The Effect of a System-Level Tiered Huddle System on Reporting Patient Safety Events: An Interrupted Time Series Analysis.

BACKGROUND: The objective of this research was to evaluate the effect of implementing a system-level tiered huddle system (THS) on the reporting of patient safety events into the official event reporting system. METHODS: A quasi-experimental study using interrupted time series was conducted to assess the impact and changes to trends in the reporting of patient safety events pre- (February-July 2020; six months) and post- (September 2020-February 2021; six months) THS implementation within one health care system (238 clinics and 4 hospitals). The severity of harm was analyzed in July 2021 using a modified Agency for Healthcare Research and Quality (AHRQ) harm score classification. The primary outcome measure was the number of patient safety events reported per month. Secondary outcomes included the number of patient safety events reported per month by each AHRQ harm score classification. RESULTS: The system-level THS implementation led to a significant and immediate increase in the total number of patient safety events reported per month (777.73, 95% confidence interval [CI] 310.78-1,244.68, p = 0.004). Similar significant increases were seen for reported numbers of unsafe conditions, near misses, no-harm events that reached patients, and temporary harm (p < 0.05 for each). Reporting of events with permanent harm and deaths also increased but was not statistically significant, likely due to the small number of reported events involving actual harm. CONCLUSION: These findings suggest that system-level THS implementation may increase reporting of patient safety events in the official event reporting system.

Ongoing Refinement and Innovation in the Data Collection Protocols of the Third Round of the National Social Life, Health, and Aging Project.

OBJECTIVES: The third round (R3) of the National Social Life, Health, and Aging Project, a nationally representative, longitudinal survey of community-residing older adults, consisted of 4,777 in-person interviews and 6,100 completed visits to households to identify newly eligible respondents. It revisited respondents from the first rounds (Cohort 1), born in the years 1920 through 1947, and added new respondents (Cohort 2) born in the years 1948 through 1965. Coresidential romantic partners of both cohorts were also eligible. Data collection included in-person questionnaires, up to 11 biomeasures, and a self-administered, postinterview paper questionnaire. METHODS: Questionnaire domains included social network and social support, elder mistreatment, physical health, cognitive function, romantic partners and sexuality, fertility and menopause, mental health, and employment and finances. Biomeasure collection included height, weight, waist circumference, blood pressure and heart rate, timed walk, balance, chair stands, smell, saliva passive drool in a tube (cortisol, dehydroepiandrosterone, estradiol, progesterone, testosterone), dried blood spots (C-reactive protein, Epstein-Barr virus antibodies, high-density lipoprotein cholesterol, hemoglobin, glycosylated hemoglobin [HbA1c], total cholesterol), and accelerometry (sleep patterns and physical activity). A brief questionnaire also collected data on respondents who were deceased or in too poor health to participate. RESULTS: Measures such as response and cooperation rates are provided to evaluate the design and implementation. DISCUSSION: This article describes innovation in the development and implementation of R3, the recruitment of a new cohort of respondents, and fidelity to prior rounds' study design and data collection procedures.

Integrating Palliative and Oncology Care for Patients with Advanced Cancer: A Quality Improvement Intervention.

BACKGROUND: Practice guidelines recommend palliative care for patients with advanced cancer, but gaps in access and quality of care persist. OBJECTIVE: To increase goals-of-care (GOC) communication for hospitalized patients with Stage IV cancer. METHODS: An interdisciplinary team designed a quality improvement intervention to enhance oncology palliative care, including training in communication skills and triggers for palliative care consults. SETTING/SUBJECTS: All adult inpatients with Stage IV cancer and unplanned admission at an 804-bed hospital affiliated with a National Cancer Institute (NCI) Comprehensive Cancer Center. MEASUREMENTS: The primary quality measure was the percentage of patients with Stage IV cancer who had a GOC discussion during hospitalization; secondary measures included screening for pain, dyspnea, spiritual needs, and outcomes of intensive care, hospice, and 30-day readmission. RESULTS: In the 11-month study period, n = 330, Stage IV cancer patients were hospitalized. Comparing the first three months with the final three months, rates of GOC discussion increased from 29% to 48% (p = 0.013), and specialty palliative care consultation increased from 18% to 33%, (p = 0.026). Rates of symptom screening, intensive care unit transfer, hospice, and 30-day re-admission did not change overall. However, patients with specialty palliative care more frequently had pain screening (91% vs. 81%, p = 0.020), spiritual assessment (48% vs. 10%, p < 0.001), and hospice referral (39% vs. 9%, p < 0.001), and they were less likely to be re-admitted within 30 days (12% vs. 21%, p = 0.059). DISCUSSION: Interdisciplinary quality improvement was effective to increase GOC discussions and palliative care consults for patients with Stage IV cancer.