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1.
Medicine (Baltimore) ; 99(10): e19363, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150080

RESUMO

Hospital readmission rates are used as a metric to measure quality patient care. While several tools predict readmissions based on patient-specific characteristics, this study assesses if physician characteristics correlate with hospital readmission rates.In a 5-year retrospective electronic record review at a single institution, 31 internal medicine attending physicians' discharges were tracked for a total of 70 physician years, and 15,933 hospital discharges. Each physician's yearly 7-day, 8 to 30-day, and 30-day readmission rates were compared. Each rate was also correlated with years of post-graduate clinical experience, discharge volume, physician sex, and fiscal year.Individual physicians had significantly different 7-day, 8 to 30-day, and 30-day readmission rates from each other. The rates were not related to sex, years after post-graduate training, or fiscal year. However, physician patient volume correlated with 7-day readmission rates. Physicians who discharged ≤100 patients per year had a higher 7-day readmission rate than physicians who discharged >100 patients per year. This correlation with patient volume did not hold for the 8 to 30-day and 30-day readmission rates.Individual physicians differ in their patient readmission rates in 7-day, 8 to 30-day, and 30-day categories. A critical level of a physician's hospital activity, as reflected by the number of patient discharges per year (>100), results in lower 7-day readmission rates. Sex, post-graduate years of clinical experience, and fiscal year did not play a role. The lack of correlation between each physicians' 7-day and 8 to 30-day readmission rates suggests that different physician factors are involved in these 2 rates.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Padrões de Prática Médica/normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Pennsylvania , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos
2.
BMJ ; 367: l5205, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31578187

RESUMO

OBJECTIVES: To determine how clinicians vary in their response to new guidance on existing or new interventions, by measuring the timing and magnitude of change at healthcare institutions. DESIGN: Automated change detection in longitudinal prescribing data. SETTING: Prescribing data in English primary care. PARTICIPANTS: English general practices. MAIN OUTCOME MEASURES: In each practice the following were measured: the timing of the largest changes, steepness of the change slope (change in proportion per month), and magnitude of the change for two example time series (expiry of the Cerazette patent in 2012, leading to cheaper generic desogestrel alternatives becoming available; and a change in antibiotic prescribing guidelines after 2014, favouring nitrofurantoin over trimethoprim for uncomplicated urinary tract infection (UTI)). RESULTS: Substantial heterogeneity was found between institutions in both timing and steepness of change. The range of time delay before a change was implemented was large (interquartile range 2-14 months (median 8) for Cerazette, and 5-29 months (18) for UTI). Substantial heterogeneity was also seen in slope following a detected change (interquartile range 2-28% absolute reduction per month (median 9%) for Cerazette, and 1-8% (2%) for UTI). When changes were implemented, the magnitude of change showed substantially less heterogeneity (interquartile range 44-85% (median 66%) for Cerazette and 28-47% (38%) for UTI). CONCLUSIONS: Substantial variation was observed in the speed with which individual NHS general practices responded to warranted changes in clinical practice. Changes in prescribing behaviour were detected automatically and robustly. Detection of structural breaks using indicator saturation methods opens up new opportunities to improve patient care through audit and feedback by moving away from cross sectional analyses, and automatically identifying institutions that respond rapidly, or slowly, to warranted changes in clinical practice.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Anti-Infecciosos/uso terapêutico , Conjuntos de Dados como Assunto , Substituição de Medicamentos/estatística & dados numéricos , Medicamentos Genéricos/uso terapêutico , Inglaterra , Medicina Geral/organização & administração , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Humanos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Medicina Estatal/normas , Fatores de Tempo , Infecções Urinárias/tratamento farmacológico
3.
Emergencias (Sant Vicenç dels Horts) ; 31(5): 304-310, oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184119

RESUMO

Objetivo. Investigar la calidad asistencial en los episodios de exposición a monóxido de carbono (CO) asistidos por unidades prehospitalarias mediante indicadores de calidad (IC) y las variables relacionadas con el uso del pulsicooxímetro para medir de forma incruenta el porcentaje de saturación de la hemoglobina con CO (SpCO). Método. Estudio de cohorte de los episodios de exposición a CO atendidos por las unidades de soporte vital avanza-do (SVA) del Sistema de Emergencias Médicas de Cataluña. Se seleccionaron 11 IC y se diseñó un análisis multivariante para investigar las variables relacionadas con el uso del pulsicooxímetro.Resultados. Se recogieron 1.676 episodios de exposición a CO. En 1.108 (66,1%) se registró la SpCO con pulsicooxímetro, siendo SpCO > 10% en 358 (32,3%). De los 11 IC, cinco no alcanzaron el estándar recomendado. El análisis multivariante mostró un menor uso del pulsicooxímetro cuando había asociación con otro tóxico, OR 0,34 (IC 95% 0,11-1,00) y cuando la primera asistencia era realizada por SVA médico, OR 0,43 (IC 95% 0,31-0,59). Hubo mayor uso del pulsicooxímetro ante la presencia de antecedentes psiquiátricos OR 3,01 (IC 95% 1,27-7,17), la cefalea OR 2,13 (IC 95% 1,22-3,72) y el uso de oxigenoterapia OR 10,33 (5,46-19,53). Conclusión. En la asistencia prehospitalaria de los episodios de exposición al CO existe una falta de cumplimiento de algunos IC. Hay variables relacionadas con la infrautilización del pulsicooxímetro, con puntos de mejora


Objective. To describe health care quality indicators in cases of carbon monoxide (CO) exposure attended by prehospital services and to explore factors associated with the use of pulse CO-oximetry (SpCO) for the noninvasive estimation of CO saturation of arterial blood. Method. Cohort study of patients exposed to CO and transported by advanced life support units of the Emergency Medical Services of Catalonia between January 2015 and December 2017. We selected 11 applicable quality indicators and used multivariate analysis to explore factors associated with the recording of SpCO. Results. We studied 1676 cases of CO exposure. SpCO was recorded in 1108 cases (66.1%). CO saturation exceeded 10% in 358 patients (32.3%). Adherence was deficient in 5 of the 11 applicable quality indicators. Multivariate analysis showed less use of pulse CO-oximetry when another toxic exposure was present (odds ratio [OR], 0.34; 95% CI, 0.11-1.00) and when the first responder was from the advanced life support service (OR, 0.43; 95% CI, 0.31-0.59). SpCO was used more in the presence of a history of mental health problems (OR, 3.01; 95% CI,1.27-7.17), headache (OR, 2.13; 95% CI, 1.2-3.72), and along with use of oxygen therapy (OR, 10.33; 95% CI, 5.46-19.53). Conclusion. Prehospital attendance of episodes of CO exposure is marked by failure to comply with some health care quality indicators. We detected factors associated with under use of SpCO as well as areas to target for improvement


Assuntos
Humanos , Adulto , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Assistência Pré-Hospitalar/organização & administração , Intoxicação por Monóxido de Carbono/diagnóstico , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Assistência Pré-Hospitalar/normas , Melhoria de Qualidade/organização & administração , Exposição Ambiental , Estudos Transversais , Estudos de Coortes , Razão de Chances
4.
J Manag Care Spec Pharm ; 25(10): 1073-1077, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556829

RESUMO

Estimating medication adherence through the use of pharmacy claims-based adherence calculations such as medication possession ratio (MPR) and proportion of days covered (PDC) plays a significant role in specialty pharmacy practice. Although MPR and PDC are frequently used in clinical practice, calculation methodologies vary, making meaningful comparisons of adherence rates difficult. In addition, MPR and PDC are increasingly used by insurance companies, pharmacies, accrediting bodies, and drug manufacturers to demonstrate quality differences or clinical benefit across the specialty pharmacy industry. Therefore, recognizing the source and effect of calculation variability is necessary to fully understand reported adherence results. This article highlights the challenges in standardizing adherence methodologies, minimum methodology considerations that should be reported with MPR and PDC results, and key elements to consider when interpreting and applying adherence results. Further, recommendations are provided to promote a more consistent description of calculation methods and to aid pharmacies in adherence measure analysis, interpretation, and application to practice, with a focus on specialty pharmacy programs. A detailed description of methodology as outlined in this article must be provided to ensure reproducibility, external validation, and scientific rigor. In the absence of standardization, specialty pharmacies should be prudent in their use of adherence calculations as a clinical benchmarking tool or comparative quality indicator with outside organizations. Furthermore, specialty pharmacies should consider using current adherence measure calculations to identify and provide targeted interventions to patients with potential adherence problems and strive to better demonstrate ties between adherence measures and direct clinical and cost outcomes. DISCLOSURES: No outside funding supported the writing of this article. Anguiano is a speaker and research consultant for United Therapeutics. The other authors have nothing to disclose.


Assuntos
Benchmarking/normas , Adesão à Medicação/estatística & dados numéricos , Assistência Farmacêutica/normas , Farmácias/normas , Benchmarking/estatística & dados numéricos , Assistência Farmacêutica/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Reprodutibilidade dos Testes
5.
7.
World J Gastroenterol ; 25(23): 2833-2838, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31249442

RESUMO

Postoperative complications represent a basic quality indicator for measuring outcomes at surgical units. At present, however, they are not systematically measured in all surgical procedures. A more accurate assessment of their impact could help to evaluate the real morbidity associated with different surgical interventions, establish measures for improvement, increase efficiency and identify benchmarking services. The Clavien-Dindo Classification is the most widely used system worldwide for assessing postoperative complications. However, the postoperative period is summarized by the most serious complication without taking into account others of lesser magnitude. Recently, two new scoring systems have emerged, the Comprehensive Complication Index and the Complication Severity Score, which include all postoperative complications and quantify them from 0 (no complications) to 100 (patient's death), These allow the comparison of results. It is important to train surgical staff to report and classify complications and to record 90-d morbidity rates in all patients. Comparisons with other services must take into account patient comorbidities and the complexity of the particular surgical procedure. To avoid subjectivity and bias, external audits are necessary. In addition, ensuring transparency in the reporting of the results is an urgent obligation.


Assuntos
Benchmarking/métodos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Humanos , Complicações Pós-Operatórias/diagnóstico , Índice de Gravidade de Doença
8.
Nurs Adm Q ; 43(3): 222-229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162341

RESUMO

Little is known about how hospital-based nurse managers use electronic health records (EHR) to monitor nurse-sensitive quality measures, or about how they learn to do so. This article describes the role of nurse managers in quality monitoring, their experience in using the EHR to monitor nurse-sensitive quality measures, and their related training. A convenience sample of nurse managers and directors (n = 28) was recruited to participate in semistructured interviews. The resulting data were analyzed, using content analysis. This study revealed 3 components of the nurse manager's quality-monitoring role: monitoring documentation, monitoring practice, and performing investigations. Facilitators for accessing EHR information included ease of navigation, timeliness and accessibility of reports, and usefulness of EHR tools. Participants described a range of formal and informal approaches to learning how to access information for quality monitoring in general and for the EHR specifically. The findings provide direction for further exploration of the EHR structures and processes needed to support nurse managers' information needs and quality-monitoring training.


Assuntos
Registros Eletrônicos de Saúde/normas , Enfermeiras Administradoras/psicologia , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Entrevistas como Assunto/métodos , Invenções/tendências , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
9.
Nurs Adm Q ; 43(3): 280-288, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162348

RESUMO

Traditional quality assurance processes provide significant opportunities for positive disruption. Doctor of Nursing Practice (DNP) students are well positioned to apply program learning to large-scale change in complex organizations. This article presents an innovative approach for creating a point-of-care interdisciplinary approach to address high fall risk frequencies in ambulatory oncology clinics using complexity leadership principles. Processes for nurse executives to consider for replication of this approach for other challenging clinical situations are suggested using the emerging competence of DNP educated nurses. Adults with cancer who are older than 65 years are at a higher risk for falls than older adults without cancer. Oncology providers and nurses are not routinely screening, documenting, and preventing falls. A fall injury in an older adult with cancer may not only delay or impact cancer treatment but also result in hospitalization, loss of function, and/or death. Increasing awareness of the impact of falls and implementing change within a large ambulatory health care organization requires an interdisciplinary team approach. Complexity theory supports nonlinear change initiated at the grassroots level to create a dynamic movement to bring forth emergence and adaptation. The use of the Centers for Disease Control and Prevention STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative will enable oncology professionals to screen, assess, and intervene by collaborating, communicating, and coordinating with other health care specialists to introduce a fall prevention quality improvement system process. Nurse executives need to know about STEADI.


Assuntos
Acidentes por Quedas/prevenção & controle , Indicadores de Qualidade em Assistência à Saúde/normas , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Geriatria/métodos , Geriatria/normas , Humanos , Masculino , Serviço Hospitalar de Oncologia/organização & administração , Serviço Hospitalar de Oncologia/normas , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Melhoria de Qualidade/tendências , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos
10.
Glob Health Action ; 12(1): 1619155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31159680

RESUMO

Background: Globally, opportunities to validate government reports through external audits are rare, notably in India. A cross-sectional maternal health study in Uttar Pradesh, India's most populous state, compares government administrative data and externally collected data on maternal health service indicators. Objectives: Our study aims to determine the level of concordance between government-reported health facility data compared to externally collected health facility data on the same maternal healthcare quality indicators. Second, our study aims to explore whether the level of agreement between government administrative data versus the externally collected data differs by level of facility or by type of maternal health service. Methods: Facility assessment surveys were administered to key health staff by government-hired enumerators from January 2017 to March 2017 at nearly 750 government health facilities across UP. The same survey was re-conducted by external data collectors from August 2017 to October 2017 at 40 of the same facilities. We conduct comparative analyses of the two datasets for agreement among the same measures of maternal healthcare quality. Results: The findings indicate concordance between most indicators across government administrative data and externally collected health facility data. However, when stratified by facility-level or service type, results suggest significant over-reporting in the government administrative data on indicators that are incentivized. This finding is consistent across all levels of facilities; however, the most significant disparities appear at higher-level facilities, namely District Hospitals. Conclusion: This study has a number of important programmatic and policy implications. Government administrative health data have the potential to be highly critical in informing large-scale quality improvements in maternal healthcare quality, but its credibility must be readily verifiable and accessible to politicians, researchers, funders, and most importantly, the public, to improve the overall health, patient experience, and well-being of women and newborns.


Assuntos
Confiabilidade dos Dados , Coleta de Dados/métodos , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
11.
Health Serv Res ; 54(5): 1090-1098, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31197825

RESUMO

OBJECTIVE: To compare the performance of widely used approaches for defining groups of hospitals and a new approach based on network analysis of shared patient volume. STUDY SETTING: Non-federal acute care hospitals in the United States. STUDY DESIGN: We assessed the measurement properties of four methods of grouping hospitals: hospital referral regions (HRRs), metropolitan statistical areas (MSAs), core-based statistical areas (CBSAs), and community detection algorithms (CDAs). DATA EXTRACTION METHODS: We combined data from the 2014 American Hospital Association Annual Survey, the Census Bureau, the Dartmouth Atlas, and Medicare data on interhospital patient travel patterns. We then evaluated the distinctiveness of each grouping, reliability over time, and generalizability across populations. PRINCIPLE FINDINGS: Hospital groups defined by CDAs were the most distinctive (modularity = 0.86 compared to 0.75 for HRRs and 0.83 for MSAs; 0.72 for CBSA), were reliable to alternative specifications, and had greater generalizability than HRRs, MSAs, or CBSAs. CDAs had lower reliability over time than MSAs or CBSAs (normalized mutual information between 2012 and 2014 CDAs = 0.93). CONCLUSIONS: Community detection algorithm-defined hospital groups offer high validity, reliability to different specifications, and generalizability to many uses when compared to approaches in widespread use today. They may, therefore, offer a better choice for efforts seeking to analyze the behaviors and dynamics of groups of hospitals. Measures of modularity, shared information, inclusivity, and shared behavior can be used to evaluate different approaches to grouping providers.


Assuntos
Classificação/métodos , Cuidados Críticos/estatística & dados numéricos , Hospitais/classificação , Hospitais/estatística & dados numéricos , Hospitais/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Humanos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Reprodutibilidade dos Testes , Estados Unidos
12.
Crit Care ; 23(1): 207, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31171026

RESUMO

BACKGROUND: Known colloquially as the "weekend effect," the association between weekend admissions and increased mortality within hospital settings has become a highly contested topic over the last two decades. Drawing interest from practitioners and researchers alike, a sundry of works have emerged arguing for and against the presence of the effect across various patient cohorts. However, it has become evident that simply studying population characteristics is insufficient for understanding how the effect manifests. Rather, to truly understand the effect, investigations into its underlying factors must be considered. As such, the work presented in this manuscript serves to address this consideration by moving beyond identification of patient cohorts to examining the role of ICU performance. METHODS: Employing a comprehensive, publicly available database of electronic medical records (EMR), we began by utilizing multiple logistic regression to identify and isolate a specific cohort in which the weekend effect was present. Next, we leveraged the highly detailed nature of the EMR to evaluate ICU performance using well-established ICU quality scorecards to assess differences in clinical factors among patients admitted to an ICU on the weekend versus weekday. RESULTS: Our results demonstrate the weekend effect to be most prevalent among emergency surgery patients (OR 1.53; 95% CI 1.19, 1.96), specifically those diagnosed with circulatory diseases (P<.001). Differences between weekday and weekend admissions for this cohort included a variety of clinical factors such as ventilatory support and night-time discharges. CONCLUSIONS: This work reinforces the importance of accounting for differences in clinical factors as well as patient cohorts in studies investigating the weekend effect.


Assuntos
Unidades de Terapia Intensiva/normas , Qualidade da Assistência à Saúde/normas , Fatores de Tempo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/tendências , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Fatores de Risco
13.
J Wound Ostomy Continence Nurs ; 46(4): 327-331, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31107858

RESUMO

PURPOSE: The purpose of this quality improvement (QI) project was to determine if use of an algorithm focusing on skin care in patients with fecal and urinary incontinence reduces the rate of hospital-acquired incontinence-associated dermatitis (IAD) over a period of 4 months. PARTICIPANTS AND SETTING: The QI setting was an 18-bed surgical intensive care unit (SICU) in an acute care urban hospital located in the southeastern United States. Two hundred eleven patients participated in this pre/postintervention QI project. APPROACH: The algorithm for skin care used evidence-based bundled interventions for patients with fecal and urinary incontinence. The project comprised education of the SICU nursing staff in January 2018 and implementation of the algorithm from February 5, 2018, to June 5, 2018. Weekly chart reviews were conducted to determine algorithm compliance, documentation of fecal and urinary incontinence, and accuracy of IAD documentation. Descriptive statistics were used to determine the rate of hospital-acquired IAD, algorithm compliance, and average length of time from admission to the onset of hospital-acquired IAD. OUTCOMES: Seventy-nine individuals with incontinence were included in the 3-month preintervention period and 132 individuals with incontinence in the 3-month postintervention period. We observed a 24% reduction in the rate of hospital-acquired IAD following implementation of the algorithm (29% vs 5%). The average length of time from admission to the onset of hospital-acquired IAD increased from 15 days in February 2018 to 25 days in May 2018. IMPLICATIONS FOR PRACTICE: Our experience with this QI project suggest that IAD can be identified and managed at the bedside by first clinical nursing staff without expertise in skin assessment and wound care.


Assuntos
Dermatite/etiologia , Incontinência Urinária/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Dermatite/epidemiologia , Incontinência Fecal/complicações , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/tendências , Higiene da Pele/enfermagem
14.
Ann R Coll Surg Engl ; 101(5): 366-372, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31042429

RESUMO

INTRODUCTION: The 'weekend effect' describes variation in outcomes of patients treated over the weekend compared with those treated during weekdays. This study examines whether a weekend effect exists for patients who undergo emergency laparotomy. MATERIALS AND METHODS: Data entered into the National Emergency Laparotomy Audit between 2014 and 2017 at four NHS trusts in England and Wales were analysed. Patients were grouped into those admitted on weekdays and those on weekends (Friday 5pm to Monday 8am). Patient factors, markers of quality of care and patient outcomes were compared. Secondary analysis was performed according to the day of surgery. RESULTS: After exclusion of patients who underwent laparotomy more than one week after admission to hospital, a total of 1717 patients (1138 patients admitted on weekdays and 579 admitted on weekends) were analysed. Age, preoperative lactate and P-POSSUM scores were not significantly different between the two groups. Time from admission to consultant review, decision to operate, commencement of antibiotics and theatre were not significantly different. Grades of operating surgeon were also similar in both groups. Inpatient 60-day mortality was 12.5% on weekdays and 12.8% on weekends (P = 0.878). Median length of postoperative stay was 12 days in both groups. When analysed according to day of surgery, only number of hours from admission to antibiotics (12.8 weekday vs 9.4 weekend, P = 0.046) and number of hours to theatre (26.5 weekday vs 24.1 hours weekend, P = 0.020) were significantly different. DISCUSSION: Quality of care and clinical outcomes for patients undergoing emergency laparotomy during the weekend are not significantly different to those carried out during weekdays.


Assuntos
Plantão Médico/normas , Mortalidade Hospitalar , Laparotomia/mortalidade , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Plantão Médico/estatística & dados numéricos , Idoso , Auditoria Clínica , Emergências , Inglaterra , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Medicina Estatal/normas , País de Gales
15.
BJOG ; 126 Suppl 3: 49-57, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31090183

RESUMO

OBJECTIVE: To compare severe maternal outcomes (SMOs) from two multi-centre surveys in Nigerian hospitals, and to evaluate how the SMO burden affects quality of secondary and tertiary hospital care. DESIGN: Two facility-based surveys of women experiencing SMO (maternal near-miss or maternal deaths). SETTING: Sixteen secondary and five tertiary facilities in Nigeria [WHO Multi-Country Survey on Maternal and Newborn Health (WHOMCS)] and 42 public tertiary facilities in Nigeria (Nigeria Near-Miss and Maternal Death Survey). POPULATION: 371 women in WHOMCS-Nigeria and 2449 women in Nigeria Near-Miss and Maternal Death Survey who experienced SMO. METHODS: Secondary analysis and comparison of SMO data from two surveys, stratified by facility level. MAIN OUTCOME MEASURES: Maternal mortality ratio (MMR) per 100 000 livebirths (LB), maternal near-miss (MNM) ratio per 1000 LB, SMO ratio per 1000 LB and mortality index (deaths/SMO). RESULTS: Maternal mortality ratio and mortality indices were highest in tertiary facilities of the WHOMCS-Nigeria (706 per 100 000; 26.7%) and the Nigeria Near-Miss and Maternal Death Survey (1088 per 100 000; 40.8%), and lower in secondary facilities of the WHOMCS-Nigeria (593 per 100 000; 17.9%). The MNM ratio and SMO ratio were highest in secondary WHOMCS-Nigeria facilities (27.2 per 1000 LB; 33.1 per 1000 LB). CONCLUSIONS: Tertiary-level facilities in Nigeria experience unacceptably high maternal mortality rates, but secondary-level facilities had a proportionately higher burden of severe maternal outcomes. Common conditions with a high mortality index (postpartum haemorrhage, eclampsia, and infectious morbidities) should be prioritised for action. Surveillance using SMO indicators can guide quality improvement efforts and assess changes over time. TWEETABLE ABSTRACT: 2820 Nigerian women with severe maternal outcomes: high mortality in tertiary level hospitals, higher burden in secondary level.


Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Complicações na Gravidez/mortalidade , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto , Feminino , Humanos , Morte Materna/estatística & dados numéricos , Serviços de Saúde Materna/normas , Mortalidade Materna , Near Miss/normas , Nigéria/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Inquéritos e Questionários , Centros de Atenção Terciária/normas
16.
Medicine (Baltimore) ; 98(20): e15644, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096485

RESUMO

Comparing hospital performance in a health system is traditionally done with multilevel regression models that adjust for differences in hospitals' patient case-mix. In contrast, "template matching" compares outcomes of similar patients at different hospitals but has been used only in limited patient settings.Our objective was to test a basic template matching approach in the nationwide Veterans Affairs healthcare system (VA), compared with a more standard regression approach.We performed various simulations using observational data from VA electronic health records whereby we randomly assigned patients to "pseudo hospitals," eliminating true hospital level effects. We randomly selected a representative template of 240 patients and matched 240 patients on demographic and physiological factors from each pseudo hospital to the template. We varied hospital performance for different simulations such that some pseudo hospitals negatively impacted patient mortality.Electronic health record data of 460,213 hospitalizations at 111 VA hospitals across the United States in 2015.We assessed 30-day mortality at each pseudo hospital and identified lowest quintile hospitals by template matching and regression. The regression model adjusted for predicted 30-day mortality (as a measure of illness severity).Regression identified the lowest quintile hospitals with 100% accuracy compared with 80.3% to 82.0% for template matching when systematic differences in 30-day mortality existed.The current standard practice of risk-adjusted regression incorporating patient-level illness severity was better able to identify lower-performing hospitals than the simplistic template matching algorithm.


Assuntos
Benchmarking/métodos , Benchmarking/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , United States Department of Veterans Affairs/estatística & dados numéricos , Grupos Diagnósticos Relacionados , Feminino , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Mortalidade/tendências , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Índice de Gravidade de Doença , Estados Unidos
17.
Crit Care Nurs Clin North Am ; 31(2): 237-247, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31047096

RESUMO

Emergency departments across the United States struggle to balance the overutilization of emergency services. Nurse practitioners (NPs) practicing in emergency departments improve quality indicators leading to the increased efficiency, timeliness, and effectiveness of care. NPs providing emergency services improve multiple national metrics, such as door-to-provider time, patient satisfaction, diagnostic test ordering, and left without being seen rates. NPs should be aware of the positive impact they make on the quality of care. NPs should monitor and trend patient outcomes they directly effect. More research is needed to identify ways NPs can continue to improve the quality of emergency services provided.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Profissionais de Enfermagem , Avaliação de Resultados da Assistência ao Paciente , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Humanos , Estados Unidos
18.
J Surg Res ; 242: 4-10, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31059948

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of trauma-related death and disability. Computed tomography (CT) imaging of the head is essential for diagnosis of intracranial hemorrhage. This study aimed to identify optimal time to imaging and its impact on mortality for older patients with mild TBIs. MATERIALS AND METHODS: State-wide quality collaborative data were used from level I-II trauma centers. Inclusion criteria were ICD-9/10 codes for head trauma, age ≥50, admission/emergency department Glasgow Coma Scale ≥14, injury severity score ≤20, nonfull trauma activation, and head CT imaging time between 5 and 90 min of arrival. Locally weighted scatterplot smoothing plot data were used to dichotomize patients into early and late head CT imaging cohorts. Multivariable logistic regression and negative binomial models were used to evaluate the effect of early verses late head CT on clinical outcomes. The primary outcome was in-hospital mortality. RESULTS: Mortality nadired at 35 min. Each 1-min delay in CT imaging resulted in a 2% increase in mortality (P = 0.002). Early patients had significantly reduced in-hospital mortality (P = 0.03), shorter emergency department length of stay (P < 0.001), and were more likely to receive fresh frozen plasma within 4 h if anticoagulated (P = 0.03). Teaching, high-volume, and level 2 trauma centers were all less likely to provide early head CTs (all P < 0.05). CONCLUSIONS: Delay in head CT imaging in the setting of potential mild TBI was associated with an increase in mortality. A delay in diagnosis cascades into delays in delivery of therapeutic interventions. Head CT within 35 min should be evaluated as a quality metric for older patients with mild TBI.


Assuntos
Concussão Encefálica/diagnóstico , Encéfalo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Benchmarking/métodos , Concussão Encefálica/mortalidade , Concussão Encefálica/terapia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Centros de Traumatologia/organização & administração , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento
20.
Emerg Med J ; 36(6): 326-332, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30944115

RESUMO

INTRODUCTION: Hospital inspection and the publication of inspection ratings are widely used regulatory interventions that may improve hospital performance by providing feedback, creating incentives to change and promoting choice. However, evidence that these interventions assess performance accurately and lead to improved performance is scarce. METHODS: We calculated six standard indicators of emergency department (ED) performance for 118 hospitals in England whose EDs were inspected by the Care Quality Commission, the national regulator in England, between 2013 and 2016. We linked these to inspection dates and subsequent rating scores. We used multilevel linear regression models to estimate the relationship between prior performance and subsequent rating score and the relationship between rating score and post-inspection performance. RESULTS: We found no relationship between performance on any of the six indicators prior to inspection and the subsequent rating score. There was no change in performance on any of the six indicators following inspection for any rating score. In each model, CIs were wide indicating no statistically significant relationships. DISCUSSION: We found no association between established performance indicators and rating scores. This might be because the inspection and rating process adds little to the external performance management that EDs receive. It could also indicate the limited ability of hospitals to improve ED performance because of extrinsic factors that are beyond their control.


Assuntos
Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/organização & administração , Inglaterra , Hospitais/normas , Hospitais/tendências , Humanos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Medicina Estatal/organização & administração , Medicina Estatal/normas , Inquéritos e Questionários , Fatores de Tempo
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