Abstract:
BACKGROUND:Metformin is recommended as initial therapy for most patients with type 2 diabetes mellitus. Its most serious adverse effect, lactic acidosis, is a rare entity with a high mortality rate. Despite well-publicized contraindications, metformin is inappropriately prescribed to many hospitalized patients. OBJECTIVE:To determine the efficacy of computer alerts at reducing inappropriate metformin prescribing. METHODS:Retrospective chart review of all hospitalized patients who received an order for metformin, before (n = 144) and after (n = 147) an intervention designed to reduce inappropriate administration. This intervention included 2 "hard-stop" computer alerts that prevented prescribing metformin to patients with renal dysfunction and in critical care or postoperative units; and 2 "soft" alerts that fired when no serum creatinine was available or the patient was in an outpatient surgical unit. Charts were reviewed for the presence of contraindications: renal insufficiency, congestive heart failure, recent myocardial infarction, surgery, or intravenous contrast use within 48 hours of metformin administration. RESULTS:In the preintervention group there were 47 violations compared with 13 violations in the postintervention group (P < .001). The greatest improvement was in surgical patients (39 violations vs 11, P < .001). CONCLUSIONS:Computer alerts at order entry were effective in decreasing the inappropriate prescribing of metformin in an inpatient setting.
journal_name
Qual Manag Health Carejournal_title
Quality management in health careauthors
Rossi AP,Wellins CA,Savic M,Devlin JTdoi
10.1097/QMH.0b013e31826d1ef9subject
Has Abstractpub_date
2012-10-01 00:00:00pages
235-9issue
4eissn
1063-8628issn
1550-5154pii
00019514-201210000-00005journal_volume
21pub_type
杂志文章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::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::Today's health care programs are being scrutinized like never before and yet few clinicians and managers know how to show the value of programs without time-consuming outcomes research. This is especially true for new and innovative programs that are dependent on outside funding and may not have enough time to show an...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200109040-00005
更新日期:2001-07-01 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: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 revi...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200610000-00008
更新日期:2006-10-01 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::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::Many hospitals are unable to successfully implement "evidence-based practices" at the unit level. For example, consistent implementation of the central line bundle (CLB), proven to prevent catheter-related bloodstream infections (CRBSIs) is often difficult. This problem has been broadly characterized as "change implem...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e31827dea7d
更新日期:2013-01-01 00:00:00
abstract::A control chart can be an effective way to display process data over time. It can differentiate common cause variation from special cause variation through the application of several probability-based interpretation rules. In addition, a control chart can be helpful in evaluating the effectiveness of a change. There a...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200109030-00003
更新日期:2001-04-01 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:OBJECTIVE:The multifaceted nature of the transition of care from the triage unit to labor and delivery has historically led to confusion, delays, and errors in care. This study evaluated the effect of standardization of roles and communication on improving this transition. METHODS:A multidisciplinary team was assemble...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000191
更新日期:2018-10-01 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:INTRODUCTION:Real-time location systems (RTLS) and Lean management approaches have been employed to improve patient flow in clinical settings. This study explored the feasibility of using these methodologies in an outpatient resident ophthalmology clinic. METHODS:Patients, providers, and staff in Wilmer Eye Institute ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000075
更新日期:2015-10-01 00:00:00
abstract::The physician-patient relationship is an essential part of end-of-life planning, including discussions of advance directives (AD). Physicians likely to encounter AD issues with their patients were identified and queried as to their knowledge, opinion, and experience with ADs. Though most physicians felt ADs were helpf...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200008030-00004
更新日期:2000-04-01 00:00:00
abstract::Increasingly, businesses are reporting successful implementation of self-directed work teams. In health care, team-based structures in both clinical and nonclinical areas are now rapidly emerging. This paper describes the linkage between the literature of sociotechnical systems theory and current applications of self-...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199301020-00007
更新日期:1993-01-01 00:00:00
abstract::There are various methods to get some projections of health indicators that do not always produce satisfactory results. Our aim is to establish the rules for obtaining reliable projections, using simple models. In the procedure proposed here, there is no need, as in many other techniques, to directly connect the level...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:2006-07-01 00:00:00
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::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::The aim of this study was to explore and evaluate managers' views of a large-scale improvement program, including their experiences and opinions about improvement initiatives and drivers for change. The study is based on a survey used in 2 nationwide mappings of improvement initiatives and developmental trends in Swed...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e31828bc276
更新日期:2013-04-01 00:00:00
abstract:OBJECTIVE:This pilot study describes the development of an instrument to measure nursing quality knowledge, skills, and attitudes for practicing pediatric oncology nurses. Because many nurse leaders of academic centers are responsible for outcomes at both local and global level, ensuring nursing quality is critical, gi...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e3181aea256
更新日期:2009-07-01 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: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::Recently, many have begun to explore the possibility of using analytical methods associated with continuous quality improvement in the efforts to improve health care. Central to this paradigm is the proposition that such analytical methods can be used to identify and react to variations in the processes and outcomes o...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:1992-10-01 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::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::Quality indicators and a quality-monitoring system developed for use in the regulatory survey process offer a quality improvement tool for nursing home staff. The systematic use of resident assessment data can aid in the identification of quality of care problems and the determination of the nature of those problems. ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199604030-00008
更新日期:1996-04-01 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::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:OBJECTIVES:To describe health care staff members' usage and documentation in a Swedish quality registry focusing on a preventive care process regarding the risk area of malnutrition among persons with dementia. The preventive care process includes risk assessment, analysis of underlying causes, planning and performing ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000116
更新日期:2017-01-01 00:00:00