RESUMO
Document includes steps institutions can take to protect and prepare staff.
Assuntos
Pessoal de Saúde/psicologia , Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Violência/tendências , Humanos , Estados Unidos , Violência/prevenção & controleAssuntos
Erros de Medicação/prevenção & controle , Assistência Perioperatória/métodos , Guias como Assunto , Humanos , Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Assistência Perioperatória/normas , Time Out na Assistência à Saúde/métodos , Estados UnidosRESUMO
Admission handoff is a high-risk component of patient care. Previous studies have shown that a standardized physician electronic signout ("eSignout") may improve ED-to-inpatient handoff safety and efficiency in teaching hospitals. This model has not yet been studied in non-teaching hospitals. The objectives of the study were to determine the efficiency of an eSignout platform at a community affiliate hospital by comparing ED length of stay (LOS) for a 5-month period before and after implementation and to compare the quality assurance (QA) events among admitted patients for the same time period. A retrospective, interventional study was conducted with the main outcome measures including ED LOS with calculation of 95% CI, mean comparison (t test), and number of QA events before and after implementation of the eSignout model. Prior to eSignout implementation, 1045 patients were admitted [mean ED LOS 330.0 min (95% CI 318.6-341.4)]. Following implementation, 1106 patients were admitted [mean ED LOS 338.9 min (95% CI 327.4-350.4, p = 0.2853)]. Nine pre-implementation QA events and six post-implementation events were identified. Use of a physician eSignout in a non-teaching hospital had no statistically significant effect on ED LOS for the admitted patients. The effect of an electronic interdepartmental handoff tool for patient safety and clinical operations in the non-teaching setting is unclear.
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Continuidade da Assistência ao Paciente/normas , Admissão do Paciente/normas , Transferência da Responsabilidade pelo Paciente/estatística & dados numéricos , Continuidade da Assistência ao Paciente/legislação & jurisprudência , Hospitalização/estatística & dados numéricos , Humanos , Joint Commission on Accreditation of Healthcare Organizations/legislação & jurisprudência , Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Tempo de Internação/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/normas , Admissão do Paciente/estatística & dados numéricos , Transferência da Responsabilidade pelo Paciente/legislação & jurisprudência , Estudos Retrospectivos , Estados UnidosRESUMO
BACKGROUND: This performance improvement (PI) project was conducted to recommend improvements for pain reassessment workflow and policies at a large military primary care clinic. The Joint Commission survey identified inconsistent pain reassessment practices at the facility in 2012. A review of the literature reveals that pain reassessment procedures can be affected by unclear organizational policies, poorly designed documentation procedures, and redundant or inefficient workflow practices. This PI project was designed to assess pain reassessment compliance rates, associated documentation, and clinic workflow, and to identify opportunities for improvement. METHODS: Pain reassessment compliance was evaluated using an Electronic Medical Record (EMR) query for patients treated between February 1 and May 30, 2013, who received Toradol at a large military outpatient clinic (n = 151). In addition, observations of clinic workflow were conducted using tracer methodology as recommended by The Joint Commission to track a convenience sample of 12 patients moving through clinic care processes. Pain reassessment documentation and workflow procedures were then evaluated using the Situation Awareness (SA) framework, which is an approach used to evaluate operational implications of factors affecting staff decisions and performance (e.g., stress and workload, interface design, automation, complexity of workflow, staff abilities and training, goals and expectations). RESULTS: The EMR review revealed compliance rates greater than 90% for all pain reassessment requirements with the exception of the maximum 30-minute interval between initial and follow-up pain assessment required by clinic policy, which had a compliance rate of 38%. Pain reassessments were documented to occur at a mean time of 48.25 minutes after initial assessment. During the tracer, none of the 12 patient encounters was fully compliant with clinic policies. An analysis of clinic workflow using the SA framework revealed that the SA of clinic staff was impacted by a lack of standardized procedures and heavy reliance on staff memory. DISCUSSION: Recommendations for improvement included possible extension of the 30-minute time requirement, development of a template for pain reassessment documentation in the EMR, standardizing hand off and admission/discharge processes, and designing an electronic or manual dashboard to indicate pain reassessment times. Future PI projects in other military clinics would benefit from use of the SA perspective to review clinic policies, EMR documentation, and workflow analysis. Further analysis will be needed to evaluate the impact of these improvements.
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Guias como Assunto/normas , Pessoal de Saúde/psicologia , Adesão à Medicação/psicologia , Medição da Dor/normas , Melhoria de Qualidade , Assistência Ambulatorial/estatística & dados numéricos , Conscientização , Registros Eletrônicos de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Humanos , Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Medição da Dor/métodos , Avaliação de Programas e Projetos de Saúde/normas , Inquéritos e Questionários , Estados UnidosAssuntos
Engenharia Biomédica/normas , Análise de Falha de Equipamento/normas , Equipamentos e Provisões/normas , Fidelidade a Diretrizes/organização & administração , Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Serviço Hospitalar de Engenharia e Manutenção/organização & administração , Estados UnidosAssuntos
Engenharia Biomédica/organização & administração , Confidencialidade , Fidelidade a Diretrizes/organização & administração , Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Serviço Hospitalar de Engenharia e Manutenção/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Estados UnidosAssuntos
Engenharia Biomédica/normas , Análise de Falha de Equipamento/normas , Equipamentos e Provisões/normas , Fidelidade a Diretrizes/organização & administração , Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Serviço Hospitalar de Engenharia e Manutenção/organização & administração , Estados UnidosAssuntos
Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Modelos Organizacionais , Cultura Organizacional , Segurança do Paciente , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Gestão da Segurança/organização & administração , Guias como Assunto , Estados UnidosAssuntos
Infecção Hospitalar/prevenção & controle , Coleta de Dados/normas , Registros Eletrônicos de Saúde/normas , Incêndios/prevenção & controle , Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Guias de Prática Clínica como Assunto , Gestão da Segurança/normas , Humanos , Estados UnidosRESUMO
How might a tertiary hospital's nursing staff respond to the huge improvement effort required for external accreditation if they are encouraged to lead the change process themselves? This article reports the results of a concurrent evaluation of the nursing work climate at ward level, before and after accreditation by the Joint Commission International. Physician-nurse relations improved; the involvement of social workers, dieticians, and physiotherapists increased; support services responded more quickly to requests; and management-line staff relations became closer.
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Acreditação/métodos , Hospitais/normas , Internacionalidade , Percepção , Local de Trabalho/psicologia , Acreditação/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Israel , Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/normas , Enfermeiras e Enfermeiros/estatística & dados numéricos , Análise de Regressão , Inquéritos e Questionários , Estados Unidos , Local de Trabalho/estatística & dados numéricosRESUMO
The purpose of this article is to describe The Joint Commission's 7 foundations of safe and effective transitions of care to home: (a) leadership support; (b) multidisciplinary collaboration; (c) early identification of patients/clients at risk; (d) transitional planning; (e) medication management; (f) patient and family action/engagement; and (g) transfer of information. These foundations were identified by The Joint Commission after a review of published research; focus groups with healthcare professionals involved in transitions of care; and visits to diverse healthcare organizations. The author, who is the executive director of The Joint Commission's Home Care Accreditation Program, illustrates how healthcare organizations are adapting the 7 foundations of safe and effective transitions of care to home.
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Serviços de Assistência Domiciliar/organização & administração , Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Planejamento de Assistência ao Paciente/organização & administração , Transferência de Pacientes/organização & administração , Humanos , Comunicação Interdisciplinar , Liderança , Inovação Organizacional , Segurança do Paciente , Estados UnidosRESUMO
Having a chronic disease has enriched Dr Loeb's understanding of the meaning of patient-centered care: "It's fine being a health care consumer when you're well. However, when you become ill, you become a patient, which is much different".
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Distinções e Prêmios , Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Segurança do Paciente , Qualidade da Assistência à Saúde/organização & administração , Centers for Medicare and Medicaid Services, U.S./organização & administração , Humanos , Liderança , Cultura Organizacional , Assistência Centrada no Paciente/organização & administração , Qualidade da Assistência à Saúde/normas , Gestão da Segurança/organização & administração , Estados UnidosRESUMO
BACKGROUND: The Society of Hospital Medicine (SHM) created "Mentored Implementation" (MI) programs with the dual aims of educating and mentoring hospitalists and their quality improvement (QI) teams and accelerating improvement in the inpatient setting in three signature programs: Venous Thromboembolism (VTE) Prevention, Glycemic Control, and Project BOOST (Better Outcomes for Older adults through Safe Transitions). METHODS: More than 300 hospital improvement teams were enrolled in SHM MI programs in a series of cohorts. Hospitalist mentors worked with individual hospitals/health systems to guide local teams through the life cycle of a QI project. Implementation Guides and comprehensive Web-based "Resource Rooms," as well as the mentor's own experience, provided best-practice definitions, practical implementation tips, measurement strategies, and other tools. E-mail interactions and mentoring were augmented by regularly scheduled teleconferences; group webinars; and, in some instances, a site visit. Performance was tracked in a centralized data tracking center. RESULTS: Preliminary data on all three MI programs show significant improvement in patient outcomes, as well as enhancements of communication and leadership skills of the hospitalists and their QI teams. CONCLUSIONS: Although objective data on outcomes and process measures for the MI program's efficacy remain preliminary at this time, the maturing data tracking system, multiple awards, and early results indicate that the MI programs are successful in providing QI training and accelerating improvement efforts.
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Distinções e Prêmios , Mentores , Segurança do Paciente , Qualidade da Assistência à Saúde/organização & administração , Gestão da Segurança/organização & administração , Glicemia , Comunicação , Continuidade da Assistência ao Paciente/organização & administração , Comportamento Cooperativo , Médicos Hospitalares/organização & administração , Humanos , Capacitação em Serviço/organização & administração , Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Liderança , Cultura Organizacional , Grupo Associado , Melhoria de Qualidade/organização & administração , Estados Unidos , Tromboembolia Venosa/prevenção & controleAssuntos
Anticoagulantes/administração & dosagem , Guias de Prática Clínica como Assunto , Varfarina/administração & dosagem , Anticoagulantes/efeitos adversos , Relação Dose-Resposta a Droga , Hospitais/normas , Humanos , Joint Commission on Accreditation of Healthcare Organizations/organização & administração , Nomogramas , Estados Unidos , Varfarina/efeitos adversosRESUMO
After two years at the helm of the Joint Commission, Mark Chassin, M.D., is pressing forward with efforts to turn the Joint Commission into a partner with hospitals and other providers and transform health care into a "high reliability" enterprise along the lines of the aviation and nuclear energy industries. Hospitals & Health Networks asked health care experts and Chassin himself how he's doing so far.