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 capacity with clinical demand, thereby avoiding gridlock that adversely affects scheduled surgical procedures, diagnostic procedures, and therapies. At our large, academic medical center, we hypothesized that an interdisciplinary approach to scheduled discharge order entry would increase the percentage of discharges occurring before 11:00 AM and improve overall discharge time. The pilot study involved moving rate-limiting steps to earlier in the discharge process, specifically medication reconciliation to the night before discharge and "discharge to home" order entry before 9:00 AM the morning of discharge. The baseline rate of discharges before 11:00 AM was 8% and significantly increased to 11% after the intervention (P = .02). Moreover, in the subset of patients (21%) for whom early medication reconciliation and discharge to home order entry were both executed, the percentage of patient discharges occurring before 11:00 AM increased to 29.7%, with an associated average discharge time of more than 3 hours earlier. No patient harm events were associated with this pilot project. There was no significant change in length of stay, and 30-day readmission rate improved significantly from 13.8% to 10.3% (P = .002). Our study demonstrates that a multidisciplinary approach using prescribed order entry and medication reconciliation is a low cost, safe, and effective way to increase early morning discharges and improve patient flow for large hospitals with high volumes of scheduled patient admissions.
journal_name
Qual Manag Health Carejournal_title
Quality management in health careauthors
Durvasula R,Kayihan A,Del Bene S,Granich M,Parker G,Anawalt BD,Staiger Tdoi
10.1097/QMH.0000000000000049subject
Has Abstractpub_date
2015-01-01 00:00:00pages
45-51issue
1eissn
1063-8628issn
1550-5154pii
00019514-201501000-00007journal_volume
24pub_type
杂志文章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::To improve processes in hospitals, a case study was conducted at a German university hospital, which consists of more than 30 clinics and institutes on a large campus. The case study focused on the analysis of the patient flow and of machine utilization in the radiology department. Radiological devices are spread over...
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::This article examines a recently implemented strategy to transfer responsibility for local public health service delivery from a county health department to a hospital-based integrated delivery system. Innovative quality management efforts at both local and state levels offer opportunities for sustained improvement in...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199705020-00003
更新日期:1997-01-01 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: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
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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
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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
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200401000-00008
更新日期:2004-01-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000116
更新日期:2017-01-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:1997-07-01 00:00:00
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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::We present an approach to assessing the impact of surveillance for surgical site infections and providing feedback to surgeons on their progress, as part of continuous quality improvement. Adjusting for patient risk factors using the Standardized Mortality Ratio, there was a marked decrease over time in both SMR (1.3 ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199806030-00006
更新日期:1998-04-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200610000-00008
更新日期:2006-10-01 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: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. OBJECT...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e31826d1ef9
更新日期:2012-10-01 00:00:00
abstract::The past decade has been marked by extensive change in the organization of health care delivery systems (the "supply side" of health care). There has been relatively less change in the nature of the health care consumer (the "demand side" of health care). The emergence of the Internet as a consumer health care technol...
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
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200008040-00002
更新日期:2000-07-01 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::While data collection is fundamental to any scientifically based effort, health care improvement teams often report that it is one of the most frustrating aspects of their work. Groups that do succeed in gathering some data can also sometimes find that the data they have worked so hard to obtain does not really help t...
journal_title:Quality management in health care
pub_type: 杂志文章,评审
doi:
更新日期:1994-01-01 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
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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::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
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000114
更新日期:2016-10-01 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
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199706010-00007
更新日期:1997-10-01 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
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abstract:BACKGROUND:Hospitals establish surgical assessment units to promote efficiency and improve patient experience. Surgical assessment units are believed to reduce unnecessary admissions. We evaluated a hospital's on-call surgery service without this facility to determine benefits of implementation. METHODS:All emergency ...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000236
更新日期:2020-01-01 00:00:00
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pub_type: 历史文章,杂志文章
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更新日期:2013-07-01 00:00:00
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journal_title:Quality management in health care
pub_type: 历史文章,杂志文章
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更新日期:2010-01-01 00:00:00