Abstract:
PURPOSE:Adherence to new guidelines for the use of ipecac syrup, gastric lavage, cathartics, and activated charcoal by a poison control center was studied with a quality improvement framework. METHODS:The rates of gastric decontamination were monitored through an electronic case record system. In February 2002, a revised guideline that narrowed the use of gastric decontamination was implemented with a performance improvement process. The rates of recommendation and utilization during 12 months following implementation of the new guidelines were compared with those during 12 previous months. RESULTS:Recommendations for the use of ipecac syrup declined from 1.50% to 0.02% (OR; 95% CI = 0.02; 0.01, 0.03), single-dose-activated charcoal declined from 5.39% to 1.38% (0.25; 0.22, 0.28), gastric lavage declined from 4.19% to 0.22% (0.05; 0.04, 0.06), and a cathartic declined from 1.48% to 0.13% (0.08; 0.06, 0.12). Declines in utilization were also significant (P < .001) for all forms of gastric decontamination. The proportions of patients managed at the scene of the poisoning were unchanged (1.04; 0.99, 1.09) before (67.64%) and after (68.50%) the new guidelines as were those for referral to a health care facility (20.57% and 21.42%, respectively, 1.05; 1.00, 1.11). CONCLUSION:Recommendations on gastric decontamination can be effectively modified with no detriment to patient outcome.
journal_name
Qual Manag Health Carejournal_title
Quality management in health careauthors
Chyka PA,Winbery SLdoi
10.1097/00019514-200610000-00008subject
Has Abstractpub_date
2006-10-01 00:00:00pages
263-7issue
4eissn
1063-8628issn
1550-5154pii
00019514-200610000-00008journal_volume
15pub_type
杂志文章abstract:CONTEXT:Residents often fail to escalate narcotics to ensure pain relief in patients with cancer because of fear of overdose. A computer simulation of patients in pain may provide a way to improve management without fear of harm. We developed a pain care simulation to train residents. STUDY DESIGN/MEASURES: Thirty-one ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/01.QMH.0000326722.70708.0d
更新日期:2008-07-01 00:00:00
abstract::This article reviews studies of the effects of medical organization structure on quality and cost conducted over the past three decades. Topics of inquiry have proceeded from the organizational to the individual provider level and from the inpatient to the ambulatory level. The article presents the findings of these s...
journal_title:Quality management in health care
pub_type: 杂志文章,评审
doi:10.1097/00019514-199503040-00002
更新日期:1995-07-01 00:00:00
abstract::In determining intervention effects, quality improvement researchers typically use statistical testing--Fisher's "significance testing" and/or Neyman and Pearson's "hypothesis testing." Such tests are employed in an effort to demonstrate whether or not a statistically and practically significant difference exists when...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/01.QMH.0000338551.05512.1b
更新日期:2008-10-01 00:00:00
abstract:CONTEXT:The phrase "Science of Improvement" or "Improvement Science" is commonly used today by a range of people and professions to mean different things, creating confusion to those trying to learn about improvement. In this article, we briefly define the concepts of improvement and science, and review the history of ...
journal_title:Quality management in health care
pub_type: 历史文章,杂志文章
doi:10.1097/QMH.0b013e31829a6a15
更新日期:2013-07-01 00:00:00
abstract::Our objective was to test whether the Structured Problem and Success Inventory (SPI) instrument could capture mental representations of organizational and work-related problems as described by individuals working in health care organizations and to test whether these representations varied according to organizational ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e31824d18ff
更新日期:2012-04-01 00:00:00
abstract::The Ritz-Carlton Hotel Company won the Malcolm Baldridge National Quality Award in 1992. One key to its success is its strategic planning process. This two-part article reviews the Ritz-Carlton's approach to strategic planning. In particular, it describes (1) the role of senior leadership in the planning process and (...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:1993-07-01 00:00:00
abstract:BACKGROUND:In Thailand, hospital accreditation (HA) is widely recognized as one of the system tools to promote effective operation of universal health coverage. This nationwide study aims to examine the relationship between accredited statuses of the provincial hospitals and their mortality outcomes. METHOD:A 5-year r...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000256
更新日期:2020-07-01 00:00:00
abstract::The Agency for Health Care Policy and Research pain guidelines and implementation theories were used in this improvement initiative to ensure that evidence-based pain management reached every provider and patient in a large tertiary care hospital. Implementation strategies, products, and outcome measures are described...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199907020-00004
更新日期:1999-01-01 00:00:00
abstract::Many hospitals are unable to successfully implement evidence-based practices. For example, implementation of the central line bundle (CLB), proven to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as a "change implementation failure." A prospective...
journal_title:Quality management in health care
pub_type: 杂志文章,多中心研究
doi:10.1097/QMH.0000000000000017
更新日期:2014-01-01 00:00:00
abstract:OBJECTIVES:Although 65% of the hospitals in Taiwan claim to be applying the clinical pathway concept, most hospitals do not implement this concept effectively. The purpose of this study was to determine the reasons for the improper or inappropriate application of the clinical pathway design in hospitals. METHODS:This ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200601000-00007
更新日期:2006-01-01 00:00:00
abstract::In an environment where there is increased demand for hospital beds, it is important that inpatient flow from admission to treatment to discharge is optimized. Among the many drivers that impact efficient patient throughput is an effective and timely discharge process. Early morning discharge helps align inpatient cap...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000049
更新日期:2015-01-01 00:00:00
abstract::The patient-centered medical home model of primary care requires increased collaboration in care delivery. Recent studies suggest that such a collaborative model of care is aided by physician leaders who practice an inclusive approach to leadership; however, they do not empirically demonstrate what such strategies loo...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e31825e876a
更新日期:2012-07-01 00:00:00
abstract:CONTEXT:In October 2008, the Centers for Medicare & Medicaid Services reduced payments to hospitals for a group of hospital-acquired conditions (HACs) not documented as present on admission (POA). It is unknown what proportion of Medicare severity diagnosis related group (MS-DRG) assignments will change when the Intern...
journal_title:Quality management in health care
pub_type: 历史文章,杂志文章
doi:10.1097/QMH.0b013e3181ccbd07
更新日期:2010-01-01 00:00:00
abstract::Should the United States require mandatory reporting of medical errors within the health care system? Many barriers to medical error reporting currently exist and have made it difficult to establish a nationwide reporting system. As such, individual states have begun to address this issue one state at a time. This art...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/01.QMH.0000344594.48510.82
更新日期:2009-01-01 00:00:00
abstract::Recently in this journal, F. Alemi (Qual Manage Health Care. 2004;13(4):216-221) proposed the use of Tukey's Control Chart because of the unique benefits associated with nonparametric inferential statistics including robust performance with (1) low N sizes, (2) nonnormal data, and (3) the presence of outliers, However...
journal_title:Quality management in health care
pub_type: 评论,杂志文章
doi:10.1097/00019514-200504000-00006
更新日期:2005-04-01 00:00:00
abstract::The p chart is widely used in health care and other service organizations as well as in manufacturing to monitor the proportion of observations with some particular characteristic for comparing several sources of data or for tracking a single source of data over time. The conventional approach is to use 3sigma limits ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/01.QMH.0000267449.32629.b1
更新日期:2007-04-01 00:00:00
abstract:BACKGROUND:Although organizational context can affect the implementation of quality initiatives, we know less about the influence of contextual conditions on quality outcomes. We examined organizational features of primary care clinics that achieved greatest performance improvements after implementing Lean redesigns. ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000198
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The mission of nonprofit health care clinics is particularly challenging to fulfill given the large number of uninsured and underinsured people they serve. In addition, these clinics feel pressure to provide services in an efficient manner to prevent patient no-shows and encourage the continua...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000215
更新日期:2019-07-01 00:00:00
abstract::In a previous article (M. K. Hart, Qual Manag Health Care. 2003;12(1):5-19), the authors presented risk-adjusted control charts applicable for attributes data. The present article discusses a similar class of control charts applicable for variables data that are often skewed. The key feature of these charts is their a...
journal_title:Quality management in health care
pub_type: 评论,杂志文章
doi:10.1097/00019514-200404000-00003
更新日期:2004-04-01 00:00:00
abstract::This article briefly describes natural induction approach to knowledge discovery, and then applies it to the problem of bad habit relapse prevention by analyzing patients' diaries. Natural induction seeks patterns in data that are in forms easy to understand and interpret, because they resemble those in which humans r...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/01.QMH.0000308640.89602.b1
更新日期:2008-01-01 00:00:00
abstract::As a group, physicians strive for quality but often resist quality measurement. Cost, inconvenience, lack of time, mistrust of quality measures, and a fear of what assessment may find are all factors contributing to this resistance. However, quality, in both rich and poor counties, continues to be poor at worse and va...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:2006-04-01 00:00:00
abstract::The article describes the Breakthrough Series, a collaborative improvement model developed by the Institute for Healthcare Improvement. The model adapts and applies existing knowledge to multiple, similar sites to accomplish common aims. It has been used to address several of the most pressing issues in health care to...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199806040-00001
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:Popular quality improvement tools such as Six Sigma and Lean Systems (SS/L) claim to provide health care managers the opportunity to improve health care quality on the basis of sound methodology and data. However, it is unclear whether these 2 quality improvement tools actually improve health care quality. ...
journal_title:Quality management in health care
pub_type: 杂志文章,评审
doi:10.1097/QMH.0b013e3181eb140e
更新日期:2010-07-01 00:00:00
abstract::Patients' perceptions provide valuable insight into areas for improvement and opportunities for strategic planning. Using both quantitative and qualitative research methods, the topics of what drives patient satisfaction, what delights patients, and what disappoints patients were examined. A case study approach was us...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:1997-04-01 00:00:00
abstract::Academic medical centers and clinicians have been slow to embrace continuous quality improvement. The Mount Sinai Medical Center in New York has created a new Department of Health Policy that combines an academic research mission with an administrative mission to demonstrate improving quality of care. This article dis...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199604040-00006
更新日期:1996-07-01 00:00:00
abstract::Patient flow improvement strategies have been effective in reducing emergency department (ED) crowding, but little guidance is available on the implementation process. By using a qualitative research design, our objective was to identify common facilitators and barriers to the implementation of patient flow improvemen...
journal_title:Quality management in health care
pub_type: 杂志文章,多中心研究
doi:10.1097/QMH.0b013e318222a3b0
更新日期:2011-07-01 00:00:00
abstract::The gastroenterology unit at the Höglands Hospital in Eksjö is responsible for the care of all 466 patients with inflammatory bowel disease (IBD) in a geographic area including approximately 115,000 inhabitants. In 2000, the frustration over an inadequate traditional outpatient clinic inspired us to redesign our outpa...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200701000-00006
更新日期:2007-01-01 00:00:00
abstract:OBJECTIVES:This article explores and describes key processes facilitating the integration of neophyte graduate nurses into safe and effective organizational systems and processes as part of a hospital's overall local clinical governance and clinical risk management (CRM) program. METHODS:This study was undertaken usin...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/01.QMH.0000316994.02039.80
更新日期:2008-04-01 00:00:00
abstract::This article proposes a new class of control charts that may be used for monitoring and improving the quality of care. Unlike conventional control charts that rely on observed performance data, these charts use risk-adjusted data in addition to the observed data. The resulting time-ordered charts are capable of reduci...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200301000-00004
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:Although often used in health care settings as a method for continuous quality improvement, experience with the breakthrough collaborative in nonclinical health care settings is limited. In this article, we report pilot data from a social services collaborative conducted in 2007 to 2009 in Sweden, with speci...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e3181c58e20
更新日期:2009-10-01 00:00:00