Patient Safety Quality Improvement Research Articles

Exploring procedure duration and risk for serious adverse events during congenital cardiac catheterization

ObjectivesWhile procedure length is considered an important metric for cardiothoracic surgical procedures, the relationship between procedure length and adverse events (AEs) in congenital cardiac catheterizations has little published data available....

Recognising and managing postoperative airway complications: a patient safety quality improvement project

Within our institution, surgery that may cause postoperative airway complications is frequently performed by several surgical specialties. A strategy to improve awareness and management of these associated complications was developed after several clinical incidents involving delayed recognition of postoperative anterior neck haematomas (ANHs), including a cardiac arrest in a patient who had deteriorated over several hours after right partial glossectomy and selective neck dissection.

Development of Tool for Case Submission and Review as Foundation for Department Patient Safety / Quality Improvement Program

Objective: Describe creation and implementation of secure case collection tool for the foundation of otolaryngology department Patient Safety/Quality Improvement (PSQI) program. Describe how tool decreased burden while fulfilling stakeholders’ reporting requirements. Methods: Incorporation of elements of required reports into online tool, facilitating improved case submission for Morbidity and Mortality conference (M&M) review. Reviewer commentary and conference discussion notes are recorded within the project. Regular reports tailored to each stakeholder were designed. Results: During first 8 months of implementation, 83 cases were submitted–5250 surgical procedures were performed by our department in that period—compared to 75 cases submitted via prior system in a same time period the year before (6930 surgical procedures performed). Elements of routine reports for interdepartmental use and external stakeholder requirements determined and reported. Discussion: Preliminary description of secure online tool with a single platform serving multiple stakeholders with unique reporting elements. This presents an opportunity to reduce the burden of essential administrative tasks while providing a reliable PSQI repository. Future metrics for ongoing evaluation will be identified and incorporated. Case submissions were maintained through a period of altered clinical activity (SARS-CoV-2 pandemic). Implications for Practice: This tool will allow our department to review cases for our required M&M with improved efficiency and efficacy, while supporting our PSQI program and generate necessary reports to stakeholders. Reduction of electronic task burden may reduce risk of physician burnout. Facilitating implementation of essential and required PSQI efforts will strengthen our curriculum and clinical work.

University of North Dakota School of Medicine and Health Sciences.

University of North Dakota School of Medicine and Health Sciences.

Patient Safety and Quality Improvement in Otolaryngology-Head and Neck Surgery: A Systematic Review.

The current landscape of patient safety/quality improvement (PS/QI) research dedicated to Otolaryngology-Head and Neck Surgery (OHNS) has not been established. This systematic review aims to define the breadth and depth of PS/QI research dedicated to OHNS and to identify knowledge gaps as well as potential areas of future study. The study protocol was developed a priori using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process. A computerized Ovid/Medline database search was conducted (January 1, 1965-September 30, 2019). Similar computerized searches were conducted using Cochrane Database, PubMed, and Google Scholar. Articles were classified by year, subspecialty, PS/QI category, Institute of Medicine (IOM) Crossing the Chasm categories, and World Health Organization (WHO) subclass. Computerized searches yielded 11,570 eligible articles, 738 (6.4%) of which met otolaryngology PS/QI inclusion criteria; 178 (24.1%) were not specific to any one subspecialty. The most prevalent subspecialty foci were head and neck (29.9%), pediatric otolaryngology (16.9%), and otology/neurotology (11.0%). Studies examining complications or risk factors (32.0%) and outcomes/quality measures (16.3%) were the most common foci. Classification by the IOM included effective care (31.4%), safety (29.9%), and safety/effective care (25.3%). Most research fell into the WHO categories of understanding causes (28.5%) or measuring harm (28.3%). Most OHNS PS/QI projects (32.0%) focus on reporting complications or risk factors, followed by outcomes/quality measures (16.3%). Knowledges gaps for future research include healthcare disparities, multidisciplinary care, and the WHO category of studies translating evidence into safer care. NA Laryngoscope, 131:33-40, 2021.

Improving the surveillance of antimicrobial resistance trends amongst anaerobic oral pathogens

Background Orofacial infections when treated by dental practitioners are not routinely sampled for culture and susceptibility testing. Consequently, antimicrobial resistant rates amongst the causative bacteria are unknown, hindering efforts to appropriately manage these infections and undertake surveillance of resistant rates. As part of the Cardiff health board leadership in patient safety quality improvement programme a multidisciplinary group was tasked with the aim of improving sampling practices. Methods Dental professionals' limited knowledge regarding the role of diagnostic support and an associated lack of confidence in sampling procedures was addressed by the creation and distribution of training aids. Sampling and transportation kits were developed and transport routes identified enabling dentists within the community setting to send samples to the specialist microbiology services based at Cardiff University Dental Hospital [UDH]. All significant anaerobes were identified and antibiotic susceptibility testing undertaken via agar dilution through referral of isolates to the UK Anaerobic Reference Unit. Results A 10% increase was seen in the proportion of pus aspirates being received in comparison to pus swabs. For the first time, pus aspirate samples have been received from community dental clinics. A vast diversity of anaerob species and susceptibility profiles have been identified. Increasing rates of resistance amongst Prevotella species to amoxicillin and clindamycin is of concern. Conclusion This project has shown that through educational interventions and support the barriers to the sampling of orofacial infections can be overcome. The ultimate aim is for all dentists in Wales to have access to diagnostic support.

Targeting specimen misprocessing safety events with failure modes and effects analysis.

Targeting specimen misprocessing safety events with failure modes and effects analysis.

Optimizing Value in Otolaryngology Through Patient Safety and Quality Improvements

The goals of this paper are to explore the relationship between patient safety/quality improvement (PS/QI) activities and value generation in the field of otolaryngology and to suggest future opportunities for improvement or research. Value is defined as the ratio between health outcomes or improvements achieved and resources and dollars spent. It can therefore be increased by improving outcomes, reducing costs, or both. We present information suggesting that PS/QI activities may impact both the numerator and denominator in the value ratio, with the potential for powerful effects on value in health care. We describe clinical and administrative strategies demonstrated to increase value across multiple subspecialties in otolaryngology. PS/QI can improve both components of value in health care. Relatively simple interventions may have significant impact and serve as good starting points. Larger-scale changes may have even broader impact but may require more infrastructure investment.

Patient Safety/Quality Improvement Primer, Part I: What PS/QI Means to Your Otolaryngology Practice.

Patient safety/quality improvement (PS/QI) is the cornerstone of 21st-century health care. Otolaryngology-Head and Neck Surgery is excited to provide a dedicated PS/QI primer. The overarching goal for this PS/QI series is to provide a comprehensive and practical resource that assists readers, authors, and peer reviewers in understanding PS/QI research, its unique methodology, and the associated reporting standards for trustworthy performance measures. The target audience includes resident and fellows, faculty from the private sector and academia, and allied health professionals. This inaugural primer reviews PS/QI background as it relates to otolaryngology practice. It explores the history, goals, and development of performance measurement. In addition, it highlights opportunities for integrating PS/QI into otolaryngology practice. Payers will drive patients to quality care based on outcomes. Otolaryngologists have a responsibility to embrace a culture of PS/QI. In doing so, we will define optimal, quality otolaryngology care through objective data and metrics.

Patient Safety and Quality Improvement in Otolaryngology Education: A Systematic Review.

Objective The breadth and depth of patient safety/quality improvement (PS/QI) research dedicated to otolaryngology-head and neck surgery (OHNS) education remains unknown. This systematic review aims to define this scope and to identify knowledge gaps as well as potential areas of future study to improved PS/QI education and training in OHNS. Data Sources A computerized Ovid/Medline database search was conducted (January 1, 1965, to May 15, 2015). Similar computerized searches were conducted using Cochrane Database, PubMed, and Google Scholar. Review Methods The study protocol was developed a priori using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were classified by year, subspecialty, Institute of Medicine (IOM) Crossing the Chasm categories, and World Health Organization (WHO) subclass. Results Computerized searches yielded 8743 eligible articles, 267 (3.4%) of which met otolaryngology PS/QI inclusion criteria; 51 (19%) were dedicated to resident/fellow education and training. Simulation studies (39%) and performance/competency evaluation (23.5%) were the most common focus. Most projects involved general otolaryngology (47%), rhinology (18%), and otology (16%). Classification by the IOM included effective care (45%), safety/effective care (41%), and effective and efficient care (7.8%). Most research fell into the WHO category of "identifying solutions" (61%). Conclusion Nineteen percent of OHNS PS/QI articles are dedicated to education, the majority of which are simulation and focus on effective care. Knowledges gaps for future research include facial plastics PS/QI and the WHO category of "studies translating evidence into safer care."

Analysis of Patient Safety Management in Committee for Quality Improvement and Patient Safety at Sumbawa Hospital, West Nusa Tenggara

Background : Patient safety is a crucial issue and a focus of policy standard in internationally accredited organizations. The specific committee responsible for quality improvement in patient safety is the committee for quality improvement and patient safety (PMKP). Incidence of malpractice often occurs but are not reported. It indicates that the committee has not worked according to required accreditation standard. This study aimed to analyze patient safety management with the committee for quality improvement and patient safety at Sumbawa Hospital, West Nusa Tenggara. Subje cts and Met hod : This was a qualitative study with phenomenology approach. Nine study participants were selected purposively, consisting of 3 committee members (chairperson, secretary, and patient safety sub-committee), 3 chiefs of ward (pediatrics, internal medicine, and surgery), and 4 nurses or midwives (pediatrics, surgery, ICU/ICCU, and obstetrics). Results : The committee for quality improvement and patient safety has been established at Sumbawa Hospital, West Nusa Tenggara to meet the requirement of hospital accreditation standard. It aimed to improve the quality of services and to assure patient safety. However, its work has not meet the required standard. The lack of knowledge among involving parties, including hospital management, PMKP member, medical professionals was identified as one important obstacle for the implementation of patient safety management. This has led to the incidence of malpractice at the hospital, sub-standard quality of services and patient safety. Conclusion : PMKP has been established at Sumbawa Hospital, West Nusa Tenggara. However, their work have not meet the required standard. The lack of knowledge among involving parties, including hospital management, PMKP, and health professional, has led to the incidence of malpractice at the hospital, sub-standard quality of services and patient safety. Keyword : quality improvement, patient safety management, committee Correspondence: Evie Sulahyuningsih. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Mobile: 08786410495. Journal of Health Policy and Management (2017), 2(2): 147-156 https://doi.org/10.26911/thejhpm.2017.02.02.06

Assessment of Patient Safety for Quality Improvement Based on Joint Commission International Accreditation Standards in Farabi Eye Hospital of Tehran University of Medical Sciences

Introduction: Quality improvement and patient safety are the most important aspects of health care delivery systems. Improving quality and safety in health care organizations is assured through accreditation. To evaluate patient safety in Farabi Eye Hospital by Joint Commission International (JCI) accreditation standards for quality improvement. Materials and Methods:This descriptive-analytical study was carried out in 2014. The data collection instrument was the translated version of JCI checklist, the validity of which was confirmed by a panel of Iranian experts. The data were obtained through interviews with all heads of departments (n=80) and observation of documentation in each department by appraisers in Farabi Hospital. To analyze the data, Spearman's rank correlation coefficient and Mann-Whitney U tests were run using SPSS Version 16. Results: The highest rate of compliance with JCI standards was 91.1%, pertaining to infection control and adopting an approach to reduce contamination. The lowest rate was associated with management monitoring of patients’ demographic information. In general, Farabi Eye Hospital observed the standards to a high level. Conclusion: Our findings exhibited that Farabi Eye Hospital is relatively efficient as to patient safety as a quality improvement factor. However, there were some shortcomings regarding some standards, which indicate deficient compliance with the JCI standards in this hospital. Absence of comprehensive training programs and defective policies and documentation are the key factors for patient safety quality improvement.

German in-hospital emergency registry: A two years analysis

Introduction: Since January 2013, the German Resuscitation Registry database includes – in addition to in-hospital resuscitation (51 participating hospitals) – also data on in-hospital emergency management (38 hospitals). To date the data base contains 5252 data sets. Methods: Registry data were collected anonymously and subsequently analysed. Results: The medical emergency team (MET) was called for resuscitation 2802 times. Circulatory arrest was due to cardiac conditions in 55.4% (n=1552) and respiratory conditions in 23.6% (n=660). Sepsis, bleeding and metabolic derangement were less than 5%. ROSC was achieved in 1753 patients (62.6%), 12% going homewith good neurological function. Most frequent locations for CPR were the ward (55%), IMC/ICU (18%), and emergency room (13%). 487 patients (19%) had no independent life before resuscitation, 63% of patients (1662) presentedwith significant pre-existing conditions (PC). 15% of patients were healthy or has minor limitations. 2450 times the MET was called to in-hospital emergency management without resuscitation. Such emergency situations occurred 1056 time (43.2%) on the ward, 368 time (15%) in the diagnostic suite and 429 time (17.5%) somewhere else on the hospital premises. The most frequent indications for emergency calls were respiratory compromise (n=973) hemodynamic instability (n=921) and neurological deterioration (n=677). 231 patients (10.6%) had no independent life before this emergency, 50.9% of patients (n=1113) presented with significant pre-existing conditions. All participating hospitals receive a yearbook with a thorough analysis of more than 100 variables including benchmarking. Discussion and conclusion: In half of hospitals, emergency teams are requested for resuscitation only. Actually, such teams should be called way before CPR becomes necessary, to initiate preventive measures. All in-hospital patients should receive vital-signs monitoring, appropriate for the severity of their condition. In Germany, structures need to be established to actually obviate the need for CPR and eliminate unexpected deaths; such structures should include early warning scores and standardized alarm criteria. The German in-hospital registry is a tool for quality improvement in patient safety and treatment.

Interview with a Quality Leader: Dale W. Bratzler, DO, MPH on Performance Measures

Dale Bratzler, DO, MPH, currently serves as the President and CEO of the Oklahoma Foundation for Medical Quality (OFMQ). In addition, he provides support as the Medical Director of the Patient Safety Quality Improvement Organization Support Center at OFMQ. In these roles, he provides clinical and technical support for local and national hospital quality improvement initiatives. He is a Past President of the American Health Quality Association and a recent member of the National Advisory Council for the Agency for Healthcare Research and Quality. Dr. Bratzler has published extensively and frequently presents locally and nationally on topics related to healthcare quality, particularly associated with improving care for pneumonia, increasing vaccination rates, and reducing surgical complications. He received his Doctor of Osteopathic Medicine degree at the Kansas City University of Medicine and Biosciences, and his Master of Public Health degree from the University of Oklahoma Health Sciences Center College of Public Health. Dr. Bratzler is board certified in internal medicine.

Aetna to Refuse Payment for Certain Preventable Errors

Aetna to Refuse Payment for Certain Preventable Errors

Preliminary outcomes and cost‐benefit analysis of a community hospital emergency department screening and referral program for patients aged 75 or more

The purpose of this article is to report preliminary outcome and cost-benefit results for a patient safety quality improvement program intended to improve outcomes for patients aged 75 or more visiting the Emergency Department (ED). The program uses the Identification of Seniors at Risk (SAR) scale to screen, and refers patients at high risk for appropriate intervention. The Plan-Do-Study-Act improvement cycle was used as a framework. Simple outcomes have been assessed by comparing patient sub-groups based on risk status and interventions received. Cost and benefits were assessed based on estimated program outcomes and average costs. Sensitivity analysis was performed to test alternate assumptions. The screening tool appears to be accurate, and screening and referral appears to have a positive impact, reducing length of stay, returns to the ED, and subsequent admissions to hospital. However, most results are not statistically significant at the 95 percent level. The value of avoided care exceeds program costs under most assumptions. Screening and referring all eligible patients has still not been achieved; these are areas for future investigation and improvement. Screening and referral appear to be effective in improving outcomes but because program costs were low, net benefits may have been achieved; however given global budgeting for hospital care improvements in the use of resources (rather than budgetary savings) would be expected. The methods for improvement (the Plan-Do-Study-Act framework; process evaluation; multidisciplinary working group meetings; outcome assessment) are practical and useful for improving quality and safety in a small community hospital with limited resources.

Identification of seniors at risk: process evaluation of a screening and referral program for patients aged ≥75 in a community hospital emergency department

Reports on the authors' experience with a patient safety quality improvement program, intended to reduce the incidence and severity of adverse outcomes for emergency department (ED) patients aged > or = 75. The Identification of Seniors at Risk scale was used for screening, and those at high risk were referred for appropriate intervention. The plan-do-study-act improvement cycle was followed, conducting process evaluation to diagnose and correct implementation difficulties. Reports that: implementing an ED screening and referral program is deceptively difficult; process evaluation multidisciplinary working group meetings are an essential improvement tool; screening inclusion criteria had to be adapted to the subject population in order to make efficient use of staff time; the screening questions and process required ongoing assessment, revision, and local adaptation in order to be useful; and high-risk screening in the ED is critical to a hospital system's ability to anticipate clinical problems; the plan-do-study-act improvement cycle is a practical and useful tool for improving quality and systems in a real care setting.

Designing and Implementing a Patient Safety Program for the OR

Surgery has a high potential for adverse outcomes. An error involving a retained retractor caused perioperative nurses at the University of Washington Medical Center, Seattle, to take another look at their department's patient safety practices and risk management procedures. Using another department's successful program as a model, the nurses considered the frameworks of risk management, quality improvement, and OR culture to develop a new patient safety quality improvement program for the OR. This article details the process of designing and implementing the program, which has energized staff members, enhanced teamwork, and resulted in improved patient outcomes.