Quality Of Review Process Research Articles

Dedicated Chest Wall Injury Program quality review: How to create and incorporate a quality and safety program for surgical stabilization of rib fractures.

Adoption of surgical stabilization of rib fractures (SSRF) in chest trauma necessitates outcomes reviews and process improvement (PI). As volume and complexity increase, such vigilance is imperative. Over 10 years, our center has developed a dedicated PI program based on our trauma PI program. Here, we outline the components of this program, aiming to share best practices and potentially improve SSRF patient outcomes. Over 10 years, our dedicated SSRF PI process has evolved to include bimonthly reviews on case and quality metrics. In 2022, all patients at our single high-volume Level 1 trauma center with flail chest segments were identified, and a PI chart review was conducted. Data collected included management approach (operative vs. nonoperative), postoperative complications, mortality, patient demographics, trauma specific variables (Injury Severity Score, etc.), and rib fracture details. Operative data collected included number of ribs plated, system used, and complication rates for each surgeon and plating system used. Of 82 patients identified, 88% underwent SSRF. Among these, 49% experienced one or more postoperative complications, not all directly related to SSRF procedures. Mortality rate for SSRF patients was 15%, predominantly in those with Injury Severity Score of >25 and mean age of 58 years. Patients who had trauma activations and required emergency department chest tube placement had higher complications. The mean number of ribs stabilized was four. Complications occurred more frequently with posterior fractures. Outcomes were collated and analyzed at SSRF Outcomes Committee. The utilization of SSRF underscores the need for a rigorous quality review process to enhance patient safety and SSRF-specific outcomes. Our program developed over time from and was implemented in fashion similar to the trauma PI processes. The resulting quality initiative has fostered center-specific PI projects and programmatic advancements. Economic and Value-Base Evaluations; Level IV.

Resuscitation following trauma & role of trauma training programmes in emergency settings: A literature review & survey.

Background & objectives Traumatic injuries, especially in low- and middle- income countries (LMICs), present significant challenges in patient resuscitation and healthcare delivery. This study explores the role of trauma training programmes in improving patient outcomes and reducing preventable trauma-related deaths. Methods A dual approach was adopted, first a literature review of trauma training in LMICs over the past decade, along with a situational assessment survey. For the review of literature, we searched the PubMed database to identify key challenges and innovative practices in trauma training programmes in LMIC's. The survey, conducted among healthcare professionals in various LMICs, collected direct insights into the challenges and the status of trauma training programmes in these countries. Results The literature review analysed 68 articles, with a significant focus on the African subcontinent (36 studies), underscoring the region's emphasis on research on trauma training programmes. These studies mainly targeted physicians, clinicians, postgraduate trainees in surgical or anaesthesia fields and medical students (86.8%), highlighting innovations like simulation-based training and the cascading training model. In our survey, we received 34 responses from healthcare professionals in India, Belarus, Azerbaijan, Nepal and Pakistan. Around 52.9 per cent reported the absence of established trauma training programmes in their settings. The majority of respondents advocated for hands-on, simulation-based training (94.1%) and emphasised the need for structured training programmes (85.3%), feedback sessions (70.6%) and updated protocols (61.8%). This combined data underlined the critical gaps and potential improvements in trauma training programmes and resuscitation practices in LMICs. Interpretation & conclusions Effective trauma care in LMICs requires the establishment of comprehensive, tailored training programmes. Key interventions should include subsidization of pre-existing trauma courses and the adoption of World Health Organization Guidelines for essential trauma care, implementation of trauma quality improvement and review processes and the incorporation of focused assessment with sonography in trauma (FAST) in emergency departments. These steps are crucial for equipping healthcare workers with vital skills and knowledge, fostering a culture of continuous learning and improvement in the realm of trauma care.

Implementation of a Severe Maternal Morbidity Quality Review Process at a Level IV Public Hospital [ID: 1377992

INTRODUCTION: Severe maternal morbidity (SMM) is tracked by national organizations offering opportunities to evaluate, monitor, and address in near real time. Using a multidisciplinary case review committee to analyze all cases of SMM at a level IV inner-city hospital, we hypothesized that case reviews will identify opportunities for improvement in obstetric practices. METHODS: A case review was triggered for any delivery with an SMM ICD-10 code, transfusion of greater than 4 units, readmission within 48 hours of discharge, a patient safety concern by staff, or a severe adverse neonatal outcome. This cohort study included all of the case reviews of cases between 2019 and 2022. Severe maternal morbidity outcomes, demographics, and obstetric practices were analyzed. RESULTS: Of 36,671 deliveries, 296 (0.8%) met criteria and were reviewed. Of these, 80 (27%) had two or more concurrent SMM events. Postpartum hemorrhage was the most common (37%), followed by intensive care unit admission (13%) and hysterectomy (12%). After review, practices done well included interdisciplinary communication and prompt decision-making. Opportunities for improvement included inadequate access to peripartum care due to socioeconomic barriers, communication, and lack of role clarity. CONCLUSION: Social barriers, inadequate communication, and lack of role clarity were identified as the most common areas of improvement in SMM cases. These findings led to the development of an escalation of care pathway for massive transfusion protocol and vital signs thresholds at which to contact anesthesia. The implementation of a standardized SMM surveillance system results in systematic improvements in obstetric practices.

Integrative Conservation: A new journal from the conservation frontline

<i>Integrative Conservation</i>: A new journal from the conservation frontline

FHH Quick App Review: How Can a Quality Review Process Assist Primary Care Providers in Choosing a Family Health History App for Patient Care?

Family health history (FHH) is a data type serving risk assessment, diagnosis, research, and preventive health. Despite technological leaps in genomic variant detection, FHH remains the most accessible, least expensive, and most practical assessment tool for assessing risks attributable to genetic inheritance. The purpose of this manuscript is to outline a process to assist primary care professionals in choosing FHH digital tools for patient care based on the new ISO/TS 82304-2 Technical Specification (TS), which is a recently developed method to determine eHealth app quality. With a focus on eHealth in primary care, we applied the quality label concept to FHH, and how a primary care physician can quickly review the quality and reliability of an FHH app. Based on our review of the ISO TS’s 81 questions, we compiled a list of 25 questions that are recommended to be more succinct as an initial review. We call this process the FHH Quick App Review. Our ‘informative-only’ 25 questions do not produce a quality score, but a guide to complete an initial review of FHH apps. Most of the questions are straight from the ISO TS, some are modified or de novo. We believe the 25 questions are not only relevant to FHH app reviews but could also serve to aid app development and clinical implementation.

Identifying administrators’ and faculty’s perspectives regarding CAEP accreditation in a College of Education: A Q methodology research

In higher education, accreditation involves an external quality review process that scrutinizes universities, colleges, and educational programs to ensure that the education provided meets acceptable quality levels. Often considered the gold standard for institutions, the accreditation process originated in the US and quickly moved beyond American borders. Specifically, the Council for the Accreditation of Educator Preparation (CAEP) has moved to provide ‘legitimacy’ to universities in the Gulf Cooperation Council (GCC) region. Using Q methodology, this study examines faculty and administrators' perceptions regarding CAEP accreditation of a College of Education (CED) in the GCC. The results identify an apparent discrepancy among participants’ perceptions regarding the CAEP accreditation’s advantages and disadvantages, procedures and requirements, and impact on faculty and administrators’ workload and agency.

Compatibility by a Nonisothermal Kinetic Study of Azathioprine Associated with Usual Excipients in the Product Quality Review Process

Azathioprine is an immunosuppressive drug for several inflammatory disorders. Due to its clinical relevance, to explore the solid-state properties for excipient compatibility in the product quality review process is essential. Fourier transform infrared spectroscopy, powder X-ray diffraction and thermal analysis (thermogravimetry/derivative thermogravimetry (TG/DTG), differential thermal analysis (DTA), and differential scanning calorimetry (DSC)) were applied. The compatibility studies evidenced that starch pregelatinized, colloidal silicon dioxide, and talc are fully compatible with azathioprine. However, stearic acid, magnesium stearate, and mannitol are incompatible after heat supply at temperatures easily reached by industrial processing. The nonlinear Vyazovkin isoconversional treatment performed the kinetic study of the thermal degradation. The activation energies were determined to clarify the influence of each excipient on the thermal drug stability, an essential procedure in the pharmaceutical development, and all over the commercial live span, in Good Manufacturing Practices.

Applying The Best Practice For Internal Quality Control (IQC) Management, Consolidation And Review Process In Sidra Medicine Clinical Chemistry Division

Abstract Introduction/Objective The management of internal quality control (IQC) in Sidra Medicine Clinical Chemistry Division has been evaluated in order to promote a more consolidated and efficient process of IQC management. The statistical data produced from Cerner QC Module are transferred to IQC review templates consisting of formulas to auto- calculate parameters such as multiple of expected QC failure frequency and desirable comparison limit between analyzers. The IQC review and documentation process using the in-house excel template requires several hours to complete, hence a faster and more efficient IQC management module is required. The main objective of this study is to improve the initial IQC management set up, work flow and review procedures and to implement Biorad Unity Real Time (URT) program to develop a more efficient IQC management system. Methods The URT software has been recently configured and implemented to consolidate and streamline IQC management. URT is built through Sidra Medicine IT Enterprise level which allows multiple users to login. IQC data are downloaded using scripts from Cerner which are filtered through Biorad Unity Connect (UC) software. Additional quality tools are also explored such as various user defined statistical reports, IQC analysis using peer reviewed total allowable error (TeA) and assignment of the most appropriate Westgard rules. Determination of sigma metrics and uncertainty of measurement is also performed using the URT application. Results The generation of any IQC report is less cumbersome and time consuming as compared with the previous process. However, some user defined formulas in the IQC templates are not found on the URT reports. The URT Levey Jennings chart are also more user friendly and directly compares the daily IQC data with Unity inter-laboratory peers enabling the production of instant and monthly reports through QCNet site when assay investigation is required and for IQC report documentation. Conclusion The combination of Cerner IQC, Unity Real-time, QCNet Inter-laboratory reports and in house IQC templates produce a high level and very detailed IQC review which effectively evaluate assay performance to assist on IQC troubleshooting and root cause analysis to be able to apply the most appropriate corrective actions.

Does an Audit Office’s Quality Control System Impact Audit Quality? Evidence from Audit Report Errors

Although practitioner literature asserts a link between an auditor’s quality control system and engagement-level audit outcomes, prior archival evidence has struggled to identify observable indicators in support of this claim. We identify an observable failure that is unambiguously attributable to the auditor – a mistake in the audit report identified by the SEC – as an office-level proxy for poor, office-level quality control systems. Audit report errors suggest a breakdown in the engagement’s quality review process, which we expect to signal broader quality control problems in the respective office. Consistent with this hypothesis, we find that clients of a Big Four office cited for an audit report error display lower financial reporting quality than do clients of offices not cited for errors. We document this pattern in abnormal accruals, report lag, and adverse opinions on internal controls. Further, the SEC comment appears to trigger increased auditor attention to the quality review; after the SEC exposes an audit report error, financial reporting quality improves in the clients of the culpable office. Our results suggest that audit firms’ internal quality mechanisms impact the quality of the financial reporting process. They also suggest that audit report errors may be used as a proxy for an office’s audit quality independent of its clients’ pre-audit inputs.

College of Medicine, University of Saskatchewan.

College of Medicine, University of Saskatchewan.

A Framework for Quality Assurance of Pediatric Revisits to the Emergency Department.

Emergency department return visits significantly impact medical costs and patient flow. A comprehensive approach to understanding these patients is required to identify deficits in care, system level inefficiencies, and improve diagnosis specific management protocols. We aimed to identify factors needed to successfully analyze return visits to explore root causes leading to unplanned returns and inform system-level improvements. A multidisciplinary committee collaborated to develop a quality review process for return visits within 72 hours to our pediatric emergency department that were then subsequently admitted to the hospital. The committee developed methodology and a web-based tool for chart review and analysis. Of 197,076 ED visits (159,164 discharged at initial visit), 5390 (3.4%) patients were discharged and represented to the ED within 72 hours and 1658 (1.0%) of those resulted in admission. Using defined criteria, approximately one third (n = 564) of revisits with admission were identified for chart review. Reason for revisit included natural progression of disease (67.6%), new condition or problem (11.2%), diagnostic error (6.9%), and scheduled or planned readmissions (3.5%). All diagnostic errors had not been previously identified by ED leadership. Of the reviewed cases, most were not preventable (84.0%); however, a number of system-level actions resulted from discussion of the potentially preventable revisits. Seventy-two-hour ED revisits were efficiently and systematically categorized with determination of root causes and preventability. This process resulted in shared provider-level feedback, identifying trends in revisits, and implementation of system-level actions, therefore, encouraging other institutions to adopt a similar process.

Welcome 2020 and a New Journal: Annals of Headache Medicine

Wish you all a blessed prosperous 2020 and would like to welcome you to “Annals of Headache Medicine”. The headache medicine field continues to be very pertinent and vibrant with the many recent seminal discoveries that substantially challenged our traditional understanding of headaches pathophysiology and shed the light on new neurobiological, mechanistic, and functional insights into headaches. According to the Center for Disease Control and Prevention and National Center for Health Statistics‎1 www.cdc.gov/nchs/data/series/sr_10/sr10_260.pdf; • 14% of adults suffer from migraine or severe headache • 14% of adults suffer from neck pain • 5% of adults suffer from face pain Up to 20% of patients don't respond to or cannot tolerate medications. Therefore; multimodal interdisciplinary approach is paramount for pain relief and to improve function. Based on the above statistics, patients with chronic headaches, neck pain, and orofacial pain outnumber patients with chronic back pain and represent an important public health problem that cannot be ignored anymore. Despite the need to address this public health problem, many physicians and other health care professionals are not adequately educated to contribute to the cultural transformation in the perception and treatment of people with headaches and pain. The need for an interdisciplinary approach and timely interactions between different physicians with unique backgrounds are essential to the success of such cultural transformation. The necessity for this approach prompted the birth of the American Interventional Headache Society (AIHS). The purpose of AIHS (www.interventionalheadache.net/) is to foster awareness, promote, and advance headache, neck and orofacial pain science through research, education, and advanced patient care. With the great success of AIHS, it became quite evident the need for an interdisciplinary headache journal, where healthcare professionals from diverse specialties (neurology, internal medicine, primary care, pain medicine, anesthesiology pain management, neurosurgery, oral surgery, clinical and basic science researchers)have a common platform to share and exchange knowledge, experience, and new research. The AIHS board decided to sponsor a new open access journal - Annals of Headache Medicine (AHM). Open access journals are now established as an integral part of the medical landscape. In fact, it seems likely that in the near future, the majority of medical journals will become open access. While the overall costs of online journals are usually lower than that of print journals, there are real costs associated with editing, formatting, and indexing of online issues. AIHS acknowledges that financial barriers can create a firewall that hinders the widespread exchange of research; accordingly, the publication fee will be waived for all authors. The plan is to have a free submission for the next 2-3 years, and then after the publication fee may be reevaluated and adjusted according to the existing circumstances. Free submission will ensure that the peer review process and editorial decisions will be independent of financial considerations. The provision of an impact factor is delayed for all new journals for obvious reasons. The AHM board is working hard towards generating an impact factor as soon as possible as well as inclusion in major bibliographic databases such as PubMed. We are currently registered at CrossRef and all published manuscripts have designated DOI numbers for citations and referencing. I’m honored to be the founder and first Editor-in-Chief for “Annals of Headache Medicine - AHM”. The trust that AIHS board has bestowed on me will motivate me to do my very best serving our readership. My long professional career in both academia and private practice and my clinical background as headache specialist, anesthesiologist and pain medicine specialist will guide me while navigating my new role. We are committed to the highest scientific and ethical standards. Peer review is the cornerstone for the success of any journal. I would like to personally offer my sincere thanks the associate editors and the editorial board of AHM (www.ahmjournal.com/editorial-board/) who will bring their rich diverse expertise and unmatched dedication to ensure transparent, high quality, and rapid review process.

Editorial Note for Journal of Forensic Research

The Journal has published in excess of 230 interesting papers in various field of forensic, including the interactions between DNA, RNA and fingerprinting, the transcription factor as well as learning how these interactions are regulated. I am glad to introduce Journal of Forensic Research (JFR) a peer-reviewed Journal which have a key worries over the forensic discoveries by investigating the cases arranged clinical examination and by displaying this data both directly, as clinical findings, and day by day arranged configurations of direct application in everyday circumstances. I am satisfied to report that, all issues of volume 11 were distributed online well inside the time and the print issues were likewise brought out and dispatched within 30 days of publishing the issue online during the year of 2019. The Journals intends to flourish and to keep up the principles in research and practice, give platform and chance to introduce evidences based medicine and analytical assessment of research and most likely it is much in deed for students, teachers and health care professionals to improve the patient care. This regular issue contains a few papers choose because of a call for papers managing instructive issues in the educating/training of argumentation and legal sciences. The points managed in this issue don't debilitate the entirety of the potential worries of educators, yet they do start to propose the assorted variety of interests inside this research arena. During the calendar year of 2019, JFR got a total of 48 manuscript, out of which 28 articles (70%) were dismissed in the preliminary screening because of plagiarism or being out of the format and during peer review process. During 2019 around 20 articles were oppressed for distribution after they are acknowledged in the peer review process. In the 4 issues of Volume 10 distributed during the year 2019, a sum of 20 articles were distributed of which, articles were published from authors all around the world. Globally articles have been accessed by the researchers and also cited to. During the calendar year 2019, a total of two Editors, Nine Reviewers joined the team of JFR and they contributed their valuable services towards contribution as well as publication of articles, and their valuable review comments will beneficial to publish quality of articles in the Journal. I would like to take this opportunity to acknowledge the contribution of (Dr. Gill Peter) during the final editing of articles distributed and the help rendered by the editorial assistant, in bringing out issues of JFR in time. I might likewise want to offer my thanks to all the authors, reviewers, the publisher, the advisory and the editorial board of JFR, the workplace bearers for their support in bringing out yet more volume of JFR and anticipate their persistent support to draw out the Volume 11 of JFR in scheduled time. The topic of our journal will keep on being varied, since we interpret the word forensic in the most extensive sense. Everything that relates legitimately to the structure, substance organization, physical nature, and elements used, or to the methods that are utilized in evidence examinations, will be within our scope. We imagine in the immediate future an extraordinary augmentation of the utilization of Environmental forensics, and we will especially invite papers coming about because of work in this field. Manuscripts can be submitted online via forensic Research or as an e-mail attachment to the editorial office at forensicres@escientificjournals.com. JFR is using Online Review and Editorial Tracking Systems for quality review process and the authors can submit manuscripts and track their progress.

Utilization of an audit tool to evaluate accuracy of treatment summary and survivorship care plans.

A quality review process was implemented to determine compliance with the requirement from the Commission on Cancer to use the American Society of Clinical Oncology (ASCO) template as the minimum data set for Treatment Summary and Survivorship Care Plans (TS/SCP) provided to cancer survivors. TS/SCPs generated during 2017 (N = 1257) were audited for concordance with each of the 66 TS/SCP line items on ASCO's template. Descriptive statistics and chi-square statistics were used to examine line item concordance, overall and by services groups (survivorship vs. other oncology service). Mixed-effects logistic regression was used to estimate the effects of service delivery group on the concordance. Institutional compliance with the ASCO template was very high; 76% of the 66 line items were present in at least 75% of the delivered TS/SCPs. There was a significantly higher rate of concordance for TS/SCPs provided by the survivorship service (83% vs. 66%, P = 0.006). TS/SCPs provided by the survivorship service were nearly twice as likely to be concordant with ASCO template (OR = 1.88, 95% CI = 1.77-2.00) compared to those by other service groups. Use of the electronic medical record to auto-populate information was instrumental in achieving a high rate of concordance. Institutions should consider providing training to improve or maintain quality of these documents. Ensuring that the information contained on the TS/SCP is consistently present is necessary for a high-quality survivorship visit between the clinician, PCP, and survivor and as a record of care for future health care encounters.

Audit Quality, Auditor's Follow-up Recommendations (Emphasis on Specific Point Paragraph) and Auditor's Opinion

Considering the importance of the audit objective, which creates reasonable assurance about the financial statements and the importance of the audit process to collect sufficient and adequate audit evidence, the audit quality is considered one of the audit process's main features. Therefore, to improve the audit and review process quality, there is a need for a framework for judging. Using the financial data of 114 companies from different industries from 2012 to 2017, this study analyzes the relationship between audit quality and auditor's follow-up recommendations (emphasis on specific point paragraph) and the relationship between auditors' follow-up recommendations (emphasis on specific point paragraph) and auditors' opinions. The results show that there is a meaningful relationship between the audit quality and the auditors' follow-up recommendations (emphasis on specific point paragraph); this shows that the auditors' greater accuracy and their control on processing financial information provide better and more accurate points on the quality improvement of financial statement reports. Moreover, the results show no significant relationship between auditors' follow-up recommendations (emphasis on specific point paragraphs) and the type of auditor's opinion in the years to come.

The Quality Assurance System of HKU SPACE: The Implementation of Collaborative Quality Assurance for Programs in Library and Information Studies with Charles Sturt University

ABSTRACTQuality assurance (QA) management has been used by educational institutions as a tool to control and measure the academic output and achievement of the faculty. The School of Professional and Continuing Education of the University of Hong Kong (HKU SPACE) implemented a QA System in 1999 for its programs including the collaborative programs offered by the HKU SPACE and its academic partners. This paper examines the structure and implementation of the QA System, introduces the conceptual framework of the QA System and discusses in detail the Quality Review Process (QRP) and QA exercise of the collaborative library and information studies (LIS) programs offered by the HKU SPACE and the Charles Sturt University (CSU). The QA System can be used to reflect on and appraise objectively the quality and effectiveness of collaborative LIS programs jointly offered by the HKU SPACE and CSU, and also similar quality review programs can be used in other contexts. It should however be noted that caution should be taken to prevent the QRP from becoming just a superficial exercise. This paper can be used as a case study in the discussion of adopting QA management in educational institutions and contexts.

Strengthening Forensic DNA Decision Making Through a Better Understanding of the Influence of Cognitive Bias

Cognitive bias may influence process flows and decision making steps in forensic DNA analyses and interpretation. Currently, seven sources of bias have been identified that may affect forensic decision making with roots in human nature; environment, culture, and experience; and case specific information. Most of the literature and research on cognitive bias in forensic science has focused on patterned evidence; however, forensic DNA testing is not immune to bias, especially when subjective interpretation is involved. DNA testing can be strengthened by recognizing the existence of bias, evaluating where it influences decision making, and, when applicable, implementing practices to reduce or control its effects. Elements that may improve forensic decision making regarding bias include cognitively informed education and training, quality assurance procedures, review processes, analysis and interpretation, and context management of irrelevant information. Although bias exists, reliable results often can be (and have been) produced. However, at times bias can (and has) impacted the interpretation of DNA results negatively. Therefore, being aware of the dangers of bias and implementing measures to control its potential impact should be considered. Measures and procedures that handicap the workings of the crime laboratory or add little value to improving the operation are not advocated, but simple yet effective measures are suggested. This article is meant to raise awareness of cognitive bias contamination in forensic DNA testing and to give laboratories possible pathways to make sound decisions to address its influences.

Strengthening forensic DNA decision making through a better understanding of the influence of cognitive bias

Cognitive bias may influence process flows and decision making steps in forensic DNA analyses and interpretation. Currently, seven sources of bias have been identified that may affect forensic decision making with roots in human nature; environment, culture, and experience; and case specific information. Most of the literature and research on cognitive bias in forensic science has focused on patterned evidence; however, forensic DNA testing is not immune to bias, especially when subjective interpretation is involved. DNA testing can be strengthened by recognizing the existence of bias, evaluating where it influences decision making, and, when applicable, implementing practices to reduce or control its effects. Elements that may improve forensic decision making regarding bias include cognitively informed education and training, quality assurance procedures, review processes, analysis and interpretation, and context management of irrelevant information. Although bias exists, reliable results often can be (and have been) produced. However, at times bias can (and has) impacted the interpretation of DNA results negatively. Therefore, being aware of the dangers of bias and implementing measures to control its potential impact should be considered. Measures and procedures that handicap the workings of the crime laboratory or add little value to improving the operation are not advocated, but simple yet effective measures are suggested. This article is meant to raise awareness of cognitive bias contamination in forensic DNA testing and to give laboratories possible pathways to make sound decisions to address its influences.

Building a Sustainable Quality MattersTM Community of Practice Through Social Network Analysis

ABSTRACTThe growth of distance education has necessitated strong evidence of quality for institutions of higher education, and numerous standards and principles of quality have been developed, such as Quality Matters™ (Quality Matters). These systems are often considered only at the course level to guide design and improve student outcomes, but they can also help to pull the institution together and galvanize advancement in online development. Adopting online quality standards can be a complex process that requires changes to institutional culture. This article describes how the use of the Community of Practice (CoP) framework engaged a campus-wide network of individuals in adoption of the Quality Matters training, rubric, and review process to advance distance education support and online course development. Using Social Network Analysis, researchers were able to identify the strengths and weakness of the CoP during the early adoption phase of Quality Matters to quantitatively measure the connections among members of the community.Based on a survey administered to every participant who attended the Applying the Quality Matters Rubric™ (APPQMR) workshop, researchers analyzed connections across the Quality Matters™ (Quality Matters) Community of Practice (CoP). This analysis indicated strong cohesion of the network based on work related to distance education but low density for connections based on Quality Matters. Furthermore, it demonstrated that significant connections existed between members prior to the adoption of Quality Matters and identified key influencers within the network. The results also indicated that the Quality Matters leadership team at the institution is highly central to the Quality Matters CoP network. The results can be used to identify strategies to further adoption of Quality Matters at the institution by strengthening the CoP.

Description and Yield of Current Quality and Safety Review in Selected US Academic Emergency Departments.

Quality and safety review for performance improvement is important for systems of care and is required for US academic emergency departments (EDs). Assessment of the impact of patient safety initiatives in the context of increasing burdens of quality measurement compels standardized, meaningful, high-yield approaches for performance review. Limited data describe how quality and safety reviews are currently conducted and how well they perform in detecting patient harm and areas for improvement. We hypothesized that decades-old approaches used in many academic EDs are inefficient and low yield for identifying patient harm. We conducted a prospective observational study to evaluate the efficiency and yield of current quality review processes at five academic EDs for a 12-month period. Sites provided descriptions of their current practice and collected summary data on the number and severity of events identified in their reviews and the referral sources that led to their capture. Categories of common referral sources were established at the beginning of the study. Sites used the Institute for Healthcare Improvement's definition in defining an adverse event and a modified National Coordinating Council for Medication Error Reporting and Prevention (MERP) Index for grading severity of events. Participating sites had similar processes for quality review, including a two-level review process, monthly reviews and conferences, similar screening criteria, and a grading system for evaluating cases. In 60 months of data collection, we reviewed a total of 4735 cases and identified 381 events. This included 287 near-misses, errors/events (MERP A-I) and 94 adverse events (AEs) (MERP E-I). The overall AE rate (event rate with harm) was 1.99 (95% confidence interval = 1.62%-2.43%), ranging from 1.24% to 3.47% across sites. The overall rate of quality concerns (events without harm) was 6.06% (5.42%-6.78%), ranging from 2.96% to 10.95% across sites. Seventy-two-hour returns were the most frequent referral source used, accounting for 47% of the cases reviewed but with a yield of only 0.81% in identifying harm. Other referral sources similarly had very low yields. External referrals were the highest yield referral source, with 14.34% (10.64%-19.03%) identifying AEs. As a percentage of the 94 AEs identified, external referrals also accounted for 41.49% of cases. With an overall adverse event rate of 1.99%, commonly used referral sources seem to be low yield and inefficient for detecting patient harm. Approximately 6% of the cases identified by these criteria yielded a near miss or quality concern. New approaches to quality and safety review in the ED are needed to optimize their yield and efficiency for identifying harm and areas for improvement.