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1.
Prev Med ; 151: 106681, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34217422

RESUMO

The COVID-19 pandemic has contributed to decreases in breast, colorectal, and cervical cancer screenings between 86 and 94% compared to three-year averages. These postponed screenings have created backlogs that systems will need to address as healthcare facilities re-open for preventive care. The American Cancer Society is leading a 17-month intervention with 22 federally qualified health centers (FQHCs) across the United States aimed at reducing cancer incidence and mortality disparities and alleviating additional strain caused by COVID-19. This study describes COVID-related cancer screening service disruptions reported by participating FQHCs. Selected FQHCs experienced service disruptions and/or preventive care cancellations due to COVID-19 that varied in severity and duration. Fifty-nine percent stopped cancer screenings completely. Centers transitioned to telehealth visits or rescheduled for the future, but the impact of these strategies may be limited by continued pandemic-related disruptions and the inability to do most screenings at home; colon cancer screening being the exception. Most centers have resumed in-person screening, but limited in person appointments and high levels of community transmission may reduce FQHC abilities to provide catch-up services. FQHCs provide critical cancer prevention services to vulnerable populations. The delivery of culturally competent, high-quality healthcare can mitigate and potentially reverse racial and ethnic disparities in cancer prevention testing and treatment. Ensuring and expanding access to care as we move out of the pandemic will be critical to preventing excess cancer incidence and mortality in vulnerable populations.


Assuntos
COVID-19 , Neoplasias Colorretais , Telemedicina , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer , Feminino , Humanos , Pandemias , Melhoria de Qualidade , SARS-CoV-2 , Estados Unidos
2.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248333

RESUMO

Background: This study was undertaken to analyze our outcomes after robotic fundoplication for GERD in patients with failed antireflux procedures, with type IV (i.e., giant) hiatal hernias, or after extensive intra-abdominal surgery with mesh, and to compare our results to outcomes predicted by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator and to national outcomes reported by NSQIP. Methods: 100 patients undergoing robotic fundoplication for the aforementioned factors were prospectively followed. Results: 100 patients, aged 67 (67 ± 10.3) years with body mass index (BMI) of 26 (25 ± 2.9) kg/m2 underwent robotic fundoplication for failed antireflux fundoplications (43%), type IV hiatal hernias (31%), or after extensive intra-abdominal surgery with mesh (26%). Operative duration was 184 (196 ± 74.3) min with an estimated blood loss of 24 (51 ± 82.9) mL. Length of stay was 1 (2 ± 3.6) day. Two patients developed postoperative ileus. Two patients were readmitted within 30 days for nausea.Nationally reported outcomes and those predicted by NSQIP were similar. When comparing our actual outcomes to predicted and national NSQIP outcomes, actual outcomes were superior for serious complications, any complications, pneumonia, surgical site infection, deep vein thrombosis, readmission, return to OR, and sepsis (P < 0.05); our actual outcomes were not worse for renal failure, deaths, cardiac complications, and discharge to a nursing facility. Conclusions: Our patients were not a selective group; rather they were more complex than reported in NSQIP. Most of our results after robotic fundoplication were superior to predicted and national outcomes. The utilization of the robotic platform for complex operations and fundoplications to treat patients with GERD is safe and efficacious.


Assuntos
Abdome/cirurgia , Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Feminino , Fundoplicatura/normas , Humanos , Laparoscopia/métodos , Laparoscopia/normas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Melhoria de Qualidade , Procedimentos Cirúrgicos Robóticos/normas , Resultado do Tratamento
3.
BMC Fam Pract ; 22(1): 140, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210271

RESUMO

BACKGROUND: Health services internationally have been compelled to change their methods of service delivery in response to the global COVID-19 pandemic, to mitigate the spread of infection amongst health professionals and patients. In Aotearoa/New Zealand, widespread electronic delivery of prescriptions (e-prescribing) was enabled. The aim of the research was to explore patients' experiences of how lockdown, changes to prescribing and the interface between general practices and community pharmacy affected access to prescription medications. METHOD: The research employed a mixed-method approach. This included an online survey (n = 1,010) and in-depth interviews with a subset of survey respondents (n = 38) during the first COVID-19 lockdown (March-May 2020). Respondents were recruited through a snowballing approach, starting with social media and email list contacts of the research team. In keeping with the approach, descriptive statistics of survey data and thematic analysis of qualitative interview and open-ended questions in survey data were combined. RESULTS: For most respondents who received a prescription during lockdown, this was sent directly to the pharmacy. Most people picked up their medication from the pharmacy; home delivery of medication was rare (4%). Survey and interview respondents wanted e-prescribing to continue post-lockdown and described where things worked well and where they encountered delays in the process of acquiring prescription medication. CONCLUSIONS: E-prescribing has the potential to improve access to prescription medication and is convenient for patients. The increase in e-prescribing during lockdown highlighted how the system could be improved, through better feedback about errors, more consistency across practices and pharmacies, more proactive communication with patients, and equitable prescribing costs.


Assuntos
COVID-19 , Atenção à Saúde , Prescrição Eletrônica , Medicina Geral , Acesso aos Serviços de Saúde , Preferência do Paciente/estatística & dados numéricos , Atitude do Pessoal de Saúde , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Serviços Comunitários de Farmácia/normas , Serviços Comunitários de Farmácia/estatística & dados numéricos , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Prescrição Eletrônica/economia , Prescrição Eletrônica/normas , Prescrição Eletrônica/estatística & dados numéricos , Feminino , Medicina Geral/métodos , Medicina Geral/tendências , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Melhoria de Qualidade , SARS-CoV-2 , Inquéritos e Questionários
4.
BMC Fam Pract ; 22(1): 143, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210284

RESUMO

BACKGROUND: Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams' delivery of mental health care. METHODS: A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. RESULTS: We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. CONCLUSIONS: From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care's capacity for mental health care for the duration of the pandemic and beyond.


Assuntos
COVID-19 , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviços de Saúde Mental , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde , Telemedicina , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/psicologia , Feminino , Grupos Focais , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Saúde Mental/tendências , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/provisão & distribuição , Ontário/epidemiologia , Padrões de Prática Médica/tendências , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Melhoria de Qualidade/organização & administração , SARS-CoV-2 , Telemedicina/métodos , Telemedicina/estatística & dados numéricos
5.
BMC Health Serv Res ; 21(1): 711, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34284785

RESUMO

BACKGROUND: Scaling up continuous quality improvement (CQI) processes could be key in achieving the 95:95:95 cascade and global HIV targets. This paper describes the experiences and outcomes related to implementing CQI processes to help reach these targets, with particular focus on clinical and programmatic settings in 6 countries from the global south. METHODS: The HIV program at the University of Maryland, Baltimore (UMB) implemented an adapted CQI model in Kenya, Tanzania, Botswana, Zambia, Nigeria and Rwanda that included the following steps: (1) analysing the problem to identify goals and objectives for improvement; (2) developing individual changes or 'change packages', (3) developing a monitoring system to measure improvements; and (4) implementing and measuring changes through continuous 'plan-do-study-act' (PDSA) cycles. We describe country-level experiences related to implementing this adaptive design, a collaborative learning and scale-up/sustainability model that addresses the 95:95:95 global HIV targets via a CQI learning network, and mechanisms for fostering communication and the sharing of ideas and results; we describe trends both before and after model implementation. RESULTS: Our selected country-level experiences based on implementing our CQI approach resulted in an increased partner testing acceptance rate from 21.7 to 48.2 % in Rwanda, which resulted in an increase in the HIV testing yield from 2.1 to 6.3 %. In Botswana, the overall linkage to treatment improved from 63 to 94 %, while in Kenya, the viral load testing uptake among paediatric and adolescent patients improved from 65 to 96 %, and the viral load suppression improved from 53 to 88 %. CONCLUSIONS: Adopting CQI processes is a useful approach for accelerating progress towards the attainment of the global 95:95:95 HIV targets. This paper also highlights the value of institutionalizing CQI processes and building the capacity of Ministry of Health (MoH) personnel in sub-Saharan Africa for the effective quality improvement of HIV programs and subsequent sustainability efforts.


Assuntos
Infecções por HIV , Melhoria de Qualidade , Adolescente , Baltimore , Botsuana , Criança , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Institucionalização , Quênia/epidemiologia , Nigéria , Ruanda , Tanzânia , Zâmbia
6.
Nephrol Nurs J ; 48(3): 251-252, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34286935

RESUMO

Nursing working in outpatient hemodialysis centers face a unique set of challenges working with patients with end stage kidney disease who carry a high medication burden for their multiple chronic conditions. Patient medication lists may not always accurately reflect the entirety of medications prescribed or taken; therefore, nurses are not aware of medication changes that occur in between dialysis treatments. This places patients at risk for medication-related problems or adverse events during treatment. A quality improvement project was developed that included an addition to the daily weight sheet related to any medication changes prior to each patient treatment. Survey results found that assessing for medication changes prior to each treatment improved the accuracy of patient medication lists, which ultimately decreased complications for patients and also improved nurse satisfaction.


Assuntos
Falência Renal Crônica , Diálise Renal , Humanos , Falência Renal Crônica/terapia , Pacientes Ambulatoriais , Melhoria de Qualidade , Inquéritos e Questionários
7.
Huan Jing Ke Xue ; 42(8): 3622-3632, 2021 Aug 08.
Artigo em Chinês | MEDLINE | ID: mdl-34309249

RESUMO

In recent years, China's air quality has been improving, and the concentration of atmospheric particulate matter has decreased significantly. In this study, the pollution characteristics and trends of two typical representative cities (Beijing and Chengdu) were analyzed. The geographical locations, pollution emissions, and meteorological diffusion conditions of the two cities were compared, to evaluate the relative contribution of meteorological conditions and pollution reduction regulations in decreasing fine particulate matter (PM2.5) concentrations. The results showed that the number of heavily polluted days and pollution episodes in Beijing and Chengdu decreased significantly from 2013 to 2018, and the concentration of SO2 and PM2.5 decreased substantially. Compared to 2013, SO2 concentration in Beijing and Chengdu has decreased by 77.8% and 70.9%, whereas PM2.5 concentration has decreased by 42.7% and 48.5%, respectively. The largest reduction appeared in winter, when PM2.5 decreased at an annual rate of 13.5 µg ·m-3 for Beijing and 14.1 µg ·m-3 for Chengdu. During the study period, the wind speed in Chengdu was less than that in Beijing, temperature was approximately 3℃ higher, and static wind in winter was more frequent. A significantly lower mixed-layer height, atmospheric capacity index, and ventilation coefficient in Chengdu resulted in more unfavorable atmospheric diffusion conditions. The static and stable weather index and the environmental meteorological index (EMI) also showed that the atmospheric diffusion conditions were better in Beijing than in Chengdu. The EMI of the two cities showed a decreasing trend during the study period, and the decline in EMI in Chengdu was the most significant in 2018, indicating an evident improvement in meteorological conditions. In 2018, emission reductions are estimated to have contributed 33.5% and 24% to the decrease in PM2.5 in Beijing and Chengdu, respectively, and meteorological conditions contributed 7.2% and 11.1% to the reduction in these two cities. In winter, emission reductions respectively contributed 31.7% and 32.5% to reduction in Beijing and Chengdu, while meteorological conditions made a larger contribution.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Pequim , China , Cidades , Monitoramento Ambiental , Material Particulado/análise , Melhoria de Qualidade , Estações do Ano
8.
Clin Interv Aging ; 16: 1265-1274, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34262266

RESUMO

Purpose: Elderly people represent a growing stroke population with different pathophysiological states than younger. Whether intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) is beneficial for elderly patients remains unclear. This study compared the efficacy and safety between elderly patients treated with MT alone and those treated with both IVT and MT. Patients and Methods: Patients aged ≥65 years who were eligible for IVT within 4.5 h from symptom onset were selected from the ANGEL-ACT (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke) registry, a prospective registry program for patients with endovascular treatment from 111 Chinese stroke centers. The primary efficacy outcome was the 90-day modified Rankin Scale score. We compared efficacy and safety outcomes using ordinal or binary logistic regression or a generalized linear model. Results: In total, 482 elderly patients were included: 187 (38.8%) received IVT and MT (bridging MT) and 295 (61.2%) received MT alone (direct MT). There was no significant difference in the 90-day modified Rankin Scale score between the two groups (median: 4 vs 4 points, respectively; adjusted ß=-0.048, P=0.822). The direct MT group had a shorter onset-to-puncture time (225 vs 255 min, respectively; adjusted ß=-55.074, P=0.002) and a lower rate of parenchymal hemorrhage type 2 within 24 h (2.80% vs 6.63%, respectively; adjusted odds ratio [OR]=0.287, 95% confidence interval [CI]=0.096-0.856, P=0.025). In addition, the direct MT group showed a trend toward a lower incidence of sICH (5.67% vs 10.06%, adjusted OR=0.453, P=0.061), procedure-related complications (7.12% vs 12.30%, adjusted OR=0.499, P=0.052) and distal or new territorial embolization (4.07% vs 6.95%, adjusted OR=0.450, P=0.093). Conclusion: Direct MT had similar efficacy to bridging MT in terms of the 90-day functional outcome in elderly patients, whereas bridging MT had a longer onset-to-puncture time and increased risk of hemorrhagic transformation and procedure-related complications.


Assuntos
Hemorragia Cerebral , Transtornos Cerebrovasculares , AVC Isquêmico , Trombectomia , Administração Intravenosa , Idoso , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiologia , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/terapia , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , AVC Isquêmico/tratamento farmacológico , AVC Isquêmico/etiologia , AVC Isquêmico/cirurgia , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Melhoria de Qualidade , Trombectomia/efeitos adversos , Trombectomia/métodos , Terapia Trombolítica/métodos , Fluxo de Trabalho
9.
J Med Syst ; 45(8): 78, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34231049

RESUMO

Surgical trays contain unused instruments which generate wasted resources from unnecessary reprocessing/replacement costs. We implemented a quality improvement initiative to optimize surgical trays for common otolaryngology procedures, and examined the impact on costs, operating room (OR) efficiency, and patient safety.We studied five common otolaryngology procedures over a 10-month period at a single community hospital. We compared pre- and post-intervention outcome measures including instrument utilization, tray set up time, tray rebuilding time, and balancing measures (operative time, instrument recall, patient safety). We estimated cost-savings from an institutional perspective over 1- and 10-year time horizons. Costs were expressed in 2017 Canadian dollars and modeled as a function of surgical volume, labor costs, instrument depreciation, and indirect costs.A total of 238 procedures by six surgeons were observed. At baseline, only 35% of instruments were utilized. We achieved an average instrument reduction of 26%, yielding 1-year cost savings of $9,010 CDN and 10-year cost savings of $69,576 CDN. Tray optimization reduced average OR tray setup time by 2.5 ± 0.4 min (p = 0.03) and average tray rebuilding time by 1.4 ± 0.2 min (p = 0.06). There was minimal impact on balancing measures such as OR time, stakeholder perception of patient safety and trainee education, and only a single case of instrument recall.Surgical tray optimization is a simple, effective, and scalable strategy for reducing costs and improving OR efficiency without compromising patient safety.


Assuntos
Salas Cirúrgicas , Instrumentos Cirúrgicos , Canadá , Redução de Custos , Humanos , Melhoria de Qualidade
10.
Artigo em Inglês | MEDLINE | ID: mdl-34199816

RESUMO

Reducing the treatment delay by organizing delivery of care on a regional basis is a priority for improving the quality of ST-segment elevated myocardial infarction (STEMI) care. This study aimed to evaluate the impact of the combined measures on quality metrics of healthcare delivery in Suzhou. The data were collected from the National Chest Pain Center (CPC) Data Reporting Database. 4775 patients were recruited, and after propensity-score matching, 1078 pairs were finally included for analysis. We examined the changes in quality metrics of care including prehospital and in-hospital processes, and clinic outcomes. Quality improvement (QI) implementation improved most process indicators. However, these improvements did not yield decreased in-hospital mortality. The door-to-balloon and the FMC-to-device time decreased from 85.0 and 98.0 min to 78 and 88 min, respectively (p < 0.001). Cases transferred directly via EMS had a greater improvement in most of process indicators. The proportion of patients transferred directly via EMS was 10.3%, much lower than that of self-transported patients at 58.3%. Tertiary hospitals showed greater performance improvement in process indicators than secondary hospitals. The percentage of cases using EMS remained low for suburban areas. The establishment of coordinated STEMI care needs to be accompanied with solving the fragmented situation of the prehospital and hospital care, and patient delay should be addressed, especially in suburban areas and on transferred-in inpatients.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST , Atenção à Saúde , Eletrocardiografia , Humanos , Melhoria de Qualidade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tempo para o Tratamento
12.
J Gerontol Nurs ; 47(8): 37-44, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34309448

RESUMO

An aging population with underlying health conditions, such as heart disease and diabetes, is at high risk for infections, including pneumonia, influenza, and coronavirus disease 2019 (COVID-19). In particular, the number of individuals in skilled nursing and long-term care facilities is increasing and older adults are at greatest risk. Research reveals these infections can lead to sepsis, septic shock, and death unless detected early through a sepsis screening process. The current quality improvement project demonstrates the capabilities of an early sepsis recognition screening tool in a skilled nursing facility and explores process changes required to operate facilities with high quality care. [Journal of Gerontological Nursing, 47(8), 37-44.].


Assuntos
Diagnóstico Precoce , Melhoria de Qualidade , Sepse/diagnóstico , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Idoso , COVID-19 , Humanos , SARS-CoV-2
15.
West J Emerg Med ; 22(3): 678-686, 2021 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-34125046

RESUMO

INTRODUCTION: The objective of this study was to compare airway management technique, performance, and peri-intubation complications during the novel coronavirus pandemic (COVID-19) using a single-center cohort of patients requiring emergent intubation. METHODS: We retrospectively collected data on non-operating room (OR) intubations from February 1-April 23, 2020. All patients undergoing emergency intubation outside the OR were eligible for inclusion. Data were entered using an airway procedure note integrated within the electronic health record. Variables included level of training and specialty of the laryngoscopist, the patient's indication for intubation, methods of intubation, induction and paralytic agents, grade of view, use of video laryngoscopy, number of attempts, and adverse events. We performed a descriptive analysis comparing intubations with an available positive COVID-19 test result with cases that had either a negative or unavailable test result. RESULTS: We obtained 406 independent procedure notes filed between February 1-April 23, 2020, and of these, 123 cases had a positive COVID-19 test result. Residents performed fewer tracheal intubations in COVID-19 cases when compared to nurse anesthetists (26.0% vs 37.4%). Video laryngoscopy was used significantly more in COVID-19 cases (91.1% vs 56.8%). No difference in first-pass success was observed between COVID-19 positive cases and controls (89.4% vs. 89.0%, p = 1.0). An increased rate of oxygen desaturation was observed in COVID-19 cases (20.3% vs. 9.9%) while there was no difference in the rate of other recorded complications and first-pass success. DISCUSSION: An average twofold increase in the rate of tracheal intubation was observed after March 24, 2020, corresponding with an influx of COVID-19 positive cases. We observed adherence to society guidelines regarding performance of tracheal intubation by an expert laryngoscopist and the use of video laryngoscopy.


Assuntos
COVID-19/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Intubação Intratraqueal/estatística & dados numéricos , COVID-19/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Intubação Intratraqueal/normas , Laringoscopia/efeitos adversos , Laringoscopia/métodos , Masculino , Melhoria de Qualidade , Estudos Retrospectivos , SARS-CoV-2
16.
West J Emerg Med ; 22(3): 696-701, 2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-34125049

RESUMO

INTRODUCTION: Burnout is a major threat to patient care quality and physician career longevity in emergency medicine. We sought to develop and implement a quality improvement process to engage emergency department (ED) faculty in identifying sources of burnout and generating interventions targeted at improving the work environment. METHODS: In this prospective interventional study conducted at a large, urban, academic medical center, we surveyed a 60-person faculty group using the Professional Fulfilment Index (PFI), as well as burnout-relevant questions from the American Medical Association's Mini-Z survey and the Maslach-Leiter framework for organizational burnout, in order to identify organizational sources of burnout. We assessed the relationship between burnout scores and responses to the Maslach-Leiter framework using univariate regression analysis. In a two-hour facilitated session, we shared survey results and led the group in a process using the six Maslach-Leiter domains to develop a rank-ordered list of interventions to reduce burnout in each domain. RESULTS: In total, 47 of 60 faculty (78.3%) completed the survey and 45 faculty (75%) attended the discussion session. Of the 47 survey respondents, 14 (30%) met criteria for moderate to severe burnout. The respondents' answers to the Maslach-Leiter organizational burnout domain questions were significantly correlated with their burnout scores (P <0.001). Session attendees generated 31 potential interventions for process improvement, which were analyzed and thematically organized. Common intervention themes included reducing documentation burden, receiving more positive feedback on patient care, improving ease of obtaining consults, decreasing ED crowding, and increasing intrafaculty social connection. Interventions were subsequently reviewed and scored based on relative importance and feasibility to create a departmental action plan for process improvement. CONCLUSION: Using the Maslach-Leiter organizational burnout framework, in conjunction with a facilitated solution-oriented faculty discussion, led to the creation of a departmental agenda focused on organizational solutions for augmenting professional fulfillment and reducing burnout. We propose that this process can be used by healthcare organizations to engage physicians and others in efforts to improve their work experiences, which in turn is likely also to support the provision of higher quality of care.


Assuntos
Esgotamento Profissional/prevenção & controle , Medicina de Emergência , Médicos/psicologia , Engajamento no Trabalho , Centros Médicos Acadêmicos , Humanos , Satisfação no Emprego , Estudos Prospectivos , Melhoria de Qualidade , Inquéritos e Questionários , Local de Trabalho/psicologia
17.
Semin Vasc Surg ; 34(2): 28-36, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34144744

RESUMO

Quality improvement programs and clinical trial research experienced disruption due to the coronavirus disease 2019 (COVID-19) pandemic. Vascular registries showed an immediate impact with significant declines in second-quarter vascular procedure volumes witnessed across Europe and the United States. To better understand the magnitude and impact of the pandemic, organizations and study groups sent grass roots surveys to vascular specialists for needs assessment. Several vascular registries responded quickly by insertion of COVID-19 variables into their data collection forms. More than 80% of clinical trials have been reported delayed or not started due to factors that included loss of enrollment from patient concerns or mandated institutional shutdowns, weighing the risk of trial participation on patient safety. Preliminary data of patients undergoing vascular surgery with active COVID-19 infection show inferior outcomes (morbidity) and increased mortality. Disease-specific vascular surgery study collaboratives about COVID-19 were created for the desire to study the disease in a more focused manner than possible through registry outcomes. This review describes the pandemic effect on multiple VASCUNET registries including Germany (GermanVasc), Sweden (SwedVasc), United Kingdom (UK National Vascular Registry), Australia and New Zealand (bi-national Australasian Vascular Audit), as well as the United States (Society for Vascular Surgery Vascular Quality Initiative). We will highlight the continued collaboration of VASCUNET with the Vascular Quality Initiative in the International Consortium of Vascular Registries as part of the Medical Device Epidemiology Network coordinated registry network. Vascular registries must remain flexible and responsive to new and future real-world problems affecting vascular patients.


Assuntos
Pesquisa Biomédica/estatística & dados numéricos , COVID-19/epidemiologia , Sistema de Registros , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , COVID-19/prevenção & controle , COVID-19/transmissão , Ensaios Clínicos como Assunto , Humanos , Utilização de Procedimentos e Técnicas , Melhoria de Qualidade
18.
Am J Manag Care ; 27(6): 256-260, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34156219

RESUMO

Individuals with multiple chronic conditions (MCCs) represent a growing proportion of the adult population in the United States, particularly among lower-income individuals and people of color. Despite ongoing efforts to characterize this population and develop approaches for effective management, individuals with MCCs continue to contribute substantially to health care expenditures. Based on a review of recent literature, several identified barriers limit the effectiveness of care for patients with MCCs. Health care delivery system structural limitations, evidence-based care concerns, patient-clinician relationship constraints, and barriers to inclusion of patient-centered priorities may singly or in combination negatively affect outcomes for individuals with MCCs. The COVID-19 pandemic has shed further light on inequities contributing to suboptimal MCC patient management. Awareness of the prevalence and demographic attributes of patients with MCCs and the identified barriers to care may help improve patient engagement and treatment outcomes for this high-cost population. This paper provides recommendations for enhancing MCC patient care outcomes in the current and post-COVID-19 health care delivery settings.


Assuntos
Doença Crônica/terapia , Atenção à Saúde/organização & administração , Multimorbidade , COVID-19/epidemiologia , Medicina Baseada em Evidências , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prevalência , Melhoria de Qualidade , SARS-CoV-2
19.
J Prof Nurs ; 37(4): 714-720, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34187669

RESUMO

An accelerated bachelor of science in nursing program adopted holistic admissions practices to increase diversity in the student body. This quality improvement project aimed to compare three cohorts of students accepted before holistic admissions practices to three cohorts accepted after holistic admissions. The authors examined demographic data, on-time graduation rate, licensure exam passing rate, remediation status, and student perceptions expressed on exit surveys. After holistic admissions were implemented, student diversity increased and on-time graduation and licensure exam pass rates were maintained. The need for student remediation decreased after holistic admissions were implemented, and student perceptions of their classmates and the relevance of their schooling to their future professional career increased.


Assuntos
Bacharelado em Enfermagem , Estudantes de Enfermagem , Humanos , Licenciamento , Melhoria de Qualidade , Estudantes , Inquéritos e Questionários
20.
J Nurs Educ ; 60(6): 337-341, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34077320

RESUMO

BACKGROUND: As the largest health care workforce, nursing is positioned to improve the health of populations using health information technology (HIT). Nurse graduates often lack confidence using HIT in practice, specifically, the electronic health record (EHR). Nurse scholars endorse the use of an academic electronic health record (AEHR) in nursing programs to provide students a safe learning platform to build levels of confidence using an EHR. METHOD: A quality improvement project was completed to evaluate student learning outcomes, satisfaction, and sustainability of an AEHR. Using an interprofessional approach, nurse educators incorporated the Systems Life Cycle Model to adopt an AEHR in two prelicensure nursing programs. RESULTS: Students' levels of confidence using an EHR in clinical settings increased markedly. Satisfaction rates for using an AEHR were high. CONCLUSION: Integration of an AEHR in nursing education contributes to building a proficient nursing workforce confident in using HIT for health care quality. [J Nurs Educ. 2021;60(6):337-341.].


Assuntos
Educação em Enfermagem , Registros Eletrônicos de Saúde , Melhoria de Qualidade , Estudantes de Enfermagem , Educação em Enfermagem/métodos , Docentes de Enfermagem , Humanos , Estudantes de Enfermagem/psicologia
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