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 study was conducted in 2 intensive care units (ICUs), a medical ICU (MICU) and a pediatric ICU (PICU), within an academic health center. Both units had low baseline adherence to CLB and higher-than-expected CRBSIs. The study sought to promote CLB implementation in both units through periodic quality improvement (QI) interventions over a 52-week period. Simultaneously, it examined (1) the content and frequency of communication related to CLB through weekly "communication logs" completed by physicians, nurses, and managers, and (2) outcomes, that is, CLB adherence rates through weekly medical record reviews. The aim of the study was 2-fold: (1) to examine associations between QI interventions and communication content and frequency at the unit level, and (2) to examine associations between communication content and frequency and outcomes at the unit level. The periodic QI interventions were expected to increase CLB adherence and reduce CRBSIs through their influence on communication content and frequency. A total of 2638 instances of communication were analyzed. Both units demonstrated a statistically significant increase in "proactive" communications-that is, communication intended to reduce infection risk between physicians and nurses over time. Proactive communications increased by 68% in the MICU (P < .05) and 61% in the PICU (P < .05). During the same timeframe, both units increased CLB adherence to 100%. Both units also demonstrated statistically significant declines in (1) catheter days: 34% decline in the MICU (P < .05) and 30% in the PICU (P < .05); and (2) CRBSI rates: 63% decline in the MICU (P < .05) and 100% in the PICU (P < .10). Direct costs savings from reduced CRBSIs in 1 year were estimated to be at least $840 000. Periodic QI interventions were effective in reframing interprofessional communication dynamics and enabling practice change. The prospective design provides insights into communication content and frequency associated with collective learning and culture change. The study identifies evidence-based management strategies for positive practice change at the unit level.
journal_name
Qual Manag Health Carejournal_title
Quality management in health careauthors
Rangachari P,Madaio M,Rethemeyer RK,Wagner P,Hall L,Roy S,Rissing Pdoi
10.1097/QMH.0000000000000017subject
Has Abstractpub_date
2014-01-01 00:00:00pages
43-58issue
1eissn
1063-8628issn
1550-5154pii
00019514-201401000-00004journal_volume
23pub_type
杂志文章,多中心研究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: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
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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
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e3181fa074e
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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
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199706010-00007
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journal_title:Quality management in health care
pub_type: 杂志文章
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更新日期:1994-10-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200109040-00005
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abstract::Accountability in health care has taken on new dimensions with the drive to base contracting and provider of care selection upon data driven "report cards." The measurement and development of reportable outcomes are driving providers to move their organizations from a focus not only on "caring" but to one highly cogni...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200009010-00005
更新日期:2000-10-01 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
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200501000-00004
更新日期:2005-01-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199503020-00005
更新日期:1995-01-01 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::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::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 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::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: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: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
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199807010-00004
更新日期:1998-10-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e3182134b3c
更新日期:2011-04-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000162
更新日期:2018-04-01 00:00:00
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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
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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
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e3181bee127
更新日期:2009-10-01 00:00:00
abstract::Improvement will be constrained by the function-based organizational model found in most health care organizations. Most components of the typical organization are driven by the concept of division of labor. The organization needs to challenge the underlying assumptions and reengineer from top to bottom. Reengineering...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:1994-04-01 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::The purpose of this study was to elucidate conditions at all system levels in a specific health care service to develop practices for identification of children as relatives. An interactive research approach with the intention to create mutual learning between practice and research was used. The participating health c...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000181
更新日期:2018-07-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200008020-00009
更新日期:2000-01-01 00:00:00
abstract::A lost surgical specimen prompted an investigation of both the human processes and the systemic factors involved in surgical specimen handling regarding how health care organizations approach medical error prevention and patient safety promotion. Quality improvement techniques and the conceptual error model of James R...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200110010-00006
更新日期:2001-10-01 00:00:00