Alignment of an interprofessional student learning experience with a hospital quality improvement initiative.

Assessment of interprofessional education (IPE) frequently focuses on students' learning outcomes including changes in knowledge, skills, and/or attitudes. While a foundational education in the values and information of their chosen profession is critical, interprofessional learning follows a continuum from formal education to practice. The continuum increases in significance and complexity as learning becomes more relationship based and dependent upon the ability to navigate complex interactions with patients, families, communities, co-workers, and others. Integrating IPE into collaborative practice is critical to enhancing students' experiential learning, developing teamwork competencies, and understanding the complexity of teams. This article describes a project that linked students with a hospital-based quality-improvement effort to focus on the acquisition and practice of teamwork skills and to determine the impact of teamwork on patient and quality outcome measures. A hospital unit was identified with an opportunity for improvement related to quality care, patient satisfaction, employee engagement, and team behaviours. One hundred and thirty-seven students from six health profession colleges at the Medical University of South Carolina underwent TeamSTEPPS® training and demonstrated proficiency of their teamwork-rating skills with the TeamSTEPPS® Team Performance Observation Tool (T-TPO). Students observed real-time team behaviours of unit staff before and after staff attended formal TeamSTEPPS® training. The students collected a total of 778 observations using the T-TPO. Teamwork performance on the unit improved significantly across all T-TPO domains (team structure, communication, leadership, situation monitoring, and mutual support). Significant improvement in each domain continued post-intervention and at 15-month follow-up, improvement remained significant compared to baseline. Student engagement in TeamSTEPPS® training and demonstration of their reliability as teamwork-observers was a valuable learning experience and also yielded an opportunity to gather unique, and otherwise difficult to attain, data from a hospital unit for use by quality managers and administrators.

Achieving High Reliability Through Cultural Mindfulness.

Healthcare has enthusiastically embraced quality and safety improvement. Yet, more radical transformation is clearly needed to make a more significant impact on error reduction and to ensure consistent quality. This need for transformation is leading healthcare to examine how other industries, such as nuclear power and aviation, improve safety to achieve a high degree of reliability and avoid potential catastrophes. Research has shown that successful organizations in high-risk industries achieve high reliability by maintaining a cultural mindfulness that allows them to continually reinvent themselves in complex environments. Healthcare faces similar challenges and could greatly benefit from instilling high-reliability principles in its operations. The Medical University of South Carolina, an academic health system, has been on a quest to improve safety and quality by implementing a high-reliability culture.

Overcoming barriers to pneumococcal vaccination in patients with pneumonia.

Inpatient pneumococcal vaccination remains underutilized, and little data exist to guide hospital personnel in improving their performance. The authors report their experience with a stepwise program to improve vaccination assessment rates for hospitalized patients with community-acquired pneumonia. They assessed barriers to vaccination and applied a stepwise educational and intranet-based decision support implementation program for hospitalized patients with community-acquired pneumonia. Preintervention vaccination rates were 0%. Primary nursing and physician barriers were assessed. An educational intervention increased vaccination assessment rates to 35%, a nursing decision-support tool to 42%, and approval of a standing order policy to 96%. For patients older than 65 years, vaccination assessment rates increased 33%, 67%, and 100%, respectively. An educational program combined with a decision support tool and a standing order policy can improve vaccination assessment rates to high levels. This study suggests that a multidimensional intervention is required to improve compliance with inpatient vaccination best clinical practices.

Hospitalists and improved cost savings in patients with bacterial pneumonia at a state level.

OBJECTIVES: In the hospitalist literature, most studies have focused on outcomes related to cost savings for individual hospital systems. This study sought to determine if hospitalists could improve cost savings at a state level. METHODS: This is a retrospective analysis of a statewide database for inpatients in 2002 with bacterial pneumonia. The primary outcomes measured were mean length of stay (LOS) and mean charges per patient between hospitalists and nonhospitalists. The secondary outcome measured was percentage of patients by severity of illness between the groups. RESULTS: The difference of LOS in the moderate illness category was 4.9 days for hospitalists and 5.2 for nonhospitalists (P = 0.04). The major illness category was 7.4 and 8 (P = 0.03), and the extreme illness category was 10.6 and 12.9 (P = 0.02). The difference of mean charges per patient in the major category were dollars 20,950 and dollars 23,259 (P = 0.03) and dollars 42,045 and dollars 56,867, respectively (P = 0.002), in the extreme category. Patients in the major/extreme categories of illness accounted for 41% of hospitalist patients versus 32% of nonhospitalist patients (P < 0.001). CONCLUSIONS: Hospitalists have shorter LOS, lower charges per patient, and admit a larger proportion of high acuity patients at a state level.