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1.
J Nurs Adm ; 50(3): 174-181, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32068626

RESUMO

OBJECTIVE: Rush University Medical Center nursing leadership undertook a process improvement project to revamp nursing handoff during unit transfer with the goal of improving patient throughput. The aim was to decrease assign-to-occupy time, the duration from bed assignment to bed occupancy. BACKGROUND: There was a lengthy lag time in admitting/transferring patients, leading to delays in patient throughput and potential threats to patient safety. In fiscal year 2016, assign-to-occupy time averaged 97 minutes. The goal was to decrease that time to 60 minutes or less. METHODS: Process improvement leaders held a rapid improvement event to determine viable solutions. A team then standardized handoff workflow; created an electronic tool, virtually eliminating verbal report; and implemented a new handoff process. RESULTS: Assign-to-occupy time at 1 year after go-live averaged 55 minutes, and it has been staying less than 60 minutes since the implementation. CONCLUSIONS: Key success strategies included engaging stakeholders during the rapid improvement event, imploring frontline nurses to create and promote the revised process to facilitate staff engagement, and leveraging electronic health records.


Assuntos
Eficiência Organizacional/normas , Registros Eletrônicos de Saúde/organização & administração , Transferência da Responsabilidade pelo Paciente/organização & administração , Transferência de Pacientes/organização & administração , Centros Médicos Acadêmicos/organização & administração , Humanos , Segurança do Paciente/normas , Melhoria de Qualidade , Fluxo de Trabalho
2.
Br J Anaesth ; 124(3): e63-e69, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31980155

RESUMO

The under-representation of women in academic leadership roles, including in anaesthesiology, is a well-documented phenomenon that has persisted for decades despite more women attending medical school, participating in anaesthesiology residencies, and joining academic faculties. The percentage of female anaesthesiologists who hold senior academic ranks or leadership roles, such as chair, lags behind the percentage of female anaesthesiologists overall. Trends towards increasing the numbers of women serving in educational leadership roles, specifically residency programme directors, suggest that there are areas in which academic anaesthesiology has been, and can continue, improving gender imbalance. Continued institutional efforts to recruit women into anaesthesiology, reduce gender bias, and promote interventions that foster gender equity in hiring and promotion will continue to benefit women, academic anaesthesiology departments, and the healthcare system overall.


Assuntos
Anestesiologia/tendências , Internato e Residência/tendências , Médicas/tendências , Sexismo/tendências , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/tendências , Anestesiologia/educação , Anestesiologia/organização & administração , Escolha da Profissão , Mobilidade Ocupacional , Educação de Pós-Graduação em Medicina/organização & administração , Educação de Pós-Graduação em Medicina/tendências , Feminino , Humanos , Internato e Residência/organização & administração , Liderança , Médicas/estatística & dados numéricos , Faculdades de Medicina/organização & administração , Faculdades de Medicina/tendências , Sexismo/prevenção & controle , Estados Unidos
3.
Acad Med ; 95(2): 180-183, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31577584

RESUMO

The use of term limits in politics and business has been proposed as a means to refresh leadership, encourage innovation, and decrease gender and racial disparities in positions of power. Many U.S. states and the executive boards of businesses have incorporated them into their constitutions and bylaws; however, studies in politics and business have shown that implementing term limits has had mixed results. Specifically, research in politics has shown that term limits have had a minimal effect on the number of women and minorities elected to office, while research in business indicates term limits do increase innovation. Additionally, term limits may have unintended negative consequences, including inhibiting individuals from developing deep expertise in a specific area of interest and destabilizing institutions that endure frequent turnover in leaders. Given this conflicting information, it is not surprising that academic medical centers (AMCs) in the United States have not widely incorporated term limits for those holding positions of power, including deans, presidents, provosts, and department heads. Notably, a few AMCs have incorporated such limits for some positions, and faculty have viewed these positively for their ability to shape a more egalitarian and collaborative culture. Drawing on studies from academic medicine, politics, and business, the author examines arguments both for and against instituting term limits at AMCs. The author concludes that despite strong arguments against term limits, they deserve attention in academic medicine, especially given their potential to help address gender and racial disparities and to encourage innovation.


Assuntos
Centros Médicos Acadêmicos/legislação & jurisprudência , Centros Médicos Acadêmicos/organização & administração , Sexismo , Feminino , Humanos , Liderança , Masculino , Política , Estados Unidos/etnologia
4.
Acad Med ; 95(2): 241-247, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31348063

RESUMO

PURPOSE: Tenure status has important implications for medical school faculty recruitment and retention and may affect educational quality, academic freedom, and collegiality. However, tenure trends in academic family medicine are unknown. This study aimed to describe trends in tenure status of family medicine faculty overall and by gender and status of minorities underrepresented in medicine (URM) in Liaison Committee on Medical Education-accredited medical schools. METHOD: Association of American Medical Colleges Faculty Roster data were used to describe trends in tenure status of full-time family medicine faculty, 1977 to 2017. Bivariate and trend analyses were conducted to assess associations and describe patterns between tenure status and gender, race, and ethnicity. Interdepartmental variations in tenure trends over the years were also examined. RESULTS: Among family medicine faculty, the proportions of faculty tenured or on a tenure track dropped more than threefold from 1977 (46.6%; n = 507/1,089) to 2017 (12.7%; n = 729/5,752). Lower proportions of women and URM faculty were tenured or on a tenure track than male and non-URM faculty, respectively. But the gaps among them were converging. Compared with other clinical departments, family medicine had the highest proportion of faculty (74.6%; n = 4,291/5,752) not on a tenure track in 2017. CONCLUSIONS: Proportion of tenure positions significantly decreased among family medicine faculty in U.S. medical schools. While gaps between male and female faculty and among certain racial/ethnic groups remained for family medicine tenure status, they have decreased over time, mainly because of a substantial increase in nontenured positions.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Docentes de Medicina/tendências , Medicina de Família e Comunidade/educação , Mobilidade Ocupacional , Feminino , Humanos , Masculino , Inquéritos e Questionários , Estados Unidos
5.
J Nurs Adm ; 49(12): 577-579, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31725515

RESUMO

The American Organization of Nurse Leaders and the American Association of Colleges of Nursing have been working together since 2010 to address how academic-practice partnerships can most effectively advance the profession by preparing a well-educated workforce. This article describes the work to date and future strategic priorities.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Relações Interinstitucionais , Prática Privada de Enfermagem/organização & administração , Escolas de Enfermagem/organização & administração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
6.
Am J Health Syst Pharm ; 76(1): 34-43, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31603982

RESUMO

PURPOSE: The development of an inpatient antimicrobial stewardship program (ASP) in an integrated healthcare system is described. SUMMARY: With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop ASPs. In 2015, BJC HealthCare, a multihospital health system, developed a system-level, multidisciplinary ASP team to assist member hospitals with ASP implementation. A comprehensive gap analysis was performed to assess current stewardship resources, activities and compliance with CDC core elements at each facility. BJC system clinical leads facilitated the development of hospital-specific leadership support statements, identification of hospital pharmacy and medical leaders, and led development of staff and patient educational components. An antimicrobial-use data dashboard was created for reporting and tracking the impact of improvement activities. Hospital-level interventions were individualized based on the needs and resources at each facility. Hospital learnings were shared at bimonthly system ASP meetings to disseminate best practices. The initial gap analysis revealed that BJC hospitals were compliant in a median of 6 ASP elements (range, 4-8) required by regulatory mandates. By leveraging system resources, all hospitals were fully compliant with regulatory requirements by January 2017. CONCLUSION: BJC's ASP model facilitated the development of broad-based stewardship activities, including education modules for patients and providers and clinical decision support, while allowing hospitals to implement activities based on local needs and resource availability.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Desenvolvimento de Programas , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Gestão de Antimicrobianos/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Illinois , Missouri , Modelos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/estatística & dados numéricos , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Lacunas da Prática Profissional/organização & administração , Lacunas da Prática Profissional/estatística & dados numéricos
7.
Pediatrics ; 144(5)2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31548337

RESUMO

Gender bias and discrimination have profound and far-reaching effects on the health care workforce, delivery of patient care, and advancement of science and are antithetical to the principles of professionalism. In the quest for gender equity, medicine, with its abundance of highly educated and qualified women, should be leading the way. The sheer number of women who comprise the majority of pediatricians in the United States suggests this specialty has a unique opportunity to stand out as progressively equitable. Indeed, there has been much progress to celebrate for women in medicine and pediatrics. However, many challenges remain, and there are areas in which progress is too slow, stalled, or even regressing. The fair treatment of women pediatricians will require enhanced and simultaneous commitment from leaders in 4 key gatekeeper groups: academic medical centers, hospitals, health care organizations, and practices; medical societies; journals; and funding agencies. In this report, we describe the 6-step equity, diversity, and inclusion cycle, which provides a strategic methodology to (1) examine equity, diversity, and inclusion data; (2) share results with stakeholders; (3) investigate causality; (4) implement strategic interventions; (5) track outcomes and adjust strategies; and (6) disseminate results. Next steps include the enforcement of a climate of transparency and accountability, with leaders prioritizing and financially supporting workforce gender equity. This scientific and data-driven approach will accelerate progress and help pave a pathway to better health care and science.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Renda/estatística & dados numéricos , Pediatria , Médicas/estatística & dados numéricos , Sexismo/tendências , Centros Médicos Acadêmicos/tendências , Políticas Editoriais , Feminino , Humanos , Liderança , Pediatria/estatística & dados numéricos , Pediatria/tendências , Publicações Periódicas como Assunto , Médicas/tendências , Faculdades de Medicina/organização & administração , Sexismo/estatística & dados numéricos , Estados Unidos
8.
Nephrol Nurs J ; 46(4): 423-452, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490052

RESUMO

Nurses should protect the affected extremities of patients who have a permanent arteriovenous access for hemodialysis by avoiding blood pressure measurements and venipuncture on access extremities. National recommendations include labeling the affected extremity with an alert mechanism, such as a wristband, to notify patients and staff of arteriovenous access. A policy change was enacted at an academic medical center in the Southeast to identify restricted extremities with a pink "limb alert" wristband after review of national recommendations on hemodialysis access preservation, individual facility procedures, product cost-benefit analysis, and unit and system educational methods. Keeping simplicity, nursing workload, and flexibility at the forefront of implementation, evaluation, and process revision, an overall adherence rate of 84.2% was achieved three months after implementation of the policy.


Assuntos
Derivação Arteriovenosa Cirúrgica/enfermagem , Equipamento de Proteção Individual , Diálise Renal , Centros Médicos Acadêmicos/organização & administração , Humanos , Política Organizacional , Sudeste dos Estados Unidos
10.
Am J Health Syst Pharm ; 76(1): 50-56, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31381099

RESUMO

PURPOSE: Results of a study to evaluate medication storage, distribution, and safety outcomes after addition of 23.4% sodium chloride to a hospital formulary and development of a novel distribution process incorporating safeguards allowing for urgent medication removal from an automated dispensing cabinet (ADC) are reported. SUMMARY: A retrospective review of 23.4% sodium chloride injection doses dispensed during a 38-month period was performed at an academic medical center to evaluate times from order entry to pharmacist verification, dispensing, and administration; adverse events related to dispensing or administration; and other outcomes. Seventy doses of 23.4% sodium chloride injection were administered to 60 patients during the study period. The mean times from order entry to pharmacist verification, medication removal from an ADC, and administration were 8, 25, and 43 minutes, respectively, when the ADC override function was not used. After 23.4% sodium chloride injection's addition to the ADC override list, 16 of 30 doses were removed "on override," with order entry performed retrospectively for 9 of these doses. There were no documented adverse events related to medication distribution and 2 adverse effects possibly related to medication administration. CONCLUSION: Novel storage and distribution processes for 23.4% sodium chloride injection were implemented at a large academic medical center to optimize safety related to the medication-use process. A retrospective review of 70 administered doses found the process of maintaining this medication in ADCs to be a safe and efficient method of storing and dispensing a high-alert medication.


Assuntos
Uso de Medicamentos/estatística & dados numéricos , Tratamento de Emergência/métodos , Erros de Medicação/prevenção & controle , Sistemas de Medicação no Hospital/organização & administração , Solução Salina Hipertônica/administração & dosagem , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Armazenamento de Medicamentos/estatística & dados numéricos , Tratamento de Emergência/efeitos adversos , Feminino , Humanos , Injeções Intravenosas/efeitos adversos , Masculino , Sistemas de Registro de Ordens Médicas/organização & administração , Sistemas de Registro de Ordens Médicas/estatística & dados numéricos , Sistemas de Medicação no Hospital/estatística & dados numéricos , Pessoa de Meia-Idade , Serviço de Farmácia Hospitalar/normas , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Estudos Retrospectivos , Solução Salina Hipertônica/efeitos adversos
11.
Am J Health Syst Pharm ; 76(7): 470-477, 2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-31415682

RESUMO

PURPOSE: The development and implementation of a team-based pharmacy practice model is described. METHODS: In January 2016 a transition from a staff-specialist to a team-based pharmacy practice model was implemented. The overall goal of the model change was to enhance the pharmacist's clinical roles and further integrate pharmacists into the healthcare team. Before implementation of the new staffing model, a formalized metric evaluation process was created. The aim of this metric evaluation was to gauge model success, determine areas of model revision, and objectively communicate pharmacist impact. Objective metrics were evaluated before implementation and 1 year after implementation. In addition, surveys were distributed to pharmacists, physicians, nursing and hospital administration before and after model implementation. RESULTS: At 1-year postimplementation, the pharmacist:patient bed ratio decreased from 1:87 to 1:47, the number of rounds/huddles with pharmacist attendance increased by 63% to 80 per week, and the number of clinical interventions and new clinical consultations increased from 57 to 62 and from 12 to 16 per day, respectively. Nonformulary medication use also decreased from 1.77 to 0.623 per 1000 patient days, and compliance with therapeutic initiatives increased from 77%to 91%. Overall, 72% of pharmacist survey responses indicated satisfaction with the model change. CONCLUSION: A team-based pharmacy practice model was designed and successfully implemented over a 3-year period. Data analysis revealed improvements in clinical and operational endpoints and enhanced pharmacist, physician, and nursing satisfaction.


Assuntos
Modelos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Papel Profissional , Centros Médicos Acadêmicos/organização & administração , Atitude do Pessoal de Saúde , Implementação de Plano de Saúde , Humanos , Satisfação no Emprego , Enfermeiras e Enfermeiros/psicologia , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Médicos/psicologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Visitas com Preceptor/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos
12.
Am J Health Syst Pharm ; 76(15): 1158-1164, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31408513

RESUMO

PURPOSE: The purpose of this study was to demonstrate the utility of failure modes and effects analysis (FMEA) for systematically identifying potential sources of controlled substance diversion and developing solutions in an academic health system. METHODS: The FMEA was conducted by an 18-member cross-functional team from the department of pharmacy. The team developed scoring criteria specifically for controlled substance diversion, outlined the controlled substance processes from procurement to administration or disposal, and identified ways in which each step of the medication supply process might fail (failure modes) and result in diversion of controlled substances. Failure modes with a vulnerability score of 48 or 64 were considered highest risk and were immediately intervened on by the FMEA team. RESULTS: The FMEA outlined a total of 10 major steps and 30 substeps in the controlled substance supply process. From this, 103 potential failure modes were identified, with 24 modes (23%) receiving a vulnerability score of 48 or 64. Development of specific reports addressed 15 failure modes, while 9 involved pharmacy workflow alterations. Notable reports included controlled substance activity under temporary patients and discrepancy trends by user, medication, and patient care area. Notable workflow alterations included expanded use of cameras in high-risk areas and additional verification checks. CONCLUSION: FMEA allowed for systematic identification of controlled substance diversion opportunities, prioritization by level of vulnerability, and the development of targeted strategies to reduce risk of diversion.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Análise do Modo e do Efeito de Falhas na Assistência à Saúde , Serviço de Farmácia Hospitalar/organização & administração , Desvio de Medicamentos sob Prescrição/prevenção & controle , Melhoria de Qualidade , Estados Unidos
13.
Am Surg ; 85(6): 611-619, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267902

RESUMO

The Medicare Severity Diagnosis Related Group (MS-DRG) weight, as derived from the MS-DRG assigned at discharge, is in part determined by the physician-documented diagnoses. However, the terminology associated with MS-DRG determination is often not aligned with typical physician language, leading to inaccurate coding and decreased hospital reimbursements. The goal of this study was to evaluate the impact of a diagnosis picklist within a paper-based history and physical examination (H&P) on the average MS-DRG weight and the Case-mix index (CMI). Our trauma center implemented a paper H&P form for trauma patients featuring picklist diagnoses aligned with the MS-DRG terminology and arranged by the physiologic system. To evaluate its impact, we conducted a cohort study using data from our trauma registry between July 2015 and November 2017. Our cohort included 442 (26.0%) paper and 1,261 (74.0%) dictated H&Ps. Average CMI (2.56 vs 2.15) and expected patients ($25,057 vs $19,825) were higher for the paper group (P < 0.001, P = 0.002). Adjusted regression models demonstrated paper coding to be associated with 0.265 CMI points, translating to an average increase in expected payment of 6.5 per cent per patient. Utilization of a standardized, paper-based H&P template with picklist diagnoses was associated with a higher trauma service CMI and higher expected payments. Preprinted diagnoses that align with the MS-DRG terminology lead to clinical documentation improvement.


Assuntos
Grupos Diagnósticos Relacionados/tendências , Documentação/tendências , Alta do Paciente/tendências , Melhoria de Qualidade , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/diagnóstico , Centros Médicos Acadêmicos/organização & administração , Arizona , Intervalos de Confiança , Bases de Dados Factuais , Grupos Diagnósticos Relacionados/normas , Documentação/métodos , Feminino , Humanos , Masculino , Medicare/economia , Admissão do Paciente/normas , Admissão do Paciente/tendências , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Exame Físico/normas , Exame Físico/tendências , Sistema de Pagamento Prospectivo/normas , Sistema de Pagamento Prospectivo/tendências , Análise de Regressão , Estudos Retrospectivos , Estados Unidos , Ferimentos e Lesões/classificação
14.
J Med Syst ; 43(9): 288, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31325062

RESUMO

Traditional methods have long been used for clinical demand forecasting. Machine learning methods represent the next evolution in forecasting, but model choice and optimization remain challenging for achieving optimal results. To determine the best method to predict demand for outpatient appointments comparing machine learning and traditional methods, this retrospective study analyzed "appointment requests" at a major outpatient department in a destination medical center. Two separate locations (A and B) were assessed with 20 traditional, hybrid (traditional + machine learning) and machine learning methods to determine the best forecasting outcome (lowest Forecast Standard Error, FSE). Data characteristics from both datasets were examined. 20 forecasting models were then assessed and compared for the best result. Location A's data displayed a cyclical and non-trending pattern while Location B's displayed a cyclical and trending pattern. Both Location A and B yielded the feature engineered XGBoost model (machine learning) with the lowest out-of-sample FSE. It is important to carefully analyze and understand the underlying data set pattern and then test a variety of traditional, machine learning, and hybrid prediction methods to achieve optimal predictive results. Additionally, the use of feature engineering or hybrid methods can augment the usefulness of machine learning methods.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Agendamento de Consultas , Aprendizado de Máquina , Pacientes Ambulatoriais , Humanos , Modelos Teóricos , Melhoria de Qualidade , Estudos Retrospectivos , Fatores de Tempo , Listas de Espera
15.
Am J Health Syst Pharm ; 76(6): 381-386, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-31361838

RESUMO

PURPOSE: A novel value-based approach to evaluate costly specialty drugs for formulary addition was developed. SUMMARY: In February 2016, Stanford Health Care launched the specialty drug subcommittee (SDSC), a subcommittee of the pharmacy and therapeutics committee, responsible for the formulary review of specialty pharmaceuticals. A process was developed for value-based review that includes not only consideration of clinical trial data and institutional acquisition costs but also internal patient outcomes and a cost-effectiveness model using internal financial data. A Markov model was developed to assess the value of trabectedin, which was approved for formulary addition in April 2016, relative to the addition of dacarbazine. The economic model and internal patient outcome analysis were presented to the prescribing oncologist and the SDSC for review. Internal data revealed that fewer patients than had been estimated received trabectedin, with outcomes significantly worse than those observed in the clinical trial leading to Food and Drug Administration approval. In the cost-effectiveness model, trabectedin had higher costs and poorer outcomes compared with dacarbazine. Based on the economic model, low utilization, and real-world outcomes, trabectedin was removed from formulary and a restrictive treatment pathway for nonformulary use, developed by the primary prescriber, was implemented. This process has since been applied to 11 more specialty drugs. CONCLUSION: Internal cost-effectiveness models in combination with real-world patient outcomes data can be effective formulary management tools. Engagement and collaboration with the requesting provider are key to developing thoughtful treatment pathways.


Assuntos
Análise Custo-Benefício , Farmacoeconomia , Formulários Farmacêuticos como Assunto , Assistência Farmacêutica/organização & administração , Comitê de Farmácia e Terapêutica/organização & administração , Centros Médicos Acadêmicos/organização & administração , Ensaios Clínicos como Assunto , Dacarbazina/economia , Dacarbazina/uso terapêutico , Aprovação de Drogas/economia , Custos de Medicamentos , Revisão de Uso de Medicamentos/métodos , Revisão de Uso de Medicamentos/organização & administração , Humanos , Comunicação Interdisciplinar , Cadeias de Markov , Modelos Econômicos , Neoplasias/tratamento farmacológico , Neoplasias/economia , Trabectedina/economia , Trabectedina/uso terapêutico , Resultado do Tratamento , Estados Unidos , United States Food and Drug Administration
16.
Am J Health Syst Pharm ; 76(6): 360-365, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-31361840

RESUMO

PURPOSE: This study evaluated employee perceptions of safety culture in 9 health-system-owned community pharmacies using a safety culture survey before and after implementation of a Pharmacy Services Call Center (PSCC) designed to reduce distractions through reduction of phone volume related to refills and prescription readiness. METHODS: The Agency for Healthcare Research and Quality (AHRQ) Community Pharmacy Survey on Patient Safety Culture (CPSPSC) was used to collect employee safety culture perceptions pre-post PSCC implementation. A percent positive score (PPS) was calculated for each of 11 CPSPSC composite questions and for 1 overall rating of patient safety question based on AHRQ-suggested analytic procedures. Pre-post PSCC implementation, PPSs were compared using a chi-square test. RESULTS: Overall, the lowest composite PPS (Staffing, Work Pressure, and Pace) and the highest composite PPS (Patient Counseling) ranked the same in both survey periods. Of the nine PSCC pharmacies, statistically significant (p < 0.05) PPS improvements occurred in 4 composites including Teamwork (11.9%), Communication About Mistakes (18%), Staff Training and Skills (20.6%), and Staffing, Work Pressure, and Pace (11.8%). PSCC pharmacies also reported a 9.3% (NS) improvement in overall rating of pharmacy patient safety post PSCC implementation. Separate analysis of pharmacist responses was consistent with pharmacy level results, but technician results differed slightly in overall rating of safety perceptions. CONCLUSION: Presence of the PSCC appeared to increase pharmacy employees' perceptions of safety culture in the community pharmacies, an integral part of overall patient safety.


Assuntos
Atitude do Pessoal de Saúde , Call Centers/organização & administração , Serviços Comunitários de Farmácia/organização & administração , Segurança do Paciente , Gestão da Segurança , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Serviços Comunitários de Farmácia/estatística & dados numéricos , Aconselhamento/organização & administração , Implementação de Plano de Saúde , Humanos , Erros de Medicação/prevenção & controle , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Técnicos em Farmácia/psicologia , Técnicos em Farmácia/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos , United States Agency for Healthcare Research and Quality , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
17.
Am J Health Syst Pharm ; 76(6): 353-359, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-31361842

RESUMO

PURPOSE: The process and methods used in an impact assessment of a centralized pharmacy call center on community pharmacy employee patient safety climate perceptions, telephone distractions/interruptions, and prescription filling efficiency are described. SUMMARY: A broad-based team designed a multi-faceted, pre-post call center implementation analysis that included multiple change assessment measures. First, yearly administration of the Agency for Healthcare Research and Quality Community Pharmacy Survey on Patient Safety Culture was used to assess patient safety climate based on employee perceptions of a safe working environment and potential for errors due to interruptions and distractions. Evaluative measures of staff workload that assessed telephone interference with prescription filling activities pre and 3 months post implementation included (1) the NASA Task Load Index, (2) multi-tasking observations through shadowing of pharmacists and technicians to count number of interruptions/distractions per prescription "touched," and (3) self-reported work sampling to assess proportional time estimates of clinical, professional, and technical activities. Finally, pharmacy efficiency and prescription filling capacity were assessed using operational measures (prescriptions filled, patients served, phone call volume changes, prescription rework counting). Data analysis included summary statistics, Student's t-test, and chi-square analysis, as appropriate, in addition to assessing convergence and agreement among measures. Every evaluative method showed a positive outcome from call center implementation, although individual pharmacies may have accrued greater benefit from call reduction than others. CONCLUSION: Multiple analysis methods can be used to evaluate the impact of workflow changes.


Assuntos
Call Centers/organização & administração , Serviços Comunitários de Farmácia/organização & administração , Erros de Medicação/prevenção & controle , Segurança do Paciente , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Serviços Comunitários de Farmácia/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Eficiência Organizacional/estatística & dados numéricos , Implementação de Plano de Saúde , Humanos , Auditoria Administrativa/estatística & dados numéricos , Comportamento Multitarefa , Farmacêuticos/organização & administração , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Técnicos em Farmácia/organização & administração , Técnicos em Farmácia/psicologia , Técnicos em Farmácia/estatística & dados numéricos , Papel Profissional/psicologia , Avaliação de Programas e Projetos de Saúde , Gestão da Segurança/organização & administração , Inquéritos e Questionários/estatística & dados numéricos , Telefone , Estados Unidos , United States Agency for Healthcare Research and Quality , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
18.
Ann Thorac Surg ; 108(3): 929-934, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31353035

RESUMO

BACKGROUND: Recent studies in noncardiac surgery have described worse outcomes in the first month of training. However, the "July effect" in the context of cardiac surgery outcomes is not well understood. We examined whether patient outcomes after cardiac surgery were affected by procedure month or academic year quartile. METHODS: Using the National Inpatient Sample, we isolated all coronary artery bypass grafting (CABG), surgical aortic valve replacement (AVR), mitral valve repair or replacement (MV), and isolated thoracic aortic aneurysm (TAA) replacement procedures between 2012 and 2014. For each procedure, overall trends in in-hospital mortality and hospital complications were compared by academic year quartiles (ie, between the first academic year quartile vs the fourth quartile) and by procedure month. Outcomes between teaching and nonteaching hospitals were also compared. RESULTS: Overall, 301,105 CABG, 111,260 AVR, 54,985 MV, and 2,655 TAA procedures met inclusion criteria. In-hospital mortality for each procedure did not vary by procedure month or academic year quartile, even after risk adjustment (all P > .05). Teaching status did not influence risk-adjusted mortality for CABG and isolated TAA replacement (both P > .05). However, teaching hospitals had significantly lower adjusted mortality than nonteaching hospitals for AVR and MV surgery (both P < .01). CONCLUSIONS: The July effect is not evident for cardiac surgery despite preexisting notions. Teaching hospitals performed at least equivalent, if not better, for major cardiac surgery procedures. These findings highlight the pivotal role of hospital support systems to ensure the safe transition of resident classes without compromising on patient outcomes.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Competência Clínica , Mortalidade Hospitalar , Corpo Clínico Hospitalar/tendências , Qualidade da Assistência à Saúde , Centros Médicos Acadêmicos/organização & administração , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Estudos de Coortes , Bases de Dados Factuais , Educação de Pós-Graduação em Medicina/organização & administração , Feminino , Hospitais de Ensino/organização & administração , Humanos , Pacientes Internados/estatística & dados numéricos , Internato e Residência/organização & administração , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Risco Ajustado , Estações do Ano , Estados Unidos
20.
Surgery ; 166(5): 721-725, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296430

RESUMO

BACKGROUND: Although a growing body of literature has focused on the impacts leadership development programs have had on the individual surgeon, little effort has been focused on understanding the impacts these programs have had on surgical culture. The purpose of this study was to explore the impacts of implementing a leadership development program on the culture of the Department of Surgery at University of Michigan, Ann Arbor. METHODS: Qualitative interviews were conducted with 14 surgery faculty in the first cohort of a leadership development program at University of Michigan. Using NVivo (version 11.4.3; QSR International, Melbourne, Australia), thematic analysis was used to locate, analyze, and report patterns within the data. RESULTS: Thematic analysis demonstrated that participation in a leadership development program influenced surgical culture in the following ways: (1) promoted a more participative leadership style, providing tools for surgeons to create a more collaborative environment; (2) increased the culture of diversity, with leaders in the department valuing a more inclusive and wide range of skill sets; and (3) strengthened the collegial environment as evidenced by improved morale and relationships within the department. In addition, several participants expressed difficulty in teasing out what was a direct benefit of a leadership development program versus what could be attributable to other factors, referred to here as the chicken or egg argument. CONCLUSION: Almost all participants expressed experiencing at least some change that they believed was related to the leadership development program. This research may provide insight into the broader implications that programs like these have on surgical culture.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Cirurgia Geral/organização & administração , Liderança , Participação dos Interessados/psicologia , Universidades/organização & administração , Docentes de Medicina/psicologia , Humanos , Michigan , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Cirurgiões/psicologia
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