduate medical education. All articles were reviewed by 2 independent abstractors. Included articles were assessed using a quality scoring system. RESULTS A total of 26 articles with 32 tools met inclusion criteria, including 3 focused on feedback, 8 on assessment, and 15 on both feedback and assessment. All tools were used in an inpatient setting. Feedback and/or assessment improved the content or organization measures of handoff, while process and professionalism measures were less reliably improved. The Handoff Clinical Evaluation Exercise or a similar tool was used most frequently. Of included studies, 23% (6 of 26) were validity evidence studies, and 31% (8 of 26) of articles included a tool with behavioral anchors. A total of 35% (9 of 26) of studies used simulation or standardized patient encounters. CONCLUSIONS A number of feedback and assessment tools for physician handoffs in several specialties have been studied. Limited research has been done on the studied tools. These tools may assist medical educators in assessing trainees' handoff skills.
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Affiliation(s)
| | | | | | | | | | - Lee Ann Riesenberg
- Corresponding author: Lee Ann Riesenberg, PhD, RN, CMQ, University of Alabama at Birmingham, Department of Anesthesiology and Perioperative Medicine, JT 909, 619 South 19th Street, Birmingham, AL 35249-6180, 205.975.3729, fax 205.975.3552,
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26
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Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. Am J Med Qual 2017; 30:543-9. [PMID: 26497490 PMCID: PMC4620592 DOI: 10.1177/1062860615605176] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the past several years, the science of health care improvement has advanced considerably. In this article, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) face-to-face consensus meetings to develop interim drafts, and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes 3 key components of systematic efforts to improve the quality, value, and safety of health care: formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve health care, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org).
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Affiliation(s)
- Greg Ogrinc
- Geisel School of Medicine at Dartmouth, Hanover, NH White River Junction VA, White River Junction, VT The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Louise Davies
- Geisel School of Medicine at Dartmouth, Hanover, NH White River Junction VA, White River Junction, VT The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Daisy Goodman
- Geisel School of Medicine at Dartmouth, Hanover, NH VA Quality Scholars Fellowship Program, Hanover, NH
| | - Paul Batalden
- Geisel School of Medicine at Dartmouth, Hanover, NH The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Frank Davidoff
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - David Stevens
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH Institute for Healthcare Improvement, Cambridge, MA
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27
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Schwartz SP, Rehder KJ. Quality improvement in pediatrics: past, present, and future. Pediatr Res 2017; 81:156-161. [PMID: 27673419 DOI: 10.1038/pr.2016.192] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/24/2016] [Indexed: 11/09/2022]
Abstract
Almost two decades ago, the landmark report "To Err is Human" compelled healthcare to address the large numbers of hospitalized patients experiencing preventable harm. Concurrently, it became clear that the rapidly rising cost of healthcare would be unsustainable in the long-term. As a result, quality improvement methodologies initially rooted in other high-reliability industries have become a primary focus of healthcare. Multiple pediatric studies demonstrate remarkable quality and safety improvements in several domains including handoffs, catheter-associated blood stream infections, and other serious safety events. While both quality improvement and research are data-driven processes, significant differences exist between the two. Research utilizes a hypothesis driven approach to obtain new knowledge while quality improvement often incorporates a cyclic approach to translate existing knowledge into clinical practice. Recent publications have provided guidelines and methods for effectively reporting quality and safety work and improvement implementations. This review examines not only how quality improvement in pediatrics has led to improved outcomes, but also looks to the future of quality improvement in healthcare with focus on education and collaboration to ensure best practice approaches to caring for children.
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Affiliation(s)
- Stephanie P Schwartz
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina
| | - Kyle J Rehder
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina.,Physician Quality Officer, Patient Safety Center, Duke University Health System, Durham, North Carolina
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SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised Publication Guidelines From a Detailed Consensus Process. J Nurs Care Qual 2016; 31:1-8. [PMID: 26429125 PMCID: PMC5411027 DOI: 10.1097/ncq.0000000000000153] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text.
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De Grood A, Blades K, Pendharkar SR. A Review of Discharge-Prediction Processes in Acute Care Hospitals. Healthc Policy 2016; 12:105-115. [PMID: 28032828 PMCID: PMC5221715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS AND OBJECTIVES Discharge prediction is designed to streamline inpatient flow and reduce hospital overcrowding without adding capacity. This study's objective was to describe the literature on discharge prediction and assess its usefulness in evaluating the implementation and outcomes of discharge prediction projects. METHODS The authors reviewed the current peer-reviewed and grey literature on discharge prediction projects in acute care hospitals. Project descriptions were analyzed using Donabedian's structure-process-outcome model for evaluating complex healthcare innovations. RESULTS The review revealed a paucity of literature on the use and effectiveness of discharge prediction. There is high variation in its use and generally poor reporting of both implementation and outcomes. CONCLUSIONS The literature on discharge prediction generally lacks the descriptive detail that would be useful to parties considering or planning a discharge prediction initiative. Further study is required to determine how best to integrate these prediction tools into acute care hospitals.
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Affiliation(s)
- Anna De Grood
- Research Assistant, Ward of the 21st Century, University of Calgary, Calgary, AB
| | - Kenneth Blades
- Research Associate, Ward of the 21st Century, University of Calgary, Calgary, AB
| | - Sachin R. Pendharkar
- Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB
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Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised Publication Guidelines from a Detailed Consensus Process. Perm J 2016; 19:65-70. [PMID: 26517437 DOI: 10.7812/tpp/15-141] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Since the publication of Standards for Quality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015, using 1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group; 2) two face-to-face consensus meetings to develop interim drafts; and 3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of three key components of systematic efforts to improve the quality, value, and safety of health care: the use of formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve health care, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org).
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Affiliation(s)
- Greg Ogrinc
- Senior Associate Dean for Medical Education in the Geisel School of Medicine at Dartmouth College; Associate Chief of Staff for Education at the White River Junction Veterans Administration Medical Center, VT; and Associate Professor of Community and Family Medicine, of Medicine, and of The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth College in Hanover, NH.
| | - Louise Davies
- Senior Scholar in the Quality Scholars Program in the Department of Veterans Affairs Medical Center, White River Junction, VT; and Associate Professor of Surgery at the Geisel School of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice in Hanover, NH
| | - Daisy Goodman
- Fellow at the Veterans Administration Quality Scholars Fellowship Program, White River Junction, VT; and an Instructor of Obstetrics and Gynecology and Community and Family Medicine at the Geisel School of Medicine at Dartmouth College in Hanover, NH
| | - Paul Batalden
- Active Emeritus Professor of Pediatrics and Community and Family Medicine at the Geisel School of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice in Hanover, NH
| | - Frank Davidoff
- Editor Emeritus of Annals of Internal Medicine; and an Adjunct Professor at The Dartmouth Institute for Health Policy and Clinical Practice and the Geisel School of Medicine at Dartmouth College in Hanover, NH
| | - David Stevens
- Adjunct Professor at The Dartmouth Institute for Health Policy and Clinical Practice in Hanover, NH; and an Editor Emeritus of BMJ Quality and Safety in London, United Kingdom; and Senior Fellow of the Institute for Healthcare Improvement in Cambridge, MA
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Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. Can J Diabetes 2016; 39:434-9. [PMID: 26443286 DOI: 10.1016/j.jcjd.2015.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 07/20/2015] [Indexed: 11/30/2022]
Abstract
Since the publication of Standards for Quality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using 1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group; 2) 2 face-to-face consensus meetings to develop interim drafts and 3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of 3 key components of systematic efforts to improve the quality, value and safety of healthcare: the use of formal and informal theory in planning, implementing and evaluating improvement work; the context in which the work is done and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve healthcare, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org).
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Affiliation(s)
- Greg Ogrinc
- White River Junction VA Medical Center, White River Junction, Vermont, USA; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA.
| | - Louise Davies
- White River Junction VA Medical Center, White River Junction, Vermont, USA; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - Daisy Goodman
- White River Junction VA Medical Center, White River Junction, Vermont, USA; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Paul Batalden
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA; Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
| | - Frank Davidoff
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - David Stevens
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA; Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
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Mardis M, Davis J, Benningfield B, Elliott C, Youngstrom M, Nelson B, Justice EM, Riesenberg LA. Shift-to-Shift Handoff Effects on Patient Safety and Outcomes. Am J Med Qual 2016; 32:34-42. [DOI: 10.1177/1062860615612923] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Multiple health care organizations have identified handoffs as a source of clinical errors; however, few studies have linked handoff interventions to improved patient outcomes. This systematic review of English-language research articles, published January 2008 to May 2015 and focusing on shift-to-shift handoff interventions and patient outcomes, yielded 10 774 unique articles. Twenty-one articles met inclusion criteria, measuring each of the following: patient falls (n = 7), reportable events (n = 6), length of stay (n = 4), mortality (n = 4), code calls (n = 4), medication errors (n = 4), medical errors (n = 3), procedural complications (n = 2), pressure ulcers (n = 2), weekend discharges (n = 2), and nosocomial infections (n = 2). One study each also measured time to first intervention, restraint use, overnight transfusions, and out-of-hours deteriorations. Studies that reported funding had higher quality scores. It is difficult to identify trends in the handoff research because of simultaneous implementation of multiple interventions and heterogeneity of the interventions, outcomes measured, and settings. The authors call for increased handoff research funding, especially for studies that include patient outcome measures.
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Affiliation(s)
| | - Joshua Davis
- Sidney Kimmel Medical College, Philadelphia, PA
- University of Alabama at Birmingham, AL
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Cooper MR, Hong A, Beaudin E, Dias A, Kreiser S, Ingersol CP, Jackson J. Implementing High Reliability for Patient Safety. JOURNAL OF NURSING REGULATION 2016. [DOI: 10.1016/s2155-8256(16)31041-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
As many as 1 in 10 patients is harmed while receiving hospital care in wealthy countries. The risk of health care-associated infection in some developing countries is as much as 20 times higher. In response, in many global regions, increased attention has turned to the implementation of a broad program of safety research, encompassing a variety of methods. Although important international ethical guidelines for research exist, literature has been emerging in the last 20 years that begins to apply such guidelines to patient safety research specifically. This paper provides a review of the literature related to ethics, oversight, and patient safety research; identifies issues highlighted in articles as being of ethical relevance; describes areas of consensus regarding how to respond to these ethical issues; and highlights areas where additional ethical analysis and discussion are needed to provide guidance to those in the field.
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SQUIRE 2.0—Standards for Quality Improvement Reporting Excellence—Revised Publication Guidelines from a Detailed Consensus Process. J Am Coll Surg 2016; 222:317-23. [DOI: 10.1016/j.jamcollsurg.2015.07.456] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 07/27/2015] [Indexed: 11/23/2022]
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Abstract
Purpose
– The quality improvement in colonoscopy study was a region wide service improvement study to improve adenoma detection rate at colonoscopy by implementing evidence into routine colonoscopy practice. Implementing evidence into clinical practice can be challenging. The purpose of this paper is to perform a qualitative interview study to evaluate factors that influenced implementation within the study.
Design/methodology/approach
– Semi-structured interviews were conducted with staff in endoscopy units taking part in the quality improvement in colonoscopy study, after study completion. Units and interviewees were purposefully sampled to ensure a range of experiences was represented. Interviews were conducted with 11 participants.
Findings
– Key themes influencing uptake of the quality improvement in colonoscopy evidence bundle included time, study promotion, training, engagement, positive outcomes and modifications. Areas within themes were increased awareness of quality in colonoscopy (QIC), emphasis on withdrawal time and empowerment of endoscopy nurses to encourage the use of quality measures were positive outcomes of the study. The simple, visible study posters were reported as useful in aiding study promotion. Feedback sessions improved engagement. Challenges included difficulty arranging set-up meetings and engaging certain speciality groups.
Originality/value
– This evaluation suggests that methods to implement evidence into clinical practice should include identification and empowerment of team members who can positively influence engagement, simple, visible reminders and feedback. Emphasis on timing of meetings and strategies to engage speciality groups should also be given consideration. Qualitative evaluations can provide important insights into why quality improvement initiatives are successful or not, across different sites.
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Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. Standards for QUality Improvement Reporting Excellence 2.0: revised publication guidelines from a detailed consensus process. J Surg Res 2016; 200:676-82. [DOI: 10.1016/j.jss.2015.09.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
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Malm D, Rolander B, Ebefors EM, Conlon L, Nygårdh A. Reducing the Prevalence of Catheter-Related Infections by Quality Improvement: Six-Year Follow-Up Study. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojn.2016.62008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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39
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Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised Publication Guidelines from a Detailed Consensus Process. Jt Comm J Qual Patient Saf 2015; 41:474-9. [DOI: 10.1016/s1553-7250(15)41062-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf 2015; 25:986-992. [PMID: 26369893 PMCID: PMC5256233 DOI: 10.1136/bmjqs-2015-004411] [Citation(s) in RCA: 1415] [Impact Index Per Article: 157.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/11/2015] [Accepted: 07/17/2015] [Indexed: 11/17/2022]
Abstract
Since the publication of Standards for QUality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasises the reporting of three key components of systematic efforts to improve the quality, value and safety of healthcare: the use of formal and informal theory in planning, implementing and evaluating improvement work; the context in which the work is done and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve healthcare, recognising that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (http://www.squire-statement.org).
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Affiliation(s)
- Greg Ogrinc
- White River Junction VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - Louise Davies
- White River Junction VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - Daisy Goodman
- White River Junction VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Paul Batalden
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - Frank Davidoff
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - David Stevens
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA.,Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
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Booth A, Carroll C. How to build up the actionable knowledge base: the role of 'best fit' framework synthesis for studies of improvement in healthcare. BMJ Qual Saf 2015; 24:700-8. [PMID: 26306609 PMCID: PMC4680127 DOI: 10.1136/bmjqs-2014-003642] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/17/2015] [Indexed: 12/21/2022]
Abstract
Increasing recognition of the role and value of theory in improvement work in healthcare offers the prospect of capitalising upon, and consolidating, actionable lessons from synthesis of improvement projects and initiatives. We propose that informed use of theory can (i) provide a mechanism by which to collect and organise data from a body of improvement work, (ii) offer a framework for analysis and identification of lessons learnt and (iii) facilitate an evaluation of the feasibility, effectiveness and acceptability of improvement programmes. Improvement practitioners can benefit from using an underpinning external structure as a lens by which to examine the specific achievements of their own projects alongside comparable initiatives led by others. We demonstrate the utility of a method known as ‘best fit framework synthesis’ (BFFS) in offering a ubiquitous and versatile means by which to collect, analyse and evaluate improvement work in healthcare. First reported in 2011, BFFS represents a pragmatic, flexible approach to integrating theory with findings from practice. A deductive phase, where a review team seeks to accommodate a substantial part of the data, is followed by an inductive phase, in which the team explores data not accommodated by the framework. We explore the potential for BFFS within improvement work by drawing upon the evidence synthesis methodology literature and practical examples of improvement work reported in BMJ Quality and Safety (2011–2015). We suggest four variants of BFFS that may have particular value in synthesising a body of improvement work. We conclude that BFFS, alongside other approaches that seek to optimise the contribution of theory to improvement work, represents one important enabling mechanism by which to establish the rigour and scientific credentials of the emerging discipline of ‘improvement science’.
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Affiliation(s)
- Andrew Booth
- School of Health & Related Research (ScHARR), University of Sheffield, Sheffield, South Yorkshire, UK
| | - Christopher Carroll
- School of Health & Related Research (ScHARR), University of Sheffield, Sheffield, South Yorkshire, UK
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Davies L, Donnelly KZ, Goodman DJ, Ogrinc G. Findings from a novel approach to publication guideline revision: user road testing of a draft version of SQUIRE 2.0. BMJ Qual Saf 2015; 25:265-72. [PMID: 26263916 PMCID: PMC4819644 DOI: 10.1136/bmjqs-2015-004117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/12/2015] [Indexed: 11/17/2022]
Abstract
Background The Standards for Quality Improvement Reporting Excellence (SQUIRE) Guideline was published in 2008 (SQUIRE 1.0) and was the first publication guideline specifically designed to advance the science of healthcare improvement. Advances in the discipline of improvement prompted us to revise it. We adopted a novel approach to the revision by asking end-users to ‘road test’ a draft version of SQUIRE 2.0. The aim was to determine whether they understood and implemented the guidelines as intended by the developers. Methods Forty-four participants were assigned a manuscript section (ie, introduction, methods, results, discussion) and asked to use the draft Guidelines to guide their writing process. They indicated the text that corresponded to each SQUIRE item used and submitted it along with a confidential survey. The survey examined usability of the Guidelines using Likert-scaled questions and participants’ interpretation of key concepts in SQUIRE using open-ended questions. On the submitted text, we evaluated concordance between participants’ item usage/interpretation and the developers’ intended application. For the survey, the Likert-scaled responses were summarised using descriptive statistics and the open-ended questions were analysed by content analysis. Results Consistent with the SQUIRE Guidelines’ recommendation that not every item be included, less than one-third (n=14) of participants applied every item in their section in full. Of the 85 instances when an item was partially used or was omitted, only 7 (8.2%) of these instances were due to participants not understanding the item. Usage of Guideline items was highest for items most similar to standard scientific reporting (ie, ‘Specific aim of the improvement’ (introduction), ‘Description of the improvement’ (methods) and ‘Implications for further studies’ (discussion)) and lowest (<20% of the time) for those unique to healthcare improvement (ie, ‘Assessment methods for context factors that contributed to success or failure’ and ‘Costs and strategic trade-offs’). Items unique to healthcare improvement, specifically ‘Evolution of the improvement’, ‘Context elements that influenced the improvement’, ‘The logic on which the improvement was based’, ‘Process and outcome measures’, demonstrated poor concordance between participants’ interpretation and developers’ intended application. Conclusions User testing of a draft version of SQUIRE 2.0 revealed which items have poor concordance between developer intent and author usage, which will inform final editing of the Guideline and development of supporting supplementary materials. It also identified the items that require special attention when teaching about scholarly writing in healthcare improvement.
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Affiliation(s)
- Louise Davies
- VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont, USA The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Kyla Z Donnelly
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Daisy J Goodman
- Department of Education, Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Greg Ogrinc
- Department of Education, Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA
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Davies L, Batalden P, Davidoff F, Stevens D, Ogrinc G. The SQUIRE Guidelines: an evaluation from the field, 5 years post release. BMJ Qual Saf 2015; 24:769-75. [PMID: 26089206 PMCID: PMC4680161 DOI: 10.1136/bmjqs-2015-004116] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/23/2015] [Indexed: 11/17/2022]
Abstract
Background The Standards for Quality Improvement Reporting Excellence (SQUIRE) Guidelines were published in 2008 to increase the completeness, precision and accuracy of published reports of systematic efforts to improve the quality, value and safety of healthcare. Since that time, the field has expanded. We asked people from the field to evaluate the Guidelines, a novel approach to a first step in revision. Methods Evaluative design using focus groups and semi-structured interviews with 29 end users and an advisory group of 18 thinkers in the field. Sampling of end users was purposive to achieve variation in work setting, geographic location, area of expertise, manuscript writing experience, healthcare improvement and research experience. Results Study participants reported that SQUIRE was useful in planning a healthcare improvement project, but not as helpful during writing because of redundancies, uncertainty about what was important to include and lack of clarity in items. The concept "planning the study of the intervention" (item 10) was hard for many participants to understand. Participants varied in their interpretation of the meaning of item 10b "the concept of the mechanism by which changes were expected to occur". Participants disagreed about whether iterations of an intervention should be reported. Level of experience in writing, knowledge of the science of improvement and the evolving meaning of some terms in the field are hypothesised as the reasons for these findings. Conclusions The original SQUIRE Guidelines help with planning healthcare improvement work, but are perceived as complicated and unclear during writing. Key goals of the revision will be to clarify items where conflict was identified and outline the key components necessary for complete reporting of improvement work.
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Affiliation(s)
- Louise Davies
- VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT
- Department of Surgery - Otolaryngology, Geisel School of Medicine at Dartmouth, Hanover, NH
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH
| | - Paul Batalden
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH
| | - Frank Davidoff
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH
| | - David Stevens
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH
| | - Greg Ogrinc
- The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Department of Veterans Affairs Medical Center, White River Junction, VT, USA
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Davis J, Riesenberg LA, Mardis M, Donnelly J, Benningfield B, Youngstrom M, Vetter I. Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review. J Grad Med Educ 2015; 7:174-80. [PMID: 26221430 PMCID: PMC4512785 DOI: 10.4300/jgme-d-14-00205.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 10/15/2014] [Accepted: 12/16/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Multiple organizations have recognized that handoffs are prone to errors, and there has been an increase in the use of electronic health records and computerized tools in health care. OBJECTIVE This systematic review evaluates the current evidence on the effectiveness of electronic solutions used to support shift-to-shift handoffs. METHODS We searched the English-language literature for research studies published between January 1, 2008, and September 19, 2014, using National Library of Medicine PubMed, EBSCO CINAHL, OvidSP All Journals, and ProQuest PsycINFO. Included studies focused on the evaluation of physician shift-to-shift handoffs and an electronic solution designed to support handoffs. We assessed articles using a quality scoring system, conducted a review of barriers and strategies, and categorized study outcomes into self-report, process, and outcome measures. RESULTS Thirty-seven articles met inclusion criteria, including 20 single group pre- and posttest studies; 8 posttest only or cross-sectional studies; 4 nonrandomized controlled trials; 1 cohort study; 1 randomized crossover study; and 3 qualitative studies. Quality scores ranged from 3.5 to 14 of a possible 16. Most articles documented some positive outcomes, with 2 of the 3 studies evaluating patient outcomes yielding statistically significant improvements. The only other study that analyzed patient outcomes showed that interventions other than the electronic tool were responsible for most of the significant improvements. CONCLUSIONS The majority of studies supported using an electronic tool, yet few measured patient outcomes, and numerous studies suffered from methodology issues. Future studies should evaluate patient outcomes, improve study design, assess the role of faculty oversight, and broaden the focus to recognize the role of human factors.
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Wiler JL, Welch S, Pines J, Schuur J, Jouriles N, Stone-Griffith S. Emergency department performance measures updates: proceedings of the 2014 emergency department benchmarking alliance consensus summit. Acad Emerg Med 2015; 22:542-53. [PMID: 25899754 DOI: 10.1111/acem.12654] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/03/2014] [Accepted: 11/12/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to review and update key definitions and metrics for emergency department (ED) performance and operations. METHODS Forty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus. RESULTS A comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency. CONCLUSIONS Standardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers.
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Affiliation(s)
- Jennifer L. Wiler
- Department of Emergency Medicine; University of Colorado School of Medicine; Aurora CO
| | - Shari Welch
- Intermountain Institute for Healthcare Delivery Research; Salt Lake City UT
- Emergency Department Benchmarking Alliance; Newark DE
| | - Jesse Pines
- Department of Emergency Medicine; George Washington University; Washington DC
| | - Jeremiah Schuur
- Department of Emergency Medicine; Brigham and Women's Hospital and Harvard University; Boston MA
| | - Nick Jouriles
- Department of Emergency Medicine; Northeast Ohio Medical University; Akron OH
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Howell V, Schwartz AE, O'Leary JD, Mc Donnell C. The effect of the SQUIRE (Standards of QUality Improvement Reporting Excellence) guidelines on reporting standards in the quality improvement literature: a before-and-after study. BMJ Qual Saf 2015; 24:400-6. [PMID: 25678444 DOI: 10.1136/bmjqs-2014-003737] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/25/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The SQUIRE (Standards of QUality Improvement Reporting Excellence) guidelines were developed to improve the reporting of quality improvement (QI) projects. The effect of the guidelines on the completeness of reporting in the QI literature is unknown. OBJECTIVES Our primary objective was to determine if the completeness of reporting in the QI literature has been improved[OUP_CE13] since the introduction of the SQUIRE guidelines. METHODS We performed a before-and-after evaluation of QI articles selected from four prominent journals of healthcare quality. Twenty-five articles published in each of two time periods (2006-2008 and 2010-2011) were confirmed to be QI projects using a standardised definition and were independently evaluated by two investigators as an interim evaluation of a planned larger sample. Articles were assessed using 50 statements of the SQUIRE guidelines, and the overall change in the completeness of reporting between the two groups was determined. The value of p<0.05 was considered significant. RESULTS Both groups were similar in characteristics. There was no significant difference in the mean (SD) number of SQUIRE statements completed by authors before and after publication of the SQUIRE guidelines, 20.2 (5.0) versus 20.4 (7.0), p=0.9. The study was stopped early due to the absence of any significant trend in the completeness of reporting. DISCUSSION There was no overall improvement observed in the completeness of reporting of QI projects after the publication of the SQUIRE guidelines, and the study was stopped early. There is potential for improvement in reporting standards, particularly for those guideline items or statements specific to QI projects.
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Affiliation(s)
- Victoria Howell
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Eva Schwartz
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Daniel O'Leary
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Conor Mc Donnell
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
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Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, Proctor EK, Kirchner JE. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci 2015; 10:21. [PMID: 25889199 PMCID: PMC4328074 DOI: 10.1186/s13012-015-0209-1] [Citation(s) in RCA: 2080] [Impact Index Per Article: 231.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/22/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Identifying, developing, and testing implementation strategies are important goals of implementation science. However, these efforts have been complicated by the use of inconsistent language and inadequate descriptions of implementation strategies in the literature. The Expert Recommendations for Implementing Change (ERIC) study aimed to refine a published compilation of implementation strategy terms and definitions by systematically gathering input from a wide range of stakeholders with expertise in implementation science and clinical practice. METHODS Purposive sampling was used to recruit a panel of experts in implementation and clinical practice who engaged in three rounds of a modified Delphi process to generate consensus on implementation strategies and definitions. The first and second rounds involved Web-based surveys soliciting comments on implementation strategy terms and definitions. After each round, iterative refinements were made based upon participant feedback. The third round involved a live polling and consensus process via a Web-based platform and conference call. RESULTS Participants identified substantial concerns with 31% of the terms and/or definitions and suggested five additional strategies. Seventy-five percent of definitions from the originally published compilation of strategies were retained after voting. Ultimately, the expert panel reached consensus on a final compilation of 73 implementation strategies. CONCLUSIONS This research advances the field by improving the conceptual clarity, relevance, and comprehensiveness of implementation strategies that can be used in isolation or combination in implementation research and practice. Future phases of ERIC will focus on developing conceptually distinct categories of strategies as well as ratings for each strategy's importance and feasibility. Next, the expert panel will recommend multifaceted strategies for hypothetical yet real-world scenarios that vary by sites' endorsement of evidence-based programs and practices and the strength of contextual supports that surround the effort.
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Affiliation(s)
- Byron J Powell
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA.
| | - Thomas J Waltz
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA.
| | - Matthew J Chinman
- VISN 4 MIRECC, Pittsburgh, PA, USA.
- RAND Corporation, Pittsburgh, PA, USA.
| | - Laura J Damschroder
- HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Jeffrey L Smith
- Central Arkansas Veterans Healthcare System, HSR&D and Mental Health Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs Medical Center, Little Rock, AR, USA.
| | - Monica M Matthieu
- Central Arkansas Veterans Healthcare System, HSR&D and Mental Health Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs Medical Center, Little Rock, AR, USA.
- School of Social Work, College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA.
| | - Enola K Proctor
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - JoAnn E Kirchner
- Central Arkansas Veterans Healthcare System, HSR&D and Mental Health Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs Medical Center, Little Rock, AR, USA.
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Druce M. Addressing quality in endocrine care. Clin Endocrinol (Oxf) 2014; 81:818-9. [PMID: 25041384 DOI: 10.1111/cen.12544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/02/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Maralyn Druce
- Centre for Endocrinology, Barts and the London School of Medicine, London, UK
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Wilkinson C, Champion JD, Sabharwal K. Promoting preventive health screening through the use of a clinical reminder tool: an accountable care organization quality improvement initiative. J Healthc Qual 2014; 35:7-19. [PMID: 24004035 DOI: 10.1111/jhq.12024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This quality improvement initiative was designed to increase clinical prevention performance rates in 11 Austin Regional Clinic primary care facilities as part of an accountable care initiative. The initiative was conducted between January 2011 and December 2011. The principal interventions included implementation of a care coordinator and care gap summary tool. The care gap summary includes recommended preventive healthcare services and serves as a prompt for healthcare providers. These interventions led to improvement in clinical prevention performance rates as demonstrated by aggregate organizational data. This initiative demonstrates that quality improvement initiatives including care gap summaries, workflow changes, and provider feedback can increase performance rates for clinical preventive services.
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Affiliation(s)
- Crystal Wilkinson
- Texas Tech University Health Sciences Center School of Nursing, Lubbock, Texas, USA.
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